Category Archives: Psychosis Articles

Concise articles exploring the link between childhood trauma and psychosis, including schizophrenia, hallucinations and impaired reality testing.

Childhood Trauma And Psychosis

Although there is now a vast amount of research that has been conducted on the link between childhood trauma and the later development of non-psychotic disorders, the amount of research that has been conducted on the link between childhood trauma and the later development of psychotic conditions has been rather less plentiful ; however, increasingly, researchers are focusing on this, so far, less studied link and in this article I will review some of what is currently known or theorized about the association.

 

Childhood Trauma And Psychosis :

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

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

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

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

An ever-increasing body of  evidence is now demonstrating the very high prevalence of experiences of severe childhood trauma in psychiatric patients who are suffering from psychotic illnesses

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

Studies About Childhood Trauma And Psychosis :

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

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

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

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

HOW IS CHILDHOOD TRAUMA THOUGHT TO LEAD TO PSYCHOSIS?

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

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

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

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

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

IMPLICATIONS:

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

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

 

Early Signs Of Psychosis :

 

Usually a person does not suddenly become psychotic. Instead, the onset of psychosis is often a gradual process and sometimes individuals may start to show possible signs of incipient psychosis in their teens.

So what are the early warning signs? I provide a list based on the most current research in this area below. However, it is important to realize these symptoms are NOT specific to psychosis, they may also be due to numerous other conditions or set of personal psychosis. Anyone worried they or someone else may be psychotic or may be developing psychosis should seek an expert opinion and NOT attempt an amateur diagnosis based on the symptoms that follow.

 

Possible Early Signs That A Person May Be Becoming Psychotic:

These signs may be split into six categories as follows:

1) Cognitive symptoms

2) Neurotic symptoms

3) Changes in mood

4) Changes in volition

5) Behavioral symptoms

6) Physical symptoms

Let’s look at each of these six categories below:

Cognitive Symptoms:

– problems with concentration/attention/mental focus

– frequent daydreaming/ retreating into fantasy worlds

– thought blocking (a sudden lapse into silence during conversation due to the mind ‘going blank’. This most frequently occurs when the individual is asked about something that is, consciously or unconsciously, psychologically disturbing to him/her. It is a psychological defense mechanism and form of repression.)

– reduced ability to think in abstract terms

Neurotic Symptoms:

– restlessness/agitation

anger

– irritability

Changes in Mood:

guilt

– suicidal ideation

– depression

– mood swings

anhedonia (an inability to derive pleasure from people, events or circumstances – a feeling of emptiness, flatness and numbness)

Change in Volition:

– loss of drive

loss of interest in events, activities and people that used to interest one

– feelings of apathy and fatigue and a general lack of energy

Behavioural Symptoms:

– social withdrawal

– drop in standard of school/college work

– increase in impulsivity

– increasingly odd/strange behaviour

– aggression

– destructiveness

Physical Symptoms:

– weight loss

– poor appetite

sleep problems

 

The Main Types Of Psychotic Delusions :

 

Psychotic delusions can occur in two conditions linked to childhood trauma : 

A) DEPRESSION WITH PSYCHOTIC FEATURES (click here to read my article about the link between childhood trauma and depression) 

B) SCHIZOPHRENIA (click here to read my article about the link between childhood trauma and SCHIZOPHRENIA) may involve the sufferer developing psychotic delusions.

 

What Is Meant By The Term ‘PSYCHOTIC DELUSION?’

A PSYCHOTIC DELUSION results from a THOUGHT DISORDER that gives rise to BLATANTLY FALSE BELIEFS. Whilst the belief is clearly and obviously false, the person who holds it has an UNSHAKEABLE BELIEF that the belief is true, even in the face of utterly overwhelming evidence to the contrary.

Classification of delusions:

Delusions can be classified as follows:

They can be:

A) Bizarre or non-bizarre

and:

B) Mood-congruent or mood- incongruent

I define these classifications below:

BIZARRE – extremely strange and odd beliefs that are CLEARLY IMPOSSIBLE. For example, a belief that the birds’ singing is really Morse code and they are communicating with each other in such code in order to form a plot to take over the world.

NON- BIZARRE – the belief held is still clearly wrong but, theoretically, not totally impossible. For example, a belief that the government has placed listening devices in every room of one’s house.

MOOD – CONGRUENT – the delusion is in line with the mood the person manifests as a result of his/her condition. For example, a depressed individual who believes that aliens have removed the part of his/her brain the used to give rise to the experience of pleasure. Or, a person who is manic may believe s/he has supernatural powers

MOOD – INCONGRUENT – the delusion is not obviously in line with the individual’s prevailing mood  (eg. a newsreader on the TV is talking about him/her. These are sometimes referred to as ‘mood-neutral’ delusions

Within these classification groups, delusions can also be of a specific type. I list these types below:

   – Delusions of jealousy : an all-consuming obsession that one’s partner is being unfaithful when there is no evidence this is the case and there is no objective reason for suspicion.

   – Delusions of nihilism : the belief that oneself, other people or the world do not really exist

   – Delusions of grandeur ,: a belief one is a person of massive importance such as Jesus, Emperor of the World etc. Or the belief one has made a great achievement (that the world refuses to recognise) such as a belief one has written plays vastly superior to those of Shakespeare when, in reality, they are barely literate.

– Delusions of control : a belief that one is having one’s thoughts and behaviour controlled by an external force e.g. by aliens

– Delusions of reference : a clearly false belief that people are talking about one or making reference to one when they are not e.g. a belief that the newsreader on the radio is always referring to one in a or a coded or indirect manner

– Delusions of guilt : a false belief one is responsible for some terrible event (such as a belief one is personally responsible for all the starving people in the world

Erotomania : the belief a famous person or person of high status (normally a person the sufferer of the delusion has never met) is deeply and passionately in love with one ( click here to read my article on this)

– Delusions of mind-reading : the belief that others are reading one’s mind

– Delusions of persecution : the belief that others are conspiring against one ( e.g trying to poison or drug one)

– Religious delusions: Delusions with a religious theme e.g .that one is a human incarnation of God

– Somatic delusions : these are delusions about one’s body ( e.g. that ants are crawling under one’s skin)

ALL OTHER ARTICLES ABOUT PSYCHOSIS :

 

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

 

 

 

Psychotic ‘Hallucinations’ : Could They Be Trauma-Based Memories?

hallucinations and trauma-based memories

are hallucinations trauma-based memories?

The renowned UK psychologist, Oliver James, argues both eloquently and convincingly in his most enlightening book :  ‘Not In Your Genes’, that the extremely serious and distressing psychiatric disorder, schizophrenia , is almost entirely the result of environmental factors, and far less related to genetic influences than has previously believed. In making this argument, he also alerts us to the incipient theory that so-called psychotic ‘hallucinations‘ may, in fact, frequently actually be intrusive, TRAUMA-BASED MEMORIES.

 

In fact, this theory is far from new ; over eighty years ago, in 1936, Sigmund Freud proposed that hallucinations were caused by repressed memories of trauma erupting out of the unconscious mind and into consciousness.

 

RESEARCH SUGGESTING LINK BETWEEN HALLUCINATIONS AND MEMORIES :

But there exists, too, much more recent research into the putative connection between hallucinations (both of the auditory kind – sometimes referred to as ‘hearing voices’ and of the visual kind – sometimes referred to as ‘visions’). For example, Read and Argyle (1999) conducted a study involving one hundred psychotic patients and found that, amongst the content of hallucinations that these patients reported, fully half of this material consisted of fragments of memories relating to trauma that they had suffered during their childhoods.

hallucinations and trauma-based memories

Furthermore, Morrison et al., (2002) conducted a study involving 35 psychotic individuals and found that very nearly half (17 out of the 35) reported having visual hallucinations, the content of which was associated with actual events which had taken place earlier during their lives.

 

Additionally, McCarthy-Jones et al.,(2014) conducted research into 199 patients who ‘heard voices’ (i,.e. experienced auditory hallucinations) and found that 12% of these individuals reported that these ‘voices’ exactly replicated actual conversations they had had in their earlier lives ; a further 31% reported ‘hearing voices’ that approximated actual conversations they had had in their earlier lives.

 

MORE RESEARCH NEEDED :

However, no firm conclusions may yet be drawn regarding the possible link between the content of hallucinations and trauma-based memories. One of the reasons for this is that most of the research that has been conducted in relation to intrusive, trauma-related memories (as occurs in PTSD and complex-PTSD) has focused upon VISUAL MEMORIES, whilst, on the other hand, most of the research that has so far be conducted into the hallucinations of psychotic patients has focused upon the AUDITORY SENSE. In order for more light to be shed on this topic, this dichotomy of research focus needs to be addressed.

 

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

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

effects_of_childhood_trauma_ptsf

Does Childhood Trauma Cause Schizophrenia?

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

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

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

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

b) psychotic individuals who were asked about their childhoods

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

THE FINDINGS OBTAINED FROM THE STUDY:

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

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

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

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

IMPLICATIONS:

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

Effects_of child_trauma_on_brain_and_psychosis_and_scizophrenia

Above: Differences in the brains of schizophrenics.

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

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

child_trauma_and_NEUROPLASTICITY, functional_and_structural_ neuroplasticity

Above eBook now available for immediate download from Amazon. Click here.

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

Psychotic Symptoms In Adolescence Linked To Childhood Trauma

 adolescent psychotic symptoms

A recent study (Upthegrove et al) has shown that individuals who have experienced significant childhood trauma are far more likely to experience early (ie during adolescence) symptoms of psychosis than those fortunate enough to have experienced a relatively stable childhood.

The study involved over 200 young people and focused upon the effects on these individuals’ mental health of the following categories of childhood trauma:

1) Physical abuse

2) Sexual abuse

3) The witnessing of domestic violence

4) Bullying

In order to find out if there was a relationship between these kinds of childhood trauma and the early development of psychotic symptoms, interviews were conducted with each of the participants in the study.

Let’s look at the effects on mental health of each of these four types of abuse:

1) Effects of physical abuse: those who had been physically abused were found to be at much greater risk of developing early signs of psychosis than those who had not had traumatic childhoods

2) Effects of sexual abuse: those who had been sexually abused were not found to be of significantly higher risk of developing early signs of psychosis than those who had not had a traumatic childhood. However, this finding might have been due to methodological shortcomings of the study

3) The witnessing of domestic violence: those who had been exposed and subjected to the witnessing of domestic violence within their household were found to be of much greater risk of developing early signs of psychosis than those who had not had traumatic childhoods

4) Effects of being bullied: those who had been significantly bullied were not found to be at increased risk of developing early signs of psychosis.

However, these individuals were found to be significantly more likely than those who had had a more settled childhood of to become bullies themselves.

This finding could be due to:

a) modelling their behaviour on the behaviour of the person who was physically abusing them.

b) modelling their behaviour on that of the perpetrator of the domestic violence they were exposed to witnessing in the home

c) genetic reasons – for example, if they had a violent father who physically abusef them they may have inherited a set of genes that predisposed them to behaving aggressively/violently

d) a need to express control/power – if these individuals felt powerless at home due to being physically abused, they may have developed the need to express power over others in order to ‘psychologically compensate’ themselves/feel less powerless/gain the control they lacked at home

PSYCHOTIC SYMPTOMS:

In all, 6.6% of the original 200+ studied had psychotic symptoms, mainly visual and auditory hallucinations (seeing and hearing things in the absence of corresponding external stimuli – ie things that weren’t there).

Compared to those who had had relatively stable childhoods:

– those who had been physically abused were 6x more likely to have experienced early psychotic symptoms

– those who had witnessed domestic violence were 10x more likely to have experienced early psychotic symptoms

F1.small

Above: Graph displaying the results of the study.

Comorbid conditions:

Those who had developed early psychotic symptoms due to childhood trauma were also more likely to have other mental health problems alongside these (psychologists often refer to these as comorbid conditions). These included:

– depression

– conduct disorder

– phobias

– ADHD

– PTSD

– nervous tic

– over anxiousness

– oppositional defiance disorder

– separation and anxiety order

Males were more at risk of developing early psychotic symptoms than females.

How Does Childhood Trauma Make A Young Person More At Risk Of Developing Early Signs And Symptoms Of Psychosis?

Experts now believe the experience of significant childhood trauma can adversely affect the biological development of the brain.

Specifically, prolonged exposure to significant stress in childhood can adversely affect the brain’s:

– structure

– biology/chemistry

– and, as a result, its functionality

For example, prolonged stress can affect the production in the brain of the hormones known as adrenalin and catecholamine (involved in the body’s stress/threat response; often referred to as the fight/flight response) and interfere with the physical development of a structure in the brain known as the amygdala (also involved in regulating how the individual responds to stress/perceived threat).

Conclusion:

This study supports an already vast quantity of research that shows a link between childhood trauma and the development of mental illness (in this case, psychosis).

Table Below: Some of the lesser known manifestations of psychosis:

psychosis_syndromes_delusions_hallucinations

Resources:

My eBook on how childhood trauma can adversely affect brain development is available from Amazon. For more details, click on image below:

child_trauma_and_NEUROPLASTICITY, functional_and_structural_ neuroplasticity  Click image for more information.

 

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

 

Psychotic Depression, Schizophrenia And Childhood Trauma Sub-Types

childhood trauma, schizophrenia, psychotic depression

childhood trauma, schizophrenia and psychotic depression

Sub-Types Of Childhood Trauma :

As we have seen from other articles I have published on this site, childhood trauma can be split into 4 main sub-types : emotional abuse, sexual abuse, physical abuse and neglect.

In this article, I briefly describe some of the main research findings in regard to the association between childhood trauma and risk of suffering from psychosis as an adult.

More specifically, I will examine which specific sub-types of childhood trauma may particularly increase an individual’s risk of developing psychosis as an adult, and if specific sub-types of childhood trauma are linked to increased risk of developing specific types of psychotic disorder as an adult and, if so, which specific types of psychotic disorder.

Study That Suggests Link Between Childhood Trauma And The Later Development Of Psychotic Depression :

A study carried out by Read et al. found that those individuals who had suffered from childhood trauma were more likely to have suffered from psychotic depression as adults. (Psychotic depression is similar to ‘ordinary’ major depression only there are additional symptoms of a psychotic nature – delusions, hallucinations and psychomotor agitation or psychomotor retardation).

More specifically, those who had experienced physical abuse or sexual abuse were found to have been particularly likely to have developed a psychotic depression later in life. (Of those in the study who had suffered from psychotic depression as adults, 59% had suffered physical abuse as children and 63% had suffered sexual abuse.)

childhood trauma, schizophrenia, psychotic depression

Studies That Suggests Link Between Childhood Trauma And The Later Development Of Schizophrenia :

A study (Compton et al) found that of those who had been sexually abused as children and of those who had been physically abused as children, 50% and 61% respectively developed schizophrenia-spectrum disorders later in life.

Another study (Rubins et al) found evidence suggesting that whilst sexual abuse in childhood is associated with the later development of depression and schizophrenia, physical abuse during childhood is associated with the later development of schizophrenia’ alone.

Finally, a study by Spence et al found that both physical and sexual abuse were associated with the later development of schizophrenia and, of these two associations, the association between physical abuse and the later development of schizophrenia was the strongest.

Type Of Psychotic Symptoms :

Studies (e.g. Read, 2008) that have focused on the specific psychotic symptoms suffered by those who develop a psychotic illness AND have a history of childhood trauma have found that the most common are AUDITORY HALLUCINATIONS and PARANOIA.

David Hosier BSc Hons; MSC; PGDE(FAHE)

 

Borderline Personality Disorder And Psychosis

childhood_trauma_effects

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

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

What is Psychosis?

Psychosis can involve :

– seeing things which are not there (visual hallucinations)

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

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

– smelling things which are not there (olfactory hallucinations)

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

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

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

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

– inability to settle and relax / agitated pacing

– loss of interest in appearance and hygiene / lack of self-care

– severe mood swings

– disrupted, disordered and disjointed thinking

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

 

Psychotic Depression

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

BPD AND REALITY TESTING

Reality testing, a concept originally introduced by Sigmund Freud (1856-1939), can be described as the capacity of an individual perceive the external events going on around him/her objectively, accurately and based on conventional interpretation rather than in a way distorted by internal mental factors. The Medical Dictionary defines it as : ‘The objective evaluation of the external world and differentiation between it and the ego or self.’

Impaired Reality Testing :

Reality testing is most obviously impaired in individuals, such as some schizophrenics, who are in the grip of florid psychotic symptoms such as hallucinations (e.g. ‘hearing voices’ or ‘seeing things that aren’t there’) and delusions (e.g. believing one’s thoughts are being broadcast / audible to others).

 

Borderline Personality Disorder, Brief Psychotic Episodes And Reality Testing :

Individuals with borderline personality disorder (BPD) generally do not have such dramatically impaired reality testing (although they can suffer from brief psychotic episodes when experiencing extreme stress). However, their reality testing can fluctuate to a significantly greater degree than is found in relatively ‘psychologically healthy’ individuals.

For example, particularly when experiencing significant levels of stress, individuals suffering from BPD may lapse into a paranoid style of thinking or experience an impaired ability to self-reflect in a realistic fashion.

Problems That May Arise As A Result Of Impaired Reality Testing :

An impaired ability to reality test can lead to various problems, including :

Improving Impaired Reality Testing :

Studies (e.g. Landa et al., 2006) suggest that cognitive behavioral therapy (CBT) can be an effective means of improving a person’s ability to reality test.

 

BPD AND HALLUCINATIONS

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

Different Types Of Hallucination :

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

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

MILD HALLUCINATIONS :

Mild hallucinations are actually not uncommon even amongst people with no mental illness (e.g. believing one has heard the doorbell ring when it hasn’t).  If the person who has the experience of hallucinations such as those listed above is aware that the sounds, visions etc are not real but are being generated from his/her own mind then experts to not consider them to be suffering from full-blown psychosis. These kind of experiences are only classified as psychotic if the person is adamant that they are real. As stated already, psychosis of this nature, involving a complete departure from reality, is rare in those with BPD.

SEVERE HALLUCINATIONS

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

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

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

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

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

 

 

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

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

 

AGITATED PACING / PSYCHOMOTOR AGITATION

Another symptom of psychosis, which those suffering from BPD and other serious mental disorders may display, is psychomotor agitation.

We have seen that those who have suffered significant childhood trauma are at an increased risk of developing anxiety disorders in their adult lives. In extreme cases, this may lead to what is known as psychomotor agitation. I explain what is meant by this term below. However, I wish to start by recounting my own experience of this most distressing of psychological conditions.

For at least three years in total, off and on, I could not take a bath. The reason for this was that, when I was in this state (each episode could last several months) I was too agitated to do so – I couldn’t relax enough to lie down in the water, or even sit in it, any more so than I could voluntarily immerse myself in molten iron.

So I showered instead, right? Wrong. I felt too agitated to even indulge in this activity, even though most people find showering extremely relaxing and pleasurable.

Instead, I carried out my ablutions with a damp flannel; however, I confess that even this frequently proved to be a challenge I could not meet. Anti-social? Well, yes, if I saw anyone : but I didn’t. I was living as a virtual recluse.

Of course, for people who haven’t experienced severe agitated depression, it is extremely difficult to imagine how acutely distressing it is to have to endure such psychological torment on a constant and unremitting basis.

I couldn’t even sit back in an armchair; I was, quite literally, always on the edge of my seat’ (so it seems the expression is not merely a metaphor).

In other words, I existed in a perpetual and unrelenting state of the most intense kind of agitation – permanently distracted and distraught. This led to a suicide attempt which left me in a coma in intensive care for five days, followed by hospitalizations and several courses of electro-convulsive shock therapy (ECT).

The name for this kind of profound, and highly distressing, restlessness is psychomotor agitation. I describe what is meant by this term below:

 

Symptoms Of Psychomotor Agitation:

– unintentional/ involuntary/ purposeless movement driven by an irresistible compulsion to do so,  feelings of inner tension, restlessness, anxiety and intense mental anguish and distress. These involuntary movements may include:

– pacing around the room

– hand wringing

 Psychomotor agitation is found particularly frequently in those with bipolar disorder, substance abusers and those with psychotic depression (to read about all the other types of depression, click here).

Treatment:

Doctors may treat the disorder pharmacologically (ie. with medication) but it also often treated non-pharmocologically by means other therapies such as meditation, mindfulness, yoga and other relaxation techniques.

RETURN TO BPD AND CHILDHOOD TRAUMA MAIN ARTICLE

 

eBook :

BPD eBook

Above eBook now available for immediate download from Amazon. Click here for further details.

David Hosier BSc Hons; MSc; PGDE(FAHE)

 

 

 

Psychotic Depression: The Symptoms

disturbing_unprocessed_memories

Psychotic Depression And Childhood Trauma :

Those of us who experienced severe childhood trauma are at a substantially higher risk of developing depression as adults than those lucky enough to have had a relatively stable upbringing. However, it is not well known amongst the general public that, in a minority of cases, depression can be so severe that it involves disturbing psychotic symptoms (estimates suggest that about 13% of those who suffer from serious depression will experience psychotic features, and this percentage can rise steeply amongst geriatric populations – perhaps as high as 50%). It is these symptoms that I will describe in this article.

symptoms_of_psychotic_depression

Symptoms of Psychotic Depression :

 

Symptoms of psychotic depression may include the following:

1) DISJOINTED THINKING – The ability to think can become severely impaired and the thoughts a person has may become very muddled and confused, rapidly flitting from one subject to another. This can make concentration impossible and lead to speech patterns which are difficult for others to follow and understand.

2) AGITATION/PACING – During my own illness I suffered very badly from this. For years I was so agitated I could not often sit down for long, and, even if I was sitting, certainly found it impossible to physically relax in a chair; I was, almost literally, constantly on the ‘edge of my seat.’ Such serious agitation is sometimes treated with major tranquillizers (these are anti-psychotic drugs) and, indeed, it was necessary for my psychiatrist to prescribe these for me.

3) DECLINE IN SELF CARE – Again, I suffered this symptom during my own illness. I did not bath for a very long time ; instead, I would occasionally wash with a flannel. I shaved rarely, and did not use soap or shaving foam when I did (this actually makes shaving quite painful). During a particularly bad period, when I was intensely suicidal and actively planning to hang myself, I did not change my clothes for three months (click here to read about this episode of my life).

4) DELUSIONS

a) Of being an exceptionally bad person or ‘evil.’

These include delusions of being an exceptionally bad person, or, even, of being ‘evil’ or of being ‘the devil.’ Also, self-blame, an extremely common symptom of non-psychotic depression, may become delusional – the sufferer might, for example, start to falsely believe he has committed terrible crimes (eg mass murder or the assassination of an important figure).

Because of this, the delusional individual may believe he will soon be horribly punished for these imaginary crimes, and start to dwell obsessively upon what form the punishment might take (eg terrible eternal torture in ‘hell’ or by a malign and clandestine ‘secret police’).

b) Nihilistic delusions.

These may take the form the sufferer believing the world does not actually exist, or that eveyone in it is dead, or that he, himself, is dead.

c) Somatic delusions.

Sometimes, individuals suffering from psychotic depression might believe part of his body is missing, such as the heart or the brain.

d) Delusions of worthlessness.

At the delusional level, ideas about being worthless become extreme. For example, a person may believe they are the most useless and worthless person in the entire world, fit only to be utterly despised, ridiculed and held in profound contempt.

The psychotically depressed may also believe that their body is wasting away, rotting and disintegrating and/or that they have some terrible, incurable disease.

e) Delusions of poverty

This involves the false belief that one has run out of money, or that one has nearly run out (even when, in fact, the individual is comfortably off), together with accompanying fears that one will starve or end up living on the streets in rags.

5) Hallucinations.

This involves seeing or hearing things which are not, in reality, there. The former are referred to as visual hallucinations and the latter as auditory hallucinations. For example, the individual may ‘see’ a vision of the ‘devil’ or ‘hear’ the ‘voice of god’ telling him to kill himself.

Sometimes, too, other senses may be affected. For example, food may lose all its pleasure and taste of nothing, or, even, taste unpleasant.

RESOURCE :

childhood trauma and depression

 

Above eBook is now available on Amazon for immediate download. CLICK HERE.

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

 

 

Schizoid Personality Disorder

schizoid personality disorder

What is schizoid personality disorder, what is the relative contribution of genes and environment in its development and what is the prognosis?

This condition is not as well understood as many other mental health conditions; this is, in no small part, due to the fact that those with the disorder often do not feel that there is anything particularly wrong with them that warrants psychiatric attention, and, furthermore,would not wish to invite such attention.

However, we do know that the condition occurs at a greater frequency amongst men than amongst women; we also know that it is likely to have a genetic component (because individuals related to schizophrenics – a different, but related, condition – are more likely to suffer from schizoid personality disorder than others). We know, too, from evidence so far accumulated, that it is also probable that there are environmental contributory causes to the condition, specifically, a childhood in which the individual was shown little affection, warmth (either verbally or physically) and generally subjected to emotional neglect (click here to read my article on this).

causes of schizoid personality

Those with the condition are frequently described by laymen as ‘loners’, ‘misfits’, ‘odd’, ‘peculiar’ etc. The schizoid personality stays aloof from others, likes to remain emotionally unattached, and, therefore, has very little interest indeed in pursuing interpersonal relationships.

This solitary nature is reflected, too, in their choice of hobbies and activities – invariably, the schizoid personality will select ones that can be undertaken alone.

Often, the person with schizoid personality disorder will be able to function reasonably well in society – however, any job the individual holds down is unlikely to involve much interaction with others.

Symptoms of Schizoid Personality Disorder :

– distant/aloof/emotionally detached from others

-displays very little emotion

-often has rich and complex inner fantasy life

-problems relating to others/feels little desire to interact with others

-likely to seek out work that is as solitary as possible (assuming the individual is functioning well enough to work)

-chosen hobbies/activities likely to be those that may be undertaken in solitude

-no close friends

-not close to members of own family (nor has a desire to be)

-derives little pleasure from life

-low sex drive

PROGNOSIS :

Because those suffering from schizoid personality disorder rarely seek out help from professionals, little is known about which therapies may be of help to them. However, it is unlikely that ‘talk-based’ therapies would be useful due to the fact that those with a schizoid personality feel uncomfortable interacting with others, especially if the interaction relates to personal issues.

According to the current evidence, it appears that the symptoms of schizoid personality disorder do not significantly improve over time ; in other words, it is a chronic (long-lasting) condition.

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

Those Raised In Care Homes More Likely To Develop Paranoia

 

raised in care home

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

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

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

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

 

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

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

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

 

RESOURCES :

 

 

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

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