About one in twenty (i.e. 5%) of the adult population reports feeling lonely ‘often’ or ‘always’ ; 16% reported feeling lonely ‘sometimes’ ; and 24% reported feeling lonely ‘occasionally’ (2016-2017).
Those who have low levels of trust for people living in their locality report feeling lonely more often.
Of all the age groups that make up the population, 16 – 24 year olds were found to be most likely to experience feelings of loneliness
Females were more likely than males to report feelings of loneliness
Childhood Trauma And Loneliness :
Those who have suffered significant childhood trauma are at greater risk, all else being equal, of experiencing feelings of chronic and debilitating loneliness in adulthood than those who did not live through traumatic childhoods. The kinds of childhood trauma that are particularly likely to put us at risk of suffering significant loneliness as adults include :
early life attachment problems between us and our parents / primary caregivers
– isolate ourselves from others in the belief that any attempt to socially integrate ourselves will be futile
On top of the problems listed above, those who have suffered significant childhood trauma are also more likely to suffer from depression, anxiety and lack of confidence in general, all of which, of course, inhibit any abilities we may have to socialize effectively.
HIDDEN LONELINESS AND SHAME
Because feelings of loneliness are intrinsically linked to feelings of shame and inadequacy, individuals who suffer from it frequently try hard to hide it from others. Indeed, they may mix with others socially and, outwardly, give the impression of enjoying doing so, whilst still experiencing intense feelings of INNER LONELINESS AND LACK OF MEANINGFUL CONNECTION TO OTHERS. In other words, deep feelings of inner loneliness can exist in us despite our frequently interacting with others on a superficial level.
And, just as frequently interacting with others does not guarantee we won’t feel lonely, being alone does not guarantee feelings of loneliness (some individuals choose to be live lives apart from others without experiencing mental distress as a result).
Adverse Effects Of Loneliness On Physical Health :
Studies suggest that chronic feelings of loneliness can :
increase levels of stress hormones in the body
increase levels of inflammation in the body
increase the risk of heart disease
increase the rate of decline of cognitive function (in the elderly)
In this article, I will focus in on the main ways in which the brains of individuals suffering from PTSD / Complex PTSD may differ from ‘normal’, non-traumatized brains.
According the various neuroimaging studies, the brain areas that differ most markedly between these two groups are as follows :
the hippocampus
the amygdala
the prefrontal cortrex
Let’s consider each of these three brain regions in turn :
THE HIPPOCAMPUS :
The hippocampus is part of the brain’s limbic system. The limbic system is intimately involved in how our memory functions, our motivation and how we experience emotions such as fear and anger.
It is theorized that it can be damaged by excess cortisol being released into the body in those who suffer severe chronic stress (cotisol is a hormone released into the body under conditions of extreme stress and perceived threat to help mobilize the body and prepare it for ‘fight or flight.’)
Indeed, studies have also shown that the size of the hippocampus is smaller in those suffering from PTSD (however, it should be borne in mind that one cannot categorically infer that this reduction in size has been caused by prolonged exposure to extreme stress – it could be that some people are born with smaller hippocampi which, in turn, makes them more vulnerable to the adverse effects of stress. Indeed, some research has been carried out that lends this alternative view some weight).
Damage done to the hippocampus by trauma can result in :
extreme and persistent fearfulness
problems recalling the traumatic event/s or parts of the traumatic event/s
constantly intruding, unwanted, distressing and vivid memories of the traumatic event/s
susceptibility to extreme fear responses in relation to ‘triggers’ (i.e. anything that reminds the traumatized individual of the traumatic event/s on either a conscious or unconscious level).
THE AMYGDALA :
The amygdala is a small part of the brain and its function is to immediately assess whether incoming sensory information (i.e. all the information we take in by sight, hearing, touch, taste and smell) IS A THREAT OR NOT.
So, for example, the amygdala is responsible for making you jump if you hear a sudden, unexpected, loud bang. It operates below the level of our conscious awareness so the responses it gives rise to (like making us jump) are NOT UNDER OUR CONSCIOUS CONTROL.
It works at lightning speed on a ‘better safe than sorry’ basis, so, using the ‘loud, unexpected noise’ example, the sound of the bang will make us jump whether it is the result of dangerous gunfire or a harmless firework.
It is only after this initial, automatic, immediate response (which has evolved in order to be of optimum survival value) that the brain further processes the information to assess whether the noise REALLY DID REPRESENT A THREAT OR NOT.
Because of the amygdala’s function, it is also sometimes referred to as the brain’s FEAR CENTER.
The effect of chronic, severe trauma on the amygydala is that it eventually becomes over-reactive, or, as it is sometimes described, ‘stuck on red alert’, so that we become hypervigilant and may become terrified by people, events, situations etc. that, objectively speaking, pose no threat whatsoever and would not, in the least, cause anxiety in a non-traumatized person. In essence, we start to ‘see threat everywhere’ and may live in a constant state of, at best, apprehension and trepidation.
OTHER EFFECTS OF AN OVERACTIVATED AMYGDALA AND CONSEQUENTLY LIVING IN A STATE OF CONSTANT FEAR :
When we are living in a constant state of fear due to an overactivated amygdala we are essentially locked into the fight / flight survival mode. As such, we become completely focused upon ourselves and selfish, (but it is not a willed, conscious, decision ; it is our brain’s way of increasing the chances that we will survive).
This can also result in a much diminished sense of empathy for others (altruistic and other positive behaviors towards others like forgiveness, generosity and consideration are far more likely to occur when a person feels safe, secure, content and has most of their own needs fulfilled ; in relation to this, one need only consider the difference in most people’s behavior when things are going well compared to when they are going badly).
It should also be noted that the amygdala cannot stay hyperactivated indefinitely which means those suffering from PTSD, at times when the amygdala becomes ‘exhausted’by its relentless, frenetic activity, will move out of the fight / flight state and move into the ‘freeze‘, or dissociated, state.
THE PREFRONTAL CORTEX :
In PTSD sufferers, the prefrontal cortex becomes UNDERACTIVATED.
The prefrontal cortex is often described as the THINKING CENTER of the brain and studies involving both humans (including functional imaging studies) and animals suggest that chronic and severe trauma impairs its functioning.
It is theorized that the resulting dysfunction of this brain area impairs its ability to appropriately inhibit the fear-generating amygdala, thus allowing it (i.e. the amygdala) to ‘run riot’, as it were.
Severely traumatized individuals may also experience increased blood flow to the right prefrontal lobe which, in turn, can intensify feelings of sadness and aggression.
7 Key Elements Of Brain Repair
REPAIRING THE BRAIN :
Damage done to the brain as a consequence of severe and protracted trauma can result in various cognitive, emotional and behavioural problems in adulthood.
However, thanks to a quality in the brain known as neuroplasticity, that it is now known that, under certain conditions, the brain has the potential to recover from the damage it incurred during early life.
For example, if our brain was affected in such a way when we were young that, as adults, we are extremely anxious and hypersensitive to stress, mindfulness meditationhas been shown by much research to have the potential to greatly alleviate this problem.
In order for positive changes to take place in the brain that are long-lasting, it is necessary to alter the structure of the brain on a neuronal level; seven major elements that are of great importance to achieving this are as follows :
REPAIRING THE BRAIN : THE SEVEN KEY ELEMENTS
NOVELTY – the brain must receive new information and stimuli in order to change itself (e.g. by using repeated self-hypnosis).
REPETITION – the brain must be repeatedly exposed to this new information to enable it to start making, strengthening and consolidating new neural connections.
ATTENTION – it is necessary to pay good attention to the new information/stimuli for the new, beneficial neural connections to occur (paying attention stimulates the production of acetylcholine in the brain which aids the development of these new neural connections)
DIET – in particular, Omega 3 helps the development of new neural connections (Omega 3 can be bought as a supplement).
AEROBIC EXERCISE – research suggests that this form of exercise helps the brain to positively regenerate itself
RELATIONSHIPS – forming close bonds with others (and, importantly, relating well to ourselves) has also been shown to lead to beneficial brain development
SLEEP – it is important to get sufficient sleep (research suggests that the brain most actively ‘repairs’ itself during sleep.)
Having parents who treat us in a passive-aggressive manner can have an extremely adverse effect upon our mental health; indeed, Scott Wetzler PhD, an expert in these matters, based at Montefiore Medical Center, has said, quite unequivocally, that being on the receiving end of passive aggressive behaviour can lead to the victim feeling as if s/he were ‘a crazy person.’
What Is Passive-Aggressive Behaviour?
To sum up in just two words, passive-aggressive behaviour is disguised hostility.
– CRITICISM PRESENTED AS ‘HELPFULNESS’ OR ‘CONCERN’ (e.g. ‘If you don’t mind my saying so, you’re putting on rather a lot of weight; I only mention it because I’m worried about your health, of course – the last thing I want to do is to offend you or make you feel self-conscious…)
– EXCLUSION – To take an example from my own experience : in the last several years of my (non-) relationship with my father / family/ step-family I was completely excluded from family occasions such as family meals; this is a typical example of passive-aggression and of hurting others through ACTS OF OMISSION) as opposed to by acts of commission.
I remember, on one occasion, my father phoning me up and saying :
‘Oh, we’re having your [my brother and stepbrother] over to celebrate [my step-mother’s/ my father’s second wife] 60th birthday. Of course, we’d invite you but you wouldn’t want to come, would you?’
(To be fair to my father, however, it was my stepmother who manipulated him into such behaviour, threatening to leave him if he did not comply with her wishes regarding his relationship with him – a threat that she was ultimately to carry out. To what degree my father allowed himself to be manipulated, because his wishes coincided with hers, I don’t know).
– ACTING WEAK AND POWERLESS to elicit sympathy
– PLAYING THE MARTYR
– USING MONEY TO CONTROL / INSTIL FEELINGS OF GUILT / INSTIL FEELINGS OF DEPENDENCY
– PROCRASTINATION
– NEVER GIVING (OR WITHHOLDING) PRAISE
– NEVER GIVING (OR WITHHOLDING) AFFECTION
– PERPETUAL LATENESS for no obvious reason
– PERPETUAL PROCRASTINATION
– EXCESSIVE USE OF PETTY, TRIVIAL COMPLAINTS
– INDIRECT AND UNDERHAND EXPRESSIONS OF RESENTMENT AND BITTERNESS
– COMMUNICATING HOSTILITY THROUGH FACIAL EXPRESSION/TONE OF VOICE/BODY POSTURE RATHER THAN DIRECTLY THROUGH LANGUAGE
(the above list, of course, is not exhaustive – the subtle ways in which individuals can express their hostility are myriad)
EFFECTS OF PASSIVE AGGRESSIVE PARENTS ON THEIR CHILDREN :
– the child may is at risk of growing up with communication problems similar to those of his/her parents and may him/herself develop passive-aggressive ways of interacting with others and find it very difficult expressing anger directly
– the child may feel a profound sense of confusion in relation to the ‘mixed messages’ sent out from the passive-aggressive parent; this can lead to the child growing up not really knowing ‘where s/he stands’ with the passive-aggressive parent and not, therefore, being able to fully trust this parent. This can lead to the child growing up unable to trust other people in general.
– if the child does indeed develop communication problems similar to those of his/her passive-aggressive parents, s/he is also likely, as an adult, to find both forming, and maintaining, interpersonal relationships problematic
It is not necessary to have a religious faith to be spiritual. But what do we mean by the term SPIRITUALITY?
Being a non – religious but spiritual person means we do not need to ‘buy into’ particular religious texts, systems of belief or traditions which have been passed on from generation to generation over many, many centuries. Indeed, free from such restrictive shackles, we are liberated to go about our spiritual practice in a way which is unique to us, if we so choose.
Our spiritual belief might involve belief in something far more intelligent than us but which we are so far unable to understand (and we certainly do not need to refer to such an entity as ‘god’).
People who are spiritual often report that being so :
– helps them to find meaning and purpose in life
– helps them during periods of suffering
– helps them to cope with the death of loved ones
– helps them to come to terms with the prospect of their own death
– helps them learn and develop in response to mistakes and suffering, rather than being defeated by them
– helps them recover from traumatic experiences
– helps with fears concerning the possibility of ‘life after death’
– helps them if they feel the need for forgiveness or the need to forgive others
– helps them develop their creativity
– helps them to become kinder, more patient and more compassionate
– helps them to develop empathy
– helps them to develop better judgement.
Many people who are spiritual report becoming more aware of the RECIPRICOL element of life (ie we tend, to some extent at least, to ‘reap what we sow’).
Also, those who are spiritual often find that they are more able to draw on their own suffering to effectively help others. Thus, suffering becomes less meaningless.
SPIRITUAL PRACTICES INCLUDE :
– meditation
– yoga
– Thi Chi
– sports that encourage the development of trust and cooperation
– appreciating nature, its beauty, exquisite complexity and ability to inspire feelings of awe
Carl Jung (1875-1961) was the founder of analytic psychology and regarded spirituality as an essential part of his work. He did not subscribe to any one, traditional religion. Indeed, he believed that fundamentalist and dogmatic religions inhibit spiritual growth, rather than enhance it.
Instead, he stressed the importance of the the person’s individual experience in spiritual growth (including the experiencing numinous events) and of discovering one’s true self (which Jung regarded as the most complete, fulfilled, integrated, balanced and effective individual that we can be – although, it has to be said, he also stated that very few people were ever able to attain this optimum state, rather as Maslow believed very few could ever ascend to the state of self-actualization in the hierarchy of human needs.
Pain, Suffering And Trauma Can Help Us Discover Our True Selves, According To Jung :
Jung also believed that our discovery of our ‘true selves’ involved a process of ‘individualization’ that was often a very protracted, extremely painful and traumatic experience.
In order to emphasize just how excruciatingly painful this process could be, he compared it to initiation tests that are undertaken by members of shamanic tribes. These initiation tests can be nearly fatal but are intended to bring about a new spiritual awareness, allowing the individuals who endure them to become spiritual teachers and healers.
In essence, Jung viewed such a process as akin to ‘death and rebirth’ and he points out that such ‘death and rebirth’ processes are central to many religions and traditions, including the death and resurrection of Jesus ; ancient Egyptian myths in which the god dies and is then reborn ; the mythical process of alchemy in which base metals are broken down and reformed into precious metal.
Related to this latter example (the mythical process of alchemy) is the SHATTERED VASE THEORY OF POSTTRAUMATIC GROWTH, and, related to the more general idea that extreme suffering may lead to spiritual development is the ADVERSITY HYPOTHESiS (though neither of these are directly connected To Jung) and I describe both of these below :
SHATTERED VASE THEORY OF POSTTRAUMATIC GROWTH :
Posttraumatic stress disorder (PTSD) was first incorporated into the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – DSM III – (sometimes informally referred to as the psychiatrists’ bible) in 1980.
Although, without appropriate and effective therapy, PTSD can devastate lives (including, of course, variants of PTSD resulting from severe childhood trauma), as the disorder has become increasingly studied by clinicians it has also become more and more apparent that some individuals affected by the disorder not only overcome their suffering, but, also, report positive changes to their lives that have derived from working through the effects of their traumatic experiences ; indeed, many have reported that they went on to function better, and extract more meaning and fulfilment from life, than they had been able to prior to developing PTSD.
As a result of this discovery (i.e. that some individuals not only recover from PTSD butgo on to thrive), the psychologists Tedeschi and Calhoun coined the term POSTTRAUMATIC GROWTH (PTG). Indeed, studies now suggest that up to seventy per cent of those who have suffered from severe trauma may, at least, gain some significant benefit from their experience. Such benefits frequently include the following :
a greater appreciation of the importance of supportive relationships
an awareness of their courage and mental strength (as demonstrated by having survived extreme adversity)
a deeper appreciation of life and a determination to ‘seize the day’
The ‘Shattered Vase’ Metaphor :
The ‘shattered vase‘ metaphor was devised by the psychologist, Professor Stephen Joseph. It is based on the idea that after a severely traumatic experience we can feel as if our lives have been ‘shattered’ and that our very being has become fragmented.
However, just as one could rearrange the broken pieces of the shattered vase into a new work of art, such as a mosaic or sculpture, so too, suggests Joseph, may we be able to ‘rebuild’ ourselves.
Like the shattered vase refashioned into a different art piece, our ‘rebuilt’ self will also be different from the original, but may well possess new qualities that did not exist in our former selves, such as those listed above. Indeed, the new, rebuilt self may well be a significant improvement upon the old one and as such would constitute posttraumatic growth.
We can, therefore, draw some solace from the shattered vase metaphor, even if our suffering has been great.
THE ADVERSITY HYPOTHESIS :
The vast majority of studies examining the effects of trauma on the individual have concentrated on the negative effects such as depression, anxiety, phobias, flashbacks, nightmares, post-traumatic stress disorder (PTSD) and so on. However, more recently, an increasing number of studies have focused on how the experience of trauma may, in some ways, actually benefit us.
Indeed, the ADVERSITY HYPOTHESIS puts forward the proposal that adversity and suffering are necessary for optimum human development.
Closely linked to the adversity hypothesis is the concept of posttraumatic growth (PTG).
The theory of posttraumatic growth suggests that some individuals who undergo traumatic experiences find that they grow and develop as a person in beneficial ways once the trauma is over. These benefits often include :
Discovering/developing strengths and abilities that weren’t apparent prior to the traumatic experience and becoming a more confident person as a result.
Feeling stronger as a person in the knowledge one can survive great difficulty and suffering.
Developing a greater appreciation of life once the trauma is over.
Strengthening of pre-existing valuable and meaningful friendships/bonds/relationships (the colloquial expression ‘finding out who your real friends are’ is of relevance here).
Gaining of a better perspective on life.
Gaining insight into life’s priorities and what one really wants to do with it to make it fulfilling – often leading to decisive and positive life-change.
Gaining a deeper insight into life in general leading to spiritual growth and development.
Indeed, there may well be other benefits, but the above list represents the main ones so far highlighted by the research carried out to date.
It is also worth noting that research carried out by Pennebaker (1990) suggests that if we are able to ‘make sense of’ our traumatic experiences in a way that is meaningful to us we are particularly likely to benefit from posttraumatic growth.
Also, research by Helgeson (2006) suggests that individuals are most likely to start to benefit from posttraumatic growth if their traumatic experiences ceased two years ago or more.
COPING PROCESS OR OUTCOME?
Whether posttraumatic growth represents an active coping process or is a more passive outcome of the experiencing of trauma (or, indeed, is a combination of the two) is still a matter of debate amongst psychologists; notwithstanding this, not everyone who experiences trauma also experiences posttraumatic growth.
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 paranoiddelusions 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.
What is Psychosis?
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 the belief that one is God.
– inability to settle and relax / agitated pacing
– loss of interest in appearance and hygiene / lack of self-care
– severe mood swings
– disrupted, disordered and disjointed thinking
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.
Psychotic Depression
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).
BPD AND REALITY TESTING
Reality testing, a concept originally introduced by Sigmund Freud (1856-1939), can be described as the capacity of an individual perceive the external events going on around him/her objectively, accurately and based on conventional interpretation rather than in a way distorted by internal mental factors. The Medical Dictionary defines it as : ‘The objective evaluation of the external world and differentiation between it and the ego or self.’
Impaired Reality Testing :
Reality testing is most obviously impaired in individuals, such as some schizophrenics, who are in the grip of florid psychotic symptoms such as hallucinations (e.g. ‘hearing voices’ or ‘seeing things that aren’t there’) and delusions (e.g. believing one’s thoughts are being broadcast / audible to others).
Borderline Personality Disorder, Brief Psychotic Episodes And Reality Testing :
Individuals with borderline personality disorder (BPD) generally do not have such dramatically impaired reality testing (although they can suffer from brief psychotic episodes when experiencing extreme stress). However, their reality testing can fluctuate to a significantly greater degree than is found in relatively ‘psychologically healthy’ individuals.
For example, particularly when experiencing significant levels of stress, individuals suffering from BPD may lapse into a paranoid style of thinking or experience an impaired ability to self-reflect in a realistic fashion.
Problems That May Arise As A Result Of Impaired Reality Testing :
An impaired ability to reality test can lead to various problems, including :
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.
MILD 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). If the person who has the experience of hallucinations such as those listed above 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.
SEVERE HALLUCINATIONS
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’reuseless’ 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.
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.
AGITATED PACING / PSYCHOMOTOR AGITATION
Another symptom of psychosis, which those suffering from BPD and other serious mental disorders may display, is psychomotor agitation.
We have seen that those who have suffered significant childhood trauma are at an increased risk of developing anxiety disorders in their adult lives. In extreme cases, this may lead to what is known as psychomotor agitation. I explain what is meant by this term below. However, I wish to start by recounting my own experience of this most distressing of psychological conditions.
For at least three years in total, off and on, I could not take a bath. The reason for this was that, when I was in this state (each episode could last several months) I was too agitated to do so – I couldn’t relax enough to lie down in the water, or even sit in it, any more so than I could voluntarily immerse myself in molten iron.
So I showered instead, right? Wrong. I felt too agitated to even indulge in this activity, even though most people find showering extremely relaxing and pleasurable.
Instead, I carried out my ablutions with a damp flannel; however, I confess that even this frequently proved to be a challenge I could not meet. Anti-social? Well, yes, if I saw anyone : but I didn’t. I was living as a virtual recluse.
Of course, for people who haven’t experienced severe agitated depression, it is extremely difficult to imagine how acutely distressing it is to have to endure such psychological torment on a constant and unremitting basis.
I couldn’t even sit back in an armchair; I was, quite literally, always on the ‘edge of my seat’ (so it seems the expression is not merely a metaphor).
In other words, I existed in a perpetual and unrelenting state of the most intense kind of agitation – permanently distracted and distraught. This led to a suicide attempt which left me in a coma in intensive care for five days, followed by hospitalizations and several courses of electro-convulsive shock therapy (ECT).
The name for this kind of profound, and highly distressing, restlessness is psychomotor agitation. I describe what is meant by this term below:
Symptoms Of Psychomotor Agitation:
– unintentional/ involuntary/ purposeless movement driven by an irresistible compulsion to do so, feelings of inner tension, restlessness, anxiety and intense mental anguish and distress. These involuntary movements may include:
Doctors may treat the disorder pharmacologically (ie. with medication) but it also often treated non-pharmocologically by means other therapies such as meditation, mindfulness, yoga and other relaxation techniques.
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If we have experienced childhood trauma to a significant degree, we may irrationally blame ourselves for it which, in turn, may well seriously, negatively, distort our self-perception; in other words, adversely affect our view of ourselves.
Our ENVIRONMENT has a large influence on how our personalities develop. For example, children brought up in a loving and secure environment are much more likely to become relatively content and self-confident adults.
On the other hand, a child who has suffered abuse and neglect may develop into an adult lacking self-confidence and prone to anxiety, depression and other serious difficulties.
Also, if a child has had an unstable parent or carer who has been unpredictable and has given mixed messages, they may develop into an adult who is fearful of abandonment. As a result, he/she may:
1. cling to close relationships 2. avoid close relationships
Children are ‘programmed’ to learn from adults (for evolutionary reasons) so if the adult carer has been abusive and critical the child may well grow up FALSELY BELIEVING that he/she is bad, stupid, unlovable and worthless. Also, trusting others may become very difficult as the individual’s experience during childhood was to be badly let down BY THE VERY PERSON/S WHO WERE SUPPOSED TO CARE FOR THEM AND PROTECT THEM.
The more stresses and traumas a child has, the more likely it is that he/she will develop into a pessimistic, anxious, depressed adult who believes things are hopeless and cannot improve.
It should be pointed out, though, that if a child suffers abuse but also has significant positive support in other areas of his/her life during childhood, this can make the individual more RESILIENT to the negative effects of the trauma.
It is also important to note that if a person has suffered trauma and as a result has a negative view of themselves, the future and the world in general (sometimes referred to as the ‘depressive cognitive triad’), IT IS POSSIBLE TO CHANGE THIS PESSIMISTIC OUTLOOK.
DEVELOPMENT OF BELIEF SYSTEMS IN CHILDHOOD:
We develop our most fundamental belief systems in childhood. If a child is brought up with love, affection and security s/he tends to build up positive beliefs. For example:
These negative beliefs often feel very true, but most of the time they are very inaccurate. JUST BECAUSE WE FEEL OUR BELIEFS ARE TRUE, IT IN NO WAY LOGICALLY FOLLOWS THAT THEY ARE.
In effect, then, childhood abuse can cause us to become PREJUDICED AGAINST OURSELVES – we see ourselves through a kind of distorting, black filter.
SELF-FULFILLING PROPHECY:
Negative, prejudiced self-beliefs are dangerous as they may become a self-fulfilling prophecy. For example:
– someone who thinks s/he will always fail may, as a result, not try to achieve anything and therefore not succeed in the way s/he in fact had the potential to do (if only s/he had believed in her/himself).
– someone who believes s/he is unlovable (when in reality this is untrue) may never attempt to form close relationships thus remaining unnecessarily lonely and isolated.
In summary, childhood EXPERIENCES form OUR FUNDAMENTAL BELIEF SYSTEMS. This in turn affects:
This negative belief system can become deeply entrenched. It is therefore necessary to ‘re-program’ our belief systems and I shall be examining how this might be achieved in later articles.
Eleven Types Of ‘Self’ That May Develop After Trauma :
In his book, The Posttraumatic Self, the psychotherapist John Wilson describes eleven types of ‘selves’ (or, what Wilson refers to, more technically, as ‘typologies of personality that form unique configurations of self-processes’) that may develop in the individual following severely traumatic experiences.
These eleven ‘selves’ can be seen as existing on a continuum such that the first (THE INERT SELF) represents those individuals most severely psychologically damaged by their traumatic experiences whereas, at the other end of the spectrum, the eleventh (THE INTEGRATED-TRANSCENDENT SELF), represents those individuals who have proved the most resilient in the face of their traumatic experiences and can be said to have ‘transcended’ them.
I list all eleven of the types of ‘selves’ below :
Inert Self
Empty Self
Fragmented Self
Imbalanced Self
Over-controlled Self
Anomic Self
Conventional Self
Grandiose Self
Cohesive Self
Accelerated Self
Integrated-Transcendent Self
There follows a brief outline of each of these eleven types :
1) THE INERT SELF :
Wilson describes those individuals who develop an ‘inert self’ in response to trauma as ‘broken in spirit‘, ‘autistically withdrawn‘ and devoid of all motivation (‘even the motivation to be safe’); they are emotionally numb and facially expressionless. They may, too, experience catanoid states, brief episodes of psychosis or paranoid states.
2) THE EMPTY SELF :
Individuals displaying the ’empty self’ are passive and devoid of energy. They have also lost interest in activities which they previously (before their traumatic experiences) found to be engaging and have become withdrawn, socially isolated (having lost social confidence and social skills) and insecure. They also suffer from anhedonia (the inability to experience pleasure), are anxious, fearful and have lost trust in the world. Suicidal ideation is also a prominent feature of this group of individuals.
Those who respond to trauma by displaying an imbalanced self suffer from extreme emotional lability similar to that suffered by individuals who have developed emotional instability disorder.
They are also afraid of being left alone and have a constant need for reassurance, to be looked after and cared for.
Such individuals have difficulty expressing their emotions and have a fear of losing control. They display trairs similar to those displayed by individuals suffering from obsessive-compulsive disorder (OCD).
It has also been suggested (e.g. Horowitz, 1999, cited in Wilson) that their intense overactiviry is an unconscious defense mechanism which serves to ‘block out’ / prevent conscious attention being directed towardstraumatic memories.
6) THE ANOMIC SELF :
These individuals experience life as empty and meaningless, are mistrustful of society in general and feel alienated and disconnected from it; indeed, often they may be seen as ‘loners’. They rebel against authority and lead an unconventional lifestyle. Also, because of the trauma they have suffered, they are wary of forming close emotional bonds with others. Furthermore, they may suffer from antisocial personality traits.
7) THE CONVENTIONAL SELF :
In contrast to individuals displaying an ‘anomic self’ (see above), these individuals have adjusted to, and reintegrated with, society following their traumatic experiences. By connecting with others, they help themselves redevelop a feeling of being safe; in relation to this, they have a strong need to gain the approval of others and to be liked and respected by them ; this powerful desire drives them to be highly conventional and conformist (Wilson, 1980).
Their grandiosity can be seen as a defense mechanism serving to ward off and protect from inner feelings of vulnerability, similar to the function it serves in those suffering fromnarcissistic personality disorder.
9) THE COHESIVE SELF :
Such individuals have proved resilient in the face of their traumatic experiences and may be described by others as having ‘bounced back.’ In contrast with the ‘anomic type’ (see above), these individuals are prosocial and concerned with questions relating to ethics and justice.
10) THE ACCELERATED SELF :
Those displaying the ‘accelerated self’ type have become highly individualistic as a result of having overcome their traumatic experiences. Wilson also describes them as being ‘tough, resolute, resilient, morally principled, altruistic and self-directed [who have] ‘transformed traumatic impact into prosocial humanitarian modes of functioning’.
Wilson refers to such people as displaying an ‘ACCELERATED’ self as they have, as a result of their profound, traumatic experiences, had their psychosocial development ‘speeded up’ which, in turn, has led them to consider ‘critical life-stage issues‘ earlier than would normally have been the case.
11) THE INTEGRATED-TRANSCENDENT SELF :
Such individuals have optimally overcome their traumatic experiences and, therefore, can be described as having ‘transcended’ them to achieve a ‘structurally [integrated] self, the components [of which] reflect optimal functioning.’ Indeed, they can be seen as having achieved whatMaslow describes as ‘SELF-ACTUALIZATION.’
These individuals embrace growth and challenges, have achieved ‘spiritual transcendence‘, gained profound wisdom and have the ‘capacity to have peak experiences of the numinous.‘ Wilson also describes such individuals as altruistic and able to ‘live in the present with consciousness attuned to a higher awareness of reality and cosmic order.’
Repairing Our Self-Image :
Those of us who suffered childhood trauma caused by our parents/primary carer are very likely to have received extremely negative messages about ourselves from these people – these messages may have been stated directly or implied and intimated.
Indeed, many of us were made to feel unwanted, worthless and utterly unlovable during the crucial stage of our development when we were forming our self-image.
In other words, we INTERNALIZED these messages which, in turn, may have led to us living all our adult life believing these messages to be true and also as being an accurate reflection of the essence of who we are ; this process can gradually erode, by a kind of drip-drip effect, and, eventually, destroy our self-esteem.
REPETITION COMPULSION :
Furthermore, if we had a bad relationship with our parents/primary carer when we were young, we may have found that we have, since, experienced a pattern of forming similarly poor relationships with others during our adult lives; for example, perhaps we have been unconsciously drawn to form relationships with others who are likely to abuse us – this can be due to what is referred to by psychologists as a REPETITION COMPULSION (an unconscious attempt to master our adverse childhood relationship experiences), leaving us extremely vulnerable to revictimization.
Naturally, this lowers our view of ourselves even further as it just serves to REINFORCE our belief that we are ‘worthless and unlovable’.
Coming to fully realize and understand this is A VITAL STEP TOWARDS COMING TO VIEW OURSELVES IN A MUCH MORE POSITIVE, AND, INDEED, COMPASSIONATE, WAY.
An effective therapy (this has been backed up by many research studies) that can help us to do this is COGNITIVE BEHAVIOURAL THERAPY (CBT) – click here to read my article on this.
It is also possible that having been indoctrinated with the belief that we are essentially bad, and having internalized this view, coupled with pent up rage about having been ill-treated in childhood, may have led us to make some significant mistakes in life.
However, we can lower the probability that we will repeat such mistakes by thinking about how we would like to change, in line with our now more positive view of ourselves (assuming we have worked at this), and then devise strategies as to how this goal may best be achieved.
It is also to point out that if we were conditioned to think ill of ourselves as children we may have found that, as adults, we have overly focused on our bad points whilst remaining oblivious to our more positive points.
Ways to help ourselves feel better about ourselves also include :
– cutting off contact with people who make us feel bad about ourselves
– associating more with people who make us feel good about ourselves
– taking up activities which make use of, and develop, our strengths
Several of the articles on this site have already examined the link between childhood trauma and anxiety. In this article, I want to consider one specific anxiety based disorder known as obsessive-compulsive disorder (OCD). When a person has this disorder, as its name suggests, s/he suffers recurring obsessions and/or compulsions. I define these below :
OBSESSIONS – intrusive and anxiety creating thoughts, images or impulses
COMPULSIONS – behaviours or mental acts intended to reduce the anxiety the obsession causes (but which, in fact, actually makes the anxiety worse over the long-term). Any effect the compulsion has on reducing the anxiety created by the obsession is temporary.
I show below how thoughts, feelings and behaviours flow into each other to keep the symptoms of OCD going :
OBSESSIONS (intrusive thoughts or images related to contamination, sexuality, danger, morality etc) >>>>>DISTRESS (eg shame, fear)>>>>>COMPULSION (repetitive behaviours or mental acts aimed at reducing the anxiety created by the obsession)>>>>>TEMPORARYRELIEF>>>>>OBSESSIONS (intrusive thoughts or images related to contamination, sexuality, danger, morality etc)>>>>> (eg shame, fear)>>>>>COMPULSIONS (repetitive behaviours or mental acts aimed at reducing the anxiety created by the obsession)>>>>>TEMPORARYRELIEF>>>>> and so on…and so on…leading to chronic distress.
In order for a person to be diagnosed with OCD, the following criteria normally have to be met :
a) the obsessions and compulsions cause significant distress
b) the obsessions and compulsions significantly interfere with day to day functioning.
c) the behaviours engendered by the OCD take up about an hour a day or more
d) the person with OCD is aware, at least at some level, that his/her behaviours are excessive and illogical
It is, of course, necessary to get a diagnosis from a professional as opposed to trying to self-diagnose.
HOW PREVALENT IS OCD THROUGHOUT THE GENERAL POPULATION?
It is estimated that approximately 2-3% of the population will suffer from OCD at some point during their lives. However, this may well be an underestimate as many people choose to keep their condition a secret. Research indicates, however, that OCD is becoming increasingly common.
Whilst the condition can begin in childhood, its onset is more common in late adolescence. It seems to be equally common in both men and women. However, women are more likely to seek out treatment for the disorder.
OCD can be made worse by stress. Also, those who suffer from OCD often suffer from other conditions as well. These include :
It should also be noted that people often have multiple obsessions/compulsions and these can change over time.
Due to the amount of distress OCD causes, and its link to other serious psychological conditions, if a person suspects s/he suffers from it, it is very important to seek out professional advice.
OCD and the brain :
Brain scans have shown that the brains of people who suffer from OCD are different from people who don’t. These scans show :
there is overactivity in certain brain regions which include ;
– the basal ganglia
– the orbital frontal regions
– the caudate nucleus
Furthermore, it has also been shown that those who suffer from OCD have less serotonin (a neurotransmitter) available in the brain. Indeed, medication called SSRIs ( selective serotonin reuptake inhibitors) increase the amount of serotonin in the brain and can be an effective treatment for OCD.
However, childhood trauma also plays a part. An individual with a biological/physiological predisposition to developing OCD will be more likely to suffer it if s/he suffers a traumatic childhood.
Various terms have been given by psychologists to what happens in the brain when a person has OCD. Schwartz termed it ‘brain lock’ whereas Rappaport referred to it as ‘a brain traffic jam.’
TREATMENT :
As mentioned above, medications can be given to increase serotonin levels, and, also, decrease brain activity in the relevant brain regions. Cognitive behavioural therapy (CBT) and hypnotherapy can also prove to be effective.
WHAT IS THE DIFFERENCE BETWEEN OBSESSIONS AND COMPULSIONS?
– OBSESSIONS are THOUGHTS, MENTAL IMAGES and IMPULSES
– COMPULSIONS are unwelcome and repetitive BEHAVIOURS.
EXAMPLES OF OBSESSIONS – these revolve around eight main themes :
a – CONTAMINATION eg ‘I can’t shake hands, I’ll catch a terrible disease’.
b – ORDER eg ‘the towels must be exactly in line
c – HARM eg ‘that candle might start a fire’
d – HOARDING eg ‘I must always keep all my rubbish, otherwise I could throw away something of value’
e – CERTAINTY eg ‘Did I definitely turn off the gas.’
f- NUMBERS eg ‘Whenever I turn off a light I must flick the switch 27 times.’
g – RELIGION/MORALITY eg ‘Thinking that thought means I’m evil – I must never think it.’
h – SEXUAL eg ‘If I think sexual thoughts I am sinful.’
Examples of compulsions are ;
– repeated hand washing
– repeatedly checking gas is switched off
– counting all the cracks in the pavement
– praying
– hoarding
– keeping things in order
– counting
PURE ‘O’
What Is Pure O?
Pure O (which stands for ‘purely obsessional’) is (at the time of writing) a little known term used to refer to a form of obsessive compulsive disorder (OCD) ; OCD, as we have seen from other articles that I have previously published on this site, is a disorder that we are at higher risk than average of developing if we have suffered from significant and chronic childhood trauma.
Spikes :
‘Pure O’ manifests as internal, mental rituals that involve a compulsion to obsessively ruminate upon, and to turn over and over in one’s mind, the same repetitive, disturbing thoughts ad infinitum. These intrusive thoughts, which the affected individual finds impossible to dismiss from conscious awareness, are sometimes referred to as ‘spikes.’
Typically, the content of these distressing, intrusive and unbidden thoughts center upon irrational fears of carrying out a behavior that are abhorrent to one and utterly contrary and antithetical to one’s set of values, ethics and morals such as rape, murder or, if one is religious, some terrible form of blasphemy.
Example Of Pure O :
Indeed, I once saw a documentary about a man who suffered from this condition. He was obsessed by the idea that he might commit murder whilst sleepwalking at night and took his concern so seriously that, as a result, he never went to sleep without first chaining his ankle, complete with padlock, to the metal bed-frame each night (however, the hypothetical question of whether he could, in theory, retrieve the key, open the padlock and then commit murder – all in his sleep – was left unaddressed!). In any event, he was no more likely to commit murder in his sleep than anybody else – his concern was what could be termed a ‘delusional concern’ and solely a symptom of his psychiatric condition as opposed to being based on any real, objective risk.
How Does Pure O Differ From Main Forms Of OCD?
Pure O differs from the main forms of OCD in so far as the rituals one feels compelled to carry out are mental, internal, and, therefore, hidden from others and (unless one chooses to confide in others about them) secret ; this contrasts with the rituals carried out by those suffering from the main forms of OCD that tend to be observable by others (such as compulsive hand-washing or checking doors, windows etc are locked and secure).
Statistics Relating To Pure O :
The onset of Pure O tends to be between the ages of approximately 13 years of age and 25 years of age. It has been estimated that it affects about one per cent of individuals. However, this could be an underestimate as it is probable that many individuals don’t realize that they have the disorder or do not wish others to know about it so keep it secret and never seek professional help.
TREATMENT FOR OCD
WHAT TREATMENTS ARE NORMALLY GIVEN?
Experts in the field of the treatment of OCD generally recommend cognitive-behavioural therapy (CBT) which is made even more effective if it is combined with medication – usually the medication will be an anti-depressant, although sometimes a benzodiazepam may be used.
Generally speaking, the anti-depressant is a long-term treatment, eg given for perhaps a minimum of a year, and up to a whole life-time, even if symptoms significantly improve (this is done in order to minimize the chances of a relapse occurring).
On the other hand, if the individual with OCD is prescribed a benzodiazepam, this will generally only be taken over a short period of time (eg a period when the symptoms are very acute) in order to minimize the risk of the individual with OCD becoming physically and/or psychologically dependent upon them (as they are addictive).
HOW EFFECTIVE IS TREATMENT?
If studies on the effectiveness of anti-depressants for the treatment of OCD are looked at as a whole, on average individuals with OCD who undergo such treatment significantly improve around about 45% of the time. Whilst any improvement is obviously extremely desirable, in general the improvements individuals make by taking anti-depressant medication are not great enough to eliminate the need for other treatments being given alongside.
As has already been referred to, cognitive-behavioural therapy (CBT) is usually the type of therapy to be used alongside medication – in fact, it is a specific type of CBT which is known as EXPOSURE WITH RESPONSE PREVENTION (which I’ll henceforth refer to as EWRP). As has also been mentioned, if symptoms are extremely severe then benzodiazepam may be prescribed over the short term before the EWRP can take place.
WHAT DOES EWRP ACTUALLY ENTAIL?
We have already looked at how sufferers of OCD have obsessive thoughts which cause them distress. What EWRP is designed to do is to help the individual TOLERATE SUCH DISTRESS. For, example, one common way in which OCD manifest itself is by making the sufferer inordinately and irrationally fearful of germs. Therefore, s/he may constantly be acutely anxious that his/her hands are ‘dirty’ and that this is potentially ‘highly dangerous’ – this, in turn. leads to constant compulsions to wash their hands in order to relieve their distressing and acute anxiety. However, the sense of relief is extremely ephemeral and the compulsion returns, perhaps leading the afflicted individual to wash his/her hands 100 times a day.
In the above example, the approach EWRP takes is to help the person tolerate the distress that his/her perception of having ‘dirty’ hands causes him/her by encouraging him/her not to wash them for a given period of time. As the person becomes better and more used to the anxiety caused by not washing them, the period of time can be gradually increased. The idea is that the person will become desensitized to the anxiety associated with unwashed hands.
On top of this, CBT can be used to help the individual challenge irrational thoughts which are connected to his/her OCD. For example, in the case described above, the individual could be helped to challenge thoughts such as ‘having any dirt on my hands is highly dangerous’ and to understand that the thought is an enormous exaggeration of any objective danger.
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