Tag Archives: Borderline Personality Disorder

BPD Sufferers Need To Be ‘Held’ According To Theory

holding

Buie And Adler :

Buie and Adler propose that the pathology displayed by sufferers of borderline personality disorder (BPD) such as instability, uncontrolled rage and anger, can be attributed, primarily, to early dysfunction in the relationship between the individual as a young child and his/her mother.

More specifically, Buie and Adler hypothesize that, as a young child, the BPD sufferer was insufficiently ‘held’ by the mother, particularly during the rapproachment phase of interactions.

What Is Meant, In Psychotherapy, By ‘Holding’?

In psychotherapeutic terms, the word ‘holding’ does not necessarily entail literal, physical holding (although, ideally, of course, a mother would physically hold her young child when s/he was distressed and in need of comfort), but can also involve its emotional equivalent (verbally comforting and soothing the child, for example).

However, because of the mother’s failure to sufficiently ‘hold’ (physically, emotionally or both) the BPD sufferer when s/he was a young child in distress, s/he never had the opportunity to internalize adequate maternal ‘holding’ behavior so that now, as an adult, s/he lacks the ability to self-soothe in response to the further distress that s/he will inevitably experience as an adult.

self-soothe

Profound Feelings Of Aloneness :

Buie and Adler further propose that the BPD sufferer’s inability to ‘self-sooth’ at times of high stress leads to a pervasive and profound sense of aloneness ; indeed, Buie and Adler consider this deep sense of loneliness to be a core feature of the BPD sufferer’s psychological experience and describe it in the following manner :

‘an experience of isolation and emptiness occasionally turning into panic and desperation.’

Projection :

Also, according to Buie and Adler, BPD sufferers use the psychological defense mechanism of projection in relation to their profound feelings of inner isolation which means, in short, that they project these feelings onto the external environment, and, as a result of this, perceive the outside world, and life in general, to be empty, meaningless and devoid of purpose.

Longing To Be Held By Idealized Others :

Furthermore, Buie and Adler propose that this inability to self-soothe and self-nurture (due to the original failure to internalize maternal holding behavior, itself a result of the mother’s dysfunctional interaction with the BPD sufferer when s/he was a young child) leads to intense, desperate longing and desire to be ‘held’ by idealized others.

Separation Anxiety :

Additionally, according to Buie and Adler, such longings perpetually leave the BPD sufferer vulnerable to feelings of extreme separation anxiety.

Rage :

Because of the BPD sufferer’s proneness to idealize others (see above), Buie and Adler point out that this can lead to him/her (i.e. the BPD sufferer) to develop extremely exacting expectations of such idealized others that it is not possible for them (i.e. the idealized others) to live up to.

This inevitable failure of the idealized others to live up to the BPD sufferer’s stratospheric expectations can then induce feelings of extreme rage and anger in him/her (i.e. the BPD sufferer) directed at the ‘failed’, idealized other.

Implications For Therapy :

In line with their theory, Buie and Adler put forward the view that it is the role of the therapist to provide the holding and soothing functions that the BPD sufferer is not capable of providing for him/herself. The ultimate goal of this is that the BPD sufferer is eventually able to internalize these functions (holding and self-soothing) so that s/he learns to provide them for him/herself in a way that s/he was unable to as a child due to the defective nature of the mothering s/he received.

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

 

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 :

 

eBook :

 BPD ebook

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

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

 

 

 

 

 

What Are The Differences Between BPD And Complex PTSD? : A Study

difference between complex ptsd and bpd

Because there is a considerable overlap in symptoms between those suffering from borderline personality disorder (BPD) and those suffering from complex posttraumatic disorder (complex PTSD) , those with the latter condition can be misdiagnosed as suffering from the former condition (you can read my article about this by clicking here).

In order to help clarify the differences between the two conditions and help show how they are distinct from one another, this article is about a research study which sought to delineate these two very serious psychiatric conditions.

What Are The Differences In Symptoms Between Those Suffering From Borderline Personality Disorder (BPD) And Those Suffering From Complex Posttraumatic Stress Disorder (Complex PTSD)?

A study into the different symptoms displayed by sufferers of borderline personality disorder (BPD) and complex posttraumatic stress disorder (complex PTSD) involving the study of two hundred at eighty adult women who had experienced abuse during their childhoods and published in the European Journal of Psychotraumatology in 2014 compared the symptoms of those suffering from BPD with those suffering from complex PTSD.

The following results from the study were obtained :

SYMPTOMS SHARED APPROXIMATELY EQUALLY BETWEEN THOSE SUFFERING FROM BPD AND THOSE SUFFERING FROM COMPLEX PTSD :

Some symptoms were found to be shared approximately equally between those suffering from  borderline personality disorder (BPD) and those suffering from complex posttraumatic stress disorder (complex PTSD). The symptoms that fell into this category were as follows :

  • AFFECTIVE DYSREGULATION (ANGER) i.e. frequent feelings of intense rage that the individual cannot control (regulate)
  • VERY LOW FEELINGS OF SELF-WORTH
  • AFFECTIVE DYSREGULATION (SENSITIVE) i.e. feelings of hypersensitivity that cannot be controlled (regulated)
  • INTENSE FEELINGS OF GUILT
  • INTERPERSONAL DETACHMENT / ALONENESS i.e. feeling cut-off and alienated from others, isolated and apart
  • FEELINGS OF EMPTINESS

However, some symptoms were found to be significantly more prevalent amongst those suffering from borderline personality disorder (BPD) than amongst those suffering from complex posttraumatic stress disorder (complex PTSD) as shown below :

SYMPTOMS THAT WERE FOUND TO BE SIGNIFICANTLY MORE PREVALENT AMONGST THOSE SUFFERING FROM BORDERLINE PERSONALITY DISORDER (BPD) THAN AMONGST THOSE SUFFERING FROM COMPLEX POSTTRAUMATIC STRESS DISORDER (COMPLEX PTSD) :

 

eBooks :

    

 

Above eBooks now available from Amazon for instant download. For further details, click here.

 

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

 

 

 

 

‘Amygdala Hijack’ And BPD

amygdala hijack

One of the main, and most problematic, symptoms that those with borderline personality disorder (BPD) suffer from is the experiencing of disproportionately intense emotional responses when under stress and an inability to control them or efficiently recover and calm down once such tempestuous emotions have been aroused. This very serious symptom of BPD is also often referred to as emotional dysregulation.

The main theory as to why such problems managing emotions occur is that damage has been done to the development of the brain region known as the amygdala in early life due to chronic trauma and, consequently, this area of the brain having been overloaded and overwhelmed by emotions such as fear and anxiety during early development causing a longterm malfunction which can extend well into adulthood or even endure for the BPD sufferer’s entire lifespan (in the absence of effective therapy).

The damage done to the development of the amygdala means that, as adults, when under stress, BPD sufferers are frequently likely to experience what is sometimes referred to as an emotional highjack or, as in the title of this article, an amygdala hijack.

What Is ‘Amygdala Hijack’ And How Does It Prevent Emotional Calm?

When external stimuli are sufficiently stressful, the amygdala ‘shuts down’ the prefrontal cortex (the prefrontal cortex is responsible planning, decision making and intellectual abilities).

In this way, when a certain threshold of stress is passed (and this threshold in far lower in BPD sufferers than the average person’s) the amygdala (responsible for generating emotions, particularly negative emotions such as anxiety, fear and aggression) essentially ‘takes over’ and ‘overrides’ the prefrontal cortex.

amygdala hijack

Above : under sufficient stress the prefrontal cortex (the seat of rational thought) is shut down, leaving the amygdala (the seat of intense, negative emotions like anxiety, fear and aggression) to ‘run riot.’

As such, the prefrontal cortex ‘goes offline’ leaving the BPD sufferer flooded with negative emotional responses and unable to reason, by logic or rational thought processes, his/her way out of them.

When the amygdala is ‘highjacked’ in this way, there are three main signs. These are :

1) An intense emotional reaction to the event (or external stimuli)

2) The onset of this intense emotional reaction is sudden

3) It is not until the BPD sufferer has calmed down and the prefrontal cortex comes ‘back online’  (which takes far longer for him/her than it would for the average person) that s/he realizes his/her response (whilst under ‘amygdala highjacking’) was inappropriate, often giving rise to feelings of embarrassment, humiliation, guilt, remorse and regret.

Resources:

Click here for further information.

 

eBook :

childhood trauma ebook

Above eBook now available on Amazon. Click here for further information.

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

 

 

 

 

BPD Sufferers May Have Subtle Learning Difficulties

Research suggests that individuals who suffer from borderline personality disorder (BPD) may have mild to moderate dysfunctions in certain areas of cognitive processing, in particular in the area of learning and memory that involves the processing of complex information.

However, such problems tend to be subtle and are therefore difficult for doctors, psychiatrists, psychologists and other clinicians to detect.

Notwithstanding this difficulty of detection, brain abnormalities have shown up in EEGs of borderline personality disorder (BPD) sufferers that are consistent with the learning/memory problem hypothesis.

In particular, the difficulties in cognitive processing appear to be associated with both visual and verbal memory (including, it is currently thought, both the encoding and retrieval of information) in which complex information is involved.

Borderline Personality Disorder (BPD) Sufferers Frequently Seem Incapable Of Learning From Experience – Is This Why?

These findings have given rise to the hypothesis that these subtle problems relating to learning and memory may help to explain why those suffering from borderline personality disorder (BPD) so frequently seem to make the same mistakes over and over again, seemingly incapable of learning from their social and interpersonal experiences.

Why May These Subtle Memory And Learning Problems Exist In Borderline Personality Disotder (BPD) Sufferers?

Many people who suffer from borderline personality disorder (BPD) experience periods of dissociation ( you can read about my article on dissociation by clicking here), particularly when under severe stress, and this state is clearly likely to seriously impair their memory functioning and, it follows, their ability to learn.

Also, the majority of individuals who go on to develop borderline personality disorder (BPD) as adults have suffered significant childhood trauma due to abusive parenting and it is known that this can lead to damage being done to the vulnerable, highly plastic, developing physical brain (to read my article about how childhood trauma can damage the developing brain on an organic level click here).

Further, severe clinical depression frequently co-morbidly exists alongside borderline personality disorder (BPD) which itself can impair both memory and learning.

Finally, it should be noted that research into this area is still at an early stage so more research needs to be conducted in order to confirm or shred further light upon the above theories.

eBook:

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

 

Related Resource :

  Improve learning and memory with hypnosis MP3 audio. Click here.

 

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

 

BPD – A Masked Illness : And Why It’s Hard To Identify

Bpd_and_childhood_trauma

We have seen from other posts how childhood trauma, especially multiple and cumulative trauma, is strongly associated with the development of borderline personality disorder (BPD) in adult life.

However, many BPD sufferers are at risk of going undiagnosed or misdiagnosed.

The reason for this is that BPD can generate a number of symptoms associated with other conditions that mask the underlying illness (BPD).

Sadly, because of this, BPD can go undiagnosed for years, decades or a whole lifetime. This means many go without the proper treatment they require.

When one considers that approximately ten per cent of those diagnosed with BPD end their lives by suicide, the full, tragic implications of this failure of accurate diagnosis can be appreciated.

What Symptoms Of BPD Can Mask It, Thus Making It Less Likely To Be Accurately Diagnosed?

They include :

– excessive use of alcohol, leading to a diagnosis of alcoholism

self-harm / suicidal thoughts, leading to a diagnosis of depression

instability of mood, leading to diagnosis of cyclothymic or bipolar disorder

aggression/violence, leading to diagnosis of sociopathy (sometimes still referred to as psychopathy)

eating problems, leading to diagnosis of anorexia nervosa or bulimia

Whilst this list is not exhaustive, it represents some of the ways in which BPD can seemingly, upon preliminary invetigations, present itself as other psychological conditions, leading to misdiagnosis or incomplete/partial diagnosis.

bpd

Because, too, many with BPD are able to work successfully, and/or socially integrate successfully, much of the time without displaying blatant signs of psychological pathology, identifying BPD in individuals becomes trickier still.

However, such individuals are still likely to display tell-tale signs of the disorder due to sudden, dramatic and unpredictable shifts in mood (such as explosions of rage) which may, by the layman (or even the professional) be put down to ‘a difficult temperament’.

In order to correctly diagnose BPD it is necessary to look at the whole tapestry of the interplay of the individual’s behaviours and emotions in the context of their lives as a whole, with a particular focus on their relationship history (tends to be tumultuous), mood stability/instability, drug/alcohol use, sexual history (tends to be promiscuous and high risk), internal/mental life (often marked by feelings of chronic emptiness and lack of identity), emotional reactiveness/lability, and, vitally, of course, experience of childhood trauma.

In short, accurate diagnosis calls for a holistic approach; only then will all BPD sufferers get the treatment they both desperately need and deserve.

Resources:

 

BPD

Above eBook now available on Amazon for instant download. Click here.

 

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

Brain Areas That May Be Adversely Affected By Childhood Trauma

BPD_and_brain_areas

We have already seen in other posts that I have published on this site that, if we have been unfortunate enough to have been subjected to severe and chronic childhood trauma, it is possible that this adversely affected how our brain physically developed during our early life.

And, if we have been particularly unlucky, this disrupted brain development could have made us highly susceptible to developing borderline personality disorder (BPD) in our adult lives.

 

Indeed, research involving brain scans suggest that sufferers of BPD can have abnormalities in the following brain areas :

– prefrontal cortex

– anterior cingulate

– medial frontal cortex

– subgenual cingulate

– ventral striatum

– ventromedial prefrontal cortex

– amygdala

 

Below : Brain Areas Which May Have Had Their Physical Development Adversely Affected By Our Traumatic Childhood Experiences, Particularly If We Have Developed Borderline Personality Disorder ( BPD) :

BPD brain

 

What Are These Brain Areas Associated With?

The function of these brain areas are described below:

PREFRONTAL CORTEX:

– decision making

– conscious control of social behaviour

– speech / writing

– logic

– purposeful (as opposed to instinctual) behaviour

– planning for the future

– expression of the personality

ANTERIOR CINGULATE :

– decision making

– heart rate

– blood pressure

– impulse control

– emotions

MEDIAL PREFRONTAL CORTEX:

– decision making

– memory

SUBGENUAL CINGULATE :

– sleep

– appetite

– anxiety

– mood

– memory

– self esteem

– transporting serotonin

– our experience of depression

VENTRAL STRIATUM :

– decision making

– emotional regulation (the control of emotios)

– the extinction of conditioned responses

AMYGDALA :

– appetite

– emotion

– emotional content of memories

– fear

The Effects Of Disruption Of The Above Brain Areas :

Poor decision making ; poor control of social behaviour ; impaired ability to think rationally ; poor planning for the future ; dysfunctional personality ; increased physiological response to stress ; poor impulse control ; poor emotional control ; insomnia ; changes in appetite ; severe anxiety ; mood instability ; low self-esteem ; impairment of the brain’s ablity to make effective use of serotonin leading to clinical depression ; changes in appetite ; emotionally charged memories leading to flashbacks, nightmares, intrusive thoughts, panic attacks ; feelings of being under constant threat, fear, terror and extreme vulnerability.

Two types of therapy that may be useful are cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT).

Resources :

General Information :

NHS information about borderline personality disorder (BPD). Click here.

EBook :

brain damage caused by childhood trauma

Above eBook now available for instant download from Amazon. Click here for more details.

Self-help :

For immediate help with many of above problems click here.

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

Nine Key Recovery Targets For BPD Sufferers

BPD symptoms and treatment

We have already seen from other articles published on this site that those of us who suffered severe childhood trauma are at much increased risk of developing borderline personality disorder (BPD) as adults than average.

We have also examined the symptoms of BPD in other posts so there is no need to repeat that here.

Instead, in this post, I will look at nine important goals that BPD sufferers may need to aim for on their road to recovery (different individuals with BPD have different sets of symptoms, so not all BPD sufferers will need to address every goal and different individual BPD sufferers will need to address their own particular combination of treatment aims accordingly).

 

1) Learn to deal with feelings of intense anger.

Many sufferers of BPD experience outbursts of severe rage which may, in part, be linked to damage done to the development of the amygdala (a brain region involved in the processing of emotions) during childhood ( caused by growing up in a chronically stressful environment).

The BPD sufferers is particularly likely to experience intense anger when events occur that remind him/her of his/her childhood trauma, such as being rejected or abandoned.

2) Eliminate self-destructive and impulsive behaviours.

These may include self-harm (eg. cutting), binge eating, excessive use of drugs/alcohol, unsafe sex, reckless driving etc.

The BPD sufferers, consciously or unconsciously, may be carrying out such activities in a desperate attempt to numb psychological pain. Psychologists refer to this short-term (and ultimately damaging) coping mechanism as dissociation.

3) Overcome intense fear of rejection and abandonment.

Many BPD sufferers intensely fear rejection/abandonment and may make desperate attempts to avoid it, including threatening/attempting suicide. This is connected to the fact that many BPD sufferers experienced deeply insecure childhoods, and being rejected as adults can trigger memories, and the corresponding emotions, of having been rejected/abandoned as children.

4) Stabilize interpersonal relationships.

Often, BPD sufferers fluctuate between idealizing and demonizing those they are emotionally intimate with, seeing them as ‘all good’ one minute and ‘all bad’ the next. Indeed, many BPD sufferers think in terms of ‘black and white’ in general, ignoring the shades of grey in-between. Such thinking is unhelpful and over – simplistic. Life is much more complex than that.

5) Improve self image.

Many BPD sufferers were excessively criticized and made to feel unlovable as children. They are then likely to have internalized these negative messages and, consequently, to have grown up to believe, erroneously, that they are ‘intrinsically a bad and unworthy person’.

6) Learn to cope with stress more effectively.

We have seen in other posts that a very stressful childhood can physically damage the brain’s development (eg. by damaging an area of the brain known as the amygdala) which can lead to severe over reactivity to stress as an adult (psychologists refer to this as emotional dysregulation or emotional lability.

7) Stop self-harming behaviour.

BPD sufferers often self-harm as a way of coping with mental anguish and distress; this is a form of dissociation. They may, too, threaten or attempt suicide in response to real or imagined rejection.

8) Find meaning in life.

Often, BPD sufferers experience life is being empty, meaningless, pointless, futile and absurd.

9) Eliminate paranoia.

Because many BPD sufferers felt constantly in danger and under threat during their childhoods, this was fertile ground in which to develop paranoid thinking which may worsen and become pathological in adulthood.

 

More Advice On BPD : Click here for very informative and helpful link.

 

eBook:

brain damage caused by childhood trauma

Above eBook now available on Amazon for instant download. Click here.

 

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

Five Types Of Dysregulation Linked To Childhood Trauma.

 

I have written extensively on this site about the link between the experience of significant childhood trauma and the possible later development of borderline personality disorder (BPD).

One of the leading experts on borderline personality disorder is Martha Linehan (who developed the treatment for BPD known as dialectical behavioral therapy, or DBT) and, according to her widely accepted theory, those who have developed BPD as a result of their adverse childhood experiences are often affected by all, or combinations of some, of the following types of DYSREGULATION:

(If we are dysregulated in relation to a quality, it means, in this context, that we have difficulty controlling and managing whatever the specific quality may be.)

download

Above: DBT has been shown to be an effective therapy for helping people who suffer from BPD and problems connected to various types of dysregulation (see five types below).

The Five Types Of Dysregulation We May Experience If We Have Developed BPD As A Result Of Our Childhood Trauma :

1) Emotional dysregulation:

We may have very volatile emotions that are so powerful we can feel controlled and overtaken by them. We may experience particularly intense and fluctuating emotions in response to our relationships with others, particularly our closest relationships.

Also, we may have difficulty identifying what exactly we are feeling (ie. find it hard to name some emotions we experience) and have problems expressing and experiencing some emotions.

2) Interpersonal dysregulation:

This means we might experience significant difficulties both forming and maintaining relationships with others. We may, too, constantly fear rejection and abandonment, leading to us becoming ‘needy’ and ‘clingy’ which, most sadly, can often cause the very rejection we are trying so ardently to prevent.

We may, too, find our feelings for others often vascillate dramatically from idealisation one minute, to demonization the next, possibly apropos (objectively speaking) very little.

3) Cognitive dysregulation:

This type of dysregulation may lead us to experience dissociation, depersonalisation and paranoia.

 4) Behavioural dysregulation:

Our behaviour may become extremely self – destructive : we may self-harm, attempt suicide, have promiscuous and unsafe sex, take unnecessary risks (such as reckless driving), become addicted to drugs and/or alcohol in a desperate attempt to numb and temporarily escape from overwhelming mental anguish, or develop eating disorders.

5) Self – dysregulation:

We may feel confused as to who we are and have a very poor sense of identity. We may feel different aspects of our personality are not well integrated so we can find ourselves acting in rather one-dimensional ways.

Our self-image can be unstable as can our values. We may be confused as to who we really are and what are beliefs and principals are ( indeed, these may frequently alter).

This can leave us feeling lonely and empty.

To read my article on the therapy devised by Marsha Linehan called dialectical behavioural therapy, click here.

 

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

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

 

The Injustice Of Prejudice Against BPD Sufferers.

It is indeed a tragedy and injustice that many people who suffer from Borderline Personality Disorder (BPD), a condition which can inflict excruciating mental pain on the suffer (10℅ eventually kill themselves), are not only not helped by others, but blamed for the symptoms they display as a result of their illness.

This can result in complete rejection from family and friends, and I state this with the benefit (if that’s the word we’re looking for) of my own bitter experience. Their lack of knowledge, understanding and imagination can lead them (family and friends) to view the BPD sufferer as having a flawed character rather than accept s/he is genuinely, and seriously, ill.

Of course, if one’s family has contributed to one’s illness (there is a strong association between childhood trauma and the later development of BPD) it can very much suit them to blame the sufferer rather than to face up to their own culpability for reasons that are far too obvious to require elucidation from me.

To use an analogy, it’s rather like one’s family beating one to a pulp and then blaming one for bleeding over them and spoiling their clothes, is it not?

The author of Borderline Personality Disorder Demystified, Robert O. Friedel, MD, Distinguished Clinical Professor at Virginia Commonwealth University, states:

Many people believe that the symptoms and behaviours of people with Borderline Personality Disorder should be entirely under their control. This is not the case. To a significant degree, Borderline Personality Disorder is the result of disturbances in brain pathways that regulate emotion and impulse control. In other words, this is a true medical disorder, and, basically, no more under one’s control than diabetes or hypertension.’

I rest my case.

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