Odd, Quasi-Psychotic And True Psychotic Thinking In BPD Sufferers

A study conducted by Zachirini et al. (2013) investigated the prevalence of disturbed thought in 290 in-patients who had been diagnosed with BPD (borderline personality disorder). The quality of disordered thinking measured in these 290 BPD in-patients was compared to the quality of disordered thinking measured in 72 non-BPD in-  patients who had another (i.e. different) Axis II disorder (BPD is an Axis ii disorder, but the category includes several other personality disorders including paranoid, schizoid, schizotypal, antisocial, histrionic or narcissistic personality disorder).

The types of disordered thought of interest to the researchers in this total of 362 in-patients were divided into three main categories which were as follows :

1) NON-PSYCHOTIC THOUGHT:

This category was broken down into:

  • odd thinking
  • atypical perceptual experiences
  • paranoid thoughts (of a type that fell below the threshold to be considered delusional)

2) QUASI-PSYCHOTIC THOUGHT: delusions and hallucinations that related only to limited aspects of perception/thought, were ephemeral (i.e. of short duration limited to hours or days) and ‘non-bizarre’ (i.e. involving situations which could theoretically and conceivably happen in real life such as fear of others conspiring  and plotting against one, fear that somebody is attempting to poison one or fear one is being covertly followed); such ‘non-bizarre’ delusions most frequently occur due to the BPD sufferer’s misinterpretation of their experiences/perceptions

3) TRUE PSYCHOTIC THOUGHT.

 

RESULTS OF THE STUDY:

It was found that the BPD in-patients had significantly more disordered thought in relation to all three of the above categories, i.e. (1) non-psychotic but odd, atypical and non-delusional paranoid thinking; (2) quasi-psychotic thinking and (3) true psychotic thinking than those non-BPD in-patients who had been diagnosed with other Axis II disorders (see above).

OTHER TYPES OF DISORDERED THINKING FOUND TO EXIST IN THE BPD IN-PATIENTS STUDIED:

The participants in the study were followed up over a sixteen-year period by the researchers and during this time 17 more specific types of thinking/perception problems were examined and it was found that the BPD sufferers, when compared to the individuals who had been diagnosed with other Axis II disorders, also had a significantly increased likelihood (over this sixteen-year period) of suffering from the following eleven of these 17 types of disordered thinking; I list these below:

  • overvalued ideas
  • recurrent illusions
  • undue suspiciousness (e.g. ‘everybody despises me’; ‘everybody wants to destroy me.’).
  • quasi-psychotic hallucinations
  • true-psychotic hallucinations
  • quasi-psychotic delusions
  • derealization
  • depersonalization
  • ideas of reference (e.g. ‘I’m a terrible person’; ‘I’m irreparably damaged, and my condition will never improve, no matter what.’)
  • paranoid ideation
  • magical thinking (the belief that one’s own desires, thoughts and wishes can directly influence the real world e.g. ‘putting a curse’ on somebody or putting pins into a voodoo doll).

However, there is better news: as time went on over the sixteen-year period of study, it was found that symptoms of the above types of disordered thought in BPD sufferers diminished (with the exception of true-psychotic hallucinations).

CONCLUSION:

The researchers concluded that the type and intensity of thought disorder in BPD sufferers could help to distinguish those suffering from the disorder from those suffering from other Axis ll personality disorders such as those mentioned above. It was also pointed out by the authors of the study that, whilst thought/perception disorder tends to diminish over time in those suffering from BPD, such thought disturbance (particularly in relation to non-psychotic thought disorder) can remain a residual problem.

THE VITAL IMPORTANCE OF REDUCING STRESS:

As alluded to above, full-blown psychotic thinking, if it does occur in BPD sufferers, tends to be ephemeral and transient, lasting no more than hours or days. Other research, as one would expect, suggests that if such disordered thinking does occur, in BPD patients, it is usually brought on by stress which provides yet another reason why it is imperative for those recovering from BPD (many do recover or go into remission with therapeutic help such as undergoing dialectical behaviour therapy) keep toxic stress levels down to an absolute minimum.

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

Traumatic Bonding With The Perpetrator Of The Trauma

Identification With The Aggressor :

Counterintuitively, it is not uncommon for those who have been badly mistreated by parents or primary carers to still feel an affectionate bond with their abusers. This can be regarded as a kind of pathological relationship that involves the victim ‘identifying with his/her aggressor,’ to use the technical term.

Emotional Bonding:

Why should this odd form of emotional bonding between the victim of abuse and the perpetrator of this abuse occur? A leading theory in response to this puzzling question is that it is an unconscious process designed to keep the victim safe. But how would this be? Well, it is hypothesized that if the victim can persuade him/herself that s/he has some understanding, sympathy and positive regard for his/her abuser, and acts in a manner which reflects such feelings, the perpetrator is more likely to reciprocate the positive regard and therefore less likely to seriously harm the victim.

Defence Mechanism:

The term ‘identification with the aggressor’ was first coined by Sandor Ferenczi and the concept was developed by Anna Freud (daughter of Sigmund Freud). In psychoanalytic terms, it falls into the category of ‘defence mechanisms’. When the victim ‘identifies with the aggressor,’ it means s/he (the victim) internalizes his/her (the aggressor’s) attitudes and behaviours; again, this can be seen as a way in which the victim strengthens the emotional bond with the aggressor.

Example Of Traumatic Bonding:

An example of such a paradoxical relationship would be that of a violent father and a physically maltreated son. Because the son is dependent upon the father, he (the son) might internalize his father’s violent behaviour (e.g. by physically bullying peers at school) and attitudes (e.g. the importance of being ‘tough’, manly’ and of despising ‘weakness’). Furthermore, he (the son) may maintain affection and admiration for his father by, for example, being grateful for the material support the father provides, looking up to him because of his ‘masculinity’ and even by having gratitude towards the father for ‘keeping him inline’ with his severe approach to ‘discipline.’

When such a bond develops in the way described above it is also sometimes referred to as the ‘trauma bond’ or the ‘terrifying bond,’ Such pathological bonding has been documented as occurring in many scenarios beyond that which is described above, including between hostages and their captors (referred to as Stockholm Syndrome’) and even between concentration camp prisoners and their guards. And, perhaps best known of all, is the tragic situation when one partner repeatedly beats the other partner in a domestic setting yet the abused partner stays in the relationship and consistently refuses to report matters to the police out of a sense, despite everything, of love and loyalty.

Vicious Cycle Of Abuse:

Unfortunately, whilst such identification with the aggressor may work as an unconscious survival mechanism in some respects to some degree, the internalization of the aggressor’s attitudes and behaviours can lead to the child identifying with the violent father to such a degree that he himself becomes a violent father when he grows up, thus perpetuating the cycle of abuse down through the generations.

Vital Importance Of Therapy / Interventions:

The danger of such a harmful cycle developing. then, makes it all the more urgent that perpetrators of such abuse seek immediate therapy and other appropriate interventions.

RELATED POST: WHY CHILDREN IDEALIZE THEIR PARENTS

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

Research Into Children Of Mothers Suffering From Borderline Personalty Disorder.

 

 

 

Reviewing previous studies involving children between the ages of 4 years and 18 years, Macfie states that such children of BPD mothers are at increased risk of :

  • experiencing changes in household composition (e.g. due to divorce/BPD parent co-habiting with varying new partners/acquisition of step-parents/acquisition of step-siblings etc.).
  • experiencing excessive changes in school (e.g. due to constant relocations).
  • being removed from the home(e.g. due to being taken into care/being palmed off to relatives/being thrown out of home etc).
  • being exposed to living with a mother who is an alcoholic.
  • being exposed to living with a mother who is a drug addict.
  • being exposed to living with a mother who threatens/attempts/completes suicide.
  • suffering from problems relating to poor powers of concentration/attention, delinquency, inability to control anger/proneness to aggressive outbursts,  anxietydepressionlow self-esteem.

And, reviewing previous studies involving infants, Macfie states that such offspring of BPD mothers are at increased risk of :

  • having mothers who are intrusive and insensitive in their behaviour towards the infant.
  • reduced responsiveness towards the mother, including dazed looks and looking away from the mother.

And, perhaps most worryingly of all, Macfie cites research conducted by Hobson et al., 2005, suggesting that, at the age of 13 months, a staggering 80% of infants of borderline mothers have a disorganized attachment style in relation to their interactions with their mothers.

ROLE REVERSAL:

Macfie suggests that mothers suffering from BPD may use the child to satisfy their own needs (e.g. the need to feel loved) and discourage the infant’s instinct to develop autonomy. This, Macfie suggests, can eventually lead to a kind of role reversal (e.g. parentification /adultification) which, in turn, increases the child’s risk of developing difficulties controlling his/her emotions and behaviours.

REPRESENTATIONS OF SELF AND OTHERS :

Macfie also states that if the child has developed a disorganized attachment style due to frequently being frightened by the BPD mother and/or due to frequently witnessing the mother in a fearful and anxious state, s/he is likely to develop a negative representation of others which may include a marked tendency to view people in general as dangerous, threatening and incompetent, Such a child’s self-representation is also likely to be negative, including seeing himself/herself as unworthy of love and care ; such a negative self-view can then become self-perpetuating.

In short, the child of the BPD mother is in danger of developing a cognitive-negative-triad involving a negative view of the self and others, a negative view of the future and a negative view of the world in general (see SHATTERED ASSUMPTIONS THEORY) together with a set of most unhelpfully distorted core beliefs.

Out of these negative representations of self and others, Macfie reminds us that the individual who holds them may develop various severe problems which include:

INTERVENTIONS:

The author of the study suggests that for ‘at risk’ children (i.e. those who are emotionally vulnerable – due, for example, to temperament, emotional reactivity and impulsivity – and grow up in a stressful environment due to various factors including those referred to above) the following interventions may mitigate the danger of developing full-blown BPD:

 

 

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

 

 

 

 

Why Trauma Survivors May Find It Hard To Learn From Past Behaviour.

Many of us who have experienced severe and protracted childhood trauma, particularly if we have gone on to be diagnosed with conditions such as complex PTSD or BPD as a result, are frequently liable to ‘act out‘  unbearable inner pain (being unable to express it in healthy ways or even to understand its origin) in ways we later regret and feel ashamed of; indeed, such feelings of shame can be intense and devastating. [Related to this concept is the theory that anger, a frequent component of ‘acting out’, may sometimes operate to soothe emotional pain.]

However, despite such regret and shame, many, too, find themselves trapped in a perpetual cycle of repeating such self-defeating, ‘acting out’ behaviours, often at a very high cost to themselves and those who trigger their trauma-related feelings (e.g. feelings of rejection). In this way, the traumatized individual seems powerless to learn from experience and past mistakes, as if driven by unconscious psychological forces beyond their control (which, without effective therapy, may indeed be the case).

THE ROLE OF FAULTY MEMORY PROCESSING :

Such apparent helplessness to learn from experience is, however, much easier to understand when we consider how the severely traumatized individual’s memory processing abilities may have been negatively affected by his/her traumatic past.

To be more specific, trauma can impair brain and memory function in a variety of different ways, including adversely affecting the functionality of a part of the brain known as the hippocampus (indeed, research has shown that those who experience severe, long-lasting trauma in childhood can develop SHRUNKEN HIPPOCAMPI due to the chronic over-stimulation of the body’s stress hormones which have, in excess concentrations, a toxic effect upon the brain and other bodily organs)

Such impairment of brain and memory function, in turn, leads to DIFFICULTIES IN TRANSFERRING MEMORIES FROM SHORT-TERM STORAGE TO LONG-TERM STORAGE and, furthermore, interferes with the brain’s ability to process and make rational sense of information. Episodic memories (memories of past personal experiences that occurred at a particular time and place) may not be properly processed which prevents a corresponding semantic memory (a form of long-term memory essential for the use and understanding of concepts and language) from being formed, making it hard for the individual to use knowledge (which, in normal circumstances, would have been gleaned from the episodic memory and have made it available to be subjected to rational analysis)) to inform and beneficially adjust future behaviour.

DISSOCIATION:

Studies also show that memory function is impaired due to the tendency of traumatized individuals, especially those suffering from complex PTSD and BDP, to dissociate when ‘acting out’ as a result of a trauma-related feeling triggered.

Both of the above (i.e.impaired memory processing ability due to organic damage and dissociation) impact on learning ability which, in turn, then, help to explain why traumatized individuals find it hard to learn from experience, particularly in the context of interpersonal conflict that mirrors early-life traumatic experiences and results in dissociated, ‘acting-out’ type behaviour). Furthermore, such individuals may also suffer from depression which is itself known to impair learning, memory and cognitive processing abilities.

Impaired memory, learning and cognitive processing ability, of course, can also interfere with other crucial areas of life, such as academic and occupational performance.

THERAPY:

Therapies that reduce stress and increase emotional resilience can help people who have been affected in this way and there exists some evidence that antidepressants can increase hippocampal volume (N.B. Always consult an appropriately qualified expert before deciding whether or not to take antidepressants).

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

Why Does Family Conflict Harm Some Children More Than Others?

Professor Gordon Harold and his colleagues have conducted a research study that helps to cast light upon why some children appear to be more resilient to the adverse psychological and behavioural effects of living in a household in which there exists family conflict than others. The findings of the research suggested that key to such resilience is related to how the child interprets the situation and the meaning that s/he attaches to it, especially in relation to the parents’ behaviours and what actually underlies the conflict (main foundations of conflicts within the families studied included adversarial relationships between parents, strained and problematic relationships between the parent/s and the child and maternal depression).

If the child interprets the situation as his / her own fault (this is, sadly, a typical, unwarranted response) s/he is at higher risk of developing behavioural problems (e.g. anti-social tendencies).

Notwithstanding the above, however, overall and on average girls are more likely to respond to conflict within the home by displaying emotional problems (internalisation) while boys are more likely to respond by displaying behavioural difficulties (externalisation), according to Professor Harold. (In relation to this, you may be interested in reading my previously published article entitled: ‘Why Girls Are More Likely To Report Suffering From Depression Than Boys).’

On the other hand, according to the research, if the child interprets the conflict as dangerous and as a threat to his/her wellbeing or is fearful it will lead to the breakdown and disintegration of the family, s/he is at increased risk of developing psychological problems such as depression and anxiety. Depression was also more likely to manifest itself in girls, the research suggested, if the parents’ relationship was volatile or if interpersonal relations between the daughter and mother were strained and stressful.

Professor Harold has also stated that for family conflict which is poorly resolved to adversely affect the child’s mental health, it does not necessarily have to be ‘high intensity’ conflict but may involve parents being very withdrawn from one another or using what has been termed ‘the silent treatment‘ as a means of inflicting psychological punishment. Furthermore, he has drawn attention to research that suggests that living in households in which there exists longterm, ongoing conflict between the parents can adversely affect children physiologically (for example, by increasing their risk of suffering from tachycardia, hypervigilance and/or impairment of normal brain development).

According to the researchers, interventions most likely to help families living in conflict are those that concentrate upon solutions that enable parents to resolve or reduce their day-to-day conflicts with one another and that also focus on encouraging and improving techniques of positive and nurturing parenting. Professor Harold has stressed that importance of effective interventions due to the risk that bad relationships between parents may get passed down the generations in a self-perpetuating cycle (concerning this, you may be interested in reading my previously published article on the topic of so-called transgenerational trauma).

Professor Harold stresses that occasional arguments between parents are reasonable and, if the parents resolve these successfully, this can set a positive example to the child that may help him/her resolve his/her disputes in future relationships. He also points out that supportive, positive relationships that the child has beyond that with his/her parents, such as with grandparents, teachers and siblings, can have a substantial impact on his/her psychological resilience, though warns that the quality of the child’s relationship with his/her parents can affect these negatively as well as positively.

Finally, it is worth emphasizing that, according to Professor Harold, often the most damaging aspect of parents’ divorce upon the child may be the chronic, unresolved conflict (arguments, confrontations etc.) which may occur before, during and after the separation. Certainly, as a young child, I can remember sitting at the top of the stairs listening to my parents screaming at each other downstairs, shaking with fear (and then being shouted at by my mother – ‘that sodding kid’s eavesdropping again!’ – if I was discovered). An all too common experience, I imagine.

 

To read the paper by Professor Harold et al. (PDF format) entitled: WHAT WORKS TO ENHANCE INTER-PERSONAL RELATIONSHIPS AND IMPROVES OUTCOMES FOR CHILDREN, click here.

 

RESOURCE:

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RELATED ARTICLES :

Divorce: Signs Children Are Being Used As Pawns Or Weapons.

Acrimonious Divorce May Damage Children’s Immune Systems

Effects Of Divorce On Children Under Five

Combined Effects Of Divorce And Emotional Abuse On Children.

 

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

 

 

 

Why Are Girls More Likely To Report Suffering Depression Than Boys?

Research shows that during adolescence girls are more likely to experience depression than are boys (this difference between males and females is also reflected in the adult population). Why should this disparity between the genders exist?

INTERNALIZATION VERSUS EXTERNALIZATION :

According to Daniel Freeman (a psychiatrist at the University of London) and Jason Freeman (his brother), authors of the fascinating book. The Stressed Sex’, one reason why females report feelings of depression more frequently than males is that they are more prone to internalizing their problems whereas men have a greater propensity to externalize theirs.

Internalization of psychological difficulties manifests itself in ways that include insomnia, anxiety, self-harm and, of course, depression whereas externalization can result in behaviours such as physical aggression, drug abuse and alcoholism.

 

LOWER SELF-ESTEEM?

Furthermore, Freeman and Freeman suggest that females are more likely to suffer from depression because, on average, they are more susceptible to low self-esteem than males (e.g. Kearney-Cooke, 1999; Bleidorn et al. 2016) which is likely to make them more prone to not only depression but other mental disorders too. (Other researchers, however, have argued that the idea that women have lower self-esteem than men is not applicable to modern, 21st century females ; for instance, one study involving over 100,000 participants found that although girls had greater anxiety in relation to their physical appearance than boys, their self-esteem was equal to that of boys in relation to their academic abilities and also in relation to their ethical standards of behaviour.

STIGMA :

It has also been suggested that females report feelings of depression more than males do because they (females) are more inclined to talk about how they feel compared to males (who feel inhibited about talking about how they feel because a greater stigma attaches itself to male disclosure of such matters and perhaps, too, because they are more likely to fear being regarded as ‘weak’ and ‘unmanly’).

SUICIDE RATES :

According to the ‘stigma’ argument, then, ACTUAL RATES of depression amongst males are not necessarily lower than amongst females but only appear to be as they are less likely to report their feelings of depression than females.

Indeed, this theory is borne out by the fact that ‘successful’ suicide rates amongst males are DOUBLE the rates amongst females (even though females are twice as likely to ATTEMPT suicide which suggests females might be less likely to intend to kill themselves when exhibiting suicidal behaviour because, more frequently than amongst males, the primary motivation behind such behaviour may be to communicate emotional pain – the classic ‘cry for help.’ (N.B.It should never be assumed a suicide threat, made by a male or female of any age, isn’t genuine and is  ‘just a cry for help.’ A very substantial number of individuals who threaten suicide go on to commit it ‘successfully.’)

SEX HORMONES :

After puberty (when, many studies have found, that differences in rates of depression between boys and girls start to become marked) the sex hormones in males and females undergo dramatic changes (males produce large quantities of testosterone whereas, in contrast, females produce large quantities of oestrogen). These hormones affect the brain and may, therefore, at least in part, help to explain the disparity in depression rates reported by female and male adolescents and adults.

PREMENSTRUAL SYNDROME (PNS) :

For the majority of females problems related to PMS are fairly minor. However, some may suffer much more serious symptoms which impair day-to-day functioning to a significant degree at which point it may be diagnosed as premenstrual dysphoric disorder (PMDD) and its symptoms include depression, extreme irritability and anxiety (approximately 7-14 days prior to the commencement of the individual’s period). Whilst the precise nature of the mechanism underlying the link between depression and PMS / PMDD is not entirely certain, it has been theorized that a primary explanation, as alluded to above, could be that certain hormones, including oestrogen and progesterone, may adversely interact with serotonin (a neurotransmitter thought to be involved in the experience of depression) in the brain.

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

 

 

 

 

Increased Risk Of STDs In Adults Who Experienced Childhood Trauma

 

 

We now know, as has been shown in a very large (and increasing) body of research, the most well known of which is the Adverse Childhood Experiences (ACE) Survey, that the more adverse childhood experiences we suffer. the greater is our risk of later developing various psychological and physical illnesses (indeed, those who have suffered significant chronic trauma as children have, on average, a reduced life expectancy and age at a faster rate compared to those fortunate enough to have experienced a relatively stable and secure childhood. For example, those who suffered, as children, severe enough chronic trauma to have gone on to develop borderline personality disorder (BPD) in adulthood may, without appropriate therapeutic intervention may have a life expectancy that is 19 years below the average.

 

WHY MIGHT THOSE WHO HAVE EXPERIENCED SIGNIFICANT CHILDHOOD TRAUMA BE AT INCREASED RISK OF CONTRACTING SEXUALLY TRANSMITTED DISEASES (STDs)?

 

  1. IMPAIRED IMMUNITY: Research suggests that childhood trauma can weaken our immune systems which, in turn, makes us more vulnerable to contracting diseases including, of course, sexually transmitted diseases (STDs).
  2. INCREASED RISK TAKING: It has also been found that those who have suffered childhood trauma are less averse to taking risks than average and this includes a greater than average propensity to taking sexual risks.
  3. ALCOHOL/DRUGS: Those who have had traumatic childhoods are more likely than average to develop problems relating to alcohol and drugs which, in turn, can lower inhibitions with obvious knock-on effects in relation to sexual behaviour.
  4. PSYCHOLOGICAL PAIN/DISSOCIATION/PROMISCUOUS SEX: Those who have suffered significant childhood trauma may suffer chronic psychological pain as adults from which they desperately need to escape – such mental escape is known by psychologists as dissociation and sex can allow a person temporarily to dissociate. Seeking such a dissociative state through sex can, therefore, become addictive (in the same way as using alcohol and drugs to detract from mental anguish can become addictive); it is easy to see, therefore, why survivors of childhood trauma may become sexually promiscuous.
  5. FEELINGS OF REJECTION/INFERIORITY: If we were rejected by parents in childhood we may grow up feeling unwanted and inferior; frequent, casual sex can make individuals feel temporarily desirable and special, acting as an ephemeral antidote to these negative feelings. However, once the sexual encounter is over, the individual will often be left feeling empty, ashamed and of as little worth as a human being as ever.
  6. LONELINESS: Related to the above, many people who have experienced significant childhood trauma develop serious problems with interpersonal relationships as adults, leaving them feeling socially isolated and alone; again, casual, promiscuous sex can provide temporary relief, but also involve the drawbacks mentioned above.

EXAMPLES OF RELEVANT RESEARCH :

Research conducted by Haydon et al. (2010) found that young women who had experienced physical neglect in childhood were at higher risk than average of contracting sexually transmitted diseases (STDs).

Wilson and Widom (2009) conducted a 30-year prospective study and found greater reporting of having suffered more than one sexually transmitted disease (STD) by participants who had suffered childhood trauma or neglect compared to controls.

Madrano and Hatch (2009) conducted research that found the greater the severity of abuse (physical, sexual and emotional) female participants had experienced in childhood the more sexually transmitted diseases (STDs), on average, they were likely to have contracted.

CONCLUSION:

The above serves to add further evidence to an already very large body of research demonstrating the potential impact of childhood trauma on adult health.

RELATED ARTICLES :

 

Effects Of Interpersonal Childhood Trauma Sexuality

The Link Between Childhood Trauma, Psychopathology And Sexual Orientation.

Childhood Trauma And Hypersexuality

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