I would like to thank all my freinds and family for the ongoing love and support this difficult year.
To all my clients and alienated parents, grand parents and children
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Month: December 2020
Categories
The Dissociative Continuum
In the face of persisting threat, the infant or young child will activate other
neurophysiological and functional responses. This involves activation of dissociative adaptations.
Dissociation is a broad descriptive term that includes a variety of mental mechanism involved in disengaging from the external world and attending to stimuli in the internal world. This can involve distraction, avoidance, numbing, daydreaming, fugue, fantasy, derealization, depersonalization and, in the extreme, fainting or catatonia.
In our experiences with young children and infants, the predominant adaptive responses during the trauma are dissociative.
Children exposed to chronic violence may report a variety of dissociative experiences.
Children describe going to a ‘different place’, assuming the persona of superheroes or animals, a sense of ‘watching a movie that I was in’ or ‘just floating’ – classic depersonalization and derealization responses. Observers will report these children as numb, robotic, non-reactive, “day dreaming”, “acting like he was not there”, staring off in a glazed look.
Younger children are more likely to use dissociative adaptations. Immobilization, inescapability or pain will increase the dissociative components of the stress response patterns at any age.
Hippocampus: Another key system linked with the RAS and playing a central role in the fear response is the hippocampus, located at the interface between the cortex and the lower diencephalic areas. It plays a major role in memory and learning. In addition it plays a key role in various activities of the autonomic nervous and neuroendocrine systems. Stress hormones and stress related neurotransmitter systems (i.e., those from the locus coeruleus and other key brainstem nuclei) have the hippocampus as a target. In animal models, various hormones (e.g., cortisol) appear to alter hippocampus synapse formation and dendritic structure, thereby causing actual changes in gross structure and hippocampal volume as defined using various brain imaging techniques (see McEwen, 1999 for review). Repeated stress appears to inhibit the development of
neurons in the dentate gyrus (part of the hippocampus) and atrophy of dendrites in the CA3 region of the hippocampus (Sapolsky & Plotsky, 1990; Sapolsky et al., 1990). These neurobiological changes are likely related to some of the observed functional problems with memory and learning that accompany stress-related neuropsychiatric syndromes, including post-traumatic stress disorder (PTSD: see Perry & Azad, 1999)
When the child perceives threat (e.g., anticipating an assault on self or loved one), their
brain will orchestrate a total-body mobilization to adapt to the challenge. Their emotional,
behavioral, cognitive, social and physiological functioning will change. These responses to threat are heterogeneous and graded. The degree and nature of a specific response will vary from individual to individual in any single event and across events for any given individual. In animals and in humans, two primary but interactive response patterns, hyperarousal and dissociative, have been described (Perry et al., 1995; Perry, 1999). Most individuals use various combinations of these two distinct response patterns during any given traumatic event. The predominant response patterns and combinations of these primary ‘styles’ appear to shift from dissociative (common in babies and young children) to hyperarousal during development.
https://www.childpsych.theclinics.com/article/S1056-4993(18)30258-X/pdf
The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caregiver-report measure of childhood traumatic stress and abuse-related experiences in children, ages three to twelve years old.
Purpose
The objective of this review is to examine the current empirical evidence (n = 22) regarding the psychometric properties of the TSCYC.
Method
A variety of study designs were reviewed for psychometric evidence supporting the reliability and validity of the TSCYC.
Results
The psychometric evidence for the TSCYC indicates it is a reliable scale. However, evidence of validity is moderate and focuses on older children.
Discussion
Clinicians may utilize the TSCYC to support a PTSD diagnosis in children. Further psychometric exploration would strengthen the body of evidence for younger children (ages 3–5) who have had traumatic experiences.
https://www.tandfonline.com/doi/full/10.1080/26408066.2020.1799892?src=
Categories
Types of attachment
Approximately 15% of infants in low psychosocial risk and as many as 82% of those in high-risk situations do not use any of the three organized strategies for dealing with stress and negative emotion (9). These children have disorganized attachment. One recently identified pathway to children’s disorganized attachment includes children’s exposure to specific forms of distorted parenting and unusual caregiver behaviours that are ‘atypical’ (10,11). Atypical caregiver behaviours, also referred to as “frightening, frightened, dissociated, sexualized or otherwise atypical” (10), are aberrant behaviours displayed by caregivers during interactions with their children that are not limited to when the child is distressed. There is evidence to suggest that caregivers who display atypical behaviours often have a history of unresolved mourning or unresolved emotional, physical or sexual trauma, or are otherwise traumatized (eg, post-traumatic stress disorder or the traumatized victim of domestic violence) (12).
Categories
Attachment
Parents play many different roles in the lives of their children, including teacher, playmate, disciplinarian, caregiver and attachment figure. Of all these roles, their role as an attachment figure is one of the most important in predicting the child’s later social and emotional outcome (1–3).
Attachment is one specific and circumscribed aspect of the relationship between a child and caregiver that is involved with making the child safe, secure and protected (4). The purpose of attachment is not to play with or entertain the child (this would be the role of the parent as a playmate), feed the child (this would be the role of the parent as a caregiver), set limits for the child (this would be the role of the parent as a disciplinarian) or teach the child new skills (this would be the role of the parent as a teacher). Attachment is where the child uses the primary caregiver as a secure base from which to explore and, when necessary, as a haven of safety and a source of comfort (5).
Attachment is not ‘bonding’. ‘Bonding’ was a concept developed by Klaus and Kennell (6) who implied that parent-child ‘bonding’ depended on skin-to-skin contact during an early critical period. This concept of ‘bonding’ was proven to be erroneous and to have nothing to do with attachment. Unfortunately, many professionals and nonprofessionals continue to use the terms ‘attachment’ and ‘bonding’ interchangeably. When asked what ‘secure attachment’ looks like, many professionals and nonprofessionals describe a ‘picture’ of a contented six-month-old infant being breastfed by their mother who is in a contented mood; they also often erroneously imply that breastfeeding per se promotes secure attachment. Others picture ‘secure attachment’ between a nine-year-old boy and his father as the father and son throw a ball in the backyard, go on a fishing trip or engage in some other activity. Unfortunately, these ‘pictures’ have little, if anything, to do with attachment, they are involved with other parental roles (eg, their role as a caregiver in the case of the breastfeeding mother and as a playmate in the case of the father and son playing catch in the backyard). One might ask why the distinction between attachment and ‘bonding’ matters. The answer may lie in the fact that ‘bonding’ has not been shown to predict any aspect of child outcome, whereas attachment is a powerful predictor of a child’s later social and emotional outcome.
Within the DSM-IV-TR, the criteria for antisocial personality read:
A. There is a pervasive pattern of disregard for and violation of the rights of
others occurring since age 15 years, as indicated by three (or more) of the
following:
Failure to conform to social norms with respect to lawful behaviors as indicated
by repeatedly performing acts that are grounds for arrest.
2). Deceitfulness, as indicated by repeated lying, use of aliases, or conning others
for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or
assaults. - Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations. - Lack of remorse, as indicated by being indifferent to or rationalizing having
hurt, mistreated, or stolen from another. - The individual is at least age 18 years.
- There is evidence of Conduct Disorder with onset before age 15 years.
- The occurrence of antisocial behavior is not exclusively during the course of
Schizophrenia or a Manic Episode (American Psychiatric Association, 2000).
Although these criteria are often seen in both sociopaths and psychopaths, there
exists an argument that sociopathology, psychopathology and antisocial personality
disorder by themselves are their own individual personality disorders (Hare, Hart &
Harpur, 1991)
https://scholarworks.smith.edu/cgi/viewcontent.cgi?article=1570&context=theses
This review proposes the ‘attachment and the deficient hemispheric integration hypothesis’ as explanation for psychopathy. The hypothesis states that since secure attachment to the parents is essential for the proper development of both the hemispheres in children, psychopaths with histories of neglect and abuse are unable to develop efficient interaction of both the hemispheres, important for emotional processing and regulation. Various studies have shown that without an efficient interaction between the two hemispheres psychopaths fail to perform adequately on tasks that require both language abilities and non-verbal emotional processing. The hypothesis also explains why psychopaths will perform inefficiently in conditions that selectively prime the left hemisphere resources as these people would have learnt to rely more on the language based mode of this hemisphere. The childhood of psychopaths is marked by insecure attachment with their parents where the parents fail to respond to the needs of the pre-verbal infant thus leading to improper development of the right hemisphere abilities, one of which is decoding and showing appropriate non-verbal emotional signals resembling a pattern shown by the parents. The hypothesis is useful in explaining different findings on laterality in psychopathy as well as answering the nature-nurture debate of the disorder. Research carried out under the proposed framework can be helpful in understanding the nature of the disorder which will be ultimately useful in the prevention of its full blown manifestation.
Haltlose personality disorder is an ICD-10 personality disorder[27] in which affected individuals possess psychopathic traits built upon short-sighted selfishness[20] and irresponsible hedonism, combined with an inability to anchor one’s identity to a future or past.[28][29] The symptoms of Haltlose share similarites with frontal lobe syndrome, sociopathic and histrionic personality traits,[28][30] and are characterized by a lack of inhibition[31] and “the immaturity of moral and volitional qualities…and the absence of positive ethical attitudes.”[32]
Described by Emil Kraepelin and Gustav Aschaffenburg in the early twentieth century as one of seven classes of psychopath,[33][34][35] and further distinguished by Karl Jaspers, Eugen and Manfred Bleuler, it has been colloquially dubbed psychopathy with an “absence of intent or lack of will”.[3]
With other hyperthymics, Haltlose personalities were considered to make up “the main component of serious crime”,[21] and are studied as one of the strains of psychopathy relevant to criminology[36][37][38] as they are “very easily involved in the criminal history”[39] and may become aggressors[4][40] or homicidal.[41] A 2020 characterization of psychopathies noted of the Haltlose that “these people constantly need vigilant control, leadership, authoritarian mentor, encouragement and behavior correction” to avoid an idle lifestyle, involvement in antisocial groups, crime and substance abuse.[32][42] The marked tendencies towards suggestibility are off-set by demonstrations of “abnormal rigidity and intransigence and firmness”.[43]
After discovering a guilty conscience due to some act or omission they have committed, “they then live under constant fear of the consequences of their action or inaction, fear of something bad that might strike them” in stark opposition to their apparent carelessness or hyperthymic temperament,[44] which is itself frequently a subconscious reaction to overwhelming fear.[9] They frequently withdraw from society.[45] Given their tendency to “exaggerate, to embroider their narratives, to picture themselves in ideal situations, to invent stories”,[25] this fear then manifests as being “apt to blame others for their offences, frequently seeking to avoid responsibility for their actions”.[46] They do not hold themselves responsible for their failed life, instead identifying as an ill-treated martyr.[20]
They were characterized as Dégénérés supérieurs,[13] demonstrating normal or heightened intellect but degraded moral standards.[47] Of the ten types of psychopaths defined by Schneider, only the Gemutlose (compassionless) and the Haltlose “had high levels of criminal behavior” without external influence, and thus made up the minority of psychopaths who are “virtually doomed to commit crimes” by virtue only of their own constitution.[48] Frequently changing their determined goals,[9] a haltlose psychopath is “constantly looking for an external hold, it doesn’t really matter whether they join occult or fascist movements”.[49] The ability to moderate external influence was considered one of three characteristics necessary to form an overall personality, thus leaving Haltlose patients without a functional personality of their own.[50] A study of those with haltlose personality disorder concludes “In all of those cases, the result was a continuous social decline that ended in asocial-parasitic existence or an antisocial-criminal life”.[48][51][52]
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