Mental Illness: A Global Economic issue

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Mental illness is one of the leading causes of mortality and morbidity worldwide and people with severe mental illnesses tend to die of preventable conditions 25 years earlier than persons without such diagnoses. Distressing symptoms can be exacerbated by the inability to participate in work, leisure or age-appropriate responsibilities.  The substantial number of people affected by mental illness worldwide (450 million) has profound socio-economic implications for quality of life, health care systems, and the economic cost to society.

Since I decided my dissertation would focus on Mental illness and UK/US labour market outcomes, I wanted to summarize here some of the main economic costs society faces today. Growing research in behavioral economics and finance acknowledge the impact of psychological mechanisms on economic behaviour, but there is still a strong need for mental health to be incorporated into research studies, economic theories and methodologies. So, we must work to conceptualizing mental illness in an intelligible way that captures and delineates the empirical facts about the relationship between mental illness and economic variables (i.e. productivity, growth and utility).

Many disorders begin in childhood/adolescence and have significant adverse effects on daily functioning.  Although mental disorders are estimated to account for 13% of the global burden of disease, the mental health budgets of the majority of countries constitute less than 1% of their total health expenditures – a colossal treatment gap . Hence, expansion of treatment would be cost-effective from occupational, economical and societal perspectives.

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Labour Market

Previously, physical health was imperative for job performance, by cause of globalisation and rises in the services sector; it is now mental health. Jobs have become innovation-driven, knowledge intensive and psychologically more demanding. A higher level of cognitive, social and emotional skills, are needed to keep up with the dynamic labour market characterized by growing (perceived) job insecurity, job turnover, and more frequent (spells of) unemployment. Thus, psychological wellbeing is of utmost importance.

On the other hand, a quality working environment is also vital for good mental health. Work has a greater psychological impact on employees today as employment could equip you with psychologically valuable elements i.e. intrinsic motivation, self-esteem, possibilities for self-development and personal growth, and a sense of meaning or negative psychological effects (i.e. work related stress, burnout, resulting MH problems like depression, anxiety,psychosis..) and the enormous costs associated with them, in terms of reduced productivity and human capital investment..increased absenteeism, work disability and health care costs

Direct Costs

  • Cost of treatment
  • Cost of medication
  • Hospitals
  • Prisons
  • Impaired work performance
  • In communities, some high income economies show that mental disorders consume more than 20% of all health service expenditure.
  • Cost of childcare
  • Loss productivity by patient and/or family members

Indirect costs 

Mental health problems costs the EU an estimated 3-4% of GDP, mainly through lost productivityThose with depression experience symptoms that interfere with work ( i.e an inability to concentrate, low energy and easy fatigability, exaggerated self-doubts, indecisiveness and disturbed sleep).

Indirect labour costs include:

  • Reduced productivity
  • Increased absenteeism
  • Work disability
  • ‘Presenteeism’ (showing up at work while being not productive/counterproductive)
  • Effects on skill acquisition
  • Reduced cognitive and social functioning

Especially in high-income countries, which are working to improve the quality and effective use of human capital, the costs associated with mental health problems and the resulting loss of functionality are vast, and increasing.

Harvard Professor Ronald Kessler specializes in global mental health studies, observes: “There is an entire burgeoning area of literature that looks at the impact of medical conditions on role performance. Depression is one of the most costly conditions in the workplace, and the majority of dollars for health care comes from employers. They are very interested in knowing what they are getting for their dollar. Where once mental health was likely to be the first thing cut, today a lot of forward thinking employers are seeing the value of high-quality mental health care”.

Conclusion

I love Economics and I love Psychiatry. This topic is salient, compelling, and also personal to me. Since childhood I always questioned economic issues and human psychology. The economy is essentially run by us and by factoring in human behavior into scientific theories, but also aspiring to greatly improve the psychological well being of the masses, then surely it would lead to greater productivity and benefits for most.

It is clear mental health is highly significant to the economy, but also an important economic asset to have. Mental illness disturbs mood, thought or functioning, which hinders a person from leading a fulfilling or productive life. It tends to obstruct a person’s ability to study, work, and to make decisions about educational, employment, housing or other social choices. Consequently, mental health disturbances not only impact the individuals who have them, but hindrance to their families and increased economic costs to society at large.world suicide

76%-85% of people with severe mental disorders in low to middle income countries receive no treatment. For high income countries 35-50% endure no treatment. Certain populations live in a situation that makes them particularly vulnerable to developing mental disorders and the social and economic impact of mental disorders.

Many resources are spent on preventing, treating and improving mental health. Antidepressants have proliferated from a modest market in the 1980 to reaching sales of $12 billion in 2008, plus the self-help market in the U.S was worth $10.82 billion in 2007.

Evidently, both the public and private sector should continue to spend on stress management and treatment programs, but a continuous effort must be made by all members of society to achieve national prosperity. 

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Posted in Psychiatry, Psychology, Socioeconomics

Borderline Personality Disorder: The Introduction

 

mood swings

Today I return to write about one of my ‘favourite’ disorders or topics in Psychiatry; Borderline Personality Disorder (BPD) (Emotionally Unstable Disorder in ICD-10). The main features include instability of affects, self image, personal goals, interpersonal relations and a tendency to carry out self destructive, injurious or impulsive behaviors which include suicide attempts. Descriptions of individuals demonstrating BPD were first mentioned in medical literature almost 3000 years ago. 

Initially, it was suggested that BPD is between or overlapped with:

  • neurosis: a functional disorder in which feelings of anxiety, obsessional thoughts, compulsive acts, and physical complaints without objective evidence of disease, in various degrees and patterns, dominate the personality.
  • psychosisa severe mental disorder in which thoughts and emotions are so impaired that contact is lost with external reality and the person may experience delusions and hallucinations.

Due to a high level of co-morbidity with other psychiatric illnesses, many perceived BPD to be a ‘wastebasket’ diblogagnosis with diagnostic precision and validity deficiencies, used when patients did not patently fall into other diagnoses. Furthermore, prognosis was thought to be ill-fated and unfortunately today a large number of mental health professionals still believe borderlines respond poorly to treatment despite increasing scientific research that opposes this consensus.

Studies have shown BPD to have diagnostic validity and integrity and some of these studies indicate that the disorder does not overlap with schizophrenia. Also, the disorder does appear to be a distinct diagnostic entity, although it co-occurs frequently with other mental disorders as seen in the table above.

To meet a diagnosis of BPD under the DSM-V, you must show ‘a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following’:

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms
  • The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations
  • The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.
  • The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)
Angelina-Jolie-Oscars-2014-Earrings

Angelina Jolie reportedly checked herself into the Neuropsychiatric Institute in the late 1990s due to self-reported suicidal and homicidal ideation. Once diagnosed with BPD, she began to improve and motherhood helped her to adapt to her condition.

I aim to highlight the maladaptive inner experiences and pathological behavior of those suffering with this disorder in this post. By organizing them into 4 groups, an individual with BPD may be battling with:

Disturbed Identity

People with BPD tend may be in a constant search for who they are. This can be seen in a vast number of life domains (i.e. home, family, style, profession, hobbies, relationships, friends, life principles etc). They may be indecisive and find difficulty in expressing their needs or principles when relating to others. Ambivalence may cause them to change jobs, activities and partners frequently.  In cases of abuse, dissociation may contribute to the development of fragmentation, compartmentalization or ‘alters’ or personalities that are born during traumatic experiences and elicit a particular response. The difficulty with not knowing who they are and what they value can cause people with BPD to experience feeling empty, hollow and lost.

Disturbed Mood

Emotions may repeatedly resurge and persist a long time. Consequently it may take longer than normal for people with BPD to return to a stable emotional baseline following an intense emotional experience. They are also prone to:

Emotional lability: Unstable emotional experiences and frequent mood changes can occur. They may be flooded with emotion then suddenly numb. Emotions are easily aroused, intense and/or out of proportion to events and circumstances. Extensive black and white thinking often turns disappointment into rage, which may be directed at others in physical attacks, bouts of anger, suicidal threats or self-injury.

Little/No Empathy: Compromised ability to recognise the feelings and needs of others associated with interpersonal hypersensitivity. Also, prone to feeling slighted or insulted.

Anxiousness: They may experience intense feelings of nervousness, tenseness or panic often in response to interpersonal stresses, worry about the effects of past negative experiences and future negative possibilities, feeling fearful, apprehensive, on the edge, threatened by uncertainty or fear of falling apart/ losing control.

Hostility: Persistent and pervasive angry feelings; anger or irritability in response to minor slights or insults, rejection or abandonment.

Separation Insecurity: Due to fears of rejection and abandonment from significant others. along with fears of excessive dependency and a complete loss of autonomy.

Depressivity/Dysphoria: Frequent feelings of being down, miserable or hopeless. Pessimism about the future, pervasive shame, feelings of inferiority, suicide and suicidal behavior. Whilst people with BPD feel joy intensely, they are especially prone to dysphoria, or feelings of mental and emotional distress with difficulty recovering from these moods.

Zanarini et alrecognized four categories of dysphoria that are typical of this condition: extreme emotions; destructiveness or self-destructiveness; feeling fragmented or lacking identity; and feelings of victimization. Within these categories, a BPD diagnosis is strongly associated with a combination of three specific states: 1) feeling betrayed 2) “feeling like hurting myself and 3) feeling out of control.

Princess Diana struggled to overcome an eating disorder and had difficulty maintaining relationships. Some experts attribute her BPD to the divorce of her parents and neglect during her childhood. Self-mutilation, binge eating, and promiscuity characterized the dissolution of her relationship with Charles.

Princess Diana struggled to overcome an eating disorder and had difficulty maintaining relationships. Some experts attribute her BPD to the divorce of her parents and neglect during her childhood. Self-mutilation, binge eating, and promiscuity characterized the dissolution of her relationship with Charles.

Disturbed Perception

Splitting: Perception of things, others and themselves oscillate between all good or all bad. They may put someone on a pedestal only to topple them off it when they don’t meet their expectations. They may strive for perfection and feel at times they have achieved it, but may return to harsh self criticism when a mistake is made. They essentially lack trust in others, which is understandable when interaction with caregivers and others were abusive and inconsistent, thus they learnt not to trust and expect to be let down/abused.

Borderlines may feel entitled to special treatment and live outside rules and boundaries. Though, at times of low self esteem they tend to believe they are ‘bad’, ‘unlovable’, ‘not good enough’ and deserving of punishment. This defense mechanism disrupts the development of enduring perceptions of self and others. Abusive relationships may be comfortable to them as they are used to the chaos.

Projection: This defense mechanism causes them to attribute their own negative traits and behaviours to someone else. The borderline may wail ‘you don’t care about me’, when infact you just feel aggravated. The denial of her blatant misconduct may cause one to question their own perception of reality which can be crazy-making.

Intimacy issues: At times, perceptions of others are selectively biased towards negative attributes or vulnerabilities. Relationships tend to be intense, unstable and conflicted. Close relationships are marked by mistrust, neediness and anxious preoccupation with real or imagined abandoned. Splitting causes relationships to bounce between overinvolvement and withdrawal as the BPD idealizes and devalues their partner. 

Disturbed Behaviour

More females are diagnosed with BPD than males by a ratio of about 3:1, though some clinicians suspect that males are underdiagnosed. Nevertheless, there is a reason why females with BPD are dubbed ‘Women of Extremes‘. They tend to have issues doing things in moderation and find themselves on polar opposites most of the time. 

Impulsivity:  Disinhibition leads to substance or alcohol abuse, eating disorders, unprotected sex or indiscriminate sex with multiple partners, reckless spending and reckless driving. Impulsive behavior may also include leaving jobs or relationships, running away, acting on a momentary basis without a plan or consideration of outcomes, lack of concern for ones limitations, denial of the reality with personal dangers, difficulty establishing or following plans and a sense of urgency and self harming behaviour under emotional distress.

People with BPD act impulsively because it gives immediate relief from their emotional pain or emergence of building tension. They tend to be risky with little regard for the consequences and are quite often ritualized. Inevitably they become irresistable and the cycle perpetuates despite feelings of shame and guilt that may accompany the aftermath. For borderlines, their acts may serve as mood stabilizers, a means to establishing a fragment of identity or a mode of escape from the emptiness and despair.

Self Harm and Suicide: Suicide is the ultimate conveyance of black and white thinking. The lifetime risk of suicide among people with BPD is around 10%. There is evidence that men diagnosed with BPD are approximately twice as likely to commit suicide as women diagnosed with BPD and considerable percentage of men who commit suicide may have undiagnosed BPD. Of those who die many were the most productive individuals with extremely high standards. Feelings of hopelessness and helplessness often follow perceived rejection or personal failure. Also, sexual abuse can be a particular trigger for suicidal behavior in adolescents with BPD tendencies.

Self mutilation is common and a trademark of BPD, with or without suicidal intent. They may be visible, hidden, ritualistic, convey a special meaning, burns, cuts, scratches, penetrating wounds etc. The irresistible urge renders the act compulsive thus physical restraint is sometimes required to prevent injury in extreme cases. Accident-proneness may be a covert form of self-injury. Self injury may act as punishment for forbidden sexuality (e.g incest), a sacrifice to protect or ‘purify’ oneself, a cry for help, distraction from intolerable emotional distress, coded message to others, and reenactment of previous abuse.

 

Marilyn Monroe demonstrated promiscuity, suicidal ideation, and drug abuse, which are characteristics of BPD. She also experienced low self-esteem and extreme attachment in relationships out of fear of abandonment.

Marilyn Monroe demonstrated promiscuity, suicidal ideation, and drug abuse, which are characteristics of BPD. She also experienced low self-esteem and extreme attachment in relationships out of fear of abandonment.

Causes of BPD

As is the case with other mental disorders, the etiology of BPD is complex and not fully agreed upon. Evidence suggests that BPD and (PTSD) may be related in some way. Most researchers agree that a history of childhood trauma can be a contributing factor; 4/5 patients with BPD have a clear history of strikingly traumatic experiences. An overwhelmingly majority have been neglected, physically abused and a similar number have been sexually abused as children by caregivers of either gender or non-caregivers. Numerous patients have witnessed severe violence among others in their household and have been traumatized repeatedly in more than one way. They also report a high incidence of incest and loss of caregivers in early childhood.

Individuals with BPD were also likely to report having caregivers of all sexes deny the validity of their thoughts and feelings. Caregivers were also reported to have failed to provide needed protection and to have neglected their child’s physical care.

Parents of all sexes were typically reported to have withdrawn from the child emotionally, and to have treated the child inconsistently. Additionally, women with BPD who reported a previous history of neglect by a female caregiver and abuse by a male caregiver were significantly more likely to report experiencing sexual abuse by a non-caregiver. Whilst some may suffer from severe functional impairment, there are high functioning borderlines who are more productive daily. Mediating factors include higher levels of executive functioning and a stable family environment.

In the 1980s, the first of a large number of neuroimaging, biochemical and genetic studies were published indicating that borderline disorder is associated with biological disturbances and reductions in areas of the brain involved in regulation of cortisol production, stress responses and emotion; affecting the hippocampus, orbitofrontal cortex and the amygdala, amongst other areas. The heritability of BPD is estimated to be 65%.

This suggests social factors (how a person interacts in their early development with their family, friends, and other children), psychological factors (individual’s personality and temperament, shaped by their environment and learned coping skills that deal with stress) alongside congenital brain abnormalities, genetics, neurobiological factors, and environmental factors contribute to the disorder.

Treatment

Long-term psychotherapy is currently the treatment of choice for BPD. In 1993, Marsha Linehan introduced Dialectical Behavior Therapy (DBT), a specific and now well documented form of psychotherapy for patients with borderline disorder prone to self injurious behavior and who require and request frequent, brief hospitalizations. Since then, other forms of psychotherapy have been developed that are specifically designed for borderline disorder: mentalization-based treatment (MBT), transference-focused psychotherapy, schema-focused therapy and general psychiatric management.

The UK National Institute for Health and Clinical Excellence (NICE) 2009 clinical guideline for the treatment and management of BPD recommends: ‘Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behavior associated with the disorder’. However, ‘drug treatment may be considered in the overall treatment of comorbid conditions” (i.e. mood stabilizers, anti-psychotics, anti-depressants, beta-blockers etc)

Over the past decade, two lay advocacy groups have been founded, the Treatment and Research Advancements Association for Personality Disorder (TARA APD), and the National Education Alliance for Borderline Personality Disorder (NEA- BPD). The missions of these organizations are: to increase the awareness of borderline disorder and its treatments; provide support to those suffering from the disorder, and to their families and friends; enhance the federal and private research funding dedicated to borderline disorder; and to decrease the stigma associated with the disorder.

 

 

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Posted in Personality Disorders, Psychiatry

Why do we engage in Self Deception?

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From time to time we find ourselves in unpleasant situations that we could have certainly done without. We may look around for something or someone to blame when infact it was simply our fault and no one elses. We often go to great lengths in order to deceive ourselves into believing the source of our stress, shame, guilt, loss or sadness originates from elsewhere instead of accepting the facts and deriving a solution so we can move on. In the Cognitive Dissonance post, I highlighted the torments internal conflict brings us, but I feel that it’s important to delve deeper into this topic. It’s often easier to see the signs of self deception in others, so, why are we doing this? What can we do to avoid the troubles and time loss this causes us?

Stop lying to yourself. When we deny our own truth, we deny our own potential – Steve Maraboli

Self Deception

Self deception is the action or practice of denying or rationalizing away the significance of a feeling, idea or situation. It involves intense psychological forces that prevent us from acknowledging a threatening truth about ourselves or a situation. Evidently, this seems inimical, but time and time again we try to pull the wool over our own eyes. The 4 basic types of lies are:

  • Prosocial: Lying to protect someone, to benefit or help others.
  • Self-enhancement: Lying to save face, to avoid embarrassment, disapproval or punishment.
  • Selfish: Lying to protect the self at the expense of another, and/or to conceal a misdeed.
  • Antisocial: Lying to hurt someone else intentionally.

Why do we engage in self deception?

Social psychologists say people deceive themselves in an unconscious effort to boost self-esteem or feel better. For some, the tendency seems to be an inborn personality trait. Others may develop a habit of self-deception as a way of coping with problems and challenges. Though, many people deceive themselves to avoid making difficult decisions.

The process of rationalization, however, may conceal the intent of self-deception in certain circumstances. When a person disbelieves they have put on a stone in the last month and intentionally try to make themselves believe that they are simply ‘big-boned’ and continues to indulge in a Big Mac meal every lunch break; consequently he misleads himself into believing or continuing to believe he is infact big boned (confirmation bias), which is appropriate for self deception. This form of rationalization can be modified in both positive and negative fashions e.g. convincing yourself that your abusive ex is to blame for your continuous failed relationships.

From Tom Hussey - Reflections

From Tom Hussey – Reflections

Other reasons we lie to ourselves include:

Maintaining an addiction or compulsion: Smoking is the only thing that calms me down’

Fear of loss, rejection, conflict or change: ‘It’s ok if my husband sleeps around, I’ve been too busy with work anyways’

Self-preservation from negative feelings such as jealousy, anger, sadness, rage, fear, inadequacy, shame or guilt

Shedding responsibility onto someone else: ‘My father was a raging alcoholic, so I must resort to violence to resolve all my issues’. Events in the past may have influenced you, but they don’t need to continue to do so.

Avoidance of judgment from others: ‘Oh yeah, that makes so much sense’ , when infact your cluelessSometimes our pride may obstruct us from owning up to our wrongs or flaws. The fact that someone else has identified a flaw in us may be damaging to our egos, thus denial seems the best way to avoid this issue.

By ignoring the truth we’re simply preventing ourselves from seeing our own true beauty.

Consequence of self deception and white lies?

  • Living in a false reality
  • Identification with a false sense of self/ego: The mask you wear to protect yourself from the truth
  • Arrested development of the authentic self and stunted psycho-spiritual awareness of others and the world around you
  • Prevention of deeper intimacy with others
  • Previously denied feelings eventually leading to an explosion of intrapsychic or interpersonal conflict
  • Suffering silently in pain, as a result of the hidden torment of the conscience.

What should be done?

FACE THE TRUTH HEAD ON

Ask yourself:

Do I have the courage to take full responsibility for everything I think, feel, and do, while avoiding the blame game?: Be willing to scrutinize the less desirable aspects of your personality, especially when you’re being defensive. Nobody is perfect; true friends and family can be sources of honest feedback. One should detach from their ego and concentrate on the desires of their soul.

Am I deluding myself into thinking that I’m accomplishing something when I’m really just doing what is comfortable and convenient at the time?: Identify the enemies of progress in your life. Candy Crush? Snapchat? Youtube?

How much more could I produce if I put some positive, proactive energy into prioritizing, organizing, and streamlining the daily activities that currently diffuse my focus?: Construct a nutrition, exercise, work and leisure timetable. Balance it out, ensuring your goals are realistic and attainable.

What behaviors are preventing me from making progress toward becoming my very best?: You should engage in honest relationships consisting of those who want the best for you and remain there for you in times of need.

How quickly do I recognize I’m in a troublesome situation? How quickly do I get out? How can I strengthen my ability leave and resolve such issues?: One should learn how to process and manage negative feelings rather than avoiding them. This may be through prayer, meditation, taking a walk etc..

Make sure your words match what you feel in your mind, your heart and your gut: This requires self insight and reflection until it becomes acquired behaviour. Preoccupation with achievements or public image and dodging a chronic problem by telling yourself you’ll solve it in the future are danger signs.

From Tom Hussey - Reflections

From Tom Hussey – Reflections

Conclusion

Facing the truth even if it means temporarily feeling unpleasant is often a necessary tunnel on the path towards enlightenment and cognitive consonance. It is amazing how far we’ll go to put off doing the things we would benefit the most from. Self-deception is not limited to our desires, motives, and moral cogitations: we can deceive ourselves about the state of the world, the people in it, and even our own personality and bodily flaws.

Self-deception, when practiced regularly, can serve as a form of global anesthetic that immunizes us against the maladies of life. This can lead to disastrous results if done in excess. However, mild and localized cases of self-deception that simply boost a person’s ego e.g simply blocking out negative thoughts, envisioning yourself enjoying future successes or adopting an optimistic view of your abilities have the tendency to improve performance or persuasive ability.

Don’t get caught up in your own mind games, the moment you feel yourself falling into that trap, take a step back and analyse your decision rationally.

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Posted in Psychology

Narcissistic Personality Disorder: The Introduction

Echo_and_Narcissus

 

Me Me Me. It’s all about me, the life of a Narcissist is self centred at the least. Narcissism is somewhat prevalent nowadays; in consequence of popular pop culture and capitalism. Some may say we have a societal narcissism epidemic on our hands. Nevertheless, the dark and sinister ways of befitting narcissists alongside the disasters they leave in the wake of their victims is not to be undermined. Malignant Narcissists can be highly perilous, especially to close friends and family members with Maternal and Paternal Narcissism being significantly clandestine.

Narcissistic Personality Disorder

Behaviour is characterized by an established pattern of grandiosity (fantasy and/or real life), an overwhelming need for admiration, and a lack of empathy toward others. They may frequently display snobbish, disdainful, or patronizing attitudes. For example, a Narcissistic female may claim to lack friends because other women are ‘envious’ of her, or a Narcissistic male may become enraged when denied gratification.

The pattern is seen in two or more of the following areas: Cognition,  Affect, Interpersonal functioning or Impulse control. The enduring pattern is obstinate and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Diagnosis

In order for a person to be diagnosed with Narcissistic personality disorder (NPD) they must meet five or more of the following symptoms:

  • Has a grandiose sense of self-importance: This is someone who can talk only about themselves and will amplify their talents and achievements. It’s not unusual for a Narcissistic parent to interrupt their child and divert the topic to something occurring in their lives.
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love: This involves magical thinking as an attempt to fend off inner emptiness, feel special and in control, and avoid feelings or acknowledgement of defectiveness .
  • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions): The individual who scorns anyone below their perceived class and will treat staff or even colleagues like peasants in their kingdom. 
  • Requires excessive admiration: Narcissists demand praise, gratitude and compliments for their work and may show rage and fury if not delivered.
  • Has a very strong sense of entitlement: They may have unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations. If they call you to help them out with something, you must be there; no ifs, buts or maybes. 
  • Is exploitative of others: They may take advantage of others to achieve his or her goals. Narcissists may only pursue ‘relationships’ with people that can help them out or they can use to get to where they want. It’s all about what people can do for them and what they have to offer, otherwise they are of no use. 
  • Lacks empathy: Many are unable to put themselves in someone elses shoes (even whilst demanding the other person does), and they will continuously repudiate the feelings and needs of others. Narcissists are blameless and will find any way possible to project the issue onto the other individual. 
  • Is often envious of others (or believes that others are envious of him or her): They may believe they are too pretty, clever or classy and exhibit threats to other individuals. Narcissistic parents may also become envious of their child’s achievements or growing independence; many like to compete with their children at every turn or use tactics like Infantilization to keep them in check. 
  • Regularly shows arrogant, haughty behaviors or attitudes: This could be anything from relentless boasting to friends or thinking their children are too good to be associated with those from lower socio-economic backgrounds. 

Causes of Narcissistic Personality Disorder

Much like other personality disorders the etiology of NPD is still unknown. There are numerous theories, however, about the possible causes. Psychodynamic theories suggest the root cause is experiences in early life which cause the narcissist to create a flawless ‘false self’, which must then be ‘defended’ throughout the individual’s lifetime. Other researchers believe the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). Evidently, no single factor is responsible, it is complex and likely a mirage of factors that lead to NPD. Research suggests that there is a slightly increased risk for pathological narcissism to be passed down to their children, or ‘inverted’ or ‘covert’ narcissism may be developed.

The Narcissistic family: The shiny red apple with a worm inside

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All families have family secrets, but in the family of a Narcissist the secrecy becomes a prison of silence. Image is of utmost priority; how you look always takes precedence over how you feel. Whether alcoholics, drug addicts, religious activists or social climbers etc, Narcissistic parenting is beguiling in it’s sheer cruelty and lack of empathy. They may be avoidant of a child’s emotional and/or physical needs or engulfing, where they endeavour to control every aspect of their child’s life. Either way, Narcissistic parents expect children to react to their needs and not the other way round.  It’s not unusual for one or more child to be made the ‘Golden Child’ who may do no wrong, and another the ‘Scapegoat’ who can do nothing right. In some families the mother may be Narcissistic and the father is an enabler of her tyranny and abuse, though it may be the other way round. Both parents may be Narcissists rendering the children helpless pawns and collateral damage in their sick games and distortions of reality.

Young-Bruehl states, children who are emotionally abused by narcissists “are not supposed to have any identity or feelings of their own; they have been taken over, like an occupied or colonized country, by the feelings that their abuser (or abusers) project onto them. The child is made into a target of elimination.”

They demand with insistence, punish absent-mindedly, idealize and devalue capriciously. They have no loyalty. They do not love, they cling or may suck you dry of all your energy, hence the term ’emotional vampires’. Their praise is quiet or unheard, coated with jealousy or your achievements are claimed as theirs. Essentially, existence is a play, they are the actors, and everyone else is props. They raise and lower the curtain of their mock ’emotions’ at will. Engulfing parents tend to look active and engaged in their children’s life from the outside, thus many Adult children of Narcissists (ACoNs) will agree that people had difficulty believing some of their life experiences during and after the abuse, especially regarding a narcissistic mother. This isn’t surprising as not all narcissists engage in physical or sexual abuse, but may use more insidious psychological tactics such as Gaslighting and Triangulation which I will cover later on. 

Books

Some useful books, especially for those close or related to an NPD individual:

Malignant Self Love: Narcissism Revisited: By Sam Vaknin and Lidija Rangelovska

Will I Ever Be Good Enough?: Healing the Daughters of Narcissistic Mothers: By Karyl McBride

The Narcissism Epidemic: Living in the Age of Entitlement: By W. Keith Campbell, Jean M. Twenge and Randye Kaye

Toxic Parents; Overcoming Their Hurtful Legacy and Reclaiming Your Life: By Susan Ford and Craig Buck

Conclusion

Our culture’s materialism and advanced technology underpins the importance of image and presentation for everyone. Researchers and psychologists have long been trying to understand the changes that have occurred in our values, ethics and our attitudes toward others in recent years and across generations. Millennials Generation Y or ‘Generation Me’ were found to view ‘money, fame, and image’ as being among the more important life-goals in a study of generational differences. The focus now is on self appearance, achievement and recognition. Aspirations concerned with self-acceptance, affiliation, and community are less important. Evidently, the increase in general selfishness presents some issues for society, though the insurmountable barriers to love and empathy constructed by true narcissists is of more concern and we should continue to help and support the victims in particular who may require an explanation and validation for their traumatizing experiences. 

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Posted in Personality Disorders, Psychiatry

Final Reflection: Living and Working on the Web module

Technological advancements are revolutionizing the way we communicate, digest information, work, recruit, shop etc. Everywhere we look there is evidence of digitization and I have always believed it’s important children, students and adults capitalize on the latest opportunities to improve their digital literacy and master principal 21st century skills.

In the new National Curriculum in England for Computing it states ‘A computing education also ensures that pupils become digitally literate – able to use, and express themselves through, in information and communication technology – at a level suitable for the future workplace and as active participants in a digital world’ (Computing at School, 2013). Some level of digital literacy is required for almost every job in today’s economy, and most employers will assume some level of computer proficiency as a prerequisite. Thus, I chose to study Living and Working on the Web because I was ardent to refine my digital literacy skills.  The online structure of the module, the essential development of online profiles and the stimulating topics covered were ideal stepping stones onto the journey of establishing my digital footprint.

Areas of Improvement

Assessing, managing and evaluating online information: Before this module I spent a great deal of time searching Google for various Psychiatry studies and articles as a form of leisure. It had occurred to me a few weeks before the initiation that I should start writing and sharing my findings and perceptions online. The module encouraged us to manipulate media to construct our own conceptualizations which was crucial for development in this area.  Furthermore, the discussions on Open Access materials led me too find new platforms i.e. Directory of Open Access Journals that are ideal for scientific research. 

Participating in online communities: Initially, I had set up networks on art and poem sharing websites. I was quiet in the early stages and didn’t share many posts on my new Twitter, but as time went by and I begun discussions with peers on this course I started to share relevant links and videos with others.

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I also set up a LinkedIn profile and worked on making connections over the course of the module. I plan to dedicate more time to this area over the coming months. The peer review tasks were interesting and thought provoking and allowed us to gain insight from different standpoints before writing our summaries. 

Building online networks around an area of interest: Initially, this blog was solely dedicated to Living and Working on the Web and I have now started posts on Psychology, Psychiatry, Behavioural Neuroscience and Socioeconomics, which I intend to enhance significantly over the coming months. I have written up an editorial schedule to cover topics well into next year.

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I have been waiting for this moment for a long time and I’m ecstatic that I finally started blogging. The online structure enabled us to share our learning with teachers, peers and family with ease. Twitter and WordPress has allowed me to engage with other activists, read up on their work and keep up to date on industry news and research.

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Creating online materials (text, audio, images, video): The module gave us the opportunity to explore technological mediums which inevitably increase job skills that employers look for in the workplace. My course is significantly Maths based and my grammar and Writing were rusty, but now I can disseminate information and write a post with ease. I enjoy selecting imagery and videos appropriate for information as it makes it easier for the brain to digest. Though, my greatest achievement in this area was the graphical development of my blog.

ccs coding

I chose to upgrade my wordpress to Custom Design which enabled me to manipulate the interface extensively. I thoroughly enjoyed hours spent learning CSS codes, and I aspire to become competent in coding over the next two years.

Final thoughts: Managing my online identity

As a second year Economics and Finance student and ‘Psychiatry Devotee’ it was clearly apparent to me that people generally tend to look online first for everything these days. It was useful that the module allowed us to create and design profiles reflective of our personalities and learning styles. This was my first opportunity to study online, but I quickly adapted to the pace of the course and drew up an Editorial Schedule for other parts of the blog. I learnt the importance of accurate and welcoming information and concluded; Social media training can make it easier for students, workers and firms to be found online, consequently increasing sales revenue and the generation of positive online content that helps to make a difference in awareness of various social and political issues. 

References

Computing at School, (2013). Computing in the national curriculum. A guide for primary teachers. Bedford. The Chartered Institute for IT, p.5

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Posted in Living and Working on the Web

My Reflection: Open access to online materials for all

The accelerating pace of scientific publishing and the rise of open access, as depicted by xkcd.com cartoonist Randall Munroe.

The accelerating pace of scientific publishing and the rise of open access, as depicted by xkcd.com cartoonist Randall Munroe.

 

This final topic was possibly the most relevant in regards to our higher education. Quality research and dissemination of information is imperative for academic study, though for me many of the issues raised were also important for the development of this blog. The general consensus amongst students was an inherent need for Open Access as it offers great benefits for authors, researchers, students and society as a whole.

This week I spent a great deal of time on the Directory of Open Access Journals (DOAJ), Public Library of Science (PLOS) and PubMed reading through articles relevant for my Psychiatry posts (see below). I was impressed with the efficacy and navigation of these sites, the searches worked very well and I was able to find useful studies in seconds. PLOS and PubMed were significantly useful for credible scientific research and I would highly recommend their use to others, although PubMed is a search engine for references and abstracts on life sciences and biomedical topics, thus content isn’t necessarily open access.

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I believe it’s important to know why we must pay for information. Essentially, peer review is of utmost importance in order to sustain integrity and share approved contents worldwide. For this reason, costs for open access journals consist of peer review, manuscript preparation and server space. In terms of the bills Open access journals pay they include payments of production costs for disseminating content, though Universities, governments or Professional organisations may provide a subsidy. Some researchers (or their sponsors) must pay a processing fee on accepted articles, although this can be waived under certain circumstances (i.e. affiliation with institutions that have purchased an annual membership, economic hardship etc..) and subsidized journals are generally exempt.

Regarding the perils of Open Access one study stood out for me. A hoax, was initiated by John Bohannon, a science journalist at Harvard University. He wrote a paper on a simple test of whether cancer cells grow more slowly in a test tube when treated with increasing concentrations of a molecule. The paper had ‘fatal flaws’ and used fabricated authors and universities with African affiliated names. Bohannon submitted around 10 articles per week to open access journals that use the ‘gold’ open access route, which requires the author to pay a fee if the paper is published. This was accepted by 157 of the journals and rejected by 98. Of the 255 versions that went through the entire editing process to either acceptance or rejection, 60% did not undergo peer review. Of the 106 journals that did conduct peer review, 70% accepted the paper (Shaw, 2013).

This is a prime example of the risks we face online whilst looking for credible sources and references that relate to our education; which is why I advocate the use of established platforms like the PLOS and PubMed so we can avoid using and sharing low quality and inaccurate information.

 

References

Infographics, (2013). The Rise of Open Access. [image] Available at: http://www.sciencemag.org/site/special/scicomm/infographic.jpg [Accessed 11 May. 2014].

Shaw, C. (2013). Hundreds of open access journals accept fake science paper. [online] Available at: http://www.theguardian.com/higher-education-network/2013/oct/04/open-access-journals-fake-paper

 

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Posted in Topic 5

Psychopathy: The Introduction

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Sad, Mad or Bad?

We hear of them in the media, see them in fictional portrayals and dish the label to the most depraved individuals, but who and what are Psychopaths? What do they do and why do they do it? Formally known as ‘Moral Insanity’ until the 20th century; Psychopathy is a serious personality disorder characterized by a lack of empathy, conscience and remorse. In 1941, Hervey Cleckley’s landmark book The Mask of Sanity pioneered the apprehension of this disorder. Representing less than 1% of the population, psychopathic individuals can appear significantly superficial and charming, yet these Wolves in Sheep’s clothing conceal a deceitful and domineering persona.

Canadian psychologist Robert D. Hare shed new light on the construct of psychopathy in Criminology with his Psychopathy Checklist (PCL-R). Some countries widely conduct self report assessments and interviews in criminal justice settings, which may have notable consequences for those involved. ‘NeuroLaw’ is a new phenomenon where neuroscience can be used as evidence in the courtroom. Currently, there is no ‘Psychopathy’ titled diagnosis in Psychiatry, although in some cases Antisocial Personality Disorder (Sociopathy) from the DSM and Dissocial Personality Disorder in the ICD may be applied. Researchers such as Robert Hare and Stephen Hart regard the mainstream psychiatric view as deeply flawed, calling for a return to a traditional model of Psychopathy as a distinct disorder.

Psychopathic Characteristics

Essentially, Psychopathy is characterized by tenacious behavioral deviancy accompanied by emotional-interpersonal detachment. The triarchic model, formulated by Christopher J. Patrick contrasts historic and contemporary conceptualizations of the disorder. It suggests that different conceptions of psychopathy emphasize three distinguishable phenotypic facets to varying degrees:

  • Boldness: Nexus of emotional resilience, low fear, toleration of unfamiliarity and danger (venturesomeness) and social dominance. Fearless dominance may correspond to differences in the amygdala and other neurological systems associated with fear.
  • Disinhibition: Poor impulse control which includes problems with planning and foresight, lacking affect and urge control, and requirement of instant gratification. Impulsive antisociality may correspond to impairments in frontal lobe systems that are involved in such control.
  • Meanness: Lacking empathy and close attachments with others, disdain of close attachments, exploitative tendencies, use of cruelty to gain empowerment, defiance of authority and destructive excitement seeking.

“I have an obsession with the unattainable. I have to eliminate what I cannot attain.” – Robert Bardo

Primary and Secondary Psychopathy

Several researchers have argued that there exist two variants of Psychopaths; Primary and Secondary (Cold/Hot). I personally believe is the case, thus I shall base the majority of my posts on Psychopathy around this conceptualization. 

Primary Psychopaths: Characterized as having an intrinsic deficit that hampers self regulation and normal adjustment. This results in fearlessness, poor passive avoidance, weak electrodermal anticipation of punishment and average levels of positive and negative emotionality.

Secondary Psychopaths: Believed to have more fear, anxiety and negative emotions than Primary Psychopaths. This manifests as relatively high levels of positive and negative emotionality, increased sensitivity to rewards, impulsiveness and sensation seeking but average levels of fearlessness, passive avoidance and electrodermal anticipation of punishment. There is empirical evidence to suggest Secondary Psychopaths manifest more Borderline Personality Disorder traits and comparable levels of antisocial behavior.

There are also different theories as to the predominant causes of either variant and apparently measures of anxiety can help to discern the etiology of the condition. Some researchers, such as Benjamin Karpman, believe that Primary Psychopaths are born with an emotional deficit and that Secondary Psychopaths acquire it through adverse environmental experiences, although others, link both variants to biological predispositions. Some preliminary research suggests that Secondary Psychopaths may have had a more abusive childhood, a higher risk of future violence, and potentially a better response to treatment.

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The Psychopaths Childhood

“I hated all my life. I hated everybody. When I first grew up and can remember, I was dressed as a girl by mother. And I stayed that way for two or three years. And after that was treated like what I call the dog of the family. I was beaten. I was made to do things that no human bein’ would want to do.” – Henry Lee Lucas

Many Psychopaths (not all), suffered horrendous emotional, physical and sexual abuse/neglect at the hands of parents or caregivers, which can have adverse effects on neurological development as mentioned in The Effects of Toxic Stress in Childhood post. Though, it is possible to see risk indicators of psychopathy very early through behaviors such as bullying, killing of animals, pyromania, kleptomania, bed-wetting etc. 

Conduct disorder is diagnosed based on a prolonged pattern of antisocial behavior in childhood and/or adolescence, and is often a precursor to Antisocial Personality Disorder. It is speculated that there are two subtypes of conduct disorder which mark dual developmental pathways to adult psychopathy. Juvenile psychopathy appears to be associated with higher levels of negative emotionality (i.e anger, hostility, anxiety, and depression). Early-onset conduct disorder and ADHD are linked with life-course-persistent antisocial behaviors as well as psychopathy. Generally, girls display significantly higher rates of physical and relational aggression than boys. They are highly aggressive toward both girls and boys, whereas boys are highly aggressive only toward other boys.

Evidence indicates the children with a combination of ADHD and Conduct Disorder are more belligerent and antisocial than those with only conduct disorder (although the majority of young children have both). Their behavioral disinhibition resembles that of adult Psychopaths and some believe this combination may give rise to Adult Secondary Psychopathy.

“As I grew up I realized, though imperfectly, that I was different from other people, and that the way of life in my home was different from that in the homes of others….This stimulated me to introspection and strange mental questionings” – John Haugh

The Psychopaths Brain

Post mortems studies have frequently shown undeveloped regions of the brain responsible for governing emotions. Professor of Psychiatry, James Fallon studied brain scans for over 20 years and noticed how cold, hardened murderers had alarmingly low activity in the frontal and temporal lobes of the brain, the areas associated with empathy and self-control. Without that self-restraint, they became crazed killers. Dysfunctions in the prefrontal cortex and amygdala regions of the brain are associated with specific learning impairments. Magnetic resonance scan MRI of the head computer enhanced and colorized to show the normal anatomy of the brain and head

Since the 1980s, scientists have linked traumatic brain injury, including damage to these regions, with violent and psychopathic behavior. Patients with damage in such areas were similar to Psychopaths as their brains were incapable of acquiring social and moral knowledge. Thus, those who acquired damage as children may have trouble conceptualizing social or moral reasoning, while those with adult-acquired damage may be aware of proper social and moral conduct but be unable to behave appropriately.

Amygdala and ventromedial prefrontal cortex abnormalities may also impair stimulus-reinforced learning in psychopaths, whether punishment-based or reward-based. People scoring 25 or higher in the PCL-R, with an associated history of violent behavior, appear to have significantly reduced mean microstructural integrity in their uncinate fasciculus—white matter connecting the amygdala and orbitofrontal cortex. In time, I shall post more on these findings.

Psychopathy in the UK

The PCL-R cut-off for Psychopathy label is 25 in the UK, whereas it is 30 in the US. ‘Psychopathic disorder’ was legally defined in the Mental Health Act (UK), under MHA1983, as “a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned”. This term was intended to reflect the presence of a personality disorder in terms of conditions for detention under the Mental Health Act 1983.

With the subsequent amendments to the Mental Health Act 1983 within the Mental Health Act 2007, the diagnosis was abolished, with all conditions for detention (e.g. mental illness, personality disorder, etc.) now being contained within the generic term of ‘mental disorder’. Today, the diagnosis of Dissocial Personality Disorder is grounds for detention in secure psychiatric hospitals under the Mental Health Act if they have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment imprisonment is often avoided.

“Possessing them physically as one would possess a potted plant, a painting, or a Porsche. Owning, as it were, this individual.” – Theodore Bundy

Criminality

As notoriously amoral individuals. it’s no surprise that psychopathy scores are positively correlated with repeated imprisonment, detention in higher security, disciplinary infractions, and substance misuse. Generally, Psychopathy is associated with several adverse life outcomes as well as increased risk of early death due to factors such as homicides, accidents, and suicides. Hare stated that
although psychopaths only make up about 1% of the general population, they account for a large proportion of the violence and social distress in every society. They make up 15%–20% the US prison inmates and are common among spouse and child abusers, gang members and terrorists. An important note is that Sociopathy and Psychopathy are NOT the same. Sociopathy tends to be an inclusive part of the Psychopaths make up as criminality and disregard for authority are significantly relevant. Studies have shown Sociopaths make up almost 70-80% of some jails, but many Sociopaths are not Psychopaths, which is a common misconception today.

Violence: Studies show a strong correlation between psychopathy scores and violence, especially concerning victims of abuse who then go on to commit violent acts. For some, aggression and violence have become a habitual way to deal with frustration and stress which echos in their social interactions. Furthermore, the Federal Bureau of Investigation reports that psychopathic behavior is consistent with traits common to some serial killers, including sensation seeking, a lack of remorse or guilt, impulsivity, the need for control, and predatory behavior. 

Sexual Offences:  Sexual fantasies and paraphilia are associated with psychopathic sexual abuse more than non-Psychopaths. Child molesters, masturbation, fetichism, exhibitionism, sadism, masochism, bestiality and necrophilia also bare strong links to psychopathy. Regarding, the issue of possible reunification of some sex offenders into homes with a non-offending parent and children, it has been advised that any sex offender with a significant criminal history should be assessed on the PCL-R, and if they score 18 or higher than they should be excluded from any consideration of being placed in a home with children under any circumstances.

Economic Crime: The words of Dr Robert Hare echo ‘If I wasn’t studying Psychopaths in prison, I’d do it at the stock exchange’. These ‘Snakes in Suits’ may be socially successful, due to factors such as low disinhibition alongside other advantages such as a favorable upbringing and good intelligence. Financial expert Max Keiser uses the term ‘financial terrorist’ to describe the low-empathy, cold left-brain thinking which currently dominates elite financial circles, particularly in the City of London and Wall Street.

Other offences: Psychopathy has been associated with organised and war crimes. Terrorists are sometimes called psychopaths they tend to exhibit traits such as violence, an egocentric world view that prohibits the welfare of others, a lack of remorse or guilt, and blame externalization. Though, John Horgan, author of The Psychology of Terrorism, argues that this assumption could also be drawn more widely: for example, to soldiers in wars. Plus, terrorist activity requires organization, loyalty and ideology; traits such as self-centeredness, irresponsibility, poor behavioral controls, and unusual behaviors may be disadvantages.

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Gender differences

This area warrants more expansion of research and knowledge. The PCL-R was developed using mainly male criminal samples reflecting the fact that most research has been based on men. They score higher than women on both the PCL-R and the Psychopathic Personality Inventory (PPI). One study found, men with psychopathic personality traits had experienced more victimization regarding physical abuse and women with psychopathic personality traits had experienced more victimization of sexual abuse but also neglect and verbal abuse. Furthermore men tend to exhibit more external antisocial behaviors and woman more internalizing behaviors. Though, this is not always the case.

Psychopaths in Films

The arrestshanniballecter and infamy of serial killers John Wayne Gacy, Jeffrey Dahmer, and Ted Bundy altered the perceptions and depictions of psychopathy in film. An increasing interest in realistic depictions of psychopaths led to the formation of a new hybrid of traditional psychopaths from early film and late-19th Century literature with the high-functioning behaviors detected in psychopaths such as Bundy (was his own defence attorney) and Dahmer.

Cannibalistic Psychiatrist Dr. Hannibal Lecter from the 1991 film The Silence of the Lambs. Lecter is erudite with disarming charisma and wit that conceal his true psychopathic nature. The Joker kills not to gain riches, as the other criminals in Batman, but actually for the sheer fun of it. This representation is credible, though in reality most Psychopaths are much harder to detect. They usually don’t look as abhorrent or behave openly psychotic as the Joker does.

Causes of Psychopathy

Genetic: Studies have indicated a connection between a variant of the monoamine oxidase A (MAO-A) gene (warrior gene) which controls the amount of serotonin in the brain and psychopathy. Whilst studying the brains of killers for over 20 years, Professor James Fallon discovered that he was carrying this gene, had a lineage of very violent killers including Lizzie Borden, and his brain was very similar to the mass murderers he studied. Apparently, his terrific childhood had saved him from going over the edge despite being a ‘born killer’.

Environment: Some of the strongest factors said to influence the development of psychopathy include , being physically neglected, low involvement of the father with his son, having a convicted parent, low socioeconomic background, and being raised in a dysfunctional family. Other significant factors include lack of supervision, harsh discipline, large family size, delinquent sibling, young mother, depressed mother, poor housing and severe peer bullying.

Biochemical: High levels of testosterone combined with low levels of cortisol and/or serotonin have been said to be contributing factors. More testosterone relative to cortisol acting on the amygdala, can cause an individual to become less fearful, more reward seeking and aggressive. It enhances sensitivity to reward relative to punishment, promotes approach rather than avoidance reactions, and reduces the emotional input from the amygdala to the orbitofrontal cortex that is critical for empathy and recognizing cues that a decision may be risky or harmful. It may also impair the ability to regulate emotion and aggression.

Hervey Cleckley believed the physiological basis for this dangerous personality disorder was because neither side of the Psychopath’s brain processes emotion properly. To psychopaths, emotionally charged statements such as ‘I love you,’ or ‘I’m sorry that I hurt you’, I’ll never do it again’ mean absolutely nothing and are simply words used to deceive and manipulate.

wolves in sheep's clothing

So that’s my introduction, it is quite long, though not long enough. My aim was to give a brief overview and dispel some of the mainstream myths of psychopathy as many people like to fling the label around. Plenty of victims and researchers are understandably skeptical to the idea that people with psychopathic personality traits are treatable; their behavior is profoundly pathological. Though, in regards to treatment previous abuse should be addressed, victimization should be validated and men may possibly need more focus on behavioral control and anger management due to their proneness to externalizing behaviors (i.e, violent outbursts and sexual perversion), whereas women might need more help with their internal emotions and behaviors (e.g, self harming behaviors, feelings of anger) and therefore require longer therapy and motivational interviewing. There is possibility for remission and positive outcomes if treatment is tailored to the individuals problems.

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Posted in Behavioural Neuroscience, Psychiatry, Psychology, Psychopathy
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