*****Lecture 9 - Clinical disorders of the self Flashcards
What counts as a disorder?
Distress + length of time
What are the criticisms of the DSM?
X – no biological basis – don’t know root cause, only symptoms
X – no recognition of sociological factors (Public services, infrastructure, employment, poverty)
X– money making machine - insurance & Healthcare
X – 2 people with same diagnosis, may have completely different symptoms – reducing effectivness of treatment
What are the good/ bad things about being diagnose?
√ - relief
√ - shows youre not alone
√- suggests treatment
√- shows they’re not crazy
X - Stigma
X - concerns they will ’freak out’
X - behaviours not seen as normal
X - Trust erodes
How do disorders relate to self?
All mental disorders involve some lack of control/ awareness of thoughts
- though spirals
- dissociation or hallucinations
Self-regulation is challenged (socially/ physically) but illness
Disorder leads to identity concerns
- am i crazy?
- am I just my ilness? Is it who I am or temporary?
Define Depression
- Persistent low mood over 2+ weeks, with decreased energy, appetit, interest, & pleasure in normal activities
- most common mental illness - 1/5 in UK
What are the symptoms of depression?
Symptoms:
- Low mood
- low energy, interest, appetite, pleasure
- fatigue, insomnia or hypersomnia
- weight loss/ gain
- difficulty concentrating
What are the the treatments of depression?
Treatment
- CBT – skills to change habitual responses
- ’Talk’ therapy – uncover subconcious/ emotional root causes
- SSRI’s
How does depression relate to self?
ABM
- Persistent rumination of events
- overgeneralised ABM’s, black and white thinking - memory is either good or bad
Self-esteem
- Ignore positive events
- Focus on failure
- underestimate how much others like them & perceived control in own life
Self-awarenss (Taylor & Brown, 1988)
- Lack of normal positive illusions (needed to maintain positive SE)
- Lackof normal, unrealistic optimism
What are the 4 body awareness disorders (not in DSM)
Body dysmorphic disorder – obsessively think something is wrong about a facial feature
Eating disorders - Severe disturbances in eating behaviours
Somatoparaphrenia - denial of ownership of body part
Alien hand syndrome - lacking control over body part
Define body dysmorphic disorder
Definition: Preoccupation with imagined defect in appearance
- related to OCD
Think there is something wrong with you, you become obsessed with it – my ears are huge
Causes distress and intense behaviour to fix it
What is the epidiemology of BDD
Epidemiology:
- Usually onset late teens
- lifelong condition - whhen fixed you just change to a new part
- Equally in males and females
What are the symptoms of BDD
Symptoms:
- obsess over defect
- try to fix it (may be unhealthy)
What is a varaition of BDD where you work out loads>
Muscle dysmorphia (bigorexia) – work out loads
- Obsessing about being too small/ weak
- Constant training – don’t socialise/ work
- More common in men
- risky behaviour (steroids)
- think you are healhty
What is the treatment for BDD?
Plastic surgery to fix the defect
- rarely succesful as they don’t believe its fixed or switch defect
SSRI’s
- can reduce feelings of distress (depression is also often comorbid)
CBT
- helps recognise and alter unhealthy thoughts
Define eating disorders
Definition: Severe disturbances in eating behaviours
What are the problems/ symptoms with anorexia nervosa?
- obsession with being thin – distorted sense of appearance
- Extreme control & Limitation of food intake (maybe excessive excersise)
- Reduced nutrition leads to other ilness, even death (highest morbidity rate of mental illness)
What is the epidimiology of anorexia?
- Mostly women, but some men
- Mostly puberty, but some old age
What is the treatment of anorexia?
- re-nutrition
- CBT
- hospitalisation
Define somatoparaphrenia
denial of ownership of body part
- aka Body integrity identity disorder
What is the epidimiology of somatoparaphrenia
- Rare
- some association with brain damges, not all cases though
What is the symptoms of somatoparaphrenia
- Feeling that a body part isnt actually ours, it doesn’t belong to us
- May neglect body part – not wash, groom or exercise it
- Paralysis or lack of motor control in body part
What is the treatment of somatoparaphrenia
Treatment
- patients typically want the limb amputated – but amputating a healthy limb tends to create more problems. But is effective in reducing stress
- Muller (2009)
- amputation doesn’t treat the neurological basis of disease
- This disorder stops people making competent decisions
- Kovacs (2009)
- people with Gender Identity disorder who wanted to change sex not treated as incompetent
- patients realise this is odd – so they’re not inompetent
- Our unwillingness shows our discomfort with active harm
Define alien hand syndrom
Lacking control over body part
what are the problems/ symptoms of alien hand syndrome?
Body part moves involuntarily
person often lacks awareness of hand
What is the causes of alien hand syndrom?
Tumour, stroke, surgery
what are the treatments? of alien hand syndrome?
No current treatment
- could be short live or last years
What are the 3 types of dissociate disorders?
Dissociative Fugue - temporary extreme dissociation, to the point of memory loss and irregular behaviour
Automatisim - act done by body without control
Dissociative identity disorder - inconsistences in behaviour that occur in sets of indentities, including sudden transition to new identies (split personalities)
All involve detachment from current self/ lived experience
Define dissociation
A feeling of detachment from present self
- emotional and physical
- Lessened attention or sensation/ awareness of simtuli
If it lasts ages, becomes a disorder
Define depersonalisation
- feeling that you are not real
- experiences happening as it to someone else (3rd Person)
If it lasts ages, becomes a disorder
Define derealisation
- Feeling everyone else in the world is not real
If it lasts ages, becomes a disorder
Define dissociative fuge
temporary extreme dissociation, to the point of memory loss and irregular behaviour
What are the symptoms of dissociative fugue?
- unexpected depature from work/ home/ normal behaviour
- Typically involves wandering off
- No memory of behaviour during it – don’t know why they left
- confusion of ID during fugue
- non-typical behaviour
What are the epedimiology of dissociative fugue?
- unclear pattern of occurance
- no clear relation to age, sex
- may be caused by trauma, alcohol, extreme stress
What are the problems of dissociative fugue?
Problems:
- unpredictable
- Damaging to social relationships – trust issues – concerns with faking
Agatha christie famously suffered this, wandered 100 miles from home
Define automatism (not in DSM)
act done by body without control or intent of mind (had no idea what was going on)
- not self-induced
- cant foresee actions or consequences of actions
Includes spasms, reflexes, convulsions, sleep walking
Can be used as a legal defence
Define parasomnia
tomatic activation of nervous system whil sleeping (parts of brain are awake but youre asleep)
Includes
- Bruxism (grinding jaw), bed wetting, sleep eating/ talking
- sleep walking – appear awake
- Sleep terro – extreme emotional arousal whilst asleep
- sexsomnia – having sex when asleep
Define Dissociative identity disorder (DID)
inconsistences in behaviour that occur in sets of identities, including sudden transition to new identities
Whats the epidimiology of DID?
- very young (mean = 9)
- Highly associated with childhood trauma – dissociate to avoid dealing with the stress of that, to protect self and cope
Whats the symptoms of DID?
Symptoms
- feeling of being deifferent people at different times – using ‘we’ not ‘i’
- Each ID has own memories and control, others ‘alters’ have no control or memories
- Different ID’s may have differnet voices, genders, beliefs, postures, handwriting, abilities
Host = neutral shell of a person with original identity as one of your
How is DID controversial?
- induced by therapy – when being treated for something else?
- Autohypnosis – when faced with threat we self-hypnotise
- unclear evidence (Kong et al, 2008)
- concerns about legal culpability
- Media portrayal – faking it
Outline Kong (2008)’s unclear evidence surround DID
– asked p’s with DID to remember word lists, then showed them emotional images, causing them to change ID to an alter, then asked to recall them, theoretically they souldnt be able to, but they could
What is the treatment for DID?
- Difficult to complete, due to alters
- Hyponisis
- CBT
- Talk therapy
- SSRI’s
Which personality disorder do we look at?
Borderline personality disorder (BPD)
Define Personality disorders
disorders where ones belief and behaviours cause problems for self and others
Long term, chronic, conditions – no cures, just treatments to reduce symptoms
Supposedlly central to persons self/identity
- Pds about who they are, not what they do (as for other disorders)
- But this suggests its unable to be changed/ treated
Highly stigmatised disorders
- moost poorly portrayed in media
- seen as problem with the person, not the ilness
Define BPD
difficulties with impulse control, fear of abandonment, unstable sense of ID and frequent mood swings
What are the problems with BPD?
- unstable relationships (I hate you then don’t leave me)
- Impulsive and risky behaviour
- Dangerous activities
- Subtance abuse
- Impulse spending, eating
- upreditable & changing mood – regulation is difficult (and have to deal with consequences)
- intense feelings can lead to outbursts/aggression
What are the epidiemiology of BPD?
- 1-2% of population
- Frequent suicidal & harming behaviours lead to frequent hospitalisation – 20% of psychiatric patients
- Suicide rate up to 50X higher than general population – 10% may commit suicide
- Late teens, early 20s
- Abuse or trauma in childhood common
- Much more likely to have BPD if 1st degree relative does as well
What are the 9 symptom categories for BPD?
Affective domain
1) Intense displays of anger, difficulty self-regulating anger
2) Chronic feelings of emptiness – constant feeling that you don’t have an ID
3) Extreme, frequent mood swings
Cognitive domain
4) Dissociation and/ or paranoid ideation
5) ID instability – no coherent self over time, one person then another
Behavioural domain
6) Recurrent suicidal behaviour, attempts or threats – self harm to deal with distress
7) Impulsive activities - includes impulse spending/ risky behaviours (drugs/ alcohol)
Relatoinship domain
8) Fear of abandonment – emptiness + mood swings make you feel unstable – need someone else to provide stability. Or a constant fear of people dying
9) Unstable relatoinships – swinging btween idealising or criticisin partner
What are the neuroscience explanations for BPD?
Highly reactive amygdala and ACC (Herpetx et al. 2001)
- Other studies report low activity in ACC – p’s should be experiencing pain but arent
Possible lower volume of brain matter in ACC & other areas (Hazlett et al., 2005)
- Problem is worse for those who are suicidal
Hyperactive HPA (Hypothalamic-pituitary-adrenal axis)
- increased production of stress hormones
What problems for everday life can BPD cause?
Extreme emotional difficulties
- unpredictable & extreme mood swings make everyday life difficult
- Exhausting emotional experiences from minor events
Can also have empathetic difficulties
Interpersonal relationships
- Difficulty maintaing relationships
- Intensity of emotion is overwhelming for self and partner
- Scared of being alone so beg people not to leave them
Stigma
- even self-help books label BPD in a negative way
- Women gone mad
- Self-harm scars cause discomfort
Outline dialectical behaviour therapy as a treatment for BPD
- Invented by Marsha Linehan - created it for her own BPD
- Like CBT – p’s practice skills to overcome maladaptaive behaviours + thought patterns
4 components/ skills needed to learn - mindfulness
- Crisis management – manage extreme emotion (not self harm)
- Emotion regulation – preventing emotional climax
- Interpersonal effectiveness – Practice other healthy behaviours
√ - most effective therapy
X – hard to implement – training of staff and lots of time
What are the treatments for BPD?
DBT
Mentalisation based therapy
- training to pay attention to emotional states and not act reactively
Mindfulness therapy
- be aware of emotion and bodily reactions at all times
- acceptance of current state
Talk therapy
- Difficulties due to stigma from doctors
- Difficulties due to inconsistent sense of self – the person being treated changes
Medication
- Not great – very temporary
- which one to choose? One for depression? One for hyperactivity?
What is the stigma surround disorders?
- lack of trust
- Associated with negative traits
- Self-stigma, people assume this about themselves
- Impact on employement - incable/ create problems
- Impact on relatinoships (stress out family)
- inability to discolse it to anyone
