Childhood Trauma May Damage Prefrontal Cortex : How To Help Reverse Such Damage.

how to reverse damage to prefrontal cortex

Childhood Trauma May Damage Development Of Certain Brain Structures :

We have seen from other articles that I have published on this site that severe and chronic psychological and emotional trauma in early life may adversely affect the physical development of various structures in the brain, including the prefrontal cortex. In individuals who have gone on to develop borderline personality disorder (BPD) or complex post traumatic stress disorder (cPTSD) following childhood trauma, such impairment to the brain is thought to be particularly likely.

What Is The Prefrontal Cortex And What Is Its Function?

The prefrontal cortex is a brain region located in the front of the skull (see diagram below) and its main functions include :

  • complex planning and decision making
  • self-control in the context of social behavior
  • setting and achieving goals
  • impulse control

reverse damage to prefrontal cortex

ABOVE : Position of frontal cortex in the brain

Evidence For Damage To The Prefrontal Cortex In Individuals Diagnosed With BPD:

MRI Studies : have shown that individuals with BPD have reduced volume in the brain’s frontal lobe and left orbitofrontal cortex (although further studies are required in order to ascertain if this link is causal).

fMRI Studies : have shown that BPD sufferers experience abnormal activation in the brain’s inferolateral prefrontal cortex in response to stimuli that generate negative emotions as well as unusually elevated levels of activation of the orbitofrontal cortex during the recollection of traumatic memories

Other Brain Imaging Studies : have suggested that BPD sufferers have an abnormally low density of neurons and abnormal neuronal function in the dorsolateral prefrontal cortex as well as abnormally low blood flow to the ventrolateral right prefrontal cortex.

(More research needs to be conducted in order to shed further light upon the nature of the link between childhood trauma, BPD and impaired physiological development of the prefrontal cortex. Furthermore, there exists evidence to suggest that severe an chronic childhood trauma can adversely affect the development of other brain regions including the amygdala and the hippocampus).

Potential Adverse Effects Of Damage To The Prefrontal Cortex :

If a person incurs physiological damage to the development of their prefrontal cortex as a result of severe and protracted childhood trauma, it follows that the functions of the prefrontal cortex may be commensurately impaired, including the functions listed above (i.e. complex planning and decision making; self-control in social situations; setting and achieving goals; and impulse control).

Reversing The Damage :

We can employ various methods that mat help to reverse such damage and I list some of the main ones below :

RESOURCES :

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

 

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BPD And Rigid Thinking

bpd and rigid thinking

One of the main hallmarks of borderline personality disorder (BPD) is the pronounced tendency of those who suffer from it to display marked rigidity in relation to both their thought processes and behaviors. 

This means that, when events occur, the way in which the BPD sufferer interprets them tend to be habitual and fixed and it is very difficult indeed for him/her to adopt a more flexible view or alternative perspective ; instead, once the rigid way of interpreting events formulated in his/her mind, it becomes a kind of idée fixe (the problem is compounded, of course, because, very frequently, such rigid thinking also leads to rigid, inflexible behavior) that s/he, terrier-like, refuses, seemingly at all costs (even if such incurred costs are extraordinarily, perhaps tragically, high), to relinquish (sometimes, it has to be said, provoking great exasperation, pain and frustration in others, particularly those who are not well versed in the disorder).

Rigid thinking is associated with poor mental health, not least because it can give rise to obsessive worry and rumination (intensely and chronically focusing on one’s problems) and a dysfunctional way of interacting with others.

rigid thinking

Examples Of Rigid Beliefs :

Examples of rigid beliefs include :

  • others should always agree with me and see things from exactly the same perspective as I do
  • others should never behave in ways of which I disapprove
  • if others don’t agree with me it’s because they’re stupid
  • I need to always be right
  • things must go perfectly
  • I must be liked and approved of by everyone at all times
  • others can NEVER be trusted and will always eventually screw you over

cognitive rigidity

Core Beliefs :

Our fundamental core beliefs about ourselves, others and the world in general develop early on in childhood and this period of development is closely related to how flexible / inflexible our ‘thinking style’ becomes. If this period is traumatic, stressful and involves chronically dysfunctional relationships with significant others (most of all, our primary carer) we are at high risk of developing negative core beliefs and a rigid way of thinking that can very seriously harm our adult lives including our intimate relationships, friendships and career. To read my article, previously published on this site, which explains more about core beliefs, click here

Possible Therapies :

Therapies that can help with correcting a dysfunctional, rigid thinking style that derive, at least in part, from the theories of Albert Ellis (a pioneer and expert in this field of psychology) include rational emotive behavior therapy (REBT)cognitive behavioral therapy (CBT)  and dialectical behavior therapy (DBT).

 

RESOURCES :

STOP HAVING A CLOSED MIND (Self-hypnosis download). Click here for further details.

 

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

 

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BPD Sufferers May Avoid ‘Mentalising’ Due To Parental Rejection

BPD Sufferers May Avoid 'Mentalising' Due To Rejecting Parents

Peter Fonagy, an internationally renowned clinical psychologist, psychoanalyst and expert in borderline psychopathology and early attachment relationships, and who has produced some of the most influential work relating to this field, has stressed the importance of MENTALISING (or, more precisely, the avoidance of it) in relation to borderline personality disorder (BPD).

What Is Meant By The Term ‘Mentalising’?

The term ‘mentalising’ refers to a person’s ability to perceive, understand and make use of other’s emotional states (and their own).

Why Might Those Suffering From BPD Avoid ‘Mentalising’?

According to Peter Fonagy’s theory, children of cold and rejecting parents avoid mentalising because thinking about their parents’ lack of emotional warmth, rejection, absence of love and, perhaps, even, hatred would be too psychologically distressing and painful.

Prevention Of Recovery :

However, Fonagy also theorizes that this evasion (both conscious and unconscious) of the truth about how one’s parents treated one and felt about one prevents the individual from resolving the trauma and recovering from the emotional mistreatment. He proposes that it is necessary for those suffering from borderline personality disorder (BPD) to confront, and consciously process, the traumatic elements of their childhoods, and, in particular, their difficult, perhaps tortured, childhood relationships with their parents.

The Need For Understanding And Verbal Expression :

Only by understanding what happened to one in childhood, and by learning to express, verbally, this understanding, Fonagy proposes, is recovery possible.

Conclusion :

Whilst Fonagy’s theory has been influential, some researchers have criticized it for not placing enough emphasis upon the fundamental problem sufferers of borderline personality disorder (BPD) frequently experience – namely their inability to control intense emotional reactions (often referred to as ’emotional dysregulation’ ; to read my previously published article relating to this, entitled ‘Three Types Of Emotional Control Difficulties Resulting From Childhood Trauma’, CLICK HERE. )

Resources :

 

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

 

 

 

 

 

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Explaining BPD In Terms Of The Diathesis-Stress Model

BPD, diathesis stress model

What Does ‘Diathesis’ Mean?

The medical definition of ‘diathesis’ is ‘a heriditary or constitutional predisposition to a disease or other disorder.‘ (The word ‘diathesis’ itself derives from the Greek word for ‘disposition).

What Is The Diathesis-Stress Model?

The diathesis-stress model is a psychological theory that proposes that a psychiatric disorder is caused not by heriditary factors (i.e. predispositional vulnerability) alone, NOR by psychologically stressful experiences alone, but by the way in which the two factors interact with one another.

Explaining Borderline Personality Disorder (BPD) In Terms Of The Diathesis-Stress Model :

The diathesis-stress model is an appropriate model with which to explain how borderline personality disorder (BPD) develops in the individual. It is appropriate because research suggests that BPD does not occur in a person solely because of his/her traumatic and stressful childhood experiences nor solely because of an unfortunate genetic inheritance. What is vital in determining whether or not a person ‘succumbs’ to BPD is  how their genes and childhood experiences combine and interact.

In other words, a person who is genetically vulnerable to developing BPD and experiences severe, protracted trauma during childhood may well go on to suffer from BPD in adulthood (see equation 1, below)

However, another individual who has low genetic vulnerability to the disorder and suffers a similarly traumatic childhood (although, of course, the ‘amount’ of trauma a person experiences is impossible to quantify – each case is utterly unique) may well avoid developing it (see equation 2, below)

So, we could represent the above with the following equations :

1)   HIGH LEVEL OF CHILDHOOD TRAUMA + HIGH GENETIC VULNERABILITY = HIGH CHANCE OF DEVELOPING BPD.

2)   HIGH LEVEL OF CHILDHOOD TRAUMA +LOW GENETIC VULNERABILITY = LOWER CHANCE OF DEVELOPING BPD (compared to 1, above).

And, of course, it naturally follows that :

3)   LOW LEVEL OF CHILDHOOD TRAUMA + LOW GENETIC VULNERABILITY = LOW CHANCE OF DEVELOPING BPD

4)   LOW LEVEL OF CHILDHOOD TRAUMA + HIGH GENETIC VULNERABILITY= HIGHER CHANCE OF DEVELOPING BPD (compared to 3, above)

More About Genetic Vulnerabilty To BPD :

In terms of genetic inheritance, what will make a person more susceptible to developing BPD?

The main consideration here is the person’s innate temperament. In particular, those who have naturally impulsive and emotionally labile personalities will, in general, be more predisposed to developing BPD if they also experience protracted and significant trauma during their childhoods compared to those more naturally inclined towards stoicism and timidity.

A Third Factor : Culture / Society :

However, the stress-diathesis model is not the whole story when we are considering the multiple, inter-relating causes that can lead to someone developing BPD. There is also the question of the culture / society in which the individual exists.

To learn more about this, you may wish to read my article entitled : Childhood Trauma, BPD, Genes And Culture.

 

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Do BPD Sufferers Have A ‘Split Personality’?

do people with BPD have a split personality?

In terms of symptoms, there exists a clear overlap between the psychiatric conditions of borderline personality disorder (BPD) and Dissociative Identity Disorder (DID). DID used to be referred to multiple-personality disorder.

Borderline Personality Disorder, Dissociative Identity Disorder And ‘Splitting’

‘Splitting’ is a psychological defense mechanism in which one ‘part’ of the personality becomes separated / un-integrated with / isolated from another ‘part’ of the personality. In the case of individuals suffering from BPD, these two parts can, in simple terms, be described as PART ONE and PART TWO, where :

PART ONE represents the part of the person’s personality which is relatively accepting of him/herself and others

whereas :

PART TWO represents the part of the person’s personality which is full of self-hatred, as well as anger and hostility (and, underlying the latter two emotions, fear of being psychologically harmed) in relation to others.

When PART ONE is ‘operational’, it tends to enter a state of denial about the existence of PART TWO.

This may be because when PART ONE is ‘in charge’, the individual develops a state of mind similar to amnesia regarding  the existence PART TWO ; alternatively, the denial may be underpinned by feelings of profound shame. However, more research needs to be conducted in relation to these possibilities.

‘Splitting’ and amnesia (when one part of the personality is unaware of how another part of the personality has manifested itself) are also symptoms of dissociative identity disorder.

do BPD sufferers have a split personality?

Borderline Personality Disorder And ‘Switching’ Between ‘Part One’ And ‘Part Two’

As stated above, ‘PART ONE’ and ‘PART TWO’ have become un-intergrated in the personality of individuals suffering from BPD (the BPD sufferers personality, in this respect, may be described as having ‘disintegrated’). A more formal way to put this would be to describe the BPD sufferer as having an un-integrated ego-state (in contrast to the relatively integrated ego-state that psychologically ‘healthy’ individuals enjoy).

Those with BPD ‘switch’ between ‘PART ONE’ and ‘PART TWO’ and this can occur quite suddenly (but is not usually dramatically instantaneous).

Furthermore, these unintegrated ego-states interfere with each other (because they are not completely separate from one another) and this may cause symptoms such as the following :

  • unstable mood / affect / emotions (sometimes referred to as emotional lability)
  • unstable sense of identity (some sufferers describe this with phrases such as : ‘I have no idea who I am…’).

How ‘Splitting’ Affects The BPD Sufferer’s Relationships With Others :

When ‘PART ONE’ is ‘in charge’, the BPD sufferer desires emotional attachments with others. However, when ‘PART TWO’ is dominant, s/he becomes hostile towards others and withdraws from them – this leads to the classic ‘love-hate’ scenario.

Why Does This Unintegrated Ego-State Arise In Those Suffering From BPD?

The two separate parts can develop in a person who has suffered severe and prolonged abuse as a child.

When the abused child becomes an adult, PART TWO (hostility etc) can be kept in abeyance for much of the time to allow daily social functioning. However, PART ONE makes itself apparent when the BPD sufferer is reminded of the abuse s/he suffered as a child (such a reminder is called a ‘trigger’).

This reminder/trigger may be detected by the BPD sufferer consciously or unconsciously and occurs as a defense mechanism against real or perceived psychological threat (especially the treat of betrayal, rejection or abandonment as occurred in the individual’s childhood).

If the individual had not developed this defense mechanism as a child, s/he faced what may reasonably be termed as ‘psychological destruction.’ In other words, the development of the ‘splitting’ defense mechanism makes complete evolutionary sense as it allowed the individual to survive childhood – it is a normal, predictable, adaptive response to childhood loss, fear, distress and betrayal.

Conclusion ;

There is an overlap between symptoms of borderline personality disorder and dissociative identity disorder in as far as they both involve ‘splitting’ and ‘dissociating’. However, in the case of DID, the separation between the different PARTS of personality are MORE DISTINCT AND CLEAR CUT THAN THEY ARE IN THE CASE BPD. Those suffering from DID may have more than two un-integrated / separate PARTS of their personality / ego-state ; however, arguably, this can also be the case in those suffering from BPD (although this is beyond the scope of this article).

In conclusion, though, we can say, with some confidence, that BPD sufferers do have a ‘split personality’, but the division between these two parts is more nebulous than in the case of DID sufferers.

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Diagnosing BPD In Adolescents : Why Some Clinicians Don’t Like Doing It

 

diagnosing BPD in adolescents

Whilst borderline personality disorder (BPD) can be diagnosed in adolescents, some clinicians may be reluctant to do so ; I summarize some of the main reasons for this below :

– Symptoms of borderline personality disorder (BPD) may overlap lap to some degree with non-pathological (‘normal’) adolescent behaviors which can somewhat muddy the waters when it comes to attempting to make a clear, unambiguous and unequivocal diagnosis.

– The personality of the adolescent is still developing and is not yet fully formed

– Although it is less the case now than it was (in even the relatively recent past) a diagnosis of borderline personality disorder (BPD) is still often perceived as being stigmatizing and can potentially make the adolescent feel yet worse about himself/herself when his/her self-esteem and sense of self-worth is already extremely low (low self-esteem and low sense of self-worth are hallmark symptoms of BPD).

However, some individuals also feel a great sense of relief to have a diagnosis as it helps them to understand the root causes of their dysfunctional behaviors and therefore feel less guilty (feelings of intense, irrational guilt are another hallmark symptom of BPD).

Also, of course, an accurate diagnosis helps to ensure appropriate and effective treatment is given (see RISK OF SUICIDE below); at present, the most effective treatment for BPD is considered to be dialectical behavioral therapy (DBT). Whilst DBT is a therapy that was initially developed in order to help to treat adults with BPD, it is possible to adapt it to the needs of the adolescent. However, the majority of clinicians are still reluctant to make the diagnosis of BPD in young people who are under the age of eighteen years.

– Because BPD has its roots in childhood experience, it is likely that some clinicians are worried about diagnosing BPD in the adolescent in case the parents may regard it as a negative judgment upon them and therefore become upset or angry.

However, if the parents’ behavior has seriously damaged their child, then alerting them to the fact may galvanize them into making a concerted effort to improve the manner in which they treat the young person (sadly, of course, this can’t be guaranteed ; indeed. abusive parents may feel humiliated at take it out on the child).

– Because BPD sufferers tend to be gravely misunderstood, even by those entrusted with their care and treatment, some clinicians may be reluctant to diagnose adolescents with BPD in case it results in them being treated with prejudice and discriminated against by other clinicians they may come into contact with in later life,

THE RISK OF SUICIDE :

It is vital to remember that one in ten (yes, 10%) of individuals with BPD end up dying by suicide. This statistic demonstrates the vital importance of the earliest possible therapeutic intervention for those suffering from this profoundly painful and complex condition. Clearly, a prerequisite to effective treatment is sensitive, timely and accurate diagnosis.

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Controlling Emotions : The Emotional Regulation System

controlling emotions

We have seen from other articles that I have published on this site that if, as children, we experienced, significant and protracted trauma we are at increased risk of developing various psychological difficulties as adults, including an increased risk of developing borderline personality disorder (BPD) and complex posttraumatic  stress disorder.

One of the hallmarks of BPD, as we have also seen from other articles, is that the sufferer of the condition finds it very difficult indeed to control intense and volatile emotions. In effect, the emotional regulation system of individuals diagnosed with BPD is out of kilter and dysfunctional.

What Is The Emotional Regulation System?

The emotional regulation system is fundamentally comprised of three interacting parts of the brain ; these are as follows :

  1. THE THREAT SYSTEM (detects and reacts to threats)
  2. THE DRIVE SYSTEM (motivates us to identify and seek resources)
  3. THE SOOTHING SYSTEM  (helps balance the two systems above and engenders in us a sense of well-being, satisfaction and contentment)

Each of these three systems is neither good nor bad per seas long as they are in balance and interacting in a healthy and functional way. However, each system is vulnerable to becoming dysfunctional (as occurs in the case of those suffering from BPD, for example). TO READ ABOUT WAYS IN WHICH THESE SYSTEMS CAN BECOME DYSFUNCTIONAL AND THERAPIES THAT CAN HELP, YOU MAY LIKE TO READ ANOTHER OF MY POSTS ON THE EMOTIONAL REGULATION SYSTEM BY CLICKING HERE.

how to control emotions

THE ROLE OF NEUROPLASTICITY IN THE DEVELOPMENT OF THE EMOTIONAL REGULATION SYSTEM :

The way in which the brain is shaped and develops depends, to a large degree, upon our early life experiences ; this is because of a quality of the brain known as neuroplasticity which you can read about by clicking here.

Because of the brain’s neuroplasticity, if, when we are young, we are constantly exposed to fear and danger because, for example, of the abusive treatment we receive from a parent or primary care giver, the THREAT SYSTEM is at very high risk of being constantly over-activated in a way that leads it to operate in a dysfunctional manner ; this dysfunction takes the form of the fight/flight/freeze; response becoming hypersensitive, resulting in the affected individual developing grave difficulties keeping related emotions (such as anger, fear and anxiety) in check. Without appropriate therapy, such dysfunction may last well into adulthood or even for an entire lifetime.

On the other hand, if, when we are young, we experience consistent and secure love, care and emotional warmth from our parents / primary caregivers, our SOOTHING SYSTEM is ‘nourished’ and becomes optimally (or close to optimally) developed resulting in us becoming more able to cope with life’s inevitable stressors, less vulnerable to feelings of anxiety and fear, and more able to calm ourselves down and ‘self-sooth’ than those who had who were brought up in an environment in which they were constantly exposed to fear and danger.

However, even if we have had a traumatic early life and have problems regulating our emotions, there are various, simple things we can do to us control our feelings (see below).

 

  • AVOID REACTING IMMEDIATELY / IMPULSIVELY : For example, if someone triggers our anger, rather than making a reflexive response (such as saying something we’ll deeply regret later) it is better to wait until the rage has subsided – this may involve calming physiological symptoms like fast heart rate and tense muscles by using relaxation exercises such as deep breathing and visualization ; we may, therefore, need to remove ourselves for a while (if possible) from the presence of whoever it may be that has upset us.
  • MAKE POSITIVE ALTERATIONS TO THE SITUATION GIVING RISE TO OUR NEGATIVE EMOTIONS (although this will not always be feasible, of course)
  • ALTER FOCUS OF ATTENTION (e.g. undertaking a distracting activity)
  • ALTER WAY IN WHICH WE ARE THINKING ABOUT THE SITUATION : A therapy that can help with this is COGNITIVE BEHAVIORAL THERAPY (CBT).

USING NEUROPLASTICITY TO OUR ADVANTAGE :

Although the brain’s quality of neuroplasticity can work against us if we experience a traumatic early life, we can also take advantage of it later in life to help reverse any damage that was done to the development of our young and vulnerable brains. In order to learn more about how this may be possible, you may wish read my article MENDING THE MIND : SELF-DIRECTED NEUROPLASTICITY.

DIALECTICAL BEHAVIORAL THERAPY (DBT) :

Dialectical Behavior Therapy (DBT) is a therapy that was designed primarily for those who are suffering from borderline personality disorder (see above). A particularly useful skill taught within this therapy is called DISTRESS TOLERANCE which can be very helpful for those experiencing emotional distress due to intense, negative feelings.

COMPASSION FOCUSED THERAPY (CFT) :

Compassion Focused Therapy (CFT) can also be an effective therapy for those suffering from emotional dysregulation.

 

RESOURCE :

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further information.

 

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Are Those With Borderline Personality Disorder (BPD) Manipulative?

are those with BPD manipulative?

Sadly, many individuals suffering from borderline personality disorder (BPD) are stigmatized by others and, amongst other perjorative terms, are frequently described as ‘manipulative’.

However, in recent years, it has been increasingly recognized that intentionally manipulative behavior is, in fact, NOT a defining characteristic of BPD sufferers after all ; this shift in attitude is best exemplified by the fact that the Diagnostic And Statistical Manual Of Mental Illness, Fifth Edition, or DSM-V (sometimes informally referred to as the ‘psychiatrists’ bible’), has ceased to list ‘manipulative’ as one of the personality traits associated with borderline personality disorder.

However, this begs the question : ‘Why has it been so common for those suffering from BPD to be scornfully dismissed as manipulative in the past?

According to the psychologist, Marsha Lineham (well known for having developed Dialectical Behavior Therapy (DBT) for the treatment of BPD), this mis-labelling of BPD sufferers as manipulative has been based on a MISINTERPRETATION of certain types of their behavior.

Lineham puts forward the view that, often, some of the behaviors of BPD patients are wrongly perceived as being  manipulative whereas, in fact, they are desperate manifestations of intense psychological and emotional pain.

Indeed, borderline personality disorder (BPD) is generally accepted as being the most excruciatingly, psychologically and emotionally, painful of all mental health conditions ; as I have stated elsewhere on this site, approximately one in ten of those suffering from BPD end their lives by suicide. (To read my article, Living With Mental Agony, click here, or to read my article, Anger May Operate To Soothe Emotional Pain, click here.)

Sometimes, an example some people may give of so-called ‘manipulative’ behavior from BPD sufferers is the threat of suicide. For example, someone with BPD may take an overdose of tablets but then phone a friend or family member to say what they have done. Lineham points out, however, that this is unlikely to be a coldly calculated ploy but, rather, a desperate and confused expression of inner mental turmoil (the intensity of which the individual may not have the words to convey) and ambivalence – ambivalence in the sense that a part of the BPD sufferer may genuinely want to die whilst another (say, instinctual) part may be driven to survive.

Indeed, the fact that, as stated above, one in ten BPD sufferers eventually die by suicide suggests that any threat to do so should be treated extremely seriously.

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BPD And Psychodynamic Treatment

bpd and psychodynamic treatment

Crucial Importance Of First Five Years Of Life :

Central to psychodynamic theory, initially developed by Sigmund Freud, is the assertion that events occurring to the child between birth and five years of age have the most vital effect upon his/her psychological development.

Safe World Versus Unsafe World :

Crucially, according to psychodynamic theory, it is during these first five years of life that an individual’s view of whether the world is fundamentally safe or unsafe is formed ; which of these two opposing views the child develops depends upon the treatment s/he receives from his/her mother / primary carer – I elucidate upon this below :

  • if the child’s mother / primary carer is loving and nurturing towards him/her then s/he is likely to develop the belief that the world is an essentially safe place
  • if the child’s mother / primary carer mistreats / neglects him/her then s/he is likely to develop the belief that the world is an essentially unsafe place

The Role Of The Unconscious :

Another concept of fundamental importance to psychodynamic theory is the absolutely critical role played by the UNCONSCIOUS MIND.

According to Freud, the unconscious mind contains memories, urges, impulses, thoughts and feelings that are cut off from conscious awareness ; frequently, according to Freud, this is because they are painful, cause us mental conflict, cause us anxiety or are otherwise unacceptable to us.

However, even though these ‘banished’, ‘buried’, ‘cut off’ memories, urges, impulses,  thoughts and feelings lie outside of our conscious awareness they, nevertheless, POWERFULLY INFLUENCE HOW WE FEEL AND HOW WE BEHAVE.

The Iceberg Metaphor :

unconscious mind iceberg

The metaphor most commonly used to help explain the unconscious mind is that of the iceberg. Just a very small part of an iceberg is visible above the surface of the water and, in this way, according to Freud,  it is similar to the mind. The visible part of the iceberg represents the conscious mind, whereas by far the largest and most powerful part of the mind – the unconscious mind –  lies below the surface of the water. In other words, the visible part of the iceberg represents the conscious mind whereas the submerged part represents the unconscious mind. (The surface of the water, therefore. represents the division between the conscious and the unconscious).

Transference :

One method that can facilitate discovery of what is going on in a patient’s unconscious mind is to analyse his/her relationship with his/her therapist. It is theorized that such an analysis can be insightful due to a process in psychodynamic theory known as TRANSFERENCE that operates within the context of this relationship.

What Is Transference?

Transference can be defined as : the redirection of emotions (usually onto a therapist) that were originally felt in childhood (towards the parents and/or significant others).

To provide a simple example : the anger a patient expresses towards his/her therapist may be redirected anger that the patient originally felt towards his/her mother during childhood.

Transference Focused Therapy :

Kernberg, of New York Hospital, Cornell University, modified Freud’s original therapeutic techniques to develop TRANSFERENCE FOCUSED PSYCHOTHERAPY which involves analysis of the process of transference that occurs via the patient’s relationship with the therapist ; it is the aim of the therapy that, by such analysis, the patient’s fundamental personality disturbance may be resolved, rather than just (relatively superficial) symptoms of the presenting psychological disorder.

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Four Types Of ‘Dysregulation’ Displayed By BPD Sufferers

types of dysregulation

BPD And Dysregulation :

We have already seen from many other articles that I have published on this site that those who have suffered severe and protracted childhood trauma are at greatly increased risk of going on to develop borderline personality disorder (BPD) than those who were fortunate enough to have experienced a relatively stable upbringing.

One of the main symptoms of this very serious and life-threatening condition (about ninety per cent of sufferers attempt suicide and about ten per cent die by suicide) is termed ‘DYSREGULATION.’

What Is Meant By The Term ‘Dysregulation?’

When the term DYSREGULATION is used in the psychological literature it most commonly refers to the great difficulty the BPD sufferer has controlling behavior and emotional states. However, more specifically, the dysregulation that those with BPD experience can be sub-divided into four particular types; these are :

1) EMOTIONAL DYSREGULATION

2) BEHAVIORAL DYSREGULATION

3) COGNITIVE DYSREGULATION

4) SELF DYSREGULATION

Below, I briefly define each of these four types of dysregulation :

  • Emotional Dysregulation :

This type of dysregulation refers to extreme sensitivity and difficulty controlling intense emotions. Individuals suffering from this type of dissociation not only feel emotions far more deeply than the average person, but also take longer to return to their ‘baseline’ / ‘normal’ mood.

For example, a person with BPD who is emotionally dysregulated may be easily moved to intense expressions of anger and then take far longer to calm down again compared to the average person. Others may disparagingly (due to their lack of knowledge and understanding of this life-threatening – see above – and acutely, indeed uniquely, mentally painful condition) describe such an individual as extremely ‘thin’skinned’, as ‘having a chip on his/her shoulder’, ‘a drama queen’ or as or as someone who is prone to extreme ‘over-reactions.’

A leading theory as to why individuals with BPD are emotionally dysregulated is that the development of their AMYGDALA (a brain region intimately involved with how we express emotions and how we react to stress) has been damaged as a result of severe childhood trauma.

emotional dysregulation

  • BEHAVIORAL DYSREGULATION :

This type of dysregulation refers to the severe problems those with BPD can have controlling their behavior ; such individuals may be highly impulsive and liable to indulge in high-risk behaviors that are self-destructive. Such behaviors may include :

    • excessive drinking
    • excessive drug taking
    • gambling
    • compulsive self-harm
    • risky sex
    • drink-driving / dangerous driving
    • excessive / compulsive spending leading to debt problems

 

  • COGNITIVE DYSREGULATION :

This type of dysregulation refers to disorganized thinking which may manifest itself as paranoid-type thinking and/or as states of DISSOCIATION.

BPD sufferers are also prone to ‘black and white’ / ‘all or nothing’ type thinking, indecision, self-doubt, distrust of others and intense self-hatred.

 

  • SELF DYSREGULATION :

This type of dysregulation refers to the weak sense of their own identity many BPD sufferers feel ( a typical BPD sufferer might express this by saying something along the lines of ‘I’ve no idea who I am‘), feelings of emptiness, and the difficulty many BPD sufferers experienced expressing their likes, dislikes, needs and feelings,

Dysregulation And Stress :

Individuals with BPD are far less able to cope with stress than the average person and dysregulation (relating to all four of the above categories) is especially likely to occur when such individuals are experiencing stress ; indeed, the greater the stress the individual is experiencing, the more dysregulated he/she is likely to become.

 

RESOURCES :

SELF-HYPNOSIS DOWNLOADABLE AUDIO :

‘CONTROL YOUR EMOTIONS.’ Click here for further details.

eBook :

BPD ebook

Above eBook now available from Amazon for instant download. Click on image above or click HERE for further information.

David Hosier BSc Hons; MSc; PGDE(FAHE)

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Copyright 2017 Child Abuse, Trauma and Recovery