Category Archives: Psychosis Articles

A Study On The Childhoods Of Murderers

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A study conducted by Lewis et al (1985) and published in the American Journal Of Psychiatry examined the childhoods of nine convicted murders with the aim of discovering what characteristics (if any) they had in common. The main characteristics identified fell into four main categories :

  1. Acts of violence as children
  2. Psychiatric / medical history
  3. Psychiatric history of parents / first-degree relatives
  4. History of parental abuse

ACTS OF VIOLENCE AS CHILDREN :

All of the nine individuals in the study had perpetrated extreme violent acts as children / adolescents. Examples of these violent acts include :

  • two had committed robbery at knife point
  • one, at the age of four, had thrown a dog out of a window
  • one had set his bed on fire
  • one, at the age of ten, had threatened his teacher with a razor

PSYCHIATRIC / MEDICAL HISTORY :

  • three had been hospitalized in psychiatric units during childhood
  • three had histories of grand mal seizures and abnormal EEGs ( the term EEG stands for electrencephalogram which is a procedure that measures the electrical activity in the brain).
  • one was macrocephalic (the term ‘macrocephalic’ refers to a condition that results in the affected individual developing an abnormally large region of the brain called the cranium) and had an abnormal EEG
  • three had histories of ‘losing contact with reality’
  • six had sustained severe head injuries as children

PSYCHIATRIC HISTORY OF PARENTS / FIRST-DEGREE RELATIVES :

  • all nine had a first-degreee relative who had been hospitalized in a psychiatric unit and/or was known to be psychotic
  • five had a mother who had been hospitalized in a psychiatric unit
  • four had fathers who were known to be psychotic (one of whom had been hospitalized in a psychiatric unit)

HISTORY OF PARENTAL ABUSE :

  • seven had been severely, physically abused by one or both parents
  • six had witnessed extreme domestic violence

Conclusion :

Based on the findings of the above study and other relevant, previously conducted studies by other researchers, the authors of this study conclude that whilst it is not possible to predict whether individuals will commit murder at some point in the future, when a person has has been affected by all of the above factors (i.e. a prior history of violence, neuropsychiatric impairment,  parental psychosis and a history of having been physically abused as a child),  therapeutic intervention is necessary, irrespective of considerations relating to what one may, or may not, be able to predict about the individual’s future conduct in relation to violence.

It seems difficult to disagree with this conclusion as, obviously, anyone who is affected by the above combination of factors is likely to be experiencing extreme levels of mental distress.

 

NB : The above description of the study is a simplification to convey the main findings as concisely as possible ; a full description of the study can be accessed here.

 

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David Hosier BSc Hons; MSc; PGDE(FAHE)

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Retraumatization Caused By Psychiatric Care Institutions

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Retraumatization :

If the trauma we experienced as children was severe enough, we may, as adults, at one time or another, require residential psychiatric care (such as inpatient treatment on a psychiatric ward in a hospital, as was necessary in my own case on several occasions).

Obviously, the quality of the care we receive in psychiatric facilities can vary very considerably ; unfortunately, this means that, if we are unlucky, we may find ourselves in an environment that not only fails to be therapeutic, but is actively retraumatizing.

In What Ways Can A Psychiatric Facility Retraumatize Us?

According to Fallot and Harris (2001), the ways in which we can be retraumatized in psychiatric institutions can be divided into two main categories ; these are :

1) BY THE SYSTEM (policies, culture, procedures, rules etc). For example :

2) BY THE RELATIONSHIPS WE HAVE WITH THOSE ENTRUSTED WITH OUR CARE (e.g nurses, psychiatrists etc)

Let’s look at each of these in turn :

1)  RETRAUMATIZATION BY THE SYSTEM. Examples of how this may occur include :

– lack of choice regarding treatment ; for example, being prescribed medication when a form of psychotherapy may be more appropriate and more effective.

– not being given the opportunity to give feedback to the professionals caring for us about how we feel in relation to the treatment we are receiving

– being treated impersonally and not as an individual but, instead, according to how one has been ‘labelled’ by one’s diagnosis (two individuals with the same diagnosis may manifest very different symptom and have very different needs. In the case of those who have been diagnosed with borderline personality disorder, such individuals may experience the additional trauma as being regarded as ‘a trouble maker’ due to misinterpretation of the true causes of their behavior.

– constantly having to retell personal details relating to one’s psychological condition.

2)  RETRAUMATIZATION BY THOSE ENTRUSTED WITH OUR CARE.  Examples of how this may occur include :

– betrayal of trust

– feeling one is not being listened to and/or is being rushed when explaining one’s condition

– feeling one’s views are being dismissed /not taken seriously / invalidated

– being spoken to disrespectfully, insultingly or inappropriately

– being subjected to punitive ‘treatment’ methods (e.g. locked in isolation room without toilet or proper bedding)

– lack of communication / collaboration between patient and staff

My Own Experiences :

SECTIONING :  When my illness was at its worst, I was sectioned (despite my ardent protests) because it was felt I was a high suicide risk (which, in truty, I was) ; however, being sectioned accentuated feelings of powerlessness, humiliation and loss of autonomy

AGGRESSIVE/THREATENING PATIENTS : Unfortunately, some patients one is exposed to in psychiatric wards can be aggressive and intimidating, leading to feelings of being unsafe and constantly under threat

UNPROFESSIONAL STAFF : Sadly, occasionally one comes across staff who are not above behaving unprofessionally ; this can exacerbate feelings of mistrust

ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) : Because I was so ill – utterly unable to function and, indeed, almost catatonic at times, as well as a very high suicide risk, I was ‘strongly encouraged’ to undergo ECT treatment ‘voluntarily’ on several occasions ; in fact, though, there was no genuine choice as I was told that, if I did not undergo it ‘voluntarily,’ I would be sectioned and the act of sectioning me would, in turn, give the hospital the legal right to administer the treatment even without my consent. Due to the controversial nature of ECT treatment, this was an intimidating, degrading and, quite arguably, dehumanizing position in which to be placed. (To read my article about my experience of ECT, click here.)

COMPULSION TO ABSCOND :  Indeed, I often found the conditions to which I was confined so intolerable that, on three occasions, I absconded (each time with the intention of committing suicide – to read about one such incident, see my article On Being Suicidal (Or, Why I Carried A Rope In A Bag Around London For Three Months ).

Obviously, vulnerable patients who find themselves compelled to abscond, as I did, potentially expose themselves to a high level of risk in a multitude of ways.

The Trauma-Informed Environment :

Tailor and Harris (2001) state, based on the main ways in which retraumatization may occur, therapeutic environments that cater for the traumatized (e.g. those suffering from PTSD or complex-PTSD) should be trauma-informed. Trauma-informed environments should :

1) Be calm and comfortable

2) Provide the patient with choice

3) Empower the patient

4) Recognize the strengths and abilities of the patient

5) Involve the patient, as far as possible, in all decision-making processes.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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BPD And Hallucinations

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What Are Hallucinations?

Hallucinations are PERCEPTIONS that people experience but which are NOT caused by external stimuli/ input. However, to the person experiencing hallucinations, these perceptions feel AS IF THEY ARE REAL and that they are being generated by stimuli/ input outside of themselves (in fact, of course, the perceptions are being INTERNALLY GENERATED by the brain of the person who is experiencing the hallucination).

Different Types Of Hallucination :

There are several different types of hallucination and I summarize these below :

  • VISUAL HALLUCINATIONS – these involve ‘seeing’ something that in reality does not exist or ‘seeing’ something that does exist in a DISTORTED / ALTERED form.
  • AUDITORY HALLUCINATIONS – these, most often, involve ‘hearing’ voices that have no external reality (though other ‘sounds’ may be hallucinated, too).
  • TACTILE HALLUCINATIONS – these occur when an individual feels as if s/he is being touched when, in fact, s/he isn’t (for example, feeling the sensation of insects crawling over one’s skin).
  • GUSTATORY HALLUCINATIONS – these occur when a person perceives a ‘taste’ in his/her mouth in the absence of any external to the person causing the taste.
  • OLFACTORY HALLUCINATION – this type of hallucination is sometimes also referred to as phantosmia and involves perceiving a smell which isn’t actually present.

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BPD And Hallucinations :

Mild hallucinations are actually not uncommon even amongst people with no mental illness (e.g. believing one has heard the doorbell ring when it hasn’t).

At the other end of the scale, however, are fully-blown hallucinations that involve the person who is experiencing them being psychotically detached from reality; for example, someone experiencing a psychotic episode might hear, very clearly and distinctly, voices that s/he fully believes are coming from an external source (such as ‘the devil’ or a dead relative). A person suffering from such hallucinations cannot in any way be convinced that the ‘voices’ are being generated within his/her own head/brain.

It is uncommon for people suffering from borderline personality disorder (BPD) to suffer from the most serious types of hallucinations (as described above); however, under acute stress (and those with BPD are, of course, far more likely to experience acute stress than the average person), the BPD sufferer may experience hallucinations that fall somewhere between the mild and severe types.

For example, if s/he (the BPD sufferer) was constantly belittled and humiliated by a parent when growing up, s/he may, when experiencing severe stress, ‘hear’ the ‘parent in their head’ saying such things as ‘you’re useless’ or ‘you’re worthless.’

However, unlike the person suffering unambiguously from psychosis, when this occurs s/he is not completely detached from reality but is aware the ‘voices’ are being generated within his/her own mind and are imaginary as opposed to real.

Severe hallucinations may be indicative of schizophrenia but can also have other causes which include : delirium tremens (linked to alcohol abuse), narcotics (e.g. LSD) and sensory deprivation.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Those Raised In Care Homes More Likely To Develop Paranoia

 

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In the past, research on how schizophrenia develops in individuals focused heavily on genetic factors. However, more recent research is now making it increasingly clear that the environment in which we grew up is strongly related to our chances of developing a psychotic disorder, such as schizophrenia, in adulthood. Indeed, a meta-analysis of the relevant research, conducted at the University of Liverpool in the United Kingdom, suggests that those individuals who were brought up in the care system are at significantly increased risk of developing paranoia (often a major symptom of schizophrenia) as adults.

Schizophrenia (including, of course, paranoid schizophrenia) is a form of psychosis (psychosis involves the affected person losing touch with reality / entering delusional states). The research conducted by the University of Liverpool also revealed that those who suffered severe childhood trauma were at significantly increased risk of developing not just paranoia, but a range of psychotic conditions. One figure derived from this research is quite staggering : in cases of severe childhood trauma, the individual affected may be 5,000% (i.e. 50 times) more likely to develop psychosis than the average person.

In connection with those who had suffered any form of trauma during childhood, such individuals were found to be at a 300% (3 times higher) increased risk of developing psychosis later on in life when compared to the average.

The bottom-line is, we may conclude from this research, is that the environment (i.e. the degree to which it is experienced as traumatic) in which one grows up is strongly associated with one’s risk of developing a psychotic disorder in later life.

 

And, just as it has already been found that being brought up in a care home increases one’s risk of developing paranoia later in life, it is thought other specific forms of psychosis may be linked to other specific forms of childhood trauma – however, research into this area is still at an early stage.

Finally, it should also be stated that genetic factors may also play a role; for example, some individuals may be ‘genetically’ more resilient to the adverse effects of trauma than others. Further research into this area, too,  needs to be conducted so that the role of genes in the development of psychosis may be more fully understood.

In the past, people with psychotic conditions have largely been treated according to the medical model (sometimes called the biological model) of mental illness; in other words, with medication. However, the above findings suggest that non-medicinal interventions may also be vitally required, such as ‘talk therapies’- therapies of this type may help the individual to process, and come to terms with, his/her traumatic past. One such therapy is trauma-focused cognitive therapy.

 

RESOURCES :

 

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Schizophrenia: Study Reveals Those Traumatized In Childhood Up To Fifty Times More Likely To Develop It

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I remember when I was doing my first degree in psychology at the University of London that, when we studied schizophrenia, in trying to explain its causes we concentrated largely upon examining genetic explanations and, also, explanations based upon the existence of individual differences in brain chemistry and brain biology.

More recently, however, evidence has been accumulating that if an individual suffers childhood trauma then this, too, puts him/ her at greater risk of developing this most debilitating of psychiatric conditions.

Indeed, a study at the University of Liverpool and Maastricht in the Netherlands lends support to this theory. The study looked at data from three groups of people

a) individuals who were known to have suffered childhood trauma who wrre followed up in their adult lives (the study was what is known as longitudinal and examined 30 years’ worth of data)

b) psychotic individuals who were asked about their childhoods

c) randomly selected individuals (data obtained from this third group served as a comparison point against which to intetpret the data generated from the above two groups). This is also known as the control group.

THE FINDINGS OBTAINED FROM THE STUDY:

– those who had suffered childhood trauma prior to the age of 16 were 3 times more likely to develop psychosis in adulthood than were the individuals from the group of randomly selected individuals (group ‘c’ above)

– the more serious the individuals’ experiences of childhood trauma were, the more likely they were to develop psychosis later on during their lives

– those who had suffered the most serious types of trauma were found to be up to 50 times more likely to go on to develop schizophrenia than individuals who had been randomly selected for the sstudy

– different kinds of trauma resulted in the development of different types of psychiatric symptoms.  For example, those individuals who had spent significant amounts of time in children’s homes were particularly likely to develop symptoms of paranoia later on during their lives

IMPLICATIONS:

In the light of these findings, they expert Professor Bengal stressed the importance that those who were responsible for diagnosing psychiatric patients should ask them about their childhood experiences as a matter of routine.

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Above: Differences in the brains of schizophrenics.

Professor Bengal also drew attention to the need for further research into the effects of childhood experiences on the physical developing brain ( click here to view details of my book on this) and also into genetic factors that may help to explain why some individuals are more resilient to the adverse effects of childhood trauma than others.

Finally, he called for further research into why symptoms of trauma often do not appear in an individual until years after the traumatic experiences have taken place. For example, a person who suffered childhood trauma between the ages of , say, eight and twelve, may not display overt psychiatric symptoms caused by it until his/her twenties.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Childhood Trauma : BPD and Brief Psychotic Episodes

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I have already published many articles about the link between the experience of significant childhood trauma and the later development of borderline personality disorder (BPD) – click here to read one such article.

If we are unfortunate enough to develop BPD following a traumatic childhood, in some cases (NOT all) we may, especially during periods of acute stress, be prone to what psychologists and psychiatrists refer to as brief psychotic episodes.

Such brief psychotic episodes can entail experiencing, for periods of short duration, symptoms such as paranoid delusions and hallucinations. However, these are likely to be of relatively minor intensity compared to how they might be experienced by someone suffering from acute schizophrenia.

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The above diagram shows that psychosis can involve not only hallucinations and delusions, but, also : poor self care, disjointed thoughts, agitation, pacing, and unusual mood changes.

Let’s look at the symptoms of paranoid delusions and hallucinations in a little more detail:

Paranoid delusions – these may involve suspecting one’s friends or associates are plotting against one when this is not the case and there is no evidence that it’s the case. It might also involve ‘reading threats into’ what others say to one when no such threats exist.

Paranoid delusions of a severe nature may involve imagining threats which clearly have no grounding in reality at all, such as believing there is a world plot, coordinated at the highest levels of power, being constructed against one. However, as I alluded to earlier, such extreme delusions are NOT usually experienced by those suffering from BPD.

 

Hallucinations – these involve the imagined perception of stimuli which, in reality, do not actually exist. These may include:

1) Imagining one can hear ‘voices’ – these are referred to as ‘auditory hallucinations’

2) Imagining one can see things which are not actually there – these are referred to as ‘visual hallucinations’

3) Imagining one can feel by touch something which is not there (eg one may imagine one can feel a hand on one’s shoulder) – these are referred to as ‘tactile hallucinations’

4) Imagining a taste in one’s mouth – imagining one can taste something when there is no corresponding stimulus is known as a ‘gustatory hallucination’

5) Imagining a smell – smelling something which is not there is known as an ‘olfactory hallucination’

6) Imagining a significant change in temperature

Whilst all of these hallucinations are figments of the mind the important point is that they can feel very real to the person who is suffering from them.

If the person who has the experience of hallucinations such as these is aware that the sounds, visions etc are not real but are being generated from his/her own mind then experts to not consider them to be suffering from full-blown psychosis. These kind of experiences are only classified as psychotic if the person is adamant that they are real. As stated already, psychosis of this nature, involving a complete departure from reality, is rare in those with BPD.

Treatment.

If a person with BPD is suffering from hallucinations which cause distress, a psychiatrist may prescribe a period of time on antipsychotic medication, until the symptoms are under control. Such medication should never be self-prescribed and only taken on the advice of a properly qualified expert.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Borderline Personality Disorder – Possible Psychotic Symptoms

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Occasionally, some individuals who suffer from borderline personality disorder (BPD) may develop transient (short-lasting) psychotic symptoms ; these are also sometimes referred to as : psychotic episodes, psychotic experiences or ‘breaks from reality.’

What is Psychosis?

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Psychosis can involve :

– seeing things which are not there (visual hallucinations)

– hearing things which are not there eg the sufferer might believe they can hear voices telling them to harm, or even kill, themselves

– having the feeling of touching things which are not there (somatic hallucinations)

– smelling things which are not there (olfactory hallucinations)

– derealization (a change of perception in which the world seems ‘unreal’)

– depersonaliztion (a change of perception in which one’s own self seems unreal).

Note : Both derealization and depersonalization are what are known as ‘dissociative’ symptoms – click here to read my article about dissociation.

– holding on to extremely odd and unusual beliefs that others cannot dissuade the sufferer from believing, especially paranoid beliefs, such as their family, or strangers, are trying to kill them ; believing they are irredeemably evil ; believing they don’t exist ; believing the government is going to kill them and they are being pursued by MI5 (UK) or the CIA (US) ; believing aliens have placed an implant in their brains which broadcasts all their thoughts. Sometimes, too, the bizarre belief may be a delusion of grandeur, such as ‘they are god’.

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Whilst such experiences can sometimes be severe, most frequently they are not long-lived. However, such symptoms are also a sign that the illness (BPD) is worsening, and, therefore, a person who has psychotic symptoms should always seek expert help as quickly as possible.

If a BPD sufferer is unlucky enough to experience a psychotic episode, when is it most likely to occur, and how can that person minimize their risk?

Sufferers of BPD are at greatest risk of experiencing a psychotic episode following a significant stressor. Such experiences are sometimes referred to as ‘reactive psychosis.’ It follows from this, of course, that those with BPD should avoid stress as far as it is possible.

Psychotic Depression

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guilt and childhood trauma

The depression which accompanies BPD can become so acute that it leads to psychotic symptoms. Extended dysphoria (the word ‘dysphoria’ refers to a highly distressing state in which the sufferer feels extreme emotional pain, restlessness, emptiness and agitation) can tip over into psychotic experiences ;These may include : feelings of extreme, irrational guilt and false beliefs about being responsible for things that they are, in fact, in no way responsible for (such as the abuse they suffered).

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David Hosier BSc Hons; MSc; PGDE(FAHE)

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Childhood Trauma and Its Link to Psychosis – Infographic

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The relationship between childhood trauma and the later development of psychosis.

The graph shows that different types of childhood trauma (represented along the x-axis) are predictive of psychosis (relative risks shown on y-axis) to variable degrees – it shows, for instance, that bullying and maltreatment put the individual at particular risk of going on to develop psychosis in later life. If you would like to read my post entitled : ‘The Link between Childhood Trauma and Psychosis’, please click here.

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Childhood Trauma : Its Link to Later Psychosis.

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‘The psychiatric profession is about to experience an earthquake that will shake its intellectual foundations…there is tectonic, plate-shifting evidence'[for the environmental basis of psychosis]’

-Oliver James (leading UK psychologist). Comment in relation to the now overwhelming evidence that psychosis is strongly related to childhood trauma and the need to stop over-focusing on biological causes.

There is now extremely strong research evidence showing the link between childhood trauma and the affected individual’s likelihood of developing PSYCHOTIC ILLNESS in later life.

It is, of course, already well-established that there is a powerful link between childhood trauma and psychiatric conditions which include depression, anxiety, substance abuse, eating disorders, post traumatic stress disorder, sexual dysfunction, personality disorder, dissociation and suicidal ideation. Now, however, it is becoming increasingly apparent that there is also a strong link with psychotic conditions such as BIPOLAR DEPRESSION and SCHIZOPHRENIA.

A plethora of evidence is now demonstrating the very high prevalence of experiences of severe childhood trauma in psychiatric patients who are suffering from psychotic illnesses

Indeed, many leading psychologists are arguing that researchers have neglected the importance of childhood experiences in relation to psychotic illness in the past. Here, then, I present some recent research which helps to redress the balance:

– Read et al reviewed 51 previous studies on causes of psychotic illness and found that 69% of female psychotic patients and 59% of male psychotic patients had suffered severe childhood trauma. It was also pointed out by the researchers that these figures, although already extremely high, may be UNDERESTIMATES due to the fact that experiences of child abuse are well known to be under-reported.

– Bebbington et al : these researchers, examining data generated from 8500 individuals, found that those suffering from psychosis were approx. 15 times more likely than the mentally well to have suffered severe childhood trauma.

– A Dutch study of 4000 patients found that those who had suffered severe childhood trauma were approx. 11 times more likely to have developed psychotic conditions in later life.

– A Californian study found that those who had suffered severe childhood trauma were 5 times more likely to have gone on to experience HALLUCINATIONS in later life.

HOW IS CHILDHOOD TRAUMA THOUGHT TO LEAD TO PSYCHOTIC CONDITIONS?

– COGNITIVE THEORY: Due to adverse childhood experiences, the individual develops what is called a NEGATIVE COGNITIVE TRIAD of beliefs; these are:

– a negative view of self
– a negative view of others
– a negative view of the world in general

More specifically, beliefs such as the following are likely to develop:
– I am vulnerable
– others cannot be trusted
– the world is dangerous

Such beliefs can become so ingrained and severe that they eventually manifest themselves in the guise of psychotic symptoms eg PARANOIA.

– AFFECT OF CHILDHOOD TRAUMA ON THE BRAIN: Research is showing that extreme stress in childhood can adversely affect the physical development of vital brain regions responsible for emotional control (eg the AMYGDALA) which can lead to extreme emotional dysregulation (INABILITY TO CONTROL STRONG EMOTIONS) and concomitant over-sensitivity and emotional over-reactivity. If the problem becomes sufficiently intense psychotic conditions may result.

IMPLICATIONS:

It is thought a new, over-arching theory of the causes of psychosis (known in scientific circles as a PARADIGM SHIFT) is likely take root in the field of psychiatric research – namely one that emphasizes the enormous importance of adverse childhood experiences.

It is argued that patients who present with psychotic symptoms should ROUTINELY undergo DETAILED ASSESSMENTS relating to their childhood experiences and that there should be a much greater emphasis upon the importance of psychological therapy (as opposed to drug therapy- so popular up until now- based upon theories of the biological origins of psychotic conditions).

If you would like to view an infographic showing the relationship between different types of childhood trauma and the relative risks of later going on to develop psychosis, please click here.

David Hosier BSc Hons; MSc; PGDE(FAHE).

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