Tag Archives: Psychotic Depression

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 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)

 

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).

 

 

Fifteen Types of Depression.

facts about depression

types of depression

On average, and all else being equal, the more traumatic a person’s childhood, the more likely it is that s/he will experience depression at some point in his/her life.

I list below sixteen different categories of depression. A person can fit into more than one category at any one time.

THE SIXTEEN CATEGORIES OF DEPRESSION :

1) AGITATED DEPRESSION – with this type of depression the person suffering from it is constantly restless, intensely worried and deeply anxious/fearful (I suffered this type of depression and was often incapable of even staying seated).

2) RETARDED DEPRESSION – this type of depression causes the person suffering from it to very significantly slow down both mentally and physically (this is technically referred to as PSYCHOMOTOR RETARDATION). There will also be great difficulty in concentrating. In its most extreme manifestation, the afflicted individual cannot move, speak or eat  which carries with it the risk that s/he will starve to death. This state of complete inactivity is sometimes referred to as CATATONIA.

3) PSYCHOTIC DEPRESSION – with this type of depression the individual may lose touch with reality and may suffer from delusions (outlandish false beliefs) or hallucinations (seeing or hearing things which are not there). It can be treated with anti-psychotic medication.

4) NEUROTIC DEPRESSION – (this term is now falling into disuse and is being replaced with the term ‘mild depression). It is a less severe form of depression than psychotic depression (see above) and the person’s mood may fluctuate from day to day and also during the day (often, for example, feeling bad in the morning but improving in the evening). The person suffering from it may have symptoms of irritability and disrupted sleep (finding it hard to go to sleep and frequently waking during the night; however, with this type of depression there does not tend to be early morning waking which is a hallmark of other types).

5) ORGANIC DEPRESSION – this type of depression has a physical cause and can manifest itself as a result of side effects of medication. For example, the British comedian Paul Merton suffered a serious depression, for which he needed to be hospitalized, as a complication of taking anti-malaria tablets.

6) DYSTHYMIA – this is a relatively mild but persistent type of depression. Its main symptoms are low self-esteem and difficulties in making decisions. It often responds better to psychotherapy than to treatment with drugs.

7) BRIEF RECURRENT DEPRESSION – this term is relatively new and refers to serious depression which comes and goes but tends only to last for a few days at a time.

8) MASKED DEPRESSION – this is also sometimes referred to as ‘smiling depression’. Whilst the individual who has this type of depression will report that they DO NOT feel depressed, they will, nevertheless, have some of the symptoms of depression. Indeed, the symptoms will often respond well to anti-depressant medication.

9) BIPOLAR DISORDER – this used to be referred to as ‘manic-depression’. With this disorder, the person vascillates between feelings of elation and periods of despair. During their highs (the ‘manic’ phase) there will be a reduced need for sleep, excessively high energy levels often leading to frenzied activity, racing thoughts and a ‘flight of ideas’, reduced need to eat and possible delusions (eg believing they are the reincarnation of a Roman Emperor, are next in line to the throne or have special, superhuman powers) and hallucinations.

Often, too, judgment will be extremely impaired leading to, for example, massive gambling losses, vast overspending or investing huge amounts of money in doomed business ventures. Also, the individual suffering from such mania is likely to feel ‘invincible’ and that s/he ‘can achieve anything.’  However, these periods burn themselves out and are replaced by depression which may be so severe the sufferer considers or attempts suicide.

The depression may be made worse due to the lack of judgment s/he experienced during the manic phase and the self-destructiveness this may have involved (eg s/he may have taken on enormous and unrepayable debts).

10) SEASONAL AFFECTIVE DISORDER (S. A. D.) – this is a form of depression which only strikes in the winter months due to the lowered amount of sunlight during this period. Symptoms can include an increased need for sleep and carbohydrate cravings.

11) UNIPOLAR DEPRESSION – this is, by a very long way, far more common than bipolar depression – only low mood is experienced ; there are no highs/manic episodes.

12) REACTIVE DEPRESSION – sometimes called ‘endogenous depression’. This type of depression occurs as a reaction to a stressful event, such as being made redundant ;  it is normally relatively short-lived and often responds well to counselling or family support.

13) RECURRENT DEPRESSION – any period of depression which is not the first one the person has experienced is called ‘recurrent depression.’

14) CHRONIC DEPRESSION – the word ‘chronic’ means long lasting (some people misuse the word when what they actually mean is ‘severe’). Doctors refer to a depression as being ‘chronic’ if it has gone on for at least two years.

15) TREATMENT RESISTANT DEPRESSION – this refers to a depression which does not improve with anti-depressant drugs. This was the type of depression I had/have. In such cases, if the depression is very severe and life-threatening (due to self-neglect or high suicide risk) electro-convulsive shock therapy (ECT)may be used as as  a last resort. I myself had to undergo ECT on a number of occasions over the years (although, unfortunately, this had no positive effect whatsoever in my own case ; however, for some it can be life saving).

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

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