Severity Of BPD Symptoms And Human Touch Negatively Correlated.


Source of image: Dreamstime

Research (Field, 2010)  suggests that the severity of borderline personality disorder (BPD) symptoms and human touch are negatively correlated. In other words, those suffering from severe symptoms of BPD experience less physical contact with other human beings than do ‘BPD sufferers with less severe symptoms (all else being equal). This finding provides further evidence in favor of the many benefits, both mental and physical, of the experience of human touch and the deprivation of human touch can be severely detrimental to a person’s psychological and emotional welfare, as we shall see below.

First, let’s look at the benefits of human touch:

  • Reduces anxiety and stress
  • Improves immune system 
  • Lowers risk of heart disease
  • Reduces blood pressure
  • Reduces heart rate
  • Increases levels of oxytocin
  • Increases levels of serotonin 
  • Increases levels of serotonin
  • Signals safety and trust
  • Soothes
  • Reduces pain
  • Activates the body’s vagus nerve which is involved with our compassion response. (Read more about the vagus nerve here).

Now let’s look at the potentially detrimental effect of being deprived of touch:

Highly Controversial Study Involving Monkeys And What We Might Infer From Such Studies:

This famous (or notorious) study was carried out by Harlow (and its controversial nature acted as a catalyst for the emergence of the animal rights movement). The study involved keeping infant monkeys in isolation chambers for up to 2 years so that they were deprived of touch. These monkeys became extremely disturbed. An earlier experiment by Harlow had already established the importance of touch to these monkeys as it was found that when given the choice between clinging to 

  1. A surrogate ‘mother’ made of wire and holding a bottle of food


      2. A surrogate ‘mother’ made from soft cloth (like a cuddly toy) and NOT holding a bottle of food

the monkeys preferred number 2, suggesting that they prioritized the sense of comfort derived from the soft touch of the surrogate mother made of cloth to the easy access to food.

It is reasonable to extrapolate from this finding, given how closely related humans are to monkeys in evolutionary and genetic terms, that touch is equally indispensable to human welfare.

Some Examples Of Human Studies Showing The Benefits Of Touch:

   – Research conducted by Field (of The Touch Research Institute at the University of Miami’s Miller School of Medicine) that involved  HIV and breast cancer patients found that massage strengthens our immune system by increasing levels of our natural killer cells which kill viral and bacteria cells.

   – Research conducted by the neuroscientist Edmund Ross found that touch stimulates the brain’s orbitofrontal cortex which is involved in feelings of compassion and reward.

   – Research conducted by Feldman et al. (2013) involved 2 groups of premature babies There were 73 babies in each group):

GROUP ONE BABIES: Received skin-to-skin touch with their mothers

GROUP TWO BABIES: Received incubator care

Later, between the ages of 6 months and 10 years, all of the 146 individuals (i.e. the total of groups one and two) were given intermittent COGNITIVE TESTS.

It was found that, overall, individuals from GROUP ONE (skin-to-skin group) did significantly better than individuals from GROUP TWO (incubator group).


At AGE 10 YEARS individuals from GROUP ONE (skin-to-skin group):

  • slept better
  • contended better with stress
  • had more advanced autonomic nervous systems
  • had better cognitive control.


  • pets (e.g. stroking a dog or cat regularly)
  • acupuncture
  • massage therapy; research suggests it can ameliorate symptoms of depression and increase the effectiveness of the immunity system)
  • tai chi
  • reiki
  • weighted blankets (can provide the sensation of being held with beneficial physiological effects including calming the nervous system.

David Hosier BSc Hons; MSc; PGDE(FAHE)




  • Carolyn Magdalen Monroe, Effects of Therapeutic Touch on Pain Journal of Holistic Nursing American Holistic Nurses Association Volume 27 Number 2June 2009 85-92
  • Feldman et al. (2013)-Preterm Skin-to-Skin Contact Enhances Child Physiologic Organization and Cognitive Control Across the First 10 Years of Life.Published:October 07, 2013DOI:
  •  Harlow, H. F.; Dodsworth, R. O.; Harlow, M. K. (June 1965). “Total social isolation in monkeys”. Proceedings of the National Academy of Sciences of the United States of America. Proceedings of the National Academy of Sciences. 54 (1): 90–97
  • Ruth Feldman PhD,; Arthur I Eidelman MD (2007) Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants. Developmental Medicine and Child Neurology.

4 Types Of Borderline Mother : Witch, Hermit, Waif And Queen.



For those of us who grew up with mothers who suffered from a borderline personality disorder (BPD), our childhoods were often painful and anguished. We found ourselves living in a world that was contradictory and confusing; it is likely that we suffered chronic anxiety as we did not know how our mother would react or behave from one moment to the next. Due to our mother’s instability, it is likely that we started off life with an insecure emotional attachment to her, and, throughout our childhood, it is likely that the mother with borderline personality disorder was inconsistent, unpredictable (expressing affection one minute but rage the next), inappropriately intense and emotionally controlling. She may, too, have been deeply verbally hostile, expressing hatred and issuing threats. We may have often been told we were not wanted and that she might well abandon us. It may well have felt like living in an emotional prison. The effects of mothers with borderline personality disorder on their offspring can be quite devastating; we can grow up feeling fragmented, confused and, later, develop symptoms of psychological ill-health ourselves, such as impulsiveness,  being full of rage and hostility, being sometimes prone to violence, depression and deep anxiety. We may become in danger of tipping over into psychosis under stress (particularly in response to rejection and abandonment). We may, too, develop addictions as short term coping mechanisms to deal with our psychological pain. In short, we become at risk of developing borderline personality disorder ourselves. Borderline personality disorder is diagnosed in women twice as frequently as in men. It has been hypothesized that this could be due to the fact that men with BPD are much more likely to be misdiagnosed as having an anti-social personality disorder and end up in the prison system (which is often clearly likely to make their condition even worse). It is estimated that, in the USA, about 6 million people are suffering from BPD, which, in turn, must mean that there are also millions of children living with mothers who have BPD. Below are some of the most common things people who have been brought up with mothers with BPD say about them :

  • she is completely unpredictable
  • she denies what has happened
  • she sees everything in extreme terms (also called ‘black and white’ or ‘all or nothing’ thinking)
  • I sometimes find myself hating her
  • I am not able to trust her
  • she’s always exploding into rage
  • she imposes her negative view of the world onto me
  • she drives me insane
  • she makes me feel terrible about myself

All individuals who have a borderline personality disorder (BPD), including the borderline mother, experience its core symptoms; these are

  • fear
  • helplessness
  • emptiness
  • anger

However, one of these symptoms may PREDOMINATE and thus shape a particular BPD sufferer’s character. Concerning this idea, James Masterson (1988) classified borderline mothers into four sub-groups; these are :

  1. Waif mother.
  2. Hermit mother.
  3. Queen mother.
  4. Witch mother.

Let’s look at each of these BPD mother types in turn : 1) THE WAIF MOTHER – personality traits include helplessness, hopelessness, proneness to deep despair, extremely low self-esteem, very high sensitivity, having a ‘victim mentality, passivity and vulnerability. Sees self as a failure. May treat her children alternately indulgently and negligently. There often exists an intense underlying feeling of rage which may particularly likely erupt in response to abandonment (either real or imagined). POSSIBLE EFFECTS OF WAIF MOTHER ON CHILDREN: A) they may come to see themselves as failures for not being able to make her happy B) they may internalise her despairing view of the world and become despairing themselves C) they may become ENMESHED in their relationship with her and therefore find it difficult to separate from it. 2) THE HERMIT MOTHER: sees the world as dangerous and people in general as self-serving and callous. Always expecting disaster to strike and sees signs of imminent calamity everywhere. Has a deep sense of inner shame which she projects onto others. May have a tough exterior and a superficial image of being confident, determined and independent. However, beneath this façade, she tends to be distrustful, insecure and prone to rage and paranoia. Gains self-esteem from work or hobbies. POSSIBLE EFFECTS OF HERMIT MOTHER ON CHILDREN: A) they may internalise the mother’s fear of the world in general and therefore become anxious if they need to adapt to new situations B) they may find it very difficult to learn appropriate coping skills concerning a large variety of life’s problems C) they may find it difficult to trust others 3) THE QUEEN MOTHER – always craves attention; uses her children to fulfil her own needs; cannot tolerate disagreement or criticism from her children as she sees this as evidence that they do not love and respect her; chronic feelings of emptiness;   inability to ‘self-soothe when distressed; a powerful sense of own entitlement; may be prepared to use blackmail in order to get what she wants; capable of planned and premeditated manipulation; discards friends without guilt when they are no longer of use to her POSSIBLE EFFECTS OF QUEEN MOTHER ON CHILDREN: Mostly this type of borderline mother sees her children as her audience who must consistently respond to her in ways that bolster her (very fragile) self-esteem; she expects from them their unquestioning and unwavering love, support, attention and admiration. Her children can’t satisfy her insatiable emotional needs, conflict increases dramatically as they get older. Rebellion, deep confusion and anger are likely responses from children who live with this kind of mother, but beneath this, the children long for approval, recognition, consistency and unconditional love. In essence, however, the ‘queen’ mother’s own needs trump those of her children’s, as far as she is concerned. 4) THE WITCH MOTHER: this type of borderline mother is consumed by self-hatred (often on an unconscious level) and tends to be extremely hostile and cruel towards their children. Because of their feelings of rage mixed with impotence, they have a propensity to be particularly brutal to those less powerful than they are (for example, younger). They also tend to be self-obsessed and have little or no concern for others. They are likely to respond particularly venomously to criticism or rejection. At the base of their need for power and control is their intense desire to prevent abandonment. This particular sub-group of BPD is very resistant to treatment as those who suffer it tend not to allow others to help them. POSSIBLE EFFECTS OF WITCH MOTHER ON CHILDREN: A) the children of this type of mother are likely to find themselves as the target of random, intense and cruel attacks B) as with other forms of abuse, children who suffer the verbal/emotional/psychological injury assume (completely incorrectly) that it is they who are at fault. As a result of this profound misconception, they are likely to become depressed, subject to feelings of shame, insecure, hypervigilant (i.e. always on ‘red alert’ on the lookout for danger) and dissociative. As adults, they may develop difficulties with forming and maintaining relationships. It is possible, too, that they will go on to develop post-traumatic stress disorder (PTSD) or suffer from BPD themselves, thus potentially perpetuating the cycle.  

The ‘witch mother’ can be sadistic. To read about sadistic parents and their effects, click HERE.

Or, to read about controlling and sociopathic parents, click HERE.

Or, to read ‘The Pattern Of The Relationship With The Sociopathic Mother,’ click HERE.



  • used by her to fulfil her own needs
  • that it was impossible to predict her emotions/behaviour
  • worthless
  • unlovable
  • manipulated
  • always on ‘red alert’ in case we may inadvertently do or say something to anger her
  • alternately idealised and demonised by her
  • that we were her caretaker
  • used to provide her with emotional support
  • that she demands unconditional love, approval and admiration from us, but seems unable to love us unconditionally
  • confused by her unpredictable behaviour and treatment of us
  • controlled by fear (for example, of her rages if we do not comply with her wishes to the letter)
  • deeply hurt by her cruel teasing
  • that we are not permitted to show anger, regardless of how provoked, we may have been
  • overly confided in (as if we were a surrogate partner or parent rather than her child: SEE SECTION BELOW)
  • burdened by responsibilities we are too young to be expected to cope with that our feelings are belittled, undermined, dismissed as trivial, denied and ignored
  • that we are supposed to achieve standards that are impossible to meet
  • deprived of displays of physical affection (for example, hugs)
  • as if we are continually receiving ‘mixed messages’ from her (this can lead to finding ourselves in an emotional ‘double bind’ which is very distressing. 
  • as if we are a ‘bad’ person. 

NB. A diagnosis of BPD needs to be left to a professional. Just because a mother makes us experience some of the feelings above does not mean she has BPD. Mothers with other conditions (for example, depression, anxiety, PTSD, alcohol addiction) may make us feel some of the things listed above, as, from time to time, may mothers with no psychiatric condition.

When BPD Mothers Treat Us Like Surrogate Partners.

After my parents’ divorce, my mother increasingly used me as her emotional caretaker, even referring to me, quite brazenly, as her ‘Little Psychiatrist’ (a role foisted upon me that I see now, with hindsight,  I was all too willing to fulfil to the point of preoccupation and even obsession) until I was thirteen and our relationship broke down in such a way that I was forced to go and live with my father and his newly acquired wife. Such a relationship with a BPD parent (in which the child essentially becomes the parent’s surrogate partner) is, in fact, by no means a rare phenomenon in dysfunctional families. It is referred to by some experts (originally Friel and Friel, 1988) in how family systems and dynamics operate as ‘covert incest and can occur between a mother and her son or between a father and his daughter. In my case, my mother used me to satisfy her psychological needs because my father had left the family home. However, such ‘covertly incestuous relationships can also occur in which both parents are still living in the same household, but their marriage/relationship has broken down (this sad scenario is particularly likely to arise when one of the parents is an alcoholic). Complicity : It is essential to realise that when a parent manipulates the child into becoming, essentially, a surrogate partner, it is not only serving this parent’s needs. It also helps to free the other parent from this parent’s emotional demands. In this way, the other parent is complicit in what is being done to the child, and, through lack of intervention, enables its continuation. Typically, the parent who is using the child as a surrogate partner will make that child his/her confidante and seek advice on subjects that the child is emotionally ill-equipped to provide such as marriage problems, loneliness, or relationship difficulties with new boyfriends or girlfriends. Enmeshed Relationship: First, I should point out that an enmeshed relationship, if it develops, is not restricted to mother-offspring but can develop between various combinations of members (whether female, male, borderline or non-borderline) of any dysfunctional family or, indeed, between partners.

First, then, I will briefly explain what is meant by an ‘enmeshed relationship.’ Essentially, an enmeshed relationship is said to exist when personal boundaries between two people are indistinct and porous, allowing the emotions of one person to ‘leak through’ (as if by osmosis) and powerfully affect the other person’s emotional experience.

For example, as a child, my own relationship with my mother was enmeshed – this meant that my own emotional state was powerfully dictated by hers; her emotional pain was my emotional pain, and, as I got older, I reciprocated her destructive emotions, too, of anger and aggression (a feature of relationships that have weak boundaries is that as one person’s emotions intensify, so, too, do the other’s).

Another hallmark of an ‘enmeshed relationship’ within a dysfunctional family is that family roles can become confused, especially in relation to age; specifically, family members adopt (mainly unconsciously) roles that are inconsistent with their chronological age. For example, the emotionally immature parent may ‘parentify’ their child (i.e. expect the child to take on a role, such as a parent’s emotional caretaker, with which s/he is not psychologically developed enough to cope – in essence, s/he is expected to become the parent’s parent. And, of course, the other side of this coin is that the parent may regress to a psychologically childlike state by demonstrating excessive dependence and neediness.

Perhaps the most famous depiction of an enmeshed relationship in fiction is that between Norman Bates and his mother in the film Psycho. Most people are familiar with Alfred Hitchcock’s classic film, but fewer may be aware that it was originally a novel (published in 1959) by Robert Bloch.

Of course, their enmeshed (and, possibly, incestuous, the novel implies) relationship is epitomized by the fact that Norman’s highly, psychologically abusive mother is almost identical to his own: Norma (viewing children, not as individuals in their own right but as possessions and as an extension of themselves is a hallmark feature of both narcissistic and borderline mothers).

In short, Norman eventually murders his malevolent and tormenting mother (by poisoning her with strychnine) because, ironically, he fears she is abandoning him to marry her fiance (whom, for good measure, he also murders by employing the same modus operandi). Following this double murder, Norman frequently dresses in his (now deceased) mother’s clothes and takes on her personality.

Borderline, narcissistic and other types of emotionally disturbed mothers may form such an emotionally interwoven relationship with their son or daughter (sometimes referred to as ’emotional incest’) that the boundary between her identity and her offspring’s identity becomes nebulous and indistinct – whatever the mother feels, the son or daughter is expected to reflect back (e.g. if the mother is happy, her offspring must be happy and, if the mother is sad, her offspring must be sad.

Furthermore, the mother who has an enmeshed relationship with her offspring may instil guilt in him/her if s/he tries to behave independently in a way that excludes her.

She may, too, be highly controlling, dictating her offspring’s lifestyle and vetting their relationships with others and demanding compliance.

In divorced households, these types of mothers may also manipulate the child into breaking off relations with his / her (now absent) father so as to have the child ‘all to herself’, making him/her all the easier to dominate, control, and, essentially, to ‘possess’. This phenomenon is known as ‘parental alienation (and also occurs when one parent, motivated by a need for revenge, tries to hurt the other (absent) patent by denying him/her any contact with the child (irrespective, often, of the psychological harm that such a course of action may do to the child, sadly).

If the child grows up into an adult who does not assert his / her right to introduce healthy boundaries into the relationship, s/he is likely to suffer a very weak sense of his / her own identity as an individual as to how s/he experiences his / her emotional life will continue to be dominated by his / her mother. Such individuals, without therapy, can go through life feeling deeply uncertain about who they actually are  

Furthermore, they may have serious problems asserting themselves as well as a low tolerance for emotional pain (‘distress intolerance’). Paradoxically, although they are psychologically hurt by the dynamics of the enmeshed relationship, they will frequently find it very hard indeed to detach themselves from it without experiences deep feelings of fear (Rosenberg)

Other problems they may experience include: lacking a sense of autonomy when it comes to how they feel (i.e. believing that how they feel is out of their control and is dictated by the emotional state of others); feeling ’empty’ as they are unable to take responsibility for their own emotions; neglecting their own needs while feeling overly responsible in relation to how others are feeling.

Once individuals are aware that they are in an unhealthy, enmeshed relationship that is spoiling their quality of life and they become willing to take steps to rectify the problem, they may find both family therapy and individual therapy to be useful for helping them set the healthy boundaries within the relationship which it had, up until then, lacked.

Repercussions For Adult Life: Unfortunately, such ‘covertly incestuous relationships can seriously harm the child’s capacity, when he becomes an adult, to form healthy, intimate and sustainable relationships with others. Many therapists are of the view that such difficulties are likely to persist until the affected individual gains insight into how his/her dysfunctional childhood relationship with his/her opposite-sex parent has significantly contributed to these difficulties.   Note: ‘Covert incest is also sometimes referred to as ’emotional incest.’


The ‘witch mother’ can be sadistic. To read about sadistic parents and their effects, click HERE.

Or, to read about controlling and sociopathic parents, click HERE.

Or, to read ‘The Pattern Of The Relationship With The Sociopathic Mother,’ click HERE.



            REFERENCES:   Friel DL & Friel JC (1988). Adult children: the secrets of dysfunctional families. Deerfield Beach, Fla: Health Communications. ISBN 0-932194-53-2. Masterson, J. Psychotherapy of the Borderline Adult: A Developmental Approach (Brunner / Mazel, 1976)  ISBN 0-87630-127-8 Masterson, J.The Search for the Real Self: Unmasking the Personality Disorders of Our Age. (Collier Macmillan, 1988) ISBN 0-02-920291-4 Masterson, J.The Real Self: A Developmental, Self and Object Relations Approach  (Brunner / Mazel, 1985)  ISBN 0-87630-400-5   Rosenberg, R., Human Magnet Syndrome: Why We Love The People That Hurt Us. Published March 1st 2013 by Pesi, Inc ISBN 1936128314 (ISBN13: 9781936128310) David Hosier BSc Hons; MSc; PGDE(FAHE).

Pathological Lying : Its Link To Childhood Trauma

What Is A Pathological Liar?

Those who have suffered significant childhood trauma are more likely to become pathological liars / compulsive liars in adulthood than those who were lucky enough to experience a relatively stable upbringing (all else being equal).

A pathological liar is an individual who:

– does not give proper thought to the consequences of his/her lying

– lies spontaneously/impulsively

– lies even though he may receive no benefit whatsoever from the lie (indeed, many lies s/he tells will be self-damaging)

– has little or no control over his/her lying behavior

Roots Of Pathological Lying (Originally Called Pseudologia Phantastica) In Childhood:

Research has demonstrated that an individual is more likely to become a pathological liar in adulthood if that individual:

– grew up in a dysfunctional family

– suffered abuse as a child

– grew up in a family in which there was substance abuse

– lived in constant fear as a child and lying developed as a form of self-protection (e.g .to avoid severe punishment)

– grew up in a household in which dishonesty was common-place (e.g. hypocrisy, false promises, parents lying to a child, family secrets)

The Link Between Pathological Lying And Personality Disorders :

We have seen in other articles on this site that several personality disorders are more likely to develop in adulthood if we have experienced significant childhood trauma. These include:

Sociopathic personality disorder,  narcissistic personality disorder,  borderline personality disorder and histrionic personality disorder. Individuals suffering from such mental health problems stand a greater chance than average developing pathological lying behavior.

Other Factors That May Contribute To The Development Of Pathological Lying Behavior:

These include neuropsychological problems and other mental health issues such as impulse control disorders such as kleptomania and pathological gambling.

Reasons To Lie:

Although pathological liars often lie for no rational or discernible reason (indeed, this is one of the most often cited definitions of pathological liars) research suggests that, when they do have a reason, these reasons include the following:

– to gain admiration eg they may claim they were a bomb disposal expert in the army and saved dozens of lives, whereas, in reality, they were the cook, expert only on beans on toast

– to manipulate and control others: sociopathic pathological liar are particularly likely to lie for this reason

– due to low self-esteem eg by vastly exaggerating their qualities and achievements whilst denying or minimising their faults and failures

– they may lie to facilitate the use of the has the gaslighting technique

– to disguise failure e.g .claiming to have a first-class degree from Oxford University when, in reality, failing to get into any university whatsoever

– to avoid punishment

– to disguise lack of knowledge (e.g. claiming to have read Complete Works Of Shakespeare and written a dissertation based on these, when, in reality, has only read Act One, Scene One of Hamlet, failing to make any sense of it)

– to avoid embarrassment

– to entertain others and gain popularity (eg telling people stories about being a lion- tamer when really an insurance salesman)

– one leading theory suggests that the main, underlying cause of pathological lying is to try to avoid feelings of shame

N.B. Many people tell white lies connected to the type of lies above, but the pathological liar is differentiated from such people by his/her compulsion to lie, together with the extent and frequency of these lies; also, the pathological liar cannot control his/her lying behavior.

The Difference Between White Lies And Pathological Lies:

White Lies:

– are not malicious or intended to harm others; indeed, people frequently tell white lies in order to spare another’s feelings; indeed, the smooth running of society would be impossible if people could not tell white lies and the average person lies much more than one might think – one study (Feldman, 2002) found that during conversations of just 10 minutes 60% of individuals lied at least once).  However, this study also found that whilst there was no significant difference between how much males and females lied, on average, during the ten-minute conversations, there did appear to be a difference between the reasons why males and females lied: Females tended to lie to make the person they were talking to feel better whilst males tended to lie to make themselves look good.

Pathological Lies:

– lies are frequent and compulsive

– the pathological liar does not experience guilt about his/her continuous lying or fear the consequences of getting caught out.

– pathological lies are often told irrespective of discernible reason or for any obvious gain; however, when there are reasons these can be very nefarious and exploitative of others. In extreme cases such lies may involve, for example,  claiming (falsely) one’s child has cancer in order to raise funds for ‘treatment’ (but, in fact, to be spent on foreign holidays, etc.) or inventing an entire false history so as to impress another in order to develop a relationship with and exploit, that person

Should the term pathological liar designate a mental health disorder (or diagnostic entity) in its own right?

A study carried out by Curtis et al. (2020) and involving 807 individuals investigated whether pathological lying should be considered as a diagnostic entity in its own right. The participants were required to provide answers to questions that were presented on two questionnaires:

  1. Lying In Everyday Situations Scale
  2. Distress Questionnaire-5


13% of the participants self-identified as pathological liars or stated that others had identified them as pathological liars.

Also, compared to non-pathological liars, pathological liars :

  • reported feeling more distress when lying
  • reported a greater degree of dysfunction in relation to social relationships, managing finances, vocation and legal matters
  • reported being a greater danger to themselves and to others

The researchers came to the conclusion that their study supported the notion that pathological lying should become a diagnostic entity in its own right.

Signs Of Lying:

Signs of dishonesty may be hard to detect in, pathological liars as they do not experience lying to be very stressful (indeed, they may well enjoy it). However, non-pathological liars do find lying stressful and are therefore more apt to show the following signs:

Psychological research has shown the following to be signs that a person is lying:

– false smiling

– slowed rate of speech (as having to think carefully about what s/he says)

– heightened pitch of voice

– more pauses than usual (punctured by erms, ahs etc.)

– a mismatch between what is said and the person’s body language

– less head movement than usual

– the incongruity between what is said and tone of voice

– an unconscious slight shake of the head (expressing ‘no’) whilst telling a lie

– less eye contact than usual

– clearing of the throat

– frequent glances to room exit (unconsciously motivated by the wish to avoid the stressful situation)

– feet pointing towards room exit (see explanation above)

– leaning back from person s/he is lying to (again, unconsciously motivated by the wish to distance self from the stressful situation)

– less blinking than normal {infrequent blinking is a sign of deep concentration and such concentration is needed to avoid contradicting self)

– frequent swallowing

– less use of terms referring to self, such as me, my, mine, I, in order to try to distance self from the lie (again, unconsciously motivated)

Lying, Intelligence and Creativity:

Good liars, on average, tend to have higher intelligence and creative ability than people not adept at lying. Indeed, children who learn to lie very early in life tend to be of higher than average intelligence, research suggests.

Implications For Polygraph Tests:

Polygraph (lie detector) tests do not directly measure lying but the stress presumed to be caused by lying (e.g. elevated pulse rate, sweating etc). This means someone who is telling the truth but is very nervous may fail a lie detector test, whereas, on the other hand, a skilled and practiced pathological liar who does not find lying stressful may pass the test even though s/he is lying.

Treatment And Therapies:

If there is an underlying disorder, such as personality disorder (see above) or substance misuse/adduction then this usually needs to be addressed first. If the treatment is successful, the pathological lying behavior may disappear.

Cognitive Behavioural Therapy (CBT) may be helpful, as may medications such as anti-depressants and antipsychotics. N.B. Disclaimer: Always consult a relevantly qualified and experienced professional when considering taking psychiatric medication.


Drew A. Curtis, Ph.D., and Christian L. Hart, Ph.D  Lying: Theoretical and Empirical Support
for a Diagnostic Entity. Psych Res Clin Pract. 2020; 2:62–69; doi: 10.1176/appi.



David Hosier BSc Hons; MSc; PGDE(FAHE)

The Manipulative Parent

There are many ways in which the manipulative parent may manipulate their offspring, including:

  1. emotional blackmail
  2.  verbal aggression
  3. implicit or explicit threats
  4. deceit
  5. use of ‘the silent treatment’
  6. control through money or material goods
  7. positive reinforcement of behaviour which is damaging to the child
  8. coercion
  9. behaving in a passive-aggressive manner
  10. projection
  11. denial of obviously destructive behaviour
  12. gaslighting
  13. causing the child to believe that s/he will only be loved by complying with the parent’s wishes at all times; in other words, there is an ABSENCE of unconditional love (indeed, some parents are emotionally ill-equipped to love their children).
  14. causing the child to feel excessive guilt and ashamed for failing to live up to the parent’s expectations and demands.
  15. with-holding love as a form of punishment to cause emotional distress
  16. direct or implied threats of physical punishment
  17. making the child feel s/he is intrinsically bad for not always bending to the parent’s will
  18. Financial manipulation. Some parents may manipulate their child using money for a whole host of reasons, including spoiling the child and then accusing him of ingratitude;  as a tacit way of keeping the child quiet about abuse; to compensate the child for emotional neglect and ameliorate feelings of guilt; to make the child feel indebted; to increase the child’s dependence; to induce feelings of guilt in the child either explicitly or implicitly; as a tool to regulate the child’s behaviour; as an expression of the parent’s superiority and contempt for the child; as a superficial way of acting ‘the good parent.’
  19. making the child believe he is uncaring for not fully meeting the parent’s needs

Such parents may also be very controlling; if our parents were overly controlling the characteristics they may have displayed include the following :

  1. Did not show respect for, or value, our reasonable ideas and opinions
  2. Imposed over-exacting demands on us and refused to listen to even the most reasonable and considered objections
  3. Were preoccupied with criticizing us, whilst minimizing or ignoring our good points
  4. Were excessively concerned about our table manners (for example, failing to hold a knife and fork correctly)
  5. Were excessively rigid about what we eat
  6. Discouraged us from developing independence of thought, especially if it led to a mismatch between our opinions, views and values and those of the parent
  7. Imposed excessive demands on us regarding household rules, duties and regulations which we were not permitted negotiate even if any reasonable person would regard them as inappropriate
  8. Never admit to being in the wrong, even in very clear-cut circumstances
  9. Were excessively and unreasonably controlling regarding our appearance; not respecting our wishes to express our individuality (for example, choosing all our clothes without any interest in our opinion about them).
  10. Did not respect our choice of career and made demands on us to reconsider and instead pursue a career the parent regarded as more suitable even when this would make us very unhappy.
  11. Expected us to reach standards that Concept sign of parent manipulating her child like a marionette were impossible to attain and berated us when we inevitably, in their eyes, failed.
  12. Did not allow us to voice reasonable objections (for example, about the family dynamics and how they caused us unhappiness).
  13. Were unnecessarily rigid regarding who we ‘ought’ to associate within a way that reflected prejudice and discrimination against individuals we wished to associate with
  14. Tried to make us suppress perfectly normal emotions such as anger, fear and unhappiness.
  15. Violated our privacy (for example, searched our bedroom for our personal diary without a good cause).
  16. Tried to control us with emotional blackmail, psychological manipulation, intimidation and threats.

Whilst some parental attempts to manipulate and control are fairly blatant, as can be seen from the above examples, some are far more subtle. This means that when we were young we may not have been aware that we were being manipulated; we may only come to realize it, in retrospect, with the extra knowledge we have gained as adults.

Let’s now look in more detail at some psychological techniques a manipulative parent might make use of in order to gain power and control over his/ her offspring :

Techniques That Manipulative Parents May Use:

1) Preventing the victim from expressing negative emotions:

With this technique, the parent maintains that it is not what they themselves have done that is the problem – according to them, the ‘real problem is the offspring’s reaction to what they have done.

For example, according to the manipulative parent, if the offspring is distressed and upset by what the parent has done then this is due to the ‘fact’ that the offspring is oversensitive.

Or, if the offspring is angry about how s/he has been treated by the parent, the parent may say that the offspring’s anger is caused by him/her being so unforgiving.

A final example: if the offspring feels a desperate need to express how hurt s/he is by the parent’s behaviour, and so keeps bringing the subject up in an attempt to understand and process what has happened, the parent may high-handedly dismiss the victim as ‘sounding like a broken record’.

In such cases, then, it can be seen that the manipulative parent can be skilfully adept at redirecting the blame onto the victim and invalidating his/ her claims.

In this way, the offspring are forced to suppress powerful emotions at the expense of his/ her mental health – such suppression actually has the effect of intensifying the emotions, and, therefore, it is only a matter of time before they burst out again, their vigour redoubled. This process will frequently lead to the development of a vicious cycle.

2) Blaming the victim :

For example, a father who hits his son may claim that it was the son’s behaviour that ‘drove him to it’

Or a drunk parent may blame his/ her habitual drinking on the stress of bringing up the offspring.

In my own case, my mother threw me out of the home when I was thirteen. Due to my ‘behaviour’, apparently. And, whenever I cried (pretty much a daily occurrence around this age, admittedly), her favourite cutting, demeaning and belittling response (and the contemptuous tone in which it was delivered is still ringing in my ears, decades later) was that I should ‘turn off the waterworks.’

3) Inappropriate personal disclosure:

Prior to my forced eviction when I had only just become a teenager, my mother had essentially used me as her personal counsellor; indeed, she used to refer to me as her ‘Little Psychiatrist’. During these, for want of a better term, ‘counselling sessions’ she would very frequently discuss with me the problems she was invariably experiencing with the latest man she was seeing (particularly one who was highly unstable and frequently in and out of jail and lived with us for two years, but that’s another story).

She would also discuss her sex life. She once told me, for example, that, despite the fact that she had been married to my father for about fifteen years (before they divorced when I was eight), she had only ever had sex with him twice. As she has two children (I have an older brother) this was highly unlikely (and subsequently transpired to be a falsehood). Manipulators often disclose such inappropriately intimate details to encourage the other person to feel close to them, which, in turn, makes the victim easier to take advantage of and exploit.

4) Empty words (talk is cheap):

Examples of this include:

‘I’d make any sacrifice for you.’


‘Your happiness is my number one priority.’


‘I think about you all the time.’

However, the manipulator’s actions fail to substantiate these claims time and time again. Indeed, the contrast between his/her words and actions is depressingly stark. Empty words, of course, cost the manipulative parent nothing but s/he knows that by using them s/he can gain great power and control over the offspring, even making the victim feel ungrateful and indebted to him/her. It can also cause mental illness in the victim by invalidating his/her own perceptions and making him/ her question his/her very sense of reality. Indeed, it places the victim in a double bind.

5) Minimising :

For example, I was always told I was overstating the negative effect my childhood had on my psychological well-being (I have since discovered, however, that I was dramatically understating it).

Minimisation, then, involves the manipulative parent telling the offspring that they are essentially ‘making mountains out of molehills’, even ( or, indeed, especially), when the accusation is grotesquely inaccurate.

6) Lying by commission or by omission:

The former refers to saying something that is not true whilst the latter refers to withholding a significant part of the truth so as to generate a false impression.

7) Rationalization :

Providing a false explanation for behaviour that would otherwise reflect badly on the person.

8) Selective attention / selective inattention:

This involves only focusing on what supports the manipulator’s case whilst studiously ignoring anything that undermines it.

9) Diversion / Evasion:

This involves not responding directly to questions but instead going off at tangents, being vague and attempting to steer awkward conversations away from anything that might cast the manipulator in a negative light.

10) Covert Intimidation: 

This involves making implied, subtle threats to force the victim into a defensive position.

11) Placing The Victim In A Bad Light:

If the victim does indeed go on to the defensive, due to the manipulator employing ‘covert intimidation tactics (see number 10, directly above), the manipulator may take the opportunity to ‘shine the spotlight on the victim and claim that his/her (what is actually defensive) behaviour is abusive, thus cunningly turning the tables.

12) False / Controlled Anger:

The manipulator might fake anger to intimidate the victim, ward off suspicion (e.g. by using ‘outraged’ phrases like, ‘how dare you suggest such a thing!’ or close down the discussion/argument.

13) Seduction : 

This involves manipulating the victim by using flattery, charm and praise and gaining his/her trust and loyalty.

14) Scapegoating.

15) Projection: this involves the manipulator attributing his/her own faults to the victim.


Controlling Parents: Their Effects On Children


Controlling And Sociopathic Parents



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

Do Gay People Have More Adverse Childhood Experiences (ACEs)?

A study conducted by Anderson and Blosnich (2013) was carried out in order to investigate whether or not gay and bisexual individuals had, on average, experienced more adverse childhood experiences than their heterosexual counterparts. Before we look at the study, it is worth very briefly reminding ourselves of the most well-known study on the effects of adverse childhood experiences, The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study (1995-1997), found that all else being equal, the more ACEs an individual had experienced, the more health, social and behavioral problems s/he experienced in later life (this type of statistical relationship is sometimes referred to a ‘dose-response relationship’). The ACEs considered in the CDC-Kaiser Permanente study were as follows:

– physical abuse

– emotional abuse

– sexual abuse

– witnessing the mother being abused by the father

– loss/abandonment/rejection by a parent (including due to separation and divorce)

– living with a parent suffering from a pathological addiction

– living with a clinically depressed mother

– living with a mother who suffers from another significant mental illness

Anderson and Blosnich carried out their study to determine if gay and bisexual individuals experienced a ‘disproportionately higher prevalence of adverse childhood experiences (such as those listed above) in comparison with heterosexuals.

They surveyed a sample of 22,071 individuals from 3 U.S. states (Maine, Washington, and Wisconsin). The survey collected information using the ACE scale (which measures childhood exposure to ACEs) and questions about sexual identity.

Once the collected data had been statistically analyzed it was found that:

  • gay/lesbian individuals obtained ACE scores, on average, 1.66 times higher than heterosexuals
  • bisexual individuals obtained ACE scores, on average, 1.58 times higher than heterosexuals

These are highly statistically significant results. However, they do not provide us with a reason as to why the childhoods of gay/lesbian individuals are, according to these figures, involve more ACEs, on average, than the childhoods of heterosexuals. 

LGBTIQ+ And Menta Health:

Other research does show that LGBTIQ+ individuals are more likely to suffer from mental health issues than heterosexual individuals. including self-harm, depression, suicidal ideation, and addiction to alcohol and narcotics, and this is thought to be linked to the fact that LGBTIQ+ people e are more likely to experience stressors such as prejudice, discrimination (including from healthcare professionals), rejection, social isolation, being the victim of ‘hate crime and the internalized negative views of some sectors of society (e.g. so-called ‘conversion therapists who have used, in the past techniques, such as aversion therapy, chemical castration, and ice-pick lobotomies) towards the LGBTIQ+ community leading to self-hatred and self-disgust.

Stonewall recently conducted a study which found that :

  • 60% of LGBTIQ+ individuals had suffered from anxiety
  • 50% of LGBTIQ+ individuals had suffered from depression
  • 12.5% of LGBTIQ+ individuals (aged 18-24) had attempted suicide
  • almost 50% of trans people had experienced suicidal ideation


Professional online counseling for the LGBTQ community (Ad). CLICK THE IMAGE BELOW FOR FURTHER INFORMATION.


LGBTIQ+ Adolescents: Effects Of Stigma, Prejudice, And Discrimination:

Emotional Isolation:

Due to the stigma that can still attach itself to being LGBTIQ+, even though things, at least in the U.K. are better than they were, say, 30 years ago, LGBTIQ+ individuals may still feel very emotionally isolated and may believe that nobody else feels as they do or that there is nobody with whom they can confide in or share their intimate feelings with. Such feelings of social isolation and the sense of loneliness that goes with it may give rise to symptoms of clinical depression.


Again, whilst things have improved in recent decades, many LGBTIQ+ individuals feel alienated from their families which can be exacerbated by a perceived (real or imagined) necessity to keep their sexuality a secret for fear of rejection, being thrown out of the family home, and/or meeting with a physically violent reaction.

What psychologists refer to as cognitive dissonance may also occur whereby there exists a conflict in the LGBTIQ+ individual’s mind between his/her parents’ expectations of him/her and how his/her sexuality may prevent these expectations from ever being met. Such cognitive dissonance is liable to give rise to feelings of guilt and shame.


According to statistics provided by Stonewall:

  • 20% of LGBTIQ+ individuals have experienced a hate crime or incident due to their sexual orientation and/or gender identity in the last year.
  • 40% of trans people have experienced a hate crime or incident due to their gender identity in the last year.
  • 80% of anti-LGBTIQ+ hate crimes and incidents are never reported (younger LGBTIQ+ individuals were found to be particularly unlikely to report anti-LGBTIQ+ hate crimes and incidents to the police).




Andersen JP, Blosnich J (2013) Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample. PLoS ONE 8(1): e54691.



The Link Between BPD And Pace-Of-Life-Syndrome (PoLS)


Image source: Dreamstime

Research by Otto et al., 2021) suggests that borderline personality disorder represents a fast ‘Pace-of-Life-Syndrome (PoLS). To explain what is meant by this, it is first necessary to explain ‘Life History Theory’ in relation to elucidating mental illness.

‘Life History Theory’ is an evolutionary theory that is increasingly being used to help explain symptoms of various mental illnesses by considering individual differences in ecological, psychological and biological factors. In other words, whether or not a person develops mental illness will depend in large part upon:

  • ECOLOGICAL FACTORS i.e. relationships with others and physical environment
  • PSYCHOLOGICAL FACTORS e.g. childhood trauma and early life exposure to toxic stress
  • BIOLOGICAL FACTORS e.g. genetic predispositions

And, furthermore, the above 3 factors are influenced by an individual’s LIFE HISTORY.

Individuals whose constellation of the above three factors, due to his/her LIFE HISTORY, line up in such a way that places him/her at the ‘FAST’ end of PoLS:

  • HAVE HIGHER ALLOSTATIC LOADS IN ADULTHOOD (allostatic load refers to chronically increased or fluctuating endocrine and neural responses linked to chronic stress which, in turn, leads to increasing ‘wear and tear’ on the body).


Otto et al. (2021) hypothesize that CHILDHOOD TRAUMA (an overwhelmingly important part of LIFE HISTORY) LEADS TO FAST PACE-OF-LIFE-SYNDROME, due to its particular effects on the three critical factors (ecological, psychological and biological, see above) and their study broadly supported this idea. Otto and colleagues highlight the finding that those in the study (involving just under 100 females half of whom had BPD) in the BPD group, 80% of whom had suffered significant childhood trauma, scored more highly on characteristics commensurate with having PoLS compared to controls, including on aggression and contending with high levels of stress. (We also know, from other research referred to on this site, that those with BPD exhibit more risk-taking than the average person and also have significantly reduced life expectancy).

In evolutionary terms, an organism needs to grow fast (calling for an increased rate of metabolism) and reproduce as early in life as possible (which may involve higher risk-taking and aggression in relation to competing for mates) if its environment is extremely dangerous (in case it dies before it reproduces). However, this fast pace of development then puts a strain on the body, resulting in a higher allostatic load and more illness in later life as well as an earlier death.

So it follows that, in the case of those suffering from BPD, PoLS may be an evolutionary response to a perceived dangerous world, this perceived danger having developed from feelings of not being safe as a child/childhood trauma. Therefore, the fact that those with BPD have a shorter life expectancy than average, have a higher allostatic load, tend to be high-risk-takers, are often sexually promiscuous may be at least in part explained by PoLS linked to childhood trauma. And it is probably no coincidence that many people with BPD may describe themselves, at certain stages in life, living their life in the ‘fast-lane’).


To view eBook below and others that I have published visit my Amazon page.

Childhood Trauma And Its Link To Borderline Personality Disorder


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




The Science Behind How Exercise Reduces Anxiety


It is becoming increasingly well known how the body is intrinsically connected to symptoms of PTSD and complex PTSD, and, accordingly, the vital role of physical therapies in helping to ameliorate these conditions. Indeed, in the UK, more and more doctors are prescribing interventions such as free gym memberships in order to help treat patients suffering from various mental health conditions (especially depression and anxiety). In this article, I want to briefly look at the science behind the anxiolytic effect of exercise :

How Does Exercise Reduce Anxiety?

Exercise Has Beneficial Effects On Nervous System:

Exercise has been shown to reduce the reactivity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. These effects on our sympathetic nervous system and HPA axis have the effect of reducing feelings of stress and anxiety. These effects are important for ameliorating symptoms of PTSD and complex PTSD (conditions associated with disruption of the nervous system and the HPA axis as well as a whole host of anxiety disorders such as generalized anxiety disorder, social phobia, and obsessive-compulsive disorder.

Exercise Has Beneficial Effects On Monoamine System:

The three main monoamines are serotonin, dopamine, and noradrenaline. Animal studies have also suggested that aerobic exercise increases levels of serotonin and noradrenaline in the brain

Exercise Increases Activation Of The Brain’s Frontal Regions:

Exercise helps activate the frontal regions of the brain. This is important for those who suffer from anxiety as the brain’s frontal regions help dampen down activity in the brain’s amygdala (the brain’s internal ‘alarm system’ which is activated by the perception of real or imagined threats it has been found that those suffering from borderline personality disorder and complex PTSD may have incurred damage to their amygdalas due to severe and protracted early life stress which, in turn, can make the amygdala over-sensitive and over-reactive, locking us into a state of ‘fight or flight.’)

Exercise Has Beneficial Effects On Endogenous Opioid System:

The endogenous (endogenous means originating from inside the organism as opposed to the external environment) opioid system can be described as the body’s innate PAIN KILLING SYSTEM. Studies suggest that vigorous exercise stimulates increased production of endogenous opioids (endorphins) in the brain which in turn improves mood and reduces feelings of anxiety. Studies also suggest that by stimulating endogenous opioids in both the ventral and peripheral nervous system exercise may also help to diminish some forms of pain.

Exercise Has Beneficial Effects On Brain-Derived Neurotrophic Factors (BDNF):

BDNF has been found to be lowered in individuals suffering from anxiety. (e.g. Duman and Montiggia, 2006) and research suggests that exercise can increase levels of BDNF. Increases in BDNF may also improve the functioning of the serotonergic system (Chen et al., 2006) and augment the growth of neurons (Altar, 1999). Exercise also increases the availability of the neurochemicals gamma-aminobutyric acid (GABA), and endocannabinoids, both of which reduce feelings of anxiety.

Exercise Encourages Growth Of New Brain Cells (Neurogenesis):

Neurogenesis refers to the process in the brain whereby new neurons are formed. Research (e.g. Eisch, 2002) suggests that the growth of new neurons in the brain (particularly the hippocampus) can help to reduce feelings of anxiety. Animal studies suggest exercise can increase neurogenesis in the hippocampus (Duman et al., 2001).

Exercise Increases Tolerance Of Some Of The Symptoms Of Anxiety And Increases Resilience::

Because physical activity causes the body to react in similar ways to some of the body’s reactions to anxiety (such as rapid heartbeat and hyperventilation) repeated exposure to such bodily reactions as a result of exercise may help to habituate the individual to such sensations (Beck and Shipherd, 1997) and therefore help him or her to build up tolerance of them, understand they are not dangerous and thus prevent escalation anxiety.

Exercise Can increase Feelings Of Self-Efficacy And Self-Mastery Which In Turn May Prevent Escalation Of Anxiety Symptoms::

Feelings of self-efficacy and self-mastery have been shown to correlate with a decrease in feelings of anxiety and evidence suggests (Bodin and Martinsen, 2004) that exercise which increases feelings of self-efficacy and self-mastery (e.g. martial arts) is better at reducing individuals’ symptoms of anxiety than exercise that is less likely to lead to these feelings (e.g. riding an exercise bike).

Exercise Acts As A Distraction:

Exercise distracts us from our worries and negative ruminations, especially exercise that allows us to enter a state of ‘flow’. ‘Flow’ is a term used in positive psychology which means, in informal parlance, ‘being in the zone‘ and involves being fully immersed in, and absorbed by, the activity one is performing. The state is both pleasurable and energizing.

Exercise Reduces Muscle Tension:

Tense muscles are one of the symptoms of anxiety and exercise reduces such tension. 

High-Level Exercise Activity Versus Low-Level Exercise.

A study conducted by Schuch et al.(2019) found that high-level exercise was more effective at reducing anxiety than low-level exercise and that such exercise can help reduce anxiety symptoms in those suffering from agoraphobia and complex- PTSD.


David Hosier BSc Hons; MSc; PGDE(FAHE)



Desperate Measures: Pseudo-Seizures, Polysurgery And Double-Doctoring

Very frequently those suffering complex PTSD have been extremely badly cared for or have been seriously psychologically harmed by those who were supposed to care for them. This, not surprisingly, can lead to a desperate and overwhelming need to be cared for as an adult. Tragically, though, such help is very often extremely hard to come by.

In rare cases, this situation can cause the complex PTSD sufferer to take extraordinary measures in a desperate attempt to secure some of the caring attention which others take for granted but that has eluded him/her, perhaps even from birth.

Three of these rare measures are:

  • Pseudoseizures
  • Polysurgery
  • Double-Doctoring


These can be brought on by psychological factors such as severe stress. Stress involving extreme feelings of shame (as is often the case in people suffering from complex PTSD) may be especially likely to precede pseudo-seizures. The main difference between seizures and pseudoseizures is that the former involves brain electrical activity abnormalities whereas this is not the case with pseudoseizures. The term ‘pseudoseizure’ is used less frequently than in the past as it has been criticized for having connotations that such seizures are deliberately faked. Because of this, the term psychogenic non-epileptic seizure (PNES) is now more commonly used. However, just because PNES may not be deliberately faked, this does not rule out the possibility that the attacks may, on occasion, be unconsciously motivated by a desperate need for psychological help and to signal extreme mental distress.


A study by Ka Tung Vivianne et al.  (2019)  asserts that some individuals who experience various forms of childhood psychological trauma, in particular, bullying (e.g. being given a cruel nickname at school relating to one’s appearance) and/or neglect (e.g. as a young child, neglect experienced included neglect by parents of the child’s appearance) may undergo cosmetic surgery in adulthood to reduce the degree of psychological distress they feel in connection with these adverse childhood experiences. The authors of the study concluded that, in some instances, such surgery can ameliorate the person’s suffering by improving body image which, in turn, contributes to a more positive frame of mind in general.

However, as Harth points out, requests for cosmetic surgery are motivated by psychological and emotional factors as well as by trends in society (e.g. placing extreme emphasis on the importance of physical beauty). Because of this, vulnerable individuals suffering from psychological disturbances such as complex PTSD  may feel a particular pressure to undertake cosmetic surgery and become addicted to the process and, in so doing, ignore risks, side effects and complications repeated procedures may entail. Harth also alerts us to the fact that those suffering from psychological disturbances such as complex PTSD may be driven to seek treatments due to unhealthy reasons such as feelings of inferiority, social phobia (which involves obsessively worrying about what others are thinking of one), and body dysmorphic disorder, ultimately leading to polysurgical addiction. Such addiction may also be fuelled, as already alluded to above, by a general need to be shown care, whatever guise such care may take.


The term ‘double doctoring’ refers to a situation in which a patient clandestinely registers with more than one doctor to obtain more of a particular drug or an additional drug that s/he would not otherwise have been able to obtain (i.e. the original doctor would not prescribe a higher dose of medication nor prescribe additional medication. This can occur when an individual is in severe distress and is not getting the relief from mental suffering  s/he craves from the medication originally prescribed. Unfortunately, it can also occur when individuals obtain medications by ‘double doctoring’ in order to sell them which, of course, constitutes illegal drug dealing.

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



Harth W, Hermes B. Psychosomatic disturbances and cosmetic surgery. J Dtsch Dermatol Ges. 2007 Sep;5(9):736-43. English, German. doi: 10.1111/j.1610-0387.2007.06293.x. PMID: 17760893.

Ip, Ka Tung Vivianne, and Wing Yee Ho. “Healing Childhood Psychological Trauma and Improving Body Image Through Cosmetic Surgery.” Frontiers in psychiatry vol. 10 540. 8 Aug. 2019, doi:10.3389/fpsyt.2019.00540


Rapper Talks About How Making Music Has Reduced His BPD Symptoms

A rapper from Bristol, Wayne Webster, has recently been reported by the BBC as explaining how music has helped him deal with his BPD and stopped him from harming himself. The rapper stated that by the age of 28 he realized ‘something wasn’t right’ with him and that he was not only hurting himself but hurting others around him as well. He also talked about how he learned to ‘rewire’ his brain and that music was the most important factor whilst going through that process.

Music Therapy:

Music therapy is an evidence-based therapy and a growing field often carried out by expert musicians who understand the effect of musical properties on how we feel, our mood, and our brain wave activity as well as how it can reduce feelings of pain and increase our speed of healing amongst other benefits (see below).


Music Therapy may include:

  • singing
  • drumming
  • dancing
  • songwriting
  • listening to music 
  • discussing music
  • making music



    • increase the ability to attach to others leading to a reduction in anxiety when relating to others and reduction in destructive thoughts and actions
    • improve psychosocial functioning
    • improve communication skills
    • improve implicit and explicit mentalization

    According To The American Music Therapy Association (AMTA), Music Therapy Has Also Been Shown To Help Children And Adolescents:

    • self-reflect
    • develop their communication skills
    • regulate (control) their emotions
    • develop their identity
    • recover from trauma

    Furthermore, According To The American Music Therapy Association (AMTA), Music Therapy Can Lead To A Number Of Physical Benefits That Include:

    • reduced heart rate
    • reduced blood pressure
    • reduced muscle tension
    • increased release of endorphins

    Music Therapy And BPD:

    Whilst those suffering from BPD have been seen as difficult to treat using Music Therapy, research by The Music Therapy Clinic Aalborg  University suggests that sometimes even the unstable and difficult clients benefit from treatment.

    Music Therapy, Trauma, And PTSD:

    Research conducted by Landis-Shack et al (2017) found evidence that Music Therapy may be useful for the relief of symptoms in those who have experienced trauma and/or are suffering from PTSD and it may also increase individuals’ levels of resilience. However, the researchers also point out the need for further research into this particular area of study.










    American Music Therapy Association (AMTA). Music therapy with specific populations: Fact sheets, resources & bibliographies.

    N, Heinz AJ, Bonn-Miller MO. Music Therapy for Posttraumatic Stress in Adults: A Theoretical Review. Psychomusicology. 2017;27(4):334-342. doi:10.1037/pmu0000192


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

    Crucial Features Of Psychoeducation For Sufferers Of Complex PTSD

    Psychoeducation is a vital part of treatment for those suffering from complex PTSD and includes many vital elements and I briefly outline the main ones below:

    The patient/client should be provided with an understanding of what is meant by the terms ‘trauma’ and ‘complex trauma’ including their symptoms.

    The patient/client should also be helped to understand that often the origins of the symptoms of complex PTSD are very frequently unidentified (even by those within the medical profession) until a suitably trained medical professional is involved in a diagnosis (for this reason many people who are eventually diagnosed as having complex PTSD have been incorrectly diagnosed with other conditions in the past that complex PTSD symptoms have been mistaken for (e.g. ADHD, bipolar disorder, or borderline personality disorder).

    Once the true origin of complex PTSD has been identified (usually severe, ongoing, interpersonal trauma caused by a parent or primary carer) the client needs to be helped to understand that his/her symptoms were originally healthy adaptations that developed as self-defense mechanisms to increase his/her chances of self-protection, self-preservation, ability to cope psychologically and survival. Or, to put it another way, the complex PTSD symptoms of the person developed as a NORMAL REACTION TO ONGOING, REPETITIVE, ABNORMAL, AND THREATENING CIRCUMSTANCES (COMPLEX TRAUMA). For example, the individual’s ‘survival brain’ may have become overdominant and s/he may have become ensnared in the ‘fight or flight’ mode.

    It should be explained to the patient/client the pervasive and profound effects that complex trauma can have on the sense of self (e.g. a feeling that the self has become fragmented) and that this can lead to feelings of intense fear, feelings of existence being pointless and meaningless and a sense of a foreshortened future.

    The patient/client needs to be made aware of how his/her current relationship difficulties are likely to be closely related to problematic relationships with his/her parents/primary carers in early life.

    The client/patient needs help to understand how his/her assumptions about the world may have been shattered by his/her traumatic experiences and that this may have profoundly affected his/her core beliefs.

    The vital importance of social support to facilitate the recovery process should be emphasized to the client/patient.

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

    BPD Mothers’ Unrealistic Needs And Resulting Resentment Of Children

    It is well known that those suffering from BPD find it very hard to maintain healthy relationships with others and this includes relationships with their own children. Why is this?

    Mothers with BPD are very likely indeed to have many unmet needs deriving from their own traumatic childhoods which, in turn, can act as an unconscious desperate desire to have these needs satisfied via their adult relationships. In other words, the BPD mother projects her childhood emotional needs (which went unfulfilled) onto her adult circumstances.

    This means the BPD mother may, on an unconscious level, have a powerful need for her own child to provide her with the emotional nourishment she missed out on from her own parents. Or, to put it another way, she may unrealistically expect her child to sacrifice his/her own emotional needs in order to satisfy hers. This, of course, is an expectation that the child cannot possibly fulfill as s/he simply does not have the psychological resources necessary to do so.

    In the eyes of the BPD mother, the child’s inability to meet her needs constitutes a slight against her which can then lead to deep resentment of her child, resulting in a catastrophic breakdown of the relationship.

    In my own case, after my parents divorced when I was eight, my mother soon started to use me as her personal counselor (she even used to refer to me as her ‘Little Psychiatristt’). However, she was also prone to outbursts of vitriolic rage and hatred towards me if I displeased her in any way and, by the time I got to be about twelve or certain, I started to argue back and express my own (defensive and reactive anger). This was intolerable to her so she threw me out of the house at the age of thirteen so that my father and step-mother (against their wishes) were forced to take me in.

    And, of course, it is not just BPD mothers’ relationships with their children that are highly volatile, but with romantic partners too. Just as her expectations of how her children relate to her unrealistic, so too are her expectations of those she attempts to form romantic partnerships with. In essence, she expects those with whom she forms a relationship to provide her with the kind of unconditional love only parents can provide. Furthermore, due to her lack of experience with genuinely healthy relationships, she often has unrealistic expectations of an IDEAL relationship in which all her emotional needs are met at all times and that the initial, exciting ‘honeymoon period’ of the relationship lasts forever.

    Because those with BPD frequently have severe problems with relationships (as described above) and are unaware that these problems derive from their own unmet childhood needs, gaining insight into this and learning to ‘self-parent their inner child’ with the help of an empathetic therapist is potentially beneficial. Unfortunately, many BPD sufferers do not accept they have a problem, instead insisting that it is everyone else who has the problem. Indeed, many individuals with BPD find any kind of criticism extremely hard to take and this tends to be linked to an extremely fragile sense of self-esteem making him/her highly defensive. Raising self-esteem, then, may be a necessary starting point.




    Parentiffication: A Closer Look At Its Harmful Effects

    David Hosier BSc Hons; MSc; PGDE(FAHE)


    REM Sleep Behaviour Disorder, Somniloquy And Childhood Trauma

    I have recently had to contact my doctor as I have been abruptly waking up in the night to find I am thrashing about which has resulted in me knocking things off my bedside table (such as my lamp and radio), screaming out, shouting, and even falling out of bed (or some combination of these). Often, I seem to be acting out my dreams/nightmares (sometimes known as ‘dream-enactment’) and this is a form of REM sleep behaviour disorder, and the ‘shouting out’ part of the disorder is known as somniloquy (it should be noted, however, that somniloquy’, or talking in one’s sleep, when it occurs by itself and does not cause distress, is very common and about two-thirds of people do it). Healthy individuals do not act out their dreams/nightmares as, during REM sleep, the body usually becomes temporarily paralyzed. In the case of REM sleep behaviour disorder, though, this self-protective temporary paralysis fails to function.

    Several studies have shown that sleep behaviour disorder and other parasomnias are often early signs of PTSD and occur more frequently in those who have been diagnosed with PTSD or have experienced significant trauma, including, of course, childhood trauma (e.g. Bader et al., 2007).

    Research carried out by Insana et al.(2012)   found that traumatic experiences during early life were associated with REM sleep fragmentation and that such fragmentation, in turn, was associated with later-life disruptive nocturnal behaviours. REM sleep fragmentation occurs because brief bursts of high arousal during REM sleep wake the individual up, thus making sleep discontinuous and potentially leading to frequent waking by the sufferer and greatly diminishing his/her quality of sleep. This poor quality of sleep, in turn, as very frequently associated with extreme daytime fatigue (i myself can often need to spend several hours a day resting/trying to sleep and, if I’m lucky, getting some fitful sleep on top of the ten or so hours of extremely poor quality, fragmented, disordered, so-called ‘sleep’ I am forced to endureevery night.

    Kajeepeta et al. (2015 involved) undertook a systematic review in order to summarize the findings of 30 studies that investigated the relationship between ADVERSE CHILDHOOD EXPERIENCES  (ACEs) and sleep disorders and found that the vast majority of studies found a significant correlation between adults who had experienced ACEs and their likelihood of suffering from a sleep disorder. Furthermore, many of the studies suggested that the more ACEs a person has experienced, the greater his/her risk of suffering from a sleep disorder during adulthood. The authors of this study concluded that their findings highlighted a need for trauma-informed care for survivors of childhood trauma who were experiencing an adult sleep disorder. Research by Sullivan et al. (2019) suggests that, without effective treatment, the damaging effects that ACEs can have on sleep can last up to 50 years.

    It is known that the experience of adverse childhood experiences (ACEs) increases the risk of various diseases in adulthood it has been theorized that the adverse effect of ACEs on quality of sleep may significantly contribute to this link.


    When Sleep Disorders Lead To Dangerous Behaviour

    Sometimes sleep disorders, including REM sleep behaviour disorder, can lead to violent and dangerous behaviour. In extremely rare cases, such dangerous and violent behaviour can lead to fatalities. One well-known example of this is the case of Brian Thomas (60 years old at the time of the incident) who, whilst on holiday in Wales and sleeping in a camper van, experienced a nightmare that involved him trying to fight off an attacker (i.e. the ‘attacker’ who featured in his nightmare) only to wake and find he had strangled his wife (Christine, age 57) to death. An expert in forensic sleep medicine investigated the case and explained to the court that Brian had been suffering from night terrors at the time of the incident which exempted him from responsibility for his wife’s death. As a result, the court found him not guilty.


    REM sleep disorder may also be associated with Lewy body dementia, Parkinson’s disease, and multiple system atrophy. I hope this is not the case with my own condition but will be certain to ensure I make my GP is aware of this link when I next see him.



    Bader, Klaus PhD*; Schäfer, Valérie MSc*; Schenkel, Maya MSc*; Nissen, Lukas MSc*; Kuhl, Hans-Christian MSc*; Schwander, Jürg MD† Increased Nocturnal Activity Associated With Adverse Childhood Experiences in Patients With Primary Insomnia, The Journal of Nervous and Mental Disease: July 2007 – Volume 195 – Issue 7 – p 588-595
    doi: 10.1097/NMD.0b013e318093ed00

    Insana S P, Kolko DJ, Germain A. Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans. Biol Psychol. 2012;89(3):570-579. doi:10.1016/j.biopsycho.2012.01.001

    Kajeepeta S, Gelaye B, Jackson CL, Williams MA. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Med. 2015;16(3):320-330. doi:10.1016/j.sleep.2014.12.013

    Sullivan K, Rochani H, Huang LT, Donley DK, Zhang J. Adverse childhood experiences affect sleep duration for up to 50 years later. Sleep. 2019 Jul 8;42(7):zsz087. doi: 10.1093/sleep/zsz087. PMID: 31281929.

    Complex PTSD Characteristics And Dimensions And The Eleven ‘I’S’

    The researchers Ford and Courtois (2017) have identified eleven characteristics of the very serious condition complex PTSD which can develop as a result of severe, protracted, interpersonal childhood trauma that builds on earlier work by Ford that identified ‘the five ‘I’s’ of complex PTSD by adding six others. These are as follows:


    Complex PTSD is particularly likely to occur as a result of INTENTIONAL ACTS such as a parent being deliberately psychologically abusive over a long period in order to exert control.


    Complex PTSD is particularly likely to develop if the person who betrays and traumatizes us is a parent or primary carer upon whom we depend emotionally and physically


    Complex PTSD is more likely to occur if the traumatizing environment is inescapable (e.g. other than ‘running away’ which is unsustainable and potentially extremely dangerous a young child is not able to escape an abusive home unless social services intervene) which, amongst many other problems, can lead to ‘learned helplessness.‘).


    This can include psychological wounds, emotional wounds, physical wounds (as in the case of physical abuse), and physical damage to the developing brain as a result of prolonged exposure to toxic stress.

    Irreparable (potentially):

    Injuries such as those referred to above can be irreparable or only partially repairable.

    Intimate, Intrusive, and Invasive:

    Acts of abuse and, maltreatment leading to complex PTSD are intrinsically intimate as they trample on an individual’s personal boundaries. Such acts that cross personal boundaries are also, by definition, intrusive and invasive. Additionally, complex PTSD often involves intrusive thoughts and intrusive memories.

    Imminent Threat:

    Complex PTSD is also particularly likely to occur if, as children, we lived in an environment in which we were constantly on the alert for danger (e.g. because one of our parents was an unpredictable, violent, abusive alcoholic). Living under such conditions can lead to us, as adults, feeling constantly hypervigilant (perhaps in part due to the adverse effects of living in a constantly fearful; state on the development of the brain region known as the amygdala) even years or decades after such abuse has ceased thus condemning us, in the absence of effective therapy, to live our whole lives as if we are in imminent danger even when, objectively speaking, we are relatively safe.

    Identity deformation:

    Complex PTSD can involve feelings of a weakened sense of identity and of ‘not really knowing who we are.’

    Integration of Identity difficulties:

    Complex PTSD may make us feel fragmented and as if our ‘self’ is separated into independent parts rather than a cohesive, whole, well-integrated entity.

    Integrity maintenance problems:

    The violation of personal boundaries which frequently precedes complex PTSD can lead us to develop an intense feeling that damage has been done to our sense of spiritual, emotional, and/or physical integrity.

    Interpersonal relationship damage:

    Not only does complex PTSD usually develop as a result of abuse and maltreatment within interpersonal relationships, but can lead to the victim experiencing lifelong problems with interpersonal relationships in general (e.g. due to an inability to trust others).


    The intimate nature of the abuse or maltreatment that can give rise to complex PTSD makes it particularly emotionally, psychologically, and spiritually damaging.

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

    When ‘Survival Brain’ Replaces ‘Learning Brain’ Due To Childhood Trauma

    If we suffer severe, protracted childhood trauma that involved us living in an environment in which we were constantly anticipating danger from an abusive parent or primary carer it is possible that our ‘survival’ brain was so frequently activated that it became dominant at the expense of the development and functioning of the ‘learning’ brain.


    A key part of the survival brain is the amygdala which acts as the brain’s alarm system. If during childhood, this is repeatedly overactivated it can eventually, figuratively speaking,  get ‘stuck’ in the ‘ON’ position causing us to become preoccupied with threat and to live in a state of fear with the perpetual feeling that catastrophe is imminent and that it is, therefore, necessary for us to stay on ‘red alert’, even though we may not be consciously aware of the reasons underlying this highly distressing state (i.e. the toxic stress to which we were subjected in childhood). 

    Overdominance of the survival brain due to early life trauma will tend to lead to dysfunctional, maladaptive survival-based coping in adulthood. As well as constantly anticipating danger, the brain stuck in survival mode can lead to extreme, reactive, defensive aggression (driven by the unconscious motive that aggression can constitute a form of defense – the ‘fight response’), avoidance (related to the ‘flight response’), and dissociation.

    Although such behaviours develop in response to the original trauma, if the ‘survival brain’ has been overactivated over a long period and become dominant, these behaviours will become generalized to life experiences outside of the original trauma that involves interpersonal vulnerability and uncertainty (e.g. a general inability to trust).

    Children who are driven by survival-based coping behaviours as a result of their home environments may avoid school (‘flight’ response), misuse drugs and alcohol (to achieve a state of dissociation), become defiant (fight-response), become socially withdrawn (‘flight’ response), indulge in high-risk behaviours (to achieve a state of ‘dissociation’) in an attempt to reduce feelings of powerlessness, vulnerability, anxiety, depression, mental distress and extremes of hypo- and hyper-arousal (i.e. the very low arousal associated with dissociation or extreme overarousal). In such children, this can lead to extreme overactivation of the brain’s stress and reward pathways which, in turn, can lead to a sudden change from the ‘learning brain’ being ‘in charge’ to the ‘survival brain’ being in charge (Lewis, 2005).


    Various areas of the brain associated with learning can have their development impaired by severe, protracted childhood trauma, including damage to the development of the Broca’s area (a part of the brain associated with the production of speech). One of the adverse effects of damage to this area of the brain is that survivors of childhood trauma may find it especially difficult to verbalize their traumatic experiences (Hull, 2002).

    Parts of the frontal cortex may also be damaged by prolonged childhood trauma which reduces the brain’s ability to inhibit survival responses (fight/flight/freeze) in response to triggers that are not (objectively speaking) threatening (Ali et al., 2011) e.g. misperceiving neutral facial expressions as threatening facial expressions or a neutral tone of voice as a hostile tone of voice, especially if it is the facial expression or tone of voice by a person in authority, such as a teacher.

    Furthermore, trauma can damage the brain’s reward pathways (see above) and this can result in individuals anticipating less pleasure (compared to the average person) from completing tasks and achieving goals. This, in turn, can reduce levels of motivation (Pechtel and Pizzagali, 2011).

    Prolonged childhood trauma can increase levels of the stress hormone known as cortisol in our systems and this excess of cortisol can damage a part of the brain known as the hippocampus, even to the extent that the volume of this part of the brain is reduced which impairs its ability to function correctly. Amongst other adverse effects, this can harm declarative memory (also known as ‘explicit’ memory where information is explicitly – i.e. consciously and deliberately – stored and retrieved, attention, and learning (Pechtel and Pizzagali, 2011).

    Damage to the prefrontal cortex caused by extensive childhood trauma adversely affects our ability to problem-solve, think logically, self-soothe, reflect on our actions, curb our impulses, and behave in flexible ways. As the thinking and reflective skills of the prefrontal cortex are required to shut down the amygdala’s and brain stem’s (constituting the ‘survival brain’) threat response once it (i.e. the prefrontal cortex) has established there is, after consideration, no danger, damage done to it by trauma can impair its ability to ‘switch off’ the ‘survival brain’ (i.e. the amygdala and brain stem). This means that if we are frightened by something that turns out not to be a threat, after all, it takes us much longer than the average person to bring our brain stem’s and amygdala’s overreaction (and associated symptoms such as rapid heartbeat, hyperventilation, etc.) under control.


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

    Do BPD Sufferers And Psychopaths Have Things In Common?

    In the U.S. has been estimated that up to 30 % of those in prison suffer from borderline personality disorder (BPD) compared to 1-2% in the general population, about 20% in psychiatric institutions.and about 10% of psychiatric outpatients.(American Psychiatric Association).

    Given the disproportionate number of individuals with BPD in prison, it seems reasonable to ask whether there are similarities between those who suffer from BPD and those who suffer from psychopathy.

    To answer this, first let’s define what is meant by psychopathy. Whilst not an official diagnosis, it is a term used within legal and clinical settings and can be viewed as a more serious form of anti-social personality disorder (psychopaths have personality traits in addition to those displayed by individuals with anti-social personality disorder; though only a small proportion of those suffering from anti-social personality disorder are categorized as being psychopaths (Buckholtz, 2010).

    Characteristics of psychopaths include:

    • persistent involvement in anti-social behaviour (which begins in childhood and adolescence)
    • impulsivity
    • deceitfulness
    • criminal activity
    • aggression

    One of the main tools used to help assess the degree of an individual’s psychopathy is Hare’s Psychopathy Checklist-Revised (PCL-R, Hare, 1991). This tool measures:


    Those who meet the criteria to be categorized as psychopaths (as measured by item 3) also score highly on Factor 1 (psychopathic personality) and Factor 2. (anti-social lifestyle). In contrast, those ‘only’ diagnosed with anti-social personality disorder are more likely only to score highly on Factor 2 (anti-social lifestyle).


    According to Conn et al, (2010), those who suffer from borderline personality disorder can have behaviours in common with individuals with psychopathy. These include:

    • lack of inhibition (click here to read about BPD and lack of inhibition)
    • drug use
    • promiscuous sexual behaviour (click here to read about BPD and sexuality).

    It has also been found in other research that both those suffering from BPD and those suffering from anti-social personality disorder have suicide rates of between 3% and 10% (Solloff et al. 2012) and both those suffering from BPD and those suffering from anti-social personality disorder are prone to hostility (although BPD sufferers are more likely to internalize their anger (e.g. by self-harming) whereas those suffering from anti-social personality disorder are more likely to externalize it (e.g. by hitting someone).

    However, there is only a slight, positive correlation (+0.26) between a high overall psychopathy score (3, above) and a high score on PAI (Personality Assessment Inventory) BPD scale. (Conn et al., 2010). It should also be stressed that the BPD personality has little in common with the psychopathic personality (Factor 1 on Hare’s PCL-R) and that most of the correlation is accounted for by similarities between the psychopath’s lifestyle and the BPD sufferer’s lifestyle. One major difference between those with BPD and those with anti-social personality disorder is that those suffering from BPD suffer from an array of intense emotions that they are unable to regulate whereas those with anti-social personality disorder experience extensive blunting of the emotions. Other differences include the fact that anti-social behaviour disorder is diagnosed about 5 times more frequently in men than in women whilst BPD is 3 times more likely to be diagnosed in women than in men. A final, important difference is that whilst BPD is now known to respond well to various forms of psychotherapy such as dialectical behavioural therapy this has not, so far, been shown to be the case with regards to anti-social personality disorder.

    From the above then, we can say that there are overlaps between the BPD sufferer’s lifestyle and the psychopath’s lifestyle but few overlaps between the personality of the BPD sufferer and the personality of the psychopath (characteristics of the psychopaths’ personalities include: lack of remorse, lack of empathy, superficiality, manipulation and deceit – and, to stress again, these personality features do NOT correlate with the personality features of the BPD sufferer. (Conn et al., 2010). Furthermore, many of the behaviours that the BPD sufferer has in common with psychopaths can be explained by the BPD sufferer’s desperate attempts to escape severe mental pain (such escape from mental pain is sometimes referred to as dissociation.

    Borderline personality disorder, then, can be seen as a quite distinct disorder from psychopathy. Indeed, some have suggested that BPD is the ‘female version’ of psychopathy and Conn draws our attention to the fact that this myth is NOT borne out by the research (Conn et al., 2010).


    Conn C, Warden R, Stuewig J, et al. Borderline Personality Disorder Among Jail Inmates: How Common and How Distinct?. Correct Compend. 2010;35(4):6-13.

    Kiehl KA, Buckholtz JW. Inside the Mind of a Psychopath. Scientific American Mind. 2010;21(4):22-29. doi:10.1038/scientificamericanmind0910-22

    Soloff PH, Chiappetta L. Subtyping borderline personality disorder by suicidal behaviorJ Pers Disord. 2012;26(3):468-480. doi:10.1521/pedi.2012.26.3.468

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