Category: Mental Health

What is Hostile Attribution Bias?

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Introduction

Hostile attribution bias, or hostile attribution of intent, is the tendency to interpret others’ behaviours as having hostile intent, even when the behaviour is ambiguous or benign.

For example, a person with high levels of hostile attribution bias might see two people laughing and immediately interpret this behaviour as two people laughing about them, even though the behaviour was ambiguous and may have been benign.

The term “hostile attribution bias” was first coined in 1980 by Nasby, Hayden, and DePaulo who noticed, along with several other key pioneers in this research area (e.g. Kenneth A. Dodge), that a subgroup of children tend to attribute hostile intent to ambiguous social situations more often than other children. Since then, hostile attribution bias has been conceptualized as a bias of social information processing (similar to other attribution biases), including the way individuals perceive, interpret, and select responses to situations. While occasional hostile attribution bias is normative (particularly for younger children), researchers have found that individuals who exhibit consistent and high levels of hostile attribution bias across development are much more likely to engage in aggressive behaviour (e.g. hitting/fighting, reacting violently, verbal or relational aggression) toward others.

In addition, hostile attribution bias is hypothesized to be one important pathway through which other risk factors, such as peer rejection or harsh parenting behaviour, lead to aggression. For example, children exposed to peer teasing at school or child abuse at home are much more likely to develop high levels of hostile attribution bias, which then lead them to behave aggressively at school and/or at home. Thus, in addition to partially explaining one way aggression develops, hostile attribution bias also represents a target for the intervention and prevention of aggressive behaviours.

Brief History

The term hostile attribution bias first emerged in 1980 when researchers began noticing that some children, particularly aggressive and/or rejected children, tended to interpret social situations differently compared to other children. For example, Nasby and colleagues presented photographs of people to a group of aggressive adolescent boys (aged 10-16) and observed that a subgroup of these youth exhibited a consistent tendency to attribute hostile intent to the photographs, even when the cues were ambiguous or benign. Similarly, Kenneth A. Dodge and colleagues conducted a study on a sample of school-aged children between 3rd-5th grade and found that children who were rejected were much more likely than other children to exhibit hostile attributions of intent to ambiguous social situations (e.g. when a behaviour could have been either accidental or intentional). Furthermore, Dodge and colleagues found that children with high hostile attribution bias then went on to exhibit the most aggressive behaviours later on.

Early studies investigating links between hostile attribution bias and aggression were somewhat mixed, with some studies reporting no significant effects or small effects and other studies reporting large effects. Since then, over 100 studies and a meta-analysis have documented a robust association between hostile attribution bias and aggressive behaviour across various samples ranging in age, gender, race, countries, and clinical populations.

Theoretical Formulation

Hostile attribution bias is typically conceptualised within a social information processing framework, in which social information (e.g. during an interaction) is processed in a series of steps that leads to a behavioural reaction. Accurate social information processing requires a person to engage in six steps that occur in order.

Step
1Accurately encode information in the brain and store it in short-term memory. During this step, an individual will pay attention to and code specific stimuli/cues in their environment, including external factors (e.g. someone bumping into you; other people’s reactions to the situation) and internal factors (e.g. your affective reaction to the situation).
2Accurately interpret or give meaning to encoded information. During this step, an individual may decide if a behaviour or situation was meant to be hostile or benign.
3Decide a goal for the interaction.
4Generate potential responses.
5Evaluate potential responses and select the “optimal” response.
6Enact chosen response.

Hostile attribution bias is theorised to result from deviations in any of these steps, including paying attention to and encoding biased information (e.g. only paying attention to cues suggestive of hostility), biases toward negative interpretations of social interactions (e.g. more likely to interpret situation as hostile), limited ability to generate a broad range of potential responses, and difficulty appropriately evaluating responses and selecting an optimal response. Furthermore, biases in any of the steps affect the rest of the steps. Hostile attribution bias has been particularly linked to step 2 of social information processing (i.e. interpretation of information), but is linked to impairments in other steps as well, including inaccurate perception/encoding of social situations and problems with generating a broad range of potential behavioural responses. For example, a child with high levels of hostile attribution bias may generate fewer potential responses than other children, and these responses may be limited to hostile or ineffective responses to a situation.

Dodge theorised that hostile attribution bias arises from an individual’s hostile schemas about the world that are formed through an interaction between a child’s neural dispositions and his/her early exposures to hostile socialisation experiences. These experiences may include disrupted parental attachment, child abuse, exposure to family violence, peer rejection or victimization, and community violence.

Measurement

In research settings, hostile attribution bias is typically measured with a laboratory task, in which participants are presented with staged interaction (live actors), video, picture, audio, or written presentations of ambiguous social situations. For example, an ambiguous social situation presented might be a video of a child opening a door, causing the door to knock over a tower of toys that another child was building. After the stimulus is presented, participants would be asked to make attributions about the intent of the actor (i.e. hostile vs. benign). (For example: “Do you think the girl who opened the door was trying to be mean, nice, or could have been mean or nice?”).

Multiple trials are administered with various ambiguous scenarios, and these attributions are then used by the researchers to determine the level of the child’s hostile attribution bias. Careful selection of stimuli and comparison of stimuli across mediums is helpful for accurately assessing an individual’s level of hostile attribution bias. A meta-analysis investigating the link between hostile attribution bias and aggressive behaviour found that the strongest effect sizes were linked with actual staging of social interactions, followed by audio presentation of stimuli, then video and picture presentation.

Implications

Aggression

Substantial literature has documented a robust association between hostile attribution bias and aggression in youth. Hostile attribution bias is traditionally associated with overt physical aggression (e.g. hitting, fighting), such that higher levels of hostile attribution bias predict more aggressive behaviour. In particular, much evidence suggests that hostile attribution bias is especially linked to “reactive aggression” (i.e. impulsive and “hot-blooded” aggression that reflects an angry retaliation to perceived provocation) rather than “proactive aggression” (i.e. unprovoked, planned/instrumental, or “cold-blooded” aggression). Beyond physical aggression, elevated hostile attribution bias is also associated with increased use of relational aggression (e.g. gossip, spreading rumours, social exclusion). This is particularly the case when youth attribute hostile intent to ambiguous relational situations (e.g. not receiving an invitation to a party or not receiving a response to a text).

Negative Adult Outcomes

Hostile attribution bias has also been documented in adult populations, and adults with high levels of hostile attribution bias are over 4 times more likely to die by the age of 50 than adults with low levels of hostile attribution bias. Hostile attribution bias is particularly linked to relational problems in adulthood, including marital conflict/violence and marital/relationship dissatisfaction. Finally, parents with high levels of hostile attribution bias are also much more likely to use harsh discipline and aggressive parenting, which may further contribute to the intergenerational continuity in hostile attribution bias and aggression across time.

Clinical Implications for Intervention

Hostile attribution bias has been tested as a malleable target for intervention for aggressive behaviours in youth, including in cognitive interventions designed to increase accurate identification of others’ intentions and attribution of benign intentions. Relative success has been documented from these interventions in changing levels of hostile attribution bias, although actual enduring changes in aggressive behaviour have been modest.

What is Displacement (Psychology)?

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Introduction

In psychology, displacement (German: Verschiebung, “shift, move”) is an unconscious defence mechanism whereby the mind substitutes either a new aim or a new object for goals felt in their original form to be dangerous or unacceptable.

Refer to Emotional Conflict.

Sigmund Freud

The concept of displacement originated with Sigmund Freud. Initially he saw it as a means of dream-distortion, involving a shift of emphasis from important to unimportant elements, or the replacement of something by a mere illusion. Freud called this “displacement of accent.”

TypeOutline
Displacement of ObjectFeelings that are connected with one person are displaced onto another person. A man who has had a bad day at the office, comes home and yells at his wife and children, is displacing his anger from the workplace onto his family. Freud thought that when children have animal phobias, they may be displacing fears of their parents onto an animal.
Displacement of AttributionA characteristic that one perceives in oneself but seems unacceptable is instead attributed to another person. This is essentially the mechanism of psychological projection; an aspect of the self is projected (displaced) onto someone else. Freud wrote that people commonly displace their own desires onto God’s will.
Bodily DisplacementsA genital sensation may be experienced in the mouth (displacement upward) or an oral sensation may be experienced in the genitals (displacement downward). Novelist John Cleland in ‘’Fanny Hill’’ referred to the vagina as “the nethermouth.” Sexual attraction toward a human body can be displaced in sexual fetishism, sometimes onto a particular body part like the foot, or at other times onto an inanimate fetish object.
Jokes and NeurosesFreud also saw displacement as occurring in jokes, as well as in neuroses – the obsessional neurotic being especially prone to the technique of displacement onto the minute. When two or more displacements occurs towards the same idea, the phenomenon is called condensation (from the German Verdichtung).
Phobia Displacement or RepressionHumans were able to express specific unconscious needs through phobias. These needs that were suppressed deep within themselves created anxiety and tension. The stress, fear, and anxiety that characterise a phobic disorder were the discharge.
Reaction FormationCognizant practices are embraced to overcompensate for the nervousness an individual feels in regards to their socially inadmissible oblivious considerations or feelings. Typically, a response arrangement is set apart by misrepresented conduct, like garishness and urgency. An illustration of reaction formation incorporates the loyal little girl who adores her mom is responding to her Oedipus scorn of her mom.

The Psychoanalytic Mainstream

Among Freud’s mainstream followers, Otto Fenichel highlighted the displacement of affect, either through postponement or by redirection, or both. More broadly, he considered that “in part the paths of displacement depend on the nature of the drives that are warded off”.

Freud’s daughter, Anna Freud, also played an important role in the upbringing of these defence mechanisms by the twentieth century. She introduced and analysed ten of her own defence mechanisms and her work has been used and increased through the years by newer psychoanalysts.

Eric Berne in his first, psychoanalytic work, maintained that “some of the most interesting and socially useful displacements of libido occur when both the aim and the object are partial substitutions for the biological aim and object…sublimation”.

Lacan

In 1957, Jacques Lacan, inspired by an article by linguist Roman Jakobson on metaphor and metonymy, argued that the unconscious has the structure of a language, linking displacement to the poetic function of metonymy, and condensation to that of metaphor.

As he himself put it, “in the case of Verschiebung, ‘displacement’, the German term is closer to the idea of that veering off of signification that we see in metonymy, and which from its first appearance in Freud is represented as the most appropriate means used by the unconscious to foil censorship”.

Aggression

The aggressive drive – known as mortido – may be displaced quite as much as the libidinal – the sex drive. Business or athletic competition, or hunting, for instance, offer plentiful opportunities for the expression of displaced mortido.

In such scapegoating behaviour, aggression may be displaced onto people with little or no connection with what is causing anger or frustration. Some people punch cushions when they are angry at friends; a college student may snap at his or her roommate when upset about an exam grade.

Displacement can also act in what looks like a ‘chain-reaction,’ with people unwittingly becoming both victims and perpetrators of displacement. For example, a man is angry with his boss, but he cannot express this properly, so he hits his wife. The wife, in turn, hits one of the children, possibly disguising this as a “punishment.” (rationalization).

Ego psychology sought to use displacement in child rearing, a dummy being used as a displaced target for toddler sibling rivalry. With a purpose to apprehend how the ego uses defence mechanisms, it is important to apprehend the defence mechanisms themselves and the way they function. A few defence mechanisms are visible as protecting us from the internal impulses (e.g. repression); other defence mechanism guard us from external threats (e.g. denial).

Transferential Displacement

The displacement of feelings and attitudes from past significant others onto the present-day analyst constitutes a central aspect of the transference, particularly in the case of the neurotic.

A subsidiary form of displacement within the transference occurs when the patient disguises transference references by applying them to an apparent third party or to themselves.

As of now encoded in subcortical neural pathways, material from our oblivious brain is pushed into our cognizant psyche as we attempt to manage mental wonders – typically agonising – that we are encountering. With the “help” of mind movement, we unknowingly re-surface and re-order struggle ridden encounters as though the past were the present and one setting were another. We move contemplations, sentiments, and perspectives, particularly about individuals who take after others. We allocate them jobs once played by others. We take on old jobs ourselves. All unwittingly.

Criticism

Later writers have objected that whereas Freud only described the displacement of sex into culture, for example, the converse – social conflict being displaced into sexuality – is also true.

Freud’s hypothesis is acceptable at clarifying however not at anticipating conduct. Therefore, Freud’s hypothesis is unfalsifiable – it cannot be demonstrated valid or invalidated. Freud may likewise have shown research predisposition in his understandings – he may have just focused on data which upheld his hypotheses, and overlooked data and different clarifications that didn’t fit them.

What is Psychological Projection?

Published on by Andrew Marshall2 Comments

Introduction

Psychological projection is the process of misinterpreting what is “inside” as coming from “outside”.

It forms the basis of empathy by the projection of personal experiences to understand someone else’s subjective world. In its malignant forms, it is a defence mechanism in which the ego defends itself against disowned and highly negative parts of the self by denying their existence in themselves and attributing them to others, breeding misunderstanding and causing untold interpersonal damage. A bully may project their own feelings of vulnerability onto the target, or a person who is confused may project feelings of confusion and inadequacy onto other people. Projection incorporates blame shifting and can manifest as shame dumping. Projection has been described as an early phase of introjection.

Refer to Emotional Conflict and Splitting (Psychology).

Brief History

A prominent precursor in the formulation of the projection principle was Giambattista Vico. In 1841, Ludwig Feuerbach was the first enlightenment thinker to employ this concept as the basis for a systematic critique of religion.

The Babylonian Talmud (500 AD) notes the human tendency toward projection and warns against it: “Do not taunt your neighbour with the blemish you yourself have.” Religious people of the Christian faith believe that in the New Testament, Jesus also warned against projection: “Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? How can you say to your brother, ‘Let me take the speck out of your eye,’ when all the time there is a plank in your own eye? You hypocrite, first take the plank out of your own eye, and then you will see clearly to remove the speck from your brother’s eye.”

Psychoanalytic Developments

Projection (German: Projektion) was conceptualised by Sigmund Freud in his letters to Wilhelm Fliess, and further refined by Karl Abraham and Anna Freud. Freud considered that, in projection, thoughts, motivations, desires, and feelings that cannot be accepted as one’s own are dealt with by being placed in the outside world and attributed to someone else. What the ego refuses to accept is split off and placed in another.

Freud would later come to believe that projection did not take place arbitrarily, but rather seized on and exaggerated an element that already existed on a small scale in the other person. The related defence of projective identification differs from projection in that the other person is expected to become identified with the impulse or desire projected outside, so that the self maintains a connection with what is projected, in contrast to the total repudiation of projection proper.

Melanie Klein saw the projection of good parts of the self as leading potentially to over-idealisation of the object. Equally, it may be one’s conscience that is projected, in an attempt to escape its control: a more benign version of this allows one to come to terms with outside authority.

Theoretical Examples

Projection tends to come to the fore in normal people at times of personal or political crisis but is more commonly found in narcissistic personality disorder or borderline personality disorder.

Carl Jung considered that the unacceptable parts of the personality represented by the Shadow archetype were particularly likely to give rise to projection, both small-scale and on a national/international basis. Marie-Louise Von Franz extended her view of projection, stating that “wherever known reality stops, where we touch the unknown, there we project an archetypal image”.

Psychological projection is one of the medical explanations of bewitchment used to explain the behaviour of the afflicted children at Salem in 1692. The historian John Demos wrote in 1970 that the symptoms of bewitchment displayed by the afflicted girls could have been due to the girls undergoing psychological projection of repressed aggression.

Practical Examples

ExampleDescription
Victim BlamingThe victim of someone else’s actions or bad luck may be offered criticism, the theory being that the victim may be at fault for having attracted the other person’s hostility. In such cases, the psyche projects the experiences of weakness or vulnerability with the aim of ridding itself of the feelings and, through its disdain for them or the act of blaming, their conflict with the ego.
Projection of Marital GuiltThoughts of infidelity to a partner may be unconsciously projected in self-defence on to the partner in question, so that the guilt attached to the thoughts can be repudiated or turned to blame instead, in a process linked to denial. For example, a person who is having a sexual affair may fear that their spouse is planning an affair or may accuse the innocent spouse of adultery.
BullyingA bully may project their own feelings of vulnerability onto the target(s) of the bullying activity. Despite the fact that a bully’s typically denigrating activities are aimed at the bully’s targets, the true source of such negativity is ultimately almost always found in the bully’s own sense of personal insecurity or vulnerability. Such aggressive projections of displaced negative emotions can occur anywhere from the micro-level of interpersonal relationships, all the way up to the macro-level of international politics, or even international armed conflict.
“Reading”People in love “reading” each others’ mind involves of a projection of the self into the other.
Projection of General GuiltProjection of a severe conscience is another form of defence, one which may be linked to the making of false accusations, personal or political.
Projection of HopeAlso, in a more positive light, a patient may sometimes project their feelings of hope onto the therapist.

Counter-Projection

Jung wrote, “All projections provoke counter-projection when the object is unconscious of the quality projected upon it by the subject.” Thus, what is unconscious in the recipient will be projected back onto the projector, precipitating a form of mutual acting out.

In a rather different usage, Harry Stack Sullivan saw counter-projection in the therapeutic context as a way of warding off the compulsive re-enactment of a psychological trauma, by emphasizing the difference between the current situation and the projected obsession with the perceived perpetrator of the original trauma.

Clinical Approaches

Drawing on Gordon Allport’s idea of the expression of self onto activities and objects, projective techniques have been devised to aid personality assessment, including the Rorschach ink-blots and the Thematic Apperception Test (TAT).

Projection may help a fragile ego reduce anxiety, but at the cost of a certain dissociation, as in dissociative identity disorder. In extreme cases, an individual’s personality may end up becoming critically depleted. In such cases, therapy may be required which would include the slow rebuilding of the personality through the “taking back” of such projections.

The method of managed projection is a projective technique. The basic principle of this method is that a subject is presented with their own verbal portrait named by the name of another person, as well as with a portrait of their fictional opposition (V.V. Stolin, 1981).

The technique is suitable for application in psychological counselling and might provide valuable information about the form and nature of their self-esteem Bodalev, A (2000). “General psychodiagnostics”.

Criticism

Some studies were critical of Freud’s theory. Research on social projection supports the existence of a false-consensus effect whereby humans have a broad tendency to believe that others are similar to themselves, and thus “project” their personal traits onto others. This applies to both good and bad traits; it is not a defence mechanism for denying the existence of the trait within the self. A study of the empirical evidence for a range of defence mechanisms by Baumeister, Dale, and Sommer (1998) concluded, “The view that people defensively project specific bad traits of their own onto others as a means of denying that they have them is not well supported.” However, Newman, Duff, and Baumeister (1997) proposed a new model of defensive projection in which the repressor’s efforts to suppress thoughts of their undesirable traits make those trait categories highly accessible – so that they are then used all the more often when forming impressions of others. The projection is then only a byproduct of the real defensive mechanism.

What is Splitting (Psychology)?

Published on by Andrew Marshall7 Comments

Introduction

Splitting (also called black-and-white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole.

It is a common defence mechanism. The individual tends to think in extremes (i.e. an individual’s actions and motivations are all good or all bad with no middle ground).

Splitting was first described by Ronald Fairbairn in his formulation of object relations theory; it begins as the inability of the infant to combine the fulfilling aspects of the parents (the good object) and their unresponsive aspects (the unsatisfying object) into the same individuals, instead seeing the good and bad as separate. In psychoanalytic theory this functions as a defence mechanism.

Refer to Emotional Conflict and Psychological Projection.

Relationships

Splitting creates instability in relationships because one person can be viewed as either personified virtue or personified vice at different times, depending on whether they gratify the subject’s needs or frustrate them. This, along with similar oscillations in the experience and appraisal of the self, leads to chaotic and unstable relationship patterns, identity diffusion, and mood swings. The therapeutic process can be greatly impeded by these oscillations, because the therapist too can come to be seen as all good or all bad. To attempt to overcome the negative effects on treatment outcome, constant interpretations by the therapist are needed.

Splitting contributes to unstable relationships and intense emotional experiences. Splitting is common during adolescence, but is regarded as transient. Splitting has been noted especially with persons diagnosed with borderline personality disorder. Treatment strategies have been developed for individuals and groups based on dialectical behaviour therapy, and for couples. There are also self-help books on related topics such as mindfulness and emotional regulation that claim to be helpful for individuals who struggle with the consequences of splitting.

Borderline Personality Disorder

Refer to Borderline Personality Disorder.

Splitting is a relatively common defence mechanism for people with borderline personality disorder. One of the DSM IV-TR criteria for this disorder is a description of splitting: “a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation”. In psychoanalytic theory, people with borderline personality disorder are not able to integrate the good and bad images of both self and others, resulting in a bad representation which dominates the good representation.

Narcissistic Personality Disorder

Refer to Narcissistic Personality Disorder.

People matching the diagnostic criteria for narcissistic personality disorder also use splitting as a central defence mechanism. Most often narcissists do this as an attempt to stabilise their sense of self-positivity in order to preserve their self-esteem, by perceiving themselves as purely upright or admirable and others who do not conform to their will or values as purely wicked or contemptible.

The cognitive habit of splitting also implies the use of other related defence mechanisms, namely idealisation and devaluation, which are preventive attitudes or reactions to narcissistic rage and narcissistic injury.

Depression

In depression, exaggerated all-or-nothing thinking can form a self-reinforcing cycle: these thoughts might be called emotional amplifiers because, as they go around and around, they become more intense. Typical all-or-nothing thoughts:

  • My efforts are either a success or they are an abject failure.
  • Other people are either all good or all bad.
  • I am either all good or all bad.
  • If you’re not with us, you’re against us.

Janet, Bleuler and Freud

Refer to Pierre Janet, Eugen Bleuler, and Sigmund Freud.

Splitting of consciousness (“normal self” vs. “secondary self”) was first described by Pierre Janet in De l’automatisme psychologique (1889). His ideas were extended by Bleuler (who in 1908 coined the word schizofrenia from the Ancient Greek skhízō [σχῐ́ζω, “to split”] and phrḗn [φρήν, “mind”]) and Freud to explain the splitting (German: Spaltung) of consciousness – not (with Janet) as the product of innate weakness, but as the result of inner conflict. With the development of the idea of repression, splitting moved to the background of Freud’s thought for some years, being largely reserved for cases of double personality. However, his late work saw a renewed interest in how it was “possible for the ego to avoid a rupture… by effecting a cleavage or division of itself”, a theme which was extended in his Outline of Psycho-Analysis (1940a [1938]) beyond fetishism to the neurotic in general.

His daughter Anna Freud explored how, in healthy childhood development, a splitting of loving and aggressive instincts could be avoided.

Melanie Klein

Refer to Melanie Klein.

There was, however, from early on, another use of the term “splitting” in Freud, referring rather to resolving ambivalence “by splitting the contradictory feelings so that one person is only loved, another one only hated … the good mother and the wicked stepmother in fairy tales”. Or, with opposing feelings of love and hate, perhaps “the two opposites should have been split apart and one of them, usually the hatred, has been repressed”. Such splitting was closely linked to the defence of “isolation … The division of objects into congenial and uncongenial ones … making ‘disconnections’.”

It was the latter sense of the term that was predominantly adopted and exploited by Melanie Klein. After Freud, “the most important contribution has come from Melanie Klein, whose work enlightens the idea of ‘splitting of the object’ (Objektspaltung) (in terms of ‘good/bad’ objects)”. In her object relations theory, Klein argues that “the earliest experiences of the infant are split between wholly good ones with ‘good’ objects and wholly bad experiences with ‘bad’ objects”, as children struggle to integrate the two primary drives, love and hate, into constructive social interaction. An important step in childhood development is the gradual depolarization of these two drives.

At what Klein called the paranoid-schizoid position, there is a stark separation of the things the child loves (good, gratifying objects) and the things the child hates (bad, frustrating objects), “because everything is polarised into extremes of love and hate, just like what the baby seems to experience and young children are still very close to.” Klein refers to the good breast and the bad breast as split mental entities, resulting from the way “these primitive states tend to deconstruct objects into ‘good’ and ‘bad’ bits (called ‘part-objects’)”. The child sees the breasts as opposite in nature at different times, although they actually are the same, belonging to the same mother. As the child learns that people and objects can be good and bad at the same time, he or she progresses to the next phase, the depressive position, which “entails a steady, though painful, approximation towards the reality of oneself and others”: integrating the splits and “being able to balance [them] out … are tasks that continue into early childhood and indeed are never completely finished.”

However, Kleinians also utilize Freud’s first conception of splitting, to explain the way “In a related process of splitting, the person divides his own self. This is called ‘splitting of the ego’.” Indeed, Klein herself maintained that “the ego is incapable of splitting the object—internal or external—without a corresponding splitting taking place within the ego”. Arguably at least, by this point “the idea of splitting does not carry the same meaning for Freud and for Klein”: for the former, “the ego finds itself ‘passively’ split, as it were. For Klein and the post-Kleinians, on the other hand, splitting is an ‘active’ defence mechanism”. As a result, by the close of the century “four kinds of splitting can be clearly identified, among many other possibilities” for post-Kleinians: “a coherent split in the object, a coherent split in the ego, a fragmentation of the object, and a fragmentation of the ego.”

Otto Kernberg

Refer to Otto Kernberg.

In the developmental model of Otto Kernberg, the overcoming of splitting is also an important developmental task. The child has to learn to integrate feelings of love and hate. Kernberg distinguishes three different stages in the development of a child with respect to splitting:

  • The child does not experience the self and the object, nor the good and the bad as different entities.
  • Good and bad are viewed as different. Because the boundaries between the self and the other are not stable yet, the other as a person is viewed as either all good or all bad, depending on their actions. This also means that thinking about another person as bad implies that the self is bad as well, so it’s better to think about the caregiver as a good person, so the self is viewed as good too. “Bringing together extremely opposite loving and hateful images of the self and of significant others would trigger unbearable anxiety and guilt.”
  • Splitting – “the division of external objects into ‘all good’ or ‘all bad'” – begins to be resolved when the self and the other can be seen as possessing both good and bad qualities. Having hateful thoughts about the other does not mean that the self is all hateful and does not mean that the other person is all hateful either.

If a person fails to accomplish this developmental task satisfactorily, borderline pathology can emerge. “In the borderline personality organization”, Kernberg found ‘dissociated ego states that result from the use of “splitting” defences’. His therapeutic work then aimed at “the analysis of the repeated and oscillating projections of unwanted self and object representations onto the therapist” so as to produce “something more durable, complex and encompassing than the initial, split-off and polarized state of affairs”.

Horizontal and Vertical

Heinz Kohut has emphasized in his self psychology the distinction between horizontal and vertical forms of splitting. Traditional psychoanalysis saw repression as forming a horizontal barrier between different levels of the mind – so that for example an unpleasant truth might be accepted superficially but denied in a deeper part of the psyche. Kohut contrasted with this vertical fractures of the mind into two parts with incompatible attitudes separated by mutual disavowal.

Transference

Refer to Transference.

It has been suggested that interpretation of the transference “becomes effective through a sort of splitting of the ego into a reasonable, judging portion and an experiencing portion, the former recognizing the latter as not appropriate in the present and as coming from the past”. Clearly, “in this sense, splitting, so far from being a pathological phenomenon, is a manifestation of self-awareness”. Nevertheless, “it remains to be investigated how this desirable ‘splitting of the ego’ and ‘self-observation’ are to be differentiated from the pathological cleavage … directed at preserving isolations”.

What is Emotional Conflict?

Published on by Andrew Marshall3 Comments

Introduction

Emotional conflict is the presence of different and opposing emotions relating to a situation that has recently taken place or is in the process of being unfolded.

They may be accompanied at times by a physical discomfort, especially when a functional disturbance has become associated with an emotional conflict in childhood, and in particular by tension headaches “expressing a state of inner tension…[or] caused by an unconscious conflict”.

For C.G. Jung, “emotional conflicts and the intervention of the unconscious are the classical features of…medical psychology”. Equally, “Freud’s concept of emotional conflict as amplified by Anna Freud…Erikson and others is central in contemporary theories of mental disorder in children, particularly with respect to the development of psychoneurosis”.

In Childhood Development

“The early stages of emotional development are full of potential conflict and disruption”. Infancy and childhood are a time when “everything is polarised into extremes of love and hate” and when “totally opposite, extreme feelings about them must be getting put together too. Which must be pretty confusing and painful. It’s very difficult to discover you hate someone you love”. Development involves integrating such primitive emotional conflicts, so that “in the process of integration, impulses to attack and destroy, and impulses to give and share are related, the one lessening the effect of the other”, until the point is reached at which “the child may have made a satisfactory fusion of the idea of destroying the object with the fact of loving the same object”.

Once such primitive relations to the mother or motherer have been at least partially resolved, “in the age period two to five or seven, each normal infant is experiencing the most intense conflicts” relating to wider relationships: “ideas of love are followed by ideas of hate, by jealousy and painful emotional conflict and by personal suffering; and where conflict is too great there follows loss of full capacity, inhibitions…symptom formation”.

Defences

Defences against emotional conflict include “splitting and projection. They deal with intrapsychic conflict not by addressing it, but by sidestepping it”. Displacement too can help resolve such conflicts: “If an individual no longer feels threatened by his father but by a horse, he can avoid hating his father; here the distortion way a way out of the conflict of ambivalence. The father, who had been hated and loved simultaneously, is loved only, and the hatred is displaced onto the bad horse”.

Physical Symptoms

Inner emotional conflicts can result in physical discomfort or pain, often in the form of tension headaches, which can be episodic or chronic, and may last from a few minutes or hours, to days – associated pain being mild, moderate, or severe.

“The physiology of nervous headaches still presents many unsolved problems”, as in general do all such “physical alterations…rooted in unconscious instinctual conflicts”. However physical discomfort or pain without apparent cause may be the way our body is telling us of an underlying emotional turmoil and anxiety, triggered by some recent event. Thus for example a woman “may be busy in her office, apparently in good health and spirits. A moment later she develops a blinding headache and shows other signs of distress. Without consciously noticing it, she has heard the foghorn of a distant ship, and this has unconsciously reminded her of an unhappy parting”.

While it is not easy, by relaxing, calming down, and trying to become aware of what recent experience or event could have been the cause of the inner conflict, and then rationally looking at and dealing with the conflicting desires and needs, a gradual dissipation and relief of the pain may be possible.

In the Workplace

With respect to the post-industrial age, “LaBier writes of ‘modern madness’, the hidden link between work and emotional conflict…feelings of self-betrayal, stress and burnout”. His “idea, which gains momentum in the post-yuppie late eighties…concludes that real professional success without regret of emotional conflict requires insanity of one kind or another”.

Cultural Examples

  • Advice on fiction writing emphasises the “necessity of creating powerful, emotional conflicts” in one’s characters: “characters create the emotional conflict and the action emerges from the characters”.
  • Shakespeare’s sonnets have been described as “implying an awareness of the possible range of human feelings, of the existence of complex and even contradictory attitudes to a single emotion”.
  • For Picasso “the presence of death is always coincident with the taste for life…the superb violence of these emotional transports have led some people to call his work expressionist”.

What is Stilted Speech?

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Introduction

In psychiatry, stilted speech or pedantic speech is communication characterised by situationally-inappropriate formality (refer to Communication Deviance). This formality can be expressed both through abnormal prosody as well as speech content that is “inappropriately pompous, legalistic, philosophical, or quaint”. Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizotypal personality disorder.

To diagnose stilted speech, researchers have previously looked for the following characteristics:

  • Speech conveying more information than necessary.
  • Vocabulary and grammar expected from formal writing rather than conversational speech.
  • Unneeded repetition or corrections.

While literal and long-winded word content is often the most identifiable feature of stilted speech, such speech often displays irregular prosody, especially in resonance. Often, the loudness, pitch, rate, and nasality of pedantic speech vary from normal speech, resulting in the perception of pedantic or stilted speaking. For example, overly loud or high-pitched speech can come across to listeners as overly forceful while slow or nasal speech creates an impression of condescension.

These attributions, which are commonly found in patients with ASD, partially account for why stilted speech has been considered a diagnostic criterion for the disorder. Stilted speech, along with atypical intonation, semantic drift, terseness, and perseveration, are all qualities known to be commonly impaired during conversation with adolescents on the autistic spectrum. Often, stilted speech found in children with ASD will also be especially stereotypic or rehearsed.

Patients with schizophrenia are also known to experience stilted speech. This symptom is attributed to both an inability to access more commonly used words and a difficulty understanding pragmatics – the relationship between language and context. However, stilted speech appears as a less common symptom compared to a certain number of other symptoms of the psychosis. This element of cognitive disorder is also exhibited as a symptom in the narcissistic personality disorder.

There is disagreement on the definition of psychophenomenology within the discipline of psychiatry, e.g. published sources provide definitions that are “various and sometimes conflicting (Rule 2005)”.

What is Communication Deviance?

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Introduction

Communication deviance (CD) occurs when a speaker fails to effectively communicate meaning to their listener with confusing speech patterns or illogical patterns.

Refer to Stilted Speech.

Background

These disturbances can range from vague linguistic references, contradictory statements to more encompassing non-verbal problems at the level of turn-taking.

The term was originally introduced by Lyman Wynne and Margaret Singer in 1963 to describe a communication style found among parents who had children with schizophrenia. According to Wynne, people are able to focus their attention and identify meaning from external stimuli beginning with their interactions, particularly with their parents, during their early years of life. In family communication, deviance is present in the way members acknowledge or affirm one another as well as in task performance.

A recent meta-analysis reported that communication deviance is highly prevalent in parents of patients diagnosed with schizophrenia and adoption studies have reported significant associations between CD in the parent and thought disorder in the offspring, however, the mechanisms by which CD impacts on the offspring’s cognition are still unknown. Some researchers theorize that, in the case of a high degree of egocentric communication in parents where the sender and the receiver do not speak and listen according to each other’s premises, the child develops uncertainty.

The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g. pseudo-mutuality, pseudo-hostility, schism and skew) in families of people with schizophrenia also became influential with systems-communications-oriented theorists and therapists.

What are Racing Thoughts?

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Introduction

Racing thoughts refers to the rapid thought patterns that often occur in manic, hypomanic, or mixed episodes.

While racing thoughts are most commonly described in people with bipolar disorder and sleep apnoea, they are also common with anxiety disorders, OCD, and other psychiatric disorders such as attention deficit hyperactivity disorder. Racing thoughts are also associated with sleep deprivation, hyperthyroidism and the use of amphetamines.

Description

Racing thoughts may be experienced as background or take over a person’s consciousness. Thoughts, music, and voices might be zooming through one’s mind as they jump tangentially from one to the next. There also might be a repetitive pattern of voice or of pressure without any associated “sound”. It is a very overwhelming and irritating feeling, and can result in losing track of time. In some cases, it may also be frightening to the person experiencing it, as there is a loss of control. If one is experiencing these thoughts at night when going to sleep, they may suddenly awaken, startled and confused by the very random and sudden nature of the thoughts.

Racing thoughts differ in manifestation according to the individual’s perspective. These manifestations can vary from unnoticed or minor distractions to debilitating stress, preventing the sufferer from maintaining a thought.

Generally, racing thoughts are described by an individual who has had an episode where the mind uncontrollably brings up random thoughts and memories and switches between them very quickly. Sometimes they are related, as one thought leads to another; other times they seem completely random. A person suffering from an episode of racing thoughts has no control over their train of thought, and it stops them from focusing on one topic or prevents sleeping.

Associated Conditions

The causes of racing thoughts are most often associated with anxiety disorders, but many influences can cause these rapid, racing thoughts. There are also many associated conditions, in addition to anxiety disorders, which can be classified as having secondary relationships with causing racing thoughts. The conditions most commonly linked to racing thoughts are bipolar disorder, anxiety disorder, attention deficit hyperactivity disorder, sleep deprivation, amphetamine dependence, and hyperthyroidism.

Anxiety Disorders

Racing thoughts associated with anxiety disorders can be caused by many different conditions, such as obsessive-compulsive disorder (OCD), panic disorder, generalised anxiety disorder, or posttraumatic stress disorder.

In people with OCD, racing thoughts can be brought on by stressors, or triggers, causing disturbing thoughts in the individual. These disturbing thoughts, then, result in compulsions characterising OCD in order to lower the stress and gain some sort of control over these stressful, racing thoughts.

Panic disorder is an anxiety disorder characterised by repeated panic attacks of fear or nervousness, lasting several minutes. During these panic attacks, the response is out of proportion to the situation. The racing thoughts may feel catastrophic and intense, but they are a symptom of the panic attack and must be controlled in order to soothe the panic and minimise the panic attack.

Generalised anxiety disorder (GAD) is a neurological anxiety disorder that involves uncontrollable and excessive worrying about irrational topics or problems. These stressful thoughts must be present for at least six months in order to be diagnosed as GAD. Along with other symptoms, racing thoughts is one of the most common ones. With GAD, there is an inability to relax or let thoughts or worries go, persistent worrying and obsessions about small concerns that are out of proportion to the result, and even worrying about their excessive worrying.

Bipolar Disorder

Racing thoughts can be brought on by bipolar disorder, defined by mood instability that range from extreme emotional highs, mania, to severe depression. During the manic phase of bipolar disorder is when racing thoughts usually occur. Disjointed, constantly changing thoughts with no underlying theme can be a sign of the manic phase of bipolar disorder. Manic thoughts can prevent performance of daily routines due to their rapid, unfocused and overwhelming nature. Racing thoughts in people with bipolar disorder are generally accompanied with other symptoms associated with this disorder.

Amphetamines

Amphetamines are used as a stimulant to trigger the central nervous system, increasing heart rate and blood pressure while decreasing appetite. Since amphetamines are a stimulant, use of these drugs result in a state that resembles the manic phase of bipolar disorder and also produces similar symptoms, as stated above.

Attention Deficit Hyperactivity Disorder

Racing thoughts associated with ADHD is most common in adults. With ADHD, racing thoughts can occur and tend to cause insomnia. Racing thoughts in people with ADHD tend to be rapid, unstable thoughts which do not follow any sort of pattern, similar to racing thoughts in people with bipolar disorder. Medications used to treat ADHD, such as Adderall or Methylphenidate, can be prescribed to patients with ADHD to calm these racing thoughts, most commonly in the morning when people wake up but just as well in the evening before sleep.

Lack of Sleep

Racing thoughts, also referred to as “racing mind”, may prevent a person from falling asleep. Chronic sleep apnoea and prolonged disturbed sleep patterns may also induce racing thoughts. Treatment for sleep apnoea and obstructive airway disorder can improve airflow and improve sleep resulting in improved brain and REM (rapid eye movement) function and reduced racing thought patterns.

Hyperthyroidism

Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone, thyroxin. This overabundance of thyroxin causes irregular and rapid heartbeat, irritability, weight loss, nervousness, anxiety and racing thoughts. The anxiety and inability to focus is very common in hyperthyroidism and leads to racing thoughts, as well as panic attacks and difficulty concentrating.

Frequency

Anxiety disorder, the most common mental illness in the United States, affects 40 million people, ages 10 and older; this accounts for 18% of the US population. Most people suffering from anxiety disorder report some form of racing thoughts symptom.

The prevalence of OCD in every culture studied is at least 2% of the population, and the majority of those have obsessions, or racing thoughts. With these reports, estimates of more than 2 million people in the United States (as of 2000) suffer from racing thoughts.

Treatment

There are various treatments available to calm racing thoughts, some of which involve medication. One type of treatment involves writing out the thoughts onto paper. Some treatments suggest using activities, such as painting, cooking, and other hobbies, to keep the mind busy and distract from the racing thoughts. Exercise may be used to tire the person, thereby calming their mind. When racing thoughts are anxiety induced during panic or anxiety attacks, it is recommended that the person wait it out. Using breathing and meditation techniques to calm the breath and mind simultaneously is another tool for handling racing thoughts induced by anxiety attacks. Mindfulness meditation has also shown to help with racing thoughts by allowing practitioners to face their thoughts head-on, without reacting.

While all of these techniques can be useful to cope with racing thoughts, it may prove necessary to seek medical attention and counsel. Since racing thoughts are associated with many other underlying mental illnesses, such as bipolar disorder, anxiety disorder, and ADHD, medications used commonly to treat these disorders will help calm racing thoughts in patients.

Treatment for the underlying causes of racing thoughts is helpful and useful in order to calm the racing thoughts more permanently. For example, in people with ADHD, medications used to promote focus and calm distracting thoughts, will help them with their ADHD.

Some obstructive airway disorders may be relieved with nasal septoplasty which can improve sleep and lead to a reduction of racing mind. Insomnia may increase racing thoughts and those effected will find sleep apnoea treatment and nasal surgery helpful to eliminate their racing thoughts.

It is important to look at the underlying defect that may be causing racing thoughts in order to prevent them in the long-term.

What is the International Society for Bipolar Disorders?

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Introduction

The International Society for Bipolar Disorders (ISBD) is a non-profit organisation based in Pittsburgh, Pennsylvania, where it was founded 17 June 1999. The society focuses on research and education in bipolar disorders.

The society has a membership consisting of mental health professionals and patients and their family members representing 50 countries. The mission of the society is to advance the treatment of all aspects of bipolar disorder, thereby improving patient outcomes and quality of life, through fostering international collaboration in education and research. The society hosts biennial professional meetings and offers educational programmes. The official journal of the society is Bipolar Disorders and a subscription is included with membership.

Brief History

The ISBD was founded at the 3rd International Conference on Bipolar Disorder, in Pittsburgh, Pennsylvania, in June 1999 by David J. Kupfer and Thomas Detre (University of Pittsburgh Medical Centre). In September 1999, the official peer-reviewed society journal, Bipolar Disorders, published its first issue.

The ISBD held its first meeting in Sydney, Australia, in February 2004 with over 400 participants in attendance. The society held its second meeting in August 2006 in Edinburgh, Scotland, with over 600 attendees. As of 2013, the society has over 800 members in 50 countries with an elected board representing 15 countries.

Educational Programmes

The society supports the following educational initiatives:

  • The Psychiatric Trainee Support programme:
    • Offers psychiatric trainees a free two-year membership in the society in order to enhance knowledge of bipolar disorder among this group, narrow the gap between bipolar research and clinical practice, and ultimately to improve diagnosis, treatment and outcomes for patients with bipolar disorder.
    • These supported memberships are open to psychiatric residents, postgraduate students and junior faculty up to the Assistant Professor or equivalent level with less than five years as faculty in their career trajectory.
    • The programmes seek to support 70% of trainees from developing countries.
  • The Samuel Gershon Awards for Junior Investigators:
    • Named in honour of Samuel Gershon, past ISBD President and pioneer of early lithium research, offer four awards for original research submissions.
    • Awards are based on the originality of the content, as well as the significance of the findings reported, and are evaluated by an international scientific panel under the auspices of the ISBD.
    • These awards are open to psychiatric trainees, postgraduate students and junior faculty up to the assistant professor rank from around the world.
    • The awards are presented in conjunction with the society’s biennial meeting where the winners present their research in a special session showcasing the work of junior people in the field.
  • The ISBD Research Fellowship for Junior Investigators:
    • Provides an opportunity for the recipient to travel to another facility to get training in a particular type of research methodology (i.e. brain imaging, genetics, clinical trials, etc.).
    • The fellowship is intended to cover up to six months support for salary, travel, or some combination of these costs as they are incurred in pursuit of additional training.
    • This could take the form of summer programs, participation in smaller prospective studies, or through some other opportunity.

Conferences

The society organises biennial meetings that provides updates on topics such as epidemiology, pharmacotherapy, psychotherapies, genetics, neurobiology, imaging research, and bipolar disorder in special populations.

What are Reversed Vegetative Symptoms?

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Introduction

Vegetative symptoms are disturbances of a person’s functions necessary to maintain life (vegetative functions). These disturbances are most commonly seen in mood disorders, and are part of the diagnostic criteria for depression, but also appear in other conditions.

Vegetative symptoms in a patient with typical depression include:

  • Weight loss and anorexia (loss of appetite).
  • Insomnia.
  • Fatigue and low energy.
  • Inattention.

Reversed Vegetative Symptoms

Reversed vegetative symptoms include only oversleeping (hypersomnia) and overeating (hyperphagia), as compared to insomnia and loss of appetite. These features are characteristic of atypical depression (AD).

However, there have been studies claiming that these symptoms alone are sufficient to diagnose the condition of AD.