Category Archives: Psychosis

Childhood trauma and psychosis.

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

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

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

1) NON-PSYCHOTIC THOUGHT:

This category was broken down into:

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

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

3) TRUE PSYCHOTIC THOUGHT.

 

RESULTS OF THE STUDY:

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

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

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

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

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

CONCLUSION:

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

THE VITAL IMPORTANCE OF REDUCING STRESS:

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

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

Childhood Trauma Leading To Psychotic And Immature Defense Mechanisms

psychotic-defense-mechanisms

According to the  Diagnostic and Statistical Manual of Mental Disorders, the unconscious defense mechanisms we employ to help us deal with stress can be split into three main types ; these are :

  • psychotic defense mechanisms.
  • immature defense mechanisms.
  • intermediate / neurotic defense mechanisms.
  • mature defense mechanisms.

If we have suffered severe and protracted childhood trauma which has led to posttraumatic stress disorder (PTSD) / complex posttraumatic stress disorder (complex PTSD), we are more likely than average to develop psychotic and immature defenses rather than intermediate and mature ones.

Psychotic Defense Mechanisms :

Those who have been so affected by their traumatic experiences that they have developed PTSD or personality disorders such as borderline personality disorder (BPD) are liable to develop psychotic defense mechanisms ; these include :

  • psychotic denial.
  • psychotic distortion,
  • psychotic projection,

All of these defense mechanisms are maladaptive.

Immature Defense Mechanisms :

Complex PTSD / PTSD sufferers are also prone to developing immature defense mechanisms; these include :

  • dissociation
  • – autistic fantasy
  • – passive aggression
  • – projection (paranoia)

These defense mechanisms are also maladaptive and  occur commonly in those suffering personality disorders such as borderline personality disorder (BPD).

Intermediate / Neurotic Defense Mechanisms :

  • displacement
  • regression
  • isolation

Mature Defense Mechanisms :

  • suppression
  • sublimation
  • altruism
  • humor
  • anticipation
  • affiliation

mature-defense-mechanisms

Whilst immature defense mechanisms are maladaptive, mature defense mechanisms can be adaptive and healthy by, for example, helping to reduce our levels of anxiety, raising our levels of self-esteem and increasing our resilience and coping abillity in times of crisis.

STUDY ON THE ADAPTIVE NATURE OF MATURE DEFENSE MECHANISMS :

Indeed, a study conducted by Malone et al., (2013), investigated the type of defense mechanisms being used by a group of individuals (all male) aged between 47 years and 63 years (specifically, the researchers were interested in THE LEVEL OF MATURITY OF THESE DEFENSE MECHANISMS).

The researchers then followed up these same individuals to assess the state of their health at the ages of 70, 75 and 80.

It was found those individuals who used defense mechanisms that were mature tended to have a higher level of social support and better health in later life than those who used less mature defense mechanisms.

This, then, suggests that mature defense mechanisms can help to improve not only mental health, but physical health, too.

Two reasons why mature coping mechanisms may improve physical health are :

  1. People who use mature defense mechanisms are better socially integrated than those who use immature ones (see above) and it is the commensurate social support they receive that benefits their health.
  2. Those who use immature defense mechanisms suffer greater levels of stress than their psychologically healthier counterparts and it is this increased stress that harms their health.

Conclusion :

If we can develop healthier and more mature defense mechanisms, then, based on the above research it would seem possible that we might become easier to be around, leading to increased social integration and more social support, leading to reduced stress and improved mental and physical health.

If you would like to see the full and detailed list of defense mechanisms taken into account in the study referred to above, click this link : FULL LIST OF DEFENSE MECHANISMS.

David Hosier BSc Hons; MSc; PGDE(FAHE)

How Childhood Trauma Can Lead To Early Signs Of Psychotic Illness

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 illness which include depression, anxiety, substance abuse, eating disorders, complex post-traumatic stress disorder, sexual dysfunction, borderline 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.

– EFFECT 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) Behavioural 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 defence 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).

 

 

 

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 which acts as a  ‘psychosis trigger‘. 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

 

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David Hosier BSc Hons; MSc; PGDE(FAHE)

 

 

Overcoming Nightmares And Hallucinations With ‘Paradoxical Intention.’

paradoxical intention

Childhood Trauma And Its Link To Adult, Psychiatric Disorders :

We have seen in many other articles that I have published on this site that there is a link between childhood trauma and the later development of a whole array of psychiatric disorders in adulthood (for example, see my article on the Adverse Childhood Experiences Study – sometimes referred to as the ACE Study).

Such psychiatric disorders include major depression, anxiety, alcoholism, borderline personality disorder (BPD), complex posttraumatic stress disorder (cPTSD) and psychosis (including schizophrenia).

All of these conditions may include the symptoms of nightmares and/or hallucinations (borderline personality disorder can sometimes involve brief psychotic episodes, as can depression).

Nightmares, Hallucinations And Trauma-Based Memories :

When nightmares and hallucinations are linked to psychiatric disorders which, in turn, are linked to childhood trauma, it is quite possible that the content of those nightmares and / or hallucinations are founded, at least in part, upon TRAUMA – BASED MEMORIES.

Paradoxical Intention :

paradoxical intention

Of course, the content of nightmares and hallucinations is frequently highly disturbing and distressing – I have had nightmares of such violence that they have, on more than one occasion, caused me to fall out of bed. Frequently, too, I have thrashed about so vigorously in my sleep that I have knocked lamps, clocks, overflowing ashtrays, radios and half-finished cups of tea off my bedside table (although never all at once, albeit small consolation) – however, one possible way to reduce their intensity, or, even, overcome them may, counter-intuitively, according to psychodynamic theory, be facilitated by a process known as PARADOXICAL INTENTION.

Paradoxical intention is a concept first described by Dr Viktor Frankl, the famous psychiatrist and concentration camp survivor who founded Logotherapy, based on the idea that psychological symptoms can be made worse by tying too hard to fight them, summed up by the pithy maxim, ‘What you resist persists.’

So, applying the idea of paradoxical intention to the treatment of nightmares and hallucinations involves a trained psychotherapist encouraging the client to view his/her nightmares and /or hallucinations from a completely different perspective,  i.e. rather than seeing the hallucinations / nightmares as something purely destructive and to be feared, the client is encouraged, instead, to try to see these phenomena as helpful clues (no matter how bizarre and nonsensical they may appear to be on the surface) which can be analyzed and interpreted for salient meanings (whether literal or symbolic), thus helping to expose, and shed light upon, possible trauma-based memories that underpin the individual’s psychiatric condition.

In this way, the client can be both empowered, and, under the care of an appropriately trained psychotherapist, can also be sensitively and compassionately helped to understand, where appropriate, the deep roots of his/her particular psychological difficulties, which may prove to be an effective first step towards ameliorating them.

RESOURCE

Stop Recurring Nightmares / Dreams

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Above eBook now available on Amazon for instant download. Click here for further information or to view other titles.

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

Psychotic Depression, Schizophrenia And Childhood Trauma Sub-Types

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)

Psychotic ‘Hallucinations’ : Could They Be 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).