Tag: Defence Mechanism

What is Experiential Avoidance?

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Introduction

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences – even when doing so creates harm in the long run.

The process of EA is thought to be maintained through negative reinforcement – that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behaviour will persist. Importantly, the current conceptualisation of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.

Background

EA has been popularised by recent third-wave cognitive-behavioural theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defence mechanisms were originally conceptualised as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.

Process-Experiential

Process-experiential therapy merges client-centred, existential, and Gestalt approaches. Gestalt theory outlines the benefits of being fully aware of and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid”. Similar ideas are expressed by early humanistic theory:

“Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness.”

Behavioural

Traditional behaviour therapy utilises exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.

Third-Wave Cognitive-Behavioural

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP), and behavioural activation (BA).

Associated Problems

  • Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.
  • Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.
  • Sustaining avoidance often requires effort and energy.
  • Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
  • Avoidance may get in the way of other important, valued aspects of life.

Empirical Evidence

  • Laboratory-based thought suppression studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
  • Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing the unpleasant emotions can lead to improvements in the long term, even though it increases negative reactions in the short term.
  • Exposure-based therapy techniques have been shown to be effective in treating a wide range of psychiatric disorders.
  • Numerous self-report studies have linked EA and related constructs (avoidance coping, thought suppression) to psychopathology and other forms of dysfunction.

Relevance to Psychopathology

Seemingly disparate forms of pathological behaviour can be understood by their common function (i.e., attempts to avoid distress). Some examples include:

DiagnosisExample BehavioursTarget of Avoidance
Major Depressive Disorder (MDD)Isolation/SuicideFeelings of sadness, guilt, and low self-worth.
Posttraumatic Stress Disorder (PTSD)Avoiding trauma reminders and hypervigilanceMemories, anxiety, and concerns of safety.
Social PhobiaAvoiding social situationsAnxiety and concerns of judgement of others.
Panic DisorderAvoiding situations that might induce panicFear and physiological sensations.
AgoraphobiaRestricting travel outside of home or other ‘safe areas’Anxiety and fear of having symptoms of panic.
Obsessive-Compulsive DisorderChecking/RitualsWorry of consequences (e.g. ‘contamination’).
Substance Use DisordersAbusing alcohol/drugsEmotions, memories, and withdrawal symptoms.
Eating DisordersRestricting food intake and purgingWorry about becoming overweight and fear of losing control.
Borderline Personality DisorderSelf-harm (e.g. cutting)High emotional arousal.

Relevance to Quality of Life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:

  • Putting off an important task because of the discomfort it evokes.
  • Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
  • Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
  • Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
  • Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
  • Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
  • Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
  • Staying in a “bad” relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
  • Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g. achieved through drug or alcohol abuse) or symptoms of withdrawal.
  • Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.
  • Engaging in self-destructive behaviours in an attempt to avoid feelings of boredom, emptiness, worthlessness.
  • Not functioning or taking care of basic responsibilities (e.g. personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
  • Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.

Measurement

Self-Report

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualised as a measure of “psychological flexibility”. The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.

What is Psychological Flexibility?

Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. This trait is used when stressors or unexpected events occur, requiring a person to change their stance, outlook, or commitment. Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, as well as simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one’s thinking and attention between tasks. Flexibility, or psychological flexibility, as it is sometimes referred to, is the ability to adapt to situational demands, balance life demands, and commit to behaviours.

  • Refer to:
  • Opposite concepts:
    • Acceptance.
    • Distress tolerance.
    • Psychological flexibility.
  • Related concepts:
    • Denial.
    • Expressive suppression.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Experiential_avoidance >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Dissociative Disorder?

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Introduction

Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

People with dissociative disorders use dissociation as a defence mechanism, pathologically and involuntarily. The individual experiences these dissociations to protect themselves. Some dissociative disorders are triggered by psychological trauma, but depersonalisation–derealisation disorder may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.

The dissociative disorders listed in the American Psychiatric Association’s DSM-5 are as follows:

  • Dissociative identity disorder (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities can be aware of all the existing personalities.
  • Dissociative amnesia (formerly psychogenic amnesia): the temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient. Dissociative fugue was previously a separate category but is now treated as a specifier for dissociative amnesia.
  • Depersonalisation-derealisation disorder: periods of detachment from self or surrounding which may be experienced as “unreal” (lacking in control of or “outside” self) while retaining awareness that this is only a feeling and not a reality.
  • The old category of dissociative disorder not otherwise specified is now split into two: other specified dissociative disorder, and unspecified dissociative disorder. These categories are used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders; or if the correct category has not been determined; or the disorder is transient.

The ICD 11 lists dissociative disorders as:

  • Dissociative neurological symptom disorder.
  • Dissociative amnesia.
  • Dissociative amnesia with dissociative fugue.
  • Trance disorder.
  • Possession trance disorder.
  • Dissociative identity disorder.
  • Partial dissociative identity disorder.
  • Depersonalisation-derealisation disorder.

Cause and Treatment

Dissociative Identity Disorder

Cause

Dissociative identity disorder is caused by ongoing childhood trauma that occurs before the ages of six to nine. People with dissociative identity disorder usually have close relatives who have also had similar experiences.

Treatment

Long-term psychotherapy to improve the patient’s quality of life.

Dissociative Amnesia

Cause

A way to cope with trauma.

Treatment

Psychotherapy (e.g. talk therapy) counselling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviours); and medications (antidepressants, anti-anxiety medications, or sedatives). These medications help control the symptoms associated with the dissociative disorders, but there are no medications yet that specifically treat dissociative disorders. However, the medication pentothal can sometimes help to restore the memories. The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation. Dissociative fugue was a separate category but is now listed as a specifier for dissociative amnesia.

Depersonalisation-Derealisation Disorder

Cause

Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one.

Treatment

Same treatment as dissociative amnesia. An episode of depersonalisation–derealisation disorder can be as brief as a few seconds or continue for several years.

Dissociative disorders, especially dissociative identity disorder (DID), while being the result of extraordinary abuse and trauma in childhood, it should not be attributed exotic status. DID would be better examined through a more holistic lens, taking into considering the social, cognitive, and neural components, and how they interact with one another.

Medications

There are no medications to treat dissociative disorders, however, drugs to treat anxiety and depression that may accompany the disorders can be given.

Diagnosis and Prevalence

The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients. Diagnosis can be made with the help of structured clinical interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), and behavioural observation of dissociative signs during the interview. Additional information can be helpful in diagnosis, including the Dissociative Experiences Scale or other questionnaires, performance-based measures, records from doctors or academic records, and information from partners, parents, or friends. A dissociative disorder cannot be ruled out in a single session and it is common for patients diagnosed with a dissociative disorder to not have a previous dissociative disorder diagnosis due to a lack of clinician training. Some diagnostic tests have also been adapted or developed for use with children and adolescents such as the Adolescent Dissociative Experiences Scale, Children’s Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), Child Behaviour Checklist (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.

Dissociative disorders have been found to be quite prevalent in outpatient populations, as well as within low-income communities. One study found that in a population of poor inner-city outpatients, there was a 29% prevalence of dissociative disorders.

There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which can be understood by the historic context of hysteria. Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined. In most cases mental health professionals are still hesitant to diagnose patients with Dissociative Disorder, because before they are considered to be diagnosed with Dissociative Disorder these patients have more than likely been diagnosed with major depressive disorder, anxiety disorder, and most often post-traumatic stress disorder (PTSD). It has been found from interviews with those who may be afflicted with dissociative disorders may be more effective at getting an accurate diagnosis than self-scoring assessments and scales.

The prevalence of dissociative disorders is not completely understood due to the many difficulties in diagnosing dissociative disorders. Many of these difficulties stem from a misunderstanding of dissociative disorders, from an unfamiliarity diagnosis or symptoms to disbelief in some dissociative disorders entirely. Due to this it has been found that only 28% to 48% of people diagnosed with a dissociative disorder receive treatment for their mental health. Patients who are misdiagnosed are often those more likely to be hospitalised repeatedly, and lack of treatment can result in intensive outpatient treatment and higher rates of disability.

An important concern in the diagnosis of dissociative disorders in forensic interviews is the possibility that the patient may be feigning symptoms in order to escape negative consequences. Young criminal offenders report much higher levels of dissociative disorders, such as amnesia. In one study it was found that 1% of young offenders reported complete amnesia for a violent crime, while 19% claimed partial amnesia. There have also been cases in which people with dissociative identity disorder provide conflicting testimonies in court, depending on the personality that is present. The world-wide prevalence of dissociative disorders is not well understood due to different cultural beliefs surrounding human emotions and the human brain

Children and Adolescents

Dissociative disorders (DD) are widely believed to have roots in adverse childhood experiences including abuse and loss, but the symptoms often go unrecognised or are misdiagnosed in children and adolescents. However, a recent western Chinese study showed an increase in awareness of dissociative disorders present in children These studies show that DD’s have an intricate relationship with the patient’s mental, physical and socio-cultural environments. This study suggested that dissociative disorders are more common in Western, or developing countries, however, some cases have been seen in both clinical and non-clinical Chinese populations. There are several reasons why recognising symptoms of dissociation in children is challenging: it may be difficult for children to describe their internal experiences; caregivers may miss signals or attempt to conceal their own abusive or neglectful behaviours; symptoms can be subtle or fleeting; disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders.

Another resource, Beacon House, informs us of dissociative disorder in children, suggesting that it is a survival mechanism that often goes unnoticed in children that have been traumatised. Dr. Shoshanah Lyons suggests that traumatised children often continue to dissociate even though they might not be in any danger, and that they are often unaware that they are dissociating. In addition to developing diagnostic tests for children and adolescents (see above), a number of approaches have been developed to improve recognition and understanding of dissociation in children. Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma. Others in the field have argued that recognising disorganised attachment (DA) in children can help alert clinicians to the possibility of dissociative disorders. In their 2008 article, Rebecca Seligman and Laurence Kirmayer suggest the existence of evidence of linkages between trauma experienced in childhood and the capacity for dissociation or depersonalisation. They also suggest that individuals who are able to utilise dissociative techniques are able to keep this as an extended strategy to cope with stressful situations.

Clinicians and researchers stress the importance of using a developmental model to understand both symptoms and the future course of DDs. In other words, symptoms of dissociation may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed. Related to this developmental approach, more research is required to establish whether a young patient’s recovery will remain stable over time.

Current Debates and the DSM-5

A number of controversies surround DD in adults as well as children. First, there is ongoing debate surrounding the aetiology of dissociative identity disorder (DID). The crux of this debate is if DID is the result of childhood trauma and disorganized attachment. A proposed view is that dissociation has a physiological basis, in that it involves automatically triggered mechanisms such as increased blood pressure and alertness, that would, as Lynn contends, imply its existence as a cross-species disorder. A second area of controversy surrounds the question of whether or not dissociation as a defence versus pathological dissociation are qualitatively or quantitatively different. Experiences and symptoms of dissociation can range from the more mundane to those associated with PTSD or acute stress disorder (ASD) to dissociative disorders. Mirroring this complexity, the DSM-5 workgroup considered grouping dissociative disorders with other trauma/stress disorders, but instead decided to put them in the following chapter to emphasize the close relationship. The DSM-5 also introduced a dissociative subtype of PTSD.

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states. However, experimental research in cognitive science continues to challenge claims concerning the validity of the dissociation construct, which is still based on Janetian notions of structural dissociation. Even the claimed etiological link between trauma/abuse and dissociation has been questioned. Links observed between trauma/abuse and DD are largely only present from a Western cultural context. For non-Western cultures dissociation “may constitute a “normal” psychological capacity”. An alternative model proposes a perspective on dissociation based on a recently established link between a labile sleep-wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality.

Debates around DD also stem from Western versus non-Western lenses of viewing the disorder, and associated views of causes of DD. DID was initially believed to be specific to the West, until cross-cultural studies indicated its occurrence worldwide. Conversely, anthropologists have largely done little work on DD in the West relating to its perceptions of possession syndromes that would be present in non-Western societies. While dissociation has been viewed and catalogued by anthropologists differently in the West and non-Western societies, there are aspects of each that show DD has universal characteristics. For example, while shamanic and rituals of non-Western societies may hold dissociative aspects, this is not exclusive as many Christian sects, such as “possession by the Holy Ghost” share similar qualities to those of non-Western trances.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Dissociative_disorder >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Introjection?

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Introduction

In psychology, introjection is the unconscious adoption of the thoughts or personality traits of others.

It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defence mechanism in situations that arouse anxiety.

The tendency is also known as identification or internalisation. It has been associated with both normal and pathological development.

Theory

Introjection is a concept rooted in the psychoanalytic theories of unconscious motivations. Unconscious motivation refers to processes in the mind which occur automatically and bypass conscious examination and considerations.

Introjection is the learning process or in some cases a defence mechanism where a person unconsciously absorbs experiences and makes them part their psyche.

Introjection in Learning

In psychoanalysis, introjection (German: Introjektion) refers to an unconscious process wherein one takes components of another person’s identity, such as feelings, experiences and cognitive functioning, and transfers them inside themselves, making such experiences part of their new psychic structure. These components are obliterated from consciousness (splitting), perceived in someone else (projection), and then experienced and performed (i.e. introjected) by that other person. Cognate concepts are identification, incorporation and internalisation.

Introjection as a Defence Mechanism

It is considered a self-stabilising defence mechanism used when there is a lack of full psychological contact between a child and the adults providing that child’s psychological needs. Here, it provides the illusion of maintaining relationship but at the expense of a loss of self. To use a simple example, a person who picks up traits from their friends is introjecting.

Projection has been described as an early phase of introjection.

Historic Precursors

Freud and Klein

In Freudian terms, introjection is the aspect of the ego’s system of relational mechanisms which handles checks and balances from a perspective external to what one normally considers ‘oneself’, infolding these inputs into the internal world of the self-definitions, where they can be weighed and balanced against one’s various senses of externality. For example:

  • “When a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality.”
  • “Individuals with weak ego boundaries are more prone to use introjection as a defense mechanism.”

According to D.W. Winnicott, “projection and introjection mechanisms… let the other person be the manager sometimes, and to hand over omnipotence.”

According to Freud, the ego and the superego are constructed by introjecting external behavioural patterns into the subject’s own person. Specifically, he maintained that the critical agency or the super ego could be accounted for in terms of introjection and that the superego derives from the parents or other figures of authority. The derived behavioural patterns are not necessarily reproductions as they actually are but incorporated or introjected versions of them.

Torok and Ferenczi

However, the aforementioned description of introjection has been challenged by Maria Torok as she favours using the term as it is employed by Sándor Ferenczi in his essay “The Meaning of Introjection” (1912). In this context, introjection is an extension of autoerotic interests that broadens the ego by a lifting of repression so that it includes external objects in its make-up. Torok defends this meaning in her 1968 essay “The Illness of Mourning and the Fantasy of the Exquisite Corpse”, where she argues that Sigmund Freud and Melanie Klein confuse introjection with incorporation and that Ferenczi’s definition remains crucial to analysis. She emphasized that in failed mourning “the impotence of the process of introjection (gradual, slow, laborious, mediated, effective)” means that “incorporation is the only choice: fantasmatic, unmediated, instantaneous, magical, sometimes hallucinatory…’crypt’ effects (of incorporation)”.

Fritz and Peris

In Gestalt therapy, the concept of “introjection” is not identical with the psychoanalytical concept. Central to Fritz and Laura Perls’ modifications was the concept of “dental or oral aggression”, when the infant develops teeth and is able to chew. They set “introjection” against “assimilation”. In Ego, Hunger and Aggression, Fritz and Laura Perls suggested that when the infant develops teeth, he or she has the capacity to chew, to break apart food, and assimilate it, in contrast to swallowing before; and by analogy to experience, to taste, accept, reject or assimilate. Laura Perls explains: “I think Freud said that development takes place through introjection, but if it remains introjection and goes no further, then it becomes a block; it becomes identification. Introjection is to a great extent unawares.”

Thus Fritz and Laura Perls made “assimilation”, as opposed to “introjection”, a focal theme in Gestalt therapy and in their work, and the prime means by which growth occurs in therapy. In contrast to the psychoanalytic stance, in which the “patient” introjects the (presumably more healthy) interpretations of the analyst, in Gestalt therapy the client must “taste” with awareness their experience, and either accept or reject it, but not introject or “swallow whole”. Hence, the emphasis is on avoiding interpretation, and instead encouraging discovery. This is the key point in the divergence of Gestalt therapy from traditional psychoanalysis: growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst.

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What is Dissociation (Psychology)?

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Introduction

Dissociation, as a concept that has been developed over time, is any of a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.

The phenomena are diagnosable under the DSM-5 as a group of disorders as well as a symptom of other disorders through various diagnostic tools. Its cause is believed to be related to neurobiological mechanisms, trauma, anxiety, and psychoactive drugs. Research has further related it to suggestibility and hypnosis, and it is inversely related to mindfulness, which is a potential treatment.

Brief History

French philosopher and psychologist Pierre Janet (1859-1947) is considered to be the author of the concept of dissociation. Contrary to some conceptions of dissociation, Janet did not believe that dissociation was a psychological defence.

Psychological defence mechanisms belong to Sigmund Freud‘s theory of psychoanalysis, not to Janetian psychology. Janet claimed that dissociation occurred only in persons who had a constitutional weakness of mental functioning that led to hysteria when they were stressed. Although it is true that many of Janet’s case histories described traumatic experiences, he never considered dissociation to be a defence against those experiences. Quite the opposite: Janet insisted that dissociation was a mental or cognitive deficit. Accordingly, he considered trauma to be one of many stressors that could worsen the already-impaired “mental deficiency” of a hysteric, thereby generating a cascade of hysterical (in today’s language, “dissociative”) symptoms.

Although there was great interest in dissociation during the last two decades of the nineteenth century (especially in France and England), this interest rapidly waned with the coming of the new century. Even Janet largely turned his attention to other matters.

There was a sharp peak in interest in dissociation in America from 1890 to 1910, especially in Boston as reflected in the work of William James, Boris Sidis, Morton Prince, and William McDougall. Nevertheless, even in America, interest in dissociation rapidly succumbed to the surging academic interest in psychoanalysis and behaviourism.

For most of the twentieth century, there was little interest in dissociation. Despite this, a review of 76 previously published cases from the 1790s to 1942 was published in 1944, describing clinical phenomena consistent with that seen by Janet and by therapists today. In 1971, Bowers and her colleagues presented a detailed, and still quite valid, treatment article. The authors of this article included leading thinkers of their time – John G. Watkins (who developed ego-state therapy) and Zygmunt A. Piotrowski (famed for his work on the Rorschach test). Further interest in dissociation was evoked when Ernest Hilgard (1977) published his neodissociation theory in the 1970s. During the 1970s and 1980s an increasing number of clinicians and researchers wrote about dissociation, particularly multiple personality disorder.

Carl Jung described pathological manifestations of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic attitudes and functions in normal individual consciousness is the basis of Jung’s Psychological Types. He theorised that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite.

Attention to dissociation as a clinical feature has been growing in recent years as knowledge of post-traumatic stress disorder (PTSD) increased, due to interest in dissociative identity disorder (DID), and as neuroimaging research and population studies show its relevance.

Historically the psychopathological concept of dissociation has also another different root: the conceptualization of Eugen Bleuler that looks into dissociation related to schizophrenia.

Diagnosis

Refer to Dissociative disorder.

Dissociation is commonly displayed on a continuum. In mild cases, dissociation can be regarded as a coping mechanism or defence mechanism in seeking to master, minimise or tolerate stress – including boredom or conflict. At the non-pathological end of the continuum, dissociation describes common events such as daydreaming. Further along the continuum are non-pathological altered states of consciousness.

More pathological dissociation involves dissociative disorders, including dissociative fugue and depersonalisation disorder with or without alterations in personal identity or sense of self. These alterations can include: a sense that self or the world is unreal (depersonalisation and derealisation), a loss of memory (amnesia), forgetting identity or assuming a new self (fugue), and separate streams of consciousness, identity and self (dissociative identity disorder, formerly termed multiple personality disorder) and complex post-traumatic stress disorder (CPTSD). Although some dissociative disruptions involve amnesia, other dissociative events do not. Dissociative disorders are typically experienced as startling, autonomous intrusions into the person’s usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling.

Dissociative disorders are sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable trigger at all. The ICD-10 classifies conversion disorder as a dissociative disorder. The DSM groups all dissociative disorders into a single category and recognises dissociation as a symptom of acute stress disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder.

Misdiagnosis is common among people who display symptoms of dissociative disorders, with an average of seven years to receive proper diagnosis and treatment. Research is ongoing into aetiologies, symptomology, and valid and reliable diagnostic tools. In the general population, dissociative experiences that are not clinically significant are highly prevalent with 60% to 65% of the respondents indicating that they have had some dissociative experiences.

Diagnostic and Statistical Manual of Mental Disorders

Diagnoses listed under the DSM-5 are dissociative identity disorder, dissociative amnesia, depersonalisation/derealisation disorder, other specified dissociative disorder and unspecified dissociative disorder. The list of available dissociative disorders listed in the DSM-5 changed from the DSM-IV-TR, as the authors removed the diagnosis of dissociative fugue, classifying it instead as a subtype of dissociative amnesia. Furthermore, the authors recognised derealisation on the same diagnostic level of depersonalisation with the opportunity of differentiating between the two.

The DSM-IV-TR considers symptoms such as depersonalisation, derealisation and psychogenic amnesia to be core features of dissociative disorders. The DSM-5 carried these symptoms over and described symptoms as positive and negative. Positive symptoms include unwanted intrusions that alter continuity of subjective experiences, which account for the first two symptoms listed earlier with the addition of fragmentation of identity. Negative symptoms include loss of access to information and mental functions that are normally readily accessible, which describes amnesia.

Peritraumatic Dissociation

Peritraumatic dissociation is considered to be dissociation that is experienced during and immediately following a traumatic event. Research is on-going related to its development, its importance, and its relationship to trauma, dissociative disorders, and predicting the development of PTSD.

Measurements

Two of the most commonly used screening tools in the community are the Dissociative Experiences Scale and the Multiscale Dissociation Inventory. Meanwhile, the Structured Clinical Interview for DSM-IV – Dissociative Disorders (SCID-D) and its second iteration, the SCID-D-R, are both semi-structured interviews and are considered psychometrically strong diagnostic tools.

Other tools include the Office Mental Status Examination (OMSE), which is used clinically due to inherent subjectivity and lack of quantitative use. There is also the Dissociative Disorders Interview Schedule (DDSI), which lacks substantive clarity for differential diagnostics.

Peritraumatic dissociation is measured through the Peritraumatic Dissociative Scale.

Aetiology

Neurobiological Mechanism

Preliminary research suggests that dissociation-inducing events, drugs like ketamine, and seizures generate slow rhythmic activity (1-3 Hz) in layer 5 neurons of the posteromedial cortex in humans (retrosplenial cortex in mice). These slow oscillations disconnect other brain regions from interacting with the posteromedial cortex, which may explain the overall experience of dissociation.

Trauma

Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse. This is supported by studies which suggest that dissociation is correlated with a history of trauma.

Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatised, yet at the same time there are many people who have suffered from trauma but who do not show dissociative symptoms.

Adult dissociation when combined with a history of child abuse and otherwise interpersonal violence-related PTSD has been shown to contribute to disturbances in parenting behaviour, such as exposure of young children to violent media. Such behaviour may contribute to cycles of familial violence and trauma.

Symptoms of dissociation resulting from trauma may include depersonalisation, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defence mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.

Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as “sequelae to abuse”) include anxiety, PTSD, low self-esteem, somatisation, depression, chronic pain, interpersonal dysfunction, substance abuse, self-harm and suicidal ideation or actions. These symptoms may lead the victim to present the symptoms as the source of the problem.

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample, including amnesia for abuse memories. It has also been seen that girls who suffered abuse during their childhood had higher reported dissociation scores than did boys who reported dissociation during their childhood. A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15, and dissociation has also been correlated with a history of childhood physical and sexual abuse. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states.

Psychoactive substances

Refer to Dissociative Drug.

Psychoactive drugs can often induce a state of temporary dissociation. Substances with dissociative properties include ketamine, nitrous oxide, alcohol, tiletamine, amphetamine, dextromethorphan, MK-801, PCP, methoxetamine, salvia, muscimol, atropine, ibogaine, and minocycline.

Correlations

Hypnosis and Suggestibility

There is evidence to suggest that dissociation is correlated with hypnotic suggestibility, specifically with dissociative symptoms related to trauma. However, the relationship between dissociation and hypnotic suggestibility appears to be complex and indicates further research is necessary.

Aspects of hypnosis include absorption, dissociation, suggestibility, and willingness to receive behavioural instruction from others. Both hypnotic suggestibility and dissociation tend to be less mindful, and hypnosis is used as a treatment modality for dissociation, anxiety, chronic pain, trauma, and more. Difference between hypnosis and dissociation: one is suggested, imposed by self or other, meaning dissociation is generally more spontaneous altering of awareness.

Mindfulness and Meditation

Mindfulness and meditation have shown an inverse relationship specifically with dissociation related to re-experiencing trauma due to the lack of present awareness inherent with dissociation. The re-experiencing episodes can include anything between illusions, distortions in perceived reality, and disconnectedness from the present moment. It is believed that the nature of dissociation as an avoidance coping or defence mechanism related to trauma inhibits resolution and integration.

Mindfulness and meditation also can alter the state of awareness to the present moment; however, unlike dissociation, it is clinically used to bring greater awareness to an individual’s present state of being. It achieves this through increased abilities to self-regulate attention, emotion, and physiological arousal, maintain continuity of consciousness, and adopt an approach to the present experience that is open and curious. In practice, non-judgmental awareness has displayed a positive relationship with lower symptoms of PTSD avoidance, which can relate to greater opportunities for success with exposure therapy and lowering PTSD symptoms of hypervigilance, re-experiencing, and overgeneralization of fears.

When using mindfulness and meditation with people expressing trauma symptoms, it is crucial to be aware of potential trauma triggers, such as the focus on the breath. Often, a meditation session will begin with focused attention and move into open monitoring. With severe trauma symptoms, it may be important to start the meditation training and an individual session at the peripheral awareness, such as the limbs. Moreover, trauma survivors often report feeling numb as a protection against trauma triggers and reminders, which are often painful, making it good practice to start all trainings at the limbs as a gradual exposure to body sensations. Doing so will also increase physical attachment to the present moment and the sense of grounding, thereby increasing tolerance to trauma reminders and decreasing the need and use of dissociation.

Treatment

When receiving treatment, patients are assessed to discover their level of functioning. Some patients might be higher functioning than others. This is taken into account when creating a patient’s potential treatment targets. To start off treatment, time is dedicated to increasing a patient’s mental level and adaptive actions in order to gain a balance in both their mental and behavioural action. Once this is achieved, the next goal is to work on removing or minimising the phobia made by traumatic memories, which is causing the patient to dissociate. The final step of treatment includes helping patients work through their grief in order to move forward and be able to engage in their own lives. This is done with the use of new coping skills attained through treatment. One coping skill that can improve dissociation is mindfulness due to the introduction of staying in present awareness while observing non-judgmentally and increasing the ability to regulate emotions. Specifically in adolescents, mindfulness has been shown to reduce dissociation after practicing mindfulness for three weeks.

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What is a Narcissistic Parent?

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Introduction

A narcissistic parent is a parent affected by narcissism or narcissistic personality disorder.

Typically, narcissistic parents are exclusively and possessively close to their children and are threatened by their children’s growing independence. This results in a pattern of narcissistic attachment, with the parent considering that the child exists solely to fulfil the parent’s needs and wishes. A narcissistic parent will often try to control their children with threats and emotional abuse. Narcissistic parenting adversely affects the psychological development of children, affecting their reasoning and their emotional, ethical, and societal behaviours and attitudes. Personal boundaries are often disregarded with the goal of moulding and manipulating the child to satisfy the parent’s expectations.

Narcissistic people have low self-esteem and feel the need to control how others regard them, fearing that otherwise they will be blamed or rejected and their personal inadequacies will be exposed. Narcissistic parents are self-absorbed, often to the point of grandiosity. They also tend to be inflexible, and lack the empathy necessary for child raising.

Characteristics

The term narcissism, as used in Sigmund Freud’s clinical study, includes behaviours such as self-aggrandisement, self-esteem, vulnerability, fear of losing the affection of people and of failure, reliance on defence mechanisms, perfectionism, and interpersonal conflict.

To maintain their self-esteem and protect their vulnerable true selves, narcissists seek to control the behaviour of others, particularly that of their children whom they view as extensions of themselves. Thus, narcissistic parents may speak of “carrying the torch”, maintaining the family image, or making the mother or father proud. They may reproach their children for exhibiting weakness, being too dramatic, being selfish, or not meeting expectations. Children of narcissists learn to play their part and to show off their special skill(s), especially in public or for others. They typically do not have many memories of having felt loved or appreciated for being themselves. Instead, they associate their experience of love and appreciation with conforming to the demands of the narcissistic parent.

Destructive narcissistic parents have a pattern of consistently needing to be the focus of attention, exaggerating, seeking compliments, and putting their children down. Punishment in the form of blame, criticism or emotional blackmail, and attempts to induce guilt may be used to ensure compliance with the parent’s wishes and their need for narcissistic supply.

Children of Narcissists

Narcissism tends to play out intergenerationally, with narcissistic parents producing either narcissistic or co-dependent children in turn. While a self-confident parent, or good-enough parent, can allow a child his or her autonomous development, the narcissistic parent may instead use the child to promote his or her own image. A parent concerned with self-enhancement, or with being mirrored and admired by their child, may leave the child feeling like a puppet to the parent’s emotional/intellectual demands.

Children of a narcissistic parent may not be supportive of others in the home. Observing the behaviour of the parent, the child learns that manipulation and guilt are effective strategies for getting what he or she wants. The child may also develop a false self and use aggression and intimidation to get their way. Instead, they may invest in the opposite behaviours if they have observed them among friends and other families. When the child of a narcissistic parent experiences safe, real love or sees the example played out in other families, they may identify and act on the differences between their life and that of a child in a healthy family. For example, the lack of empathy and volatility at home may increase the child’s own empathy and desire to be respectful. Similarly, intense emotional control and disrespect for boundaries at home may increase the child’s value for emotional expression and their desire to extend respect to others. Although the child observes the parent’s behaviour, they are often on the receiving end of the same behaviour. When an alternative to the pain and distress caused at home presents itself, the child may choose to focus on more comforting, safety-inducing behaviours.

Some common issues in narcissistic parenting result from a lack of appropriate, responsible nurturing. This may lead to a child feeling empty, insecure in loving relationships, developing imagined fears, mistrusting others, experiencing identity conflict, and suffering an inability to develop a distinct existence from that of the parent.

Sensitive, guilt-ridden children in the family may learn to meet the parent’s needs for gratification and seek love by accommodating the wishes of the parent. The child’s normal feelings are ignored, denied and eventually repressed in attempts to gain the parent’s “love”. Guilt and shame keep the child locked in a developmental arrest. Aggressive impulses and rage may become split off and not integrated with normal development. Some children develop a false self as a defence mechanism and become co-dependent in relationships. The child’s unconscious denial of their true self may perpetuate a cycle of self-hatred, fearing any reminder of their authentic self.

Narcissistic parenting may also lead to children being either victimised or bullies, having a poor or overly inflated body image, tendency to use and/or abuse drugs or alcohol, and acting out (in a potentially harmful manner) for attention.

Short-Term and Long-Term Effects

Due to their vulnerability, children are extremely affected by the behaviour of a narcissistic parent. A narcissistic parent will often abuse the normal parental role of guiding their children and being the primary decision maker in the child’s life, becoming overly possessive and controlling. This possessiveness and excessive control disempowers the child; the parent sees the child simply as an extension of themselves. This may affect the child’s imagination and level of curiosity, and they often develop an extrinsic style of motivation. This heightened level of control may be due to the need of the narcissistic parent to maintain the child’s dependence on them.

Narcissistic parents are quick to anger, putting their children at risk for physical and emotional abuse. To avoid anger and punishment, children of abusive parents often resort to complying with their parent’s every demand. This affects both the child’s well-being and their ability to make logical decisions on their own, and as adults they often lack self-confidence and the ability to gain control over their life. Identity crisis, loneliness, and struggle with self expression are also commonly seen in children raised by a narcissistic parent. The struggle to discover one’s self as an adult stems from the substantial amount of projective identification that the now adult experienced as a child. Because of excessive identification with the parent, the child may never get the opportunity to experience their own identity.

Mental Health Effects

Studies have found that children of narcissistic parents have significantly higher rates of depression and lower self-esteem during adulthood than those who did not perceive their caregivers as narcissistic. The parent’s lack of empathy towards their child contributes to this, as the child’s desires are often denied, their feelings restrained, and their overall emotional well-being ignored.

Children of narcissistic parents are taught to submit and conform, causing them to lose touch of themselves as individuals. This can lead to the child possessing very few memories of feeling appreciated or loved by their parents for being themselves, as they instead associate the love and appreciation with conformity. Children may benefit with distance from the narcissistic parent. Some children of narcissistic parents resort to leaving home during adolescence if they grow to view the relationship with their parent(s) as toxic.

What is Narcissistic Mortification?

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Introduction

Narcissistic mortification is “the primitive terror of self dissolution, triggered by the sudden exposure of one’s sense of a defective self … it is death by embarrassment”.

Narcissistic mortification is a term first used by Sigmund Freud in his last book, Moses and Monotheism, with respect to early injuries to the ego/self. The concept has been widely employed in ego psychology and also contributed to the roots of self psychology.

When narcissistic mortification is experienced for the first time, it may be defined as a sudden loss of control over external or internal reality, or both. This produces strong emotions of terror while at the same time narcissistic libido (also known as ego-libido) or destrudo is built up. Narcissistic libido or ego-libido is the concentration of libido on the self. Destrudo is the opposite of libido and is the impulse to destroy oneself and everything associated with oneself.

Early Developments: Bergler, Anna Freud, and Eidelberg

Edmund Bergler developed the concept of narcissistic mortification in connection with early fantasies of omnipotence in the developing child, and with the fury provoked by the confrontations with reality that undermine his or her illusions. For Bergler, “the narcissistic mortification suffered in this very early period continues to act as a stimulus throughout his life”.

Anna Freud used the term in connection with her exploration of the defence mechanism of altruistic surrender, whereby an individual lives only through the lives of others – seeing at the root of such an abrogation of one’s own life an early experience of narcissistic mortification at a disappointment with one’s self.

Psychoanalyst and author Ludwig Eidelberg subsequently expanded on the concept in the fifties and sixties. Eidelberg defined narcissistic mortification as occurring when “a sudden loss of control over external or internal reality…produces the painful emotional experience of terror”. He also stressed that for many patients simply to have to accept themselves as having neurotic symptoms was itself a source of narcissistic mortification.

Kohut and Self Psychology

For Heinz Kohut, narcissistic injury – the root cause of what he termed narcissistic personality disorder – was broadly equivalent to the humiliation of mortification. Kohut considered that “if the grandiosity of the narcissistic self has been insufficiently modified…then the adult ego will tend to vacillate between an irrational overestimation of the self and feelings of inferiority and will react with narcissistic mortification to the thwarting of its ambitions”.

Object Relations Theory

Unlike ego psychologists, object relations theorists have traditionally used a rather different, post-Kleinian vocabulary to describe the early woundings of narcissistic mortification. Recently however such theorists have found analogies between Freud’s emphasis on the sensitivity of the ego to narcissistic humiliation and mortification, and the views of Bion on ‘nameless dread’ or Winnicott’s on the original agonies of the breakdown of childhood consciousness. At the same time ego psychologists have been increasingly prepared to see narcissistic mortification as occurring in the context of early relations to objects.

Physical Sensations and Psychological Perceptions

An individual’s experience of mortification may be accompanied by both physical and psychological sensations. Physical sensations such as: burning, painful tingling over the body, pain in the chest that slowly expands and spreads throughout the torso, dizziness, nausea, vomiting, sweating, blanching, coldness and numbness can be experienced by the individual suffering from mortification. The psychological sensations described are feeling shocked, exposed, and humiliated. Descriptions of this experience can be, for example: “It feels like I won’t survive” and “I have the absolute conviction that he or she hates me and it’s my fault”. These sensations are always followed by shock, although they may have happened on various occasions, they also prompt the need for the individual suffering to do something both internally and externally, to effect a positive self-image in the eyes of their narcissistic object. Narcissistic mortification is extreme in its intensity, global nature, and its lack of perspective, causing the anxiety associated with it to become traumatic.

Normal versus Pathological

In Eidelberg’s view, a normal individual would usually be able to avoid being overwhelmed by internal needs because they recognise these urges in time to bring about their partial discharge. However, Eidelberg does not view occasional outbursts of temper as a sign of disorder. An individual experiencing pathological narcissistic mortification is prone to become fixated on infantile objects, resulting in an infantile form of discharge. He or she cannot be satisfied by the partial discharge of this energy, which takes place on an unconscious level, and this in turn interferes with their well-being. According to Eidelberg, the denial of an infantile narcissistic mortification can be responsible for many defensive mechanisms.

Internal versus External

Narcissistic mortification can be:

InternalOccurs when an individual is overstimulated by their emotions. For example, while debating with classmates on the importance of stem cell research an outspoken student loses his temper causing an uproar. The student has just exhibited an overstimulation of his emotions and used this outburst to relieve internal tension.
ExternalOccurs when something out of one’s control influences a situation, for example, an individual who is held at gunpoint while having their wallet stolen. This individual does not hold any control over the scenario nor the actions of the gunman, but their reaction to being held at gunpoint influences the next scenario and what the gunman does next.

In Cult Leadership

To escape the narcissistic mortification of accepting their own dependency needs, cult leaders may resort to delusions of omnipotence. Their continuing shame and underlying guilt, and their repudiation of dependency, obliges such leaders to use seduction and manic defences to externalise and locate dependency needs in others, thus making their followers controllable through a displaced sense of shame.

Death, Anxiety, and Suicide

Because in Western culture death is sometimes seen as the ultimate loss of control, fear of it may produce death anxiety in the form of a sense of extreme shame or narcissistic mortification. The shame in this context is produced by the loss of stoicism, productivity, and control, aspects that are highly valued by society and aspects that are taken away as one ages. Death according to Darcy Harris:

‘is the ultimate narcissistic wound, bringing about not just the annihilation of self, but the annihilation of one’s entire existence, resulting in a form of existential shame for human beings, who possess the ability to ponder this dilemma with their higher functioning cognitive abilities.’

Individuals who hold this anxiety are ashamed of mortality and the frailty that comes along with it; and may attempt to overcome this reality through diversions and accomplishments, deflecting feelings of inferiority and shame through strategies like grandiosity in similar fashion to those with narcissistic personality traits.

Narcissistic mortification may also be produced by death of someone close. Such a loss of an essential object may even lead through narcissistic mortification to suicide.

Among the many motives behind suicidal activities in general are shame, loss of honour, and narcissistic mortification. Those who suffer from narcissistic mortification are more likely to participate in suicidal behaviours and those who do not receive the proper help more often than not succeed. Suicide related to narcissistic mortification is different from normal sorrow in that it is associated with deep rooted self-contempt and self-hatred.

Treatment

According to a paper presented by Mary Libbey, “On Narcissistic Mortification”, presented at the 2006 Shame Symposium, long-term goal of psychoanalytic treatment for those who suffer from narcissistic mortification is to transform the mortification into shame. She says by transforming it into shame it enables the sufferer to tolerate and use it as a signal; the process of transforming mortification into shame entails working through both the early mortifying traumas as well as the defences, often unstable, related to them. If an individual sufferer does not go through this transformation, he or she is left with two unstable narcissistic defences. Libbey says these defences are: self-damning, deflated states designed to appease and hold on to self-objects, and narcissistic conceit, which is designed to project the defective self experiences onto self-objects. Both of these defensive styles require a continuation of dependence on the self-object. Transforming the mortification into shame makes it possible for self-appraisal and self-tolerance, this ultimately leads to psychic separation and self-reliance without the need to sustain one’s mortification, according to Libbey’s paper.

In the 21st Century

Postmodern Freudians link narcissistic mortification to Winnicott’s theory of primitive mental states which lack the capacity for symbolisation, and their need for re-integration. Returning in the transference to the intolerable mortification underpinning such narcissistic defences can however also produce positive analytic change, by way of the (albeit mortifying) re-experience of overwhelming object loss within an intersubjective holding environment.

21st century American analysts are particularly concerned with the potential production of narcissistic mortification as a by-product of analytic interpretation, especially with regard to masochistic personality disorder.

Literary Uses

  • Narcissistic mortification at injuries to self-esteem has been seen as pervading Captain Ahab’s motivations in his confrontation with Moby-Dick.
  • Mortification at one’s self is seen in Mary Shelley’s Frankenstein when the Creature stares at his reflection in a pool of water. This is where he becomes convinced that he is in fact the Creature and becomes filled with despondence and mortification.

What is Narcissistic Injury?

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Introduction

Narcissistic injury, also known as “narcissistic wound” or “wounded ego” are emotional traumas that overwhelm an individual’s defence mechanisms and devastate their pride and self worth.

In some cases the shame or disgrace is so significant that the individual can never again truly feel good about who they are and this is sometimes referred to as a “narcissistic scar”.

Freud maintained that “losses in love” and “losses associated with failure” often leave behind injury to an individual’s self-regard.

Treatment

Adam Phillips has argued that, contrary to what common sense might expect, therapeutic cure involves the patient being encouraged to re-experience “a terrible narcissistic wound” – the child’s experience of exclusion by the parental alliance – in order to come to terms with, and learn again, the diminishing loss of omnipotence entailed by the basic “facts of life”.

Further Psychoanalytic Developments

Freud’s concept of what in his last book he called “early injuries to the self (injuries to narcissism)” was subsequently extended by a wide variety of psychoanalysts. Karl Abraham saw the key to adult depressions in the childhood experience of a blow to narcissism through the loss of narcissistic supply. Otto Fenichel confirmed the importance of narcissistic injury in depressives and expanded such analyses to include borderline personalities.

Edmund Bergler emphasized the importance of infantile omnipotence in narcissism, and the rage that follows any blow to that sense of narcissistic omnipotence; Annie Reich stressed how a feeling of shame-fuelled rage, when a blow to narcissism exposed the gap between one’s ego ideal and mundane reality; while Lacanians linked Freud on the narcissistic wound to Lacan on the narcissistic mirror stage.

Finally, object relations theory highlights rage against early environmental failures that left patients feeling bad about themselves when childhood omnipotence was too abruptly challenged.

Perfectionism

Narcissists are often pseudo-perfectionists and create situations in which they are the centre of attention. The narcissist’s attempts at being seen as perfect are necessary for their grandiose self-image. If a perceived state of perfection is not reached, it can lead to guilt, shame, anger or anxiety because the subject believes that they will lose the admiration and love of other people if they are imperfect.

Behind such perfectionism, self psychology would see earlier traumatic injuries to the grandiose self.

Criticism

Wide dissemination of Kohut’s concepts may at times have led to their trivialization. Neville Symington points out that “You will often hear people say, ‘Oh, I’m very narcissistic,’ or, ‘It was a wound to my narcissism.’ Such comments are not a true recognition of the condition; they are throw-away lines. To really recognise narcissism in oneself is profoundly distressing and often associated with denial.”

What are Narcissistic Defences?

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Introduction

Narcissistic defences are those processes whereby the idealised aspects of the self are preserved, and its limitations denied.

They tend to be rigid and totallistic. They are often driven by feelings of shame and guilt, conscious or unconscious.

Origins

Narcissistic defences are among the earliest defence mechanisms to emerge, and include denial, distortion, and projection. Splitting is another defence mechanism prevalent among individuals with narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder – seeing people and situations in black and white terms, either as all bad or all good.

A narcissistic defence, with the disorder’s typical over-valuation of the self, can appear at any stage of development.

Defence Sequences

The narcissist typically runs through a sequence of defences to discharge painful feelings until he or she finds one that works:

  • Unconscious repression.
  • Conscious denial.
  • Distortion (including exaggeration and minimisation), rationalisation and lies.
  • Psychological projection (blaming somebody else).
  • Enlisting the help of one or more of their co-dependent friends who will support their distorted view.

Freudians

Sigmund Freud did not focus specifically on narcissistic defences, but did note in On Narcissism how “even great criminals and humorists, as they are represented in literature, compel our interest by the narcissistic consistency with which they manage to keep away from their ego anything that would diminish it”. Freud saw narcissistic regression as a defensive answer to object loss – denying the loss of an important object by way of a substitutive identification with it.

Freud also considered social narcissism as a defence mechanism, apparent when communal identifications produce irrational panics at perceived threats to ‘Throne and Altar’ or ‘Free Markets’, or in English over-reaction to any questioning of the status and identity of William Shakespeare.

Fenichel

Otto Fenichel considered that “identification, performed by means of introjection, is the most primitive form of relationship to objects” a primitive mechanism only used “if the ego’s function of reality testing is severely damaged by a narcissistic regression.”

Fenichel also highlighted “eccentrics who have more or less succeeded in regaining the security of primary narcissism and who feel ‘Nothing can happen to me’….[failing] to give up the archaic stages of repudiating displeasure and to turn toward reality”.

Lacan

Jacques Lacan, following out Freud’s view of the ego as the result of identifications, came to consider the ego itself as a narcissistic defence, driven by what he called “the ‘narcissistic passion’ …in the coming-into-being (devenir) of the subject”.

Kleinians

Melanie Klein, emphasised projective identification in narcissism, and the manic defence against becoming aware of the damage done to objects in this way. For Kleinians, at the core of manic defences in narcissism stood what Hanna Segal called “a triad of feelings—control, triumph and contempt”.

Rosenfeld

Herbert Rosenfeld looked at the role of omnipotence, combined with projective identification, as a narcissistic means of defending against awareness of separation between ego and object.

Object Relations Theory

In the wake of Klein, object relations theory, including particularly the American schools of Otto Kernberg and Heinz Kohut has explored narcissistic defences through analysis of such mechanisms as denial, projective identification, and extreme idealisation.

Kernberg emphasised the role of the splitting apart introjections, and identifications of opposing qualities, as a cause of ego weakness. Kohut too stressed the fact in narcissism “vertical splits are between self-structures (among others)—’I am grand’ and ‘I am wretched’—with very little communication between them”.

Neville Symington however placed greater weight on the way “a person dominated by narcissistic currents…survives through being able to sense the emotional tone of the other…wearing the cloaks of others”; while for Spotnitz the key element is that the narcissist turns feelings in upon the self in narcissistic defence.

Positive Defences

Kernberg emphasised the positive side to narcissistic defences, while Kohut also stressed the necessity in early life for narcissistic positions to succeed each other in orderly maturational sequences.

Others like Symington would maintain that “it is a mistake to split narcissism into positive and negative…we do not get positive narcissism without self-hatred”.

Stigmatising Attitude to Psychiatric Illness

Arikan found that a stigmatising attitude to psychiatric patients is associated with narcissistic defences.

21st century

The twenty-first century has seen a distinction drawn between cerebral and somatic narcissists – the former building up their self-sense through intellectualism, the latter through an obsession with their bodies, as with the woman who, in bad faith, invests her sense of freedom only in being an object of beauty for others.

Literary Parallels

  • Sir Philip Sidney is said to have seen poetry in itself as a narcissistic defence.
  • Jean-Paul Sartre’s aloof, detached protagonists have been seen as crude narcissists who preserve their sense of self only by petrifying it into solid form.

What is Love and Hate (Psychoanalysis)?

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Introduction

Love and hate as co-existing forces have been thoroughly explored within the literature of psychoanalysis, building on awareness of their co-existence in Western culture reaching back to the “odi et amo” of Catullus, and Plato’s Symposium.

Love and Hate in Freud’s Work

Ambivalence was the term borrowed by Sigmund Freud to indicate the simultaneous presence of love and hate towards the same object. While the roots of ambivalence can be traced back to breast-feeding in the oral stage, it was reinforced during toilet-training as well. Freudian followers such as Karl Abraham and Erik H. Erikson distinguished between an early sub-stage with no ambivalence at all towards the mother’s breast, and a later oral-sadistic sub-phase where the biting activity emerges and the phenomenon of ambivalence appears for the first time. The child is interested in both libidinal and aggressive gratifications, and the mother’s breast is at the same time loved and hated.

While during the pre-oedipal stages ambivalent feelings are expressed in a dyadic relationship between the mother and the child, during the oedipal conflict ambivalence is experienced for the first time within a triangular context which involves the child, the mother and the father. In this stage, both the boy and the girl develop negative feelings of jealousy, hostility and rivalry toward the parent of the same sex, but with different mechanisms for the two sexes. The boy’s attachment to his mother becomes stronger, and he starts developing negative feelings of rivalry and hostility toward the father. The boy wishes to destroy the father so that he can become his mother’s unique love object. On the other hand, the girl starts a love relationship with her father. The mother is seen by the girl as a competitor for the father’s love and so the girl starts feeling hostility and jealousy towards her. The negative feelings which arise in this phase coexist with love and affection toward the parent of the same sex and result in an ambivalence which is expressed in feelings, behaviour and fantasies. The negative feelings are a source of anxiety for the child who is afraid that the parent of the same sex would take revenge on him/her. In order to lessen the anxiety, the child activates the defence mechanism of identification, and identifies with the parent of the same sex. This process leads to the formation of the Super-Ego.

According to Freud, ambivalence is the precondition for melancholia, together with loss of a loved object, oral regression and discharge of the aggression toward the self. In this condition, the ambivalently loved object is introjected, and the libido is withdrawn into the self in order to establish identification with the loved object. The object loss then turns into an ego loss and the conflict between the Ego and the Super-Ego becomes manifested. The same ambivalence occurs in the obsessional neurosis, but there it remains related to the outside object.

In the Work of Melanie Klein

The object relations theory of Melanie Klein pivoted around the importance of love and hate, concern for and destruction of others, from infancy onwards. Klein stressed the importance of inborn aggression as a reflection of the death drive and talked about the battle of love and hatred throughout the life span. As life begins, the first object for the infant to relate with the external world is the mother. It is there that both good and bad aspects of the self are split and projected as love and hatred to the mother and the others around her later on: as analyst, she would find herself split similarly into a “nice” and a “bad” Mrs Klein.

During the paranoid-schizoid position, the infant sees objects around it either as good or bad, according to his/her experiences with them. They are felt to be loving and good when the infant’s wishes are gratified and happy feelings prevail. On the other hand, objects are seen as bad when the infant’s wishes are not met adequately and frustration prevails. In the child’s world there is not yet a distinction between fantasy and reality; loving and hating experiences towards the good and bad objects are believed to have an actual impact on the surrounding objects. Therefore, the infant must keep these loving and hating emotions as distinct as possible, because of the paranoid anxiety that the destructive force of the bad object will destroy the loving object from which the infant gains refuge against the bad objects. The mother must be either good or bad and the feeling experienced is either love or hate.

Emotions become integrated as a part of the development process. As the infant’s potential to tolerate ambivalent feelings with the depressive position, the infant starts forming a perception of the objects around it as both good and bad, thus tolerating the coexistence of these two opposite feelings for the same object where experience had previously been either idealised or dismissed as bad, the good object can be accepted as frustrating without losing its acceptable status. When this takes place, the previous paranoid anxiety (that the bad object will destroy everything) transforms into a depressive anxiety; this is the intense fear that the child’s own destructiveness (hate) will damage the beloved others. Subsequently, for the coexistence of love and hate to be attainable, the child must believe in her ability to contain hate, without letting it destroy the loving objects. He/she must believe in the prevalence of the loving feelings over his/her aggressiveness. Since this ambivalent state is hard to preserve, under difficult circumstances it is lost, and the person returns to the previous manner keeping love and hate distinct for a period of time until he/she is able to regain the capacity for ambivalence.

Refer to The Life and Death Instincts in Kleinian Object Relations Theory.

In the Work of Ian Suttie

Ian Dishart Suttie (1898-1935) wrote the book The Origins of Love and Hate, which was first published in 1935, a few days after his death. He was born in Glasgow and was the third of four children. His father was a general practitioner, and Ian Suttie and both of his brothers and his sister became doctors as well. He qualified from Glasgow University in 1914. After a year he went into psychiatry.

Although his work has been out of print in England for some years, it is still relevant today. It has been often cited and makes a contribution towards understanding the more difficult aspects of family relationships and friendships. He can be seen as one of the first significant object relations theorists and his ideas anticipated the concepts put forward by modern self psychologists.

Although Ian Suttie was working within the tradition set by Freud, there were a lot of concepts of Freud’s theory he disagreed with. First of all, Suttie saw sociability, the craving for companionship, the need to love and be loved, to exchange and to participate, to be as primary as sexuality itself. And in contrast with Freud he didn’t see sociability and love simply as a derivative from sexuality. Secondly, Ian Suttie explained anxiety and neurotic maladjustment, as a reaction on the failure of finding a response for this sociability; when primary social love and tenderness fails to find the response it seeks, the arisen frustration will produce a kind of separation anxiety. This view is more clearly illustrated by a piece of writing of Suttie himself: ‘Instead of an armament of instincts, latent or otherwise, the child is born with a simple attachment-to-mother who is the sole source of food and protection… the need for a mother is primarily presented to the child mind as a need for company and as a discomfort in isolation’.

Ian Suttie saw the infant as striving from the first to relate to his mother, and future mental health would depend on the success or failure of this first relationship (object relations). Another advocate of the object relations paradigm is Melanie Klein. Object relations was in contrast with Freud’s psychoanalysis. The advocates of this object relations paradigm all, in exception of Melanie Klein, held the opinion that most differences in individual development that are of importance for mental health could be traced to differences in the way children were treated by their parents or to the loss or separation of parent-figures. In the explanation of the love and hate relationship by Ian Suttie, the focus, not surprisingly, lies in relations and the social environment. According to Suttie, Freud saw love and hate as two distinct instincts. Hate had to be overcome with love, and because both terms are seen as two different instincts, this means repression. In Suttie’s view however, this is incompatible with the other Freudian view that life is a struggle to attain peace by the release of the impulse. These inconsistencies would be caused by leaving out the social situations and motives. Suttie saw hate as the frustration aspect of love. “The greater the love, the greater the hate or jealousy caused by its frustration and the greater the ambivalence or guilt that may arise in relation to it.” Hate has to be overcome with love by the child removing the cause of the anxiety and hate by restoring harmonious relationships. The feeling of anxiety and hate can then change back into the feeling of love and security. This counts for the situation between mother and child and later for following relationships.

In Suttie’s view, the beginning of the relationship between mother and child is a happy and symbiotic one as well. This happy symbiotic relationship between mother and baby can be disrupted by for example a second baby or the mother returning to work. This makes the infant feel irritable, insecure and anxious. This would be the start of the feeling of ambivalence: feelings of love and hate towards the mother. The child attempts to remove the cause of the anxiety and hate to restore the relationship (retransforming). This retransforming is necessary, because hate of a loved object (ambivalence) is intolerable.

In the Work of Edith Jacobson

The newborn baby is not able to distinguish the self from others and the relationship with the mother is symbiotic, with the two individuals forming a unique object. In this period, the child generates two different images of the mother. On one hand there is the loving mother, whose image derives from experiences of love and satisfaction in the relationship with her. On the other hand, there is the bad mother, whose image derives from frustrating and upsetting experiences in the relationship. Since the child at this stage is unable to distinguish the self from the other, those two opposite images are often fused and confused, rather than distinguished. At about six months of age, the child becomes able to distinguish the self from the others. He now understands that his mother can be both gratifying and frustrating, and he starts experiencing himself as being able to feel both love and anger.

This ambivalence results in a vacillation between attitudes of passive dependency on the omnipotent mother and aggressive strivings for self expansion and control over the love object. The passive-submissive and active-aggressive behaviour of the child during the pre-oedipal and the early oedipal period is determined by his ambivalent emotional fluctuations between loving and trusting admirations of his parents and disappointed depreciation of the loved objects. The ego can use this ambivalence conflicts to distinguish between the self and the object. At the beginning, the child tends to turn aggression toward the frustrating objects and libido towards the self. Hence, frustration, demands and restrictions imposed by parents within normal bounds, reinforce the process of discovery and distinction of the object and the self. When early experiences of severe disappointment and abandonment have prevented the building up of un-ambivalent object relations and stable identifications and weakened the child’s self-esteem, they may result in ambivalence conflict in adulthood, which in turn causes depressive states.

What is Thought Suppression?

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Introduction

Thought suppression is a psychological defence mechanism. It is a type of motivated forgetting in which an individual consciously attempts to stop thinking about a particular thought.

It is often associated with obsessive-compulsive disorder (OCD). OCD is when a person will repeatedly (usually unsuccessfully) attempt to prevent or “neutralise” intrusive distressing thoughts centred on one or more obsessions. It is also thought to be a cause of memory inhibition, as shown by research using the think/no think paradigm. Thought suppression is relevant to both mental and behavioural levels, possibly leading to ironic effects that are contrary to intention. Ironic process theory is one cognitive model that can explain the paradoxical effect.

When an individual tries to suppress thoughts under a high cognitive load, the frequency of those thoughts increases and becomes more accessible than before. Evidence shows that people can prevent their thoughts from being translated into behaviour when self-monitoring is high; this does not apply to automatic behaviours though, and may result in latent, unconscious actions. This phenomenon is made paradoxically worse by increasing the amount of distractions a person has, although the experiments in this area can be criticised for using impersonal concurrent tasks, which may or may not properly reflect natural processes or individual differences.

Empirical Work (1980s)

In order for thought suppression and its effectiveness to be studied, researchers have had to find methods of recording the processes going on in the mind. One experiment designed with this purpose was performed by Wegner, Schneider, Carter & White. They asked participants to avoid thinking of a specific target (e.g. a white bear) for five minutes, but if they did, they were told then to ring a bell. After this, participants were told that for the next five minutes they were to think about the target. There was evidence that unwanted thoughts occurred more frequently in those who used thought suppression compared to those who were not. Furthermore, there was also evidence that during the second stage, those who had used thought suppression had a higher frequency of target thoughts than did those who had not used thought suppression; later coined the rebound effect. This effect has been replicated and can even be done with implausible targets, such as the thought of a “green rabbit”. From these implications, Wegner eventually developed the “ironic process theory”.

Improved Methodology (1990s)

To better elucidate the findings of thought suppression, several studies have changed the target thought. Roemer and Borkovec found that participants who suppressed anxious or depressing thoughts showed a significant rebound effect. Furthermore, Wenzlaff, Wegner, & Roper demonstrated that anxious or depressed subjects were less likely to suppress negative, unwanted thoughts. Despite Rassin, Merkelbach and Muris reporting that this finding is moderately robust in the literature, some studies were unable to replicate results. However, this may be explained by a consideration of individual differences.

Recent research found that for individuals with low anxiety and high desirability traits (repressors), suppressed anxious autobiographical events initially intruded fewer times than in other groups (low, high, and high defensive anxious groups), but intruded more often after one week. This difference in coping style may account for the disparities within the literature. That said, the problem remains that the cause of the paradoxical effect may be in the thought tapping measures used (e.g. bell ringing). Evidence from Brown (1990) that showed participants were very sensitive to frequency information prompted Clarke, Ball and Pape to obtain participants’ aposterio estimates of the number of intrusive target thoughts and found the same pattern of paradoxical results. However, even though such a method appears to overcome the problem, it and all the other methodologies use self-report as the primary form of data-collection. This may be problematic because of response distortion or inaccuracy in self-reporting.

Behavioural Domain

Thought suppression also has the capability to change human behaviour. Macrae, Bodenhausen, Milne, and Jetten found that when people were asked not to think about the stereotypes of a certain group (e.g. a “skinhead”), their written descriptions about a group member’s typical day contained less stereotypical thoughts. However, when they were told they were going to meet an individual they had just written about, those in the suppression group sat significantly farther away from the “skinhead” (just by virtue of his clothes being present). These results show that even though there may have been an initial enhancement of the stereotype, participants were able to prevent this from being communicated in their writing; this was not true for their behaviour though.

Further experiments have documented similar findings. In one study from 1993, when participants were given cognitively demanding concurrent tasks, the results showed a paradoxical higher frequency of target thoughts than controls. However other controlled studies have not shown such effects. For example, Wenzlaff and Bates found that subjects concentrating on a positive task experienced neither paradoxical effects nor rebound effects – even when challenged with cognitive load. Wenzlaff and Bates also note that the beneficiality of concentration in their study participants was optimised when the subjects employed positive thoughts.

Some studies have shown that when test subjects are under what Wegner refers to as a “cognitive load” (for instance, using multiple external distractions to try to suppress a target thought), the effectiveness of thought suppression appears to be reduced. However, in other studies in which focused distraction is used, long term effectiveness may improve. That is, successful suppression may involve less distractors. For example, in 1987 Wegner, Schneider, Carter & White found that a single, pre-determined distracter (e.g. a red Volkswagen) was sufficient to eliminate the paradoxical effect post-testing. Evidence from Bowers and Woody in 1996 is supportive of the finding that hypnotised individuals produce no paradoxical effects. This rests on the assumption that deliberate “distracter activity” is bypassed in such an activity.

Cognitive Dynamics

When the cognitive load is increased, thought suppression typically becomes less effective. For example, in the white bear experiment, many general distractions in the environment (for instance a lamp, a light bulb, a desk etc.) might later serve as reminders of the object being suppressed (these are also referred to as “free distraction”). Some studies, however, are unable to find this effect for emotional thoughts in hypnotized individuals when one focused distraction is provided. In an attempt to account for these findings, a number of theorists have produced cognitive models of thought suppression. Wegner suggested in 1989 that individuals distract themselves using environmental items. Later, these items become retrieval cues for the thought attempting to be suppressed. This iterative process leaves the individual surrounded by retrieval cues, ultimately causing the rebound effect. Wegner hypothesized that multiple retrieval cues not being forged explains, in part, the effectiveness of focused distraction (i.e. a reduction of mental load). This is because there may be an ideal balance between the two processes; if the cognitive demand that is not too heavy, then the monitoring processes will not supersede it.

Individual differences may also play a role in regards to the ironic thought process.

Thought suppression has been seen as a form of “experiential avoidance”. Experiential avoidance is when an individual attempts to suppress, change, or control unwanted internal experiences (thoughts, feelings, bodily sensations, memories, etc.). This line of thinking supports relational frame theory.

Other Methodologies

Thought suppression has been shown to be a cause of inhibition in several ways. Two commonly-used methods to study this relationship are the list method and the item method. In this list method, participants study two lists of words, one after the other. After studying the first list, some participants are told to forget everything that they have just learned, while others are not given this instruction. After studying both lists, participants are asked to recall the words on both lists. These experiments typically find that participants who were told to forget the first list do not remember as many words from that list, suggesting that they have been suppressed due to the instruction to forget. In the item method, participants study individual words rather than lists. After each word is shown, participants are told to either remember or forget the word. As in experiments using the list method, the words followed by the instruction to forget are more poorly remembered. Some researchers believe that these two methods result in different types of forgetting. According to these researchers, the list method results in inhibition of the forgotten words, but the item method results in some words being remembered better than the others, without a specific relation to forgetting.

Think/No Think Paradigm

A paradigm from 2009 to study how suppression relates to inhibition is the think/no think paradigm. In these experiments, participants study pairs of words. An example of a possible word pair is roach-ordeal. After all the word pairs are learned, the participants see the first word of the pair and are either told to think about the second word (think phase) or not to think about the second word (no think phase). The no think phase is when suppression occurs. Some pairs were never presented after the initial study portion of the study, and these trials serve as the control group. At the end of the experiment, the participants try to remember all of the word pairs based on the first word. Studies could also use the “independent probe” method, which gives the category and first letter of the second word of the pair. Typically, regardless of the method used, results show that the no-think trials result in worse memory than the think trials, which supports the idea that suppression leads to inhibition in memory. Although this methodology was first done using word pairs, experiments have been conducted using pictures and autobiographical memories as stimuli, with the same results.

Research has also shown that doing difficult counting tasks at the same time as a think/no think task leads to less forgetting in the no think condition, which suggests that suppression takes active mental energy to be successful. Furthermore, the most forgetting during the no think phase occurs when there is a medium amount of brain activation while learning the words. The words are never learned if there is too little activation, and the association between the two words is too strong to be suppressed during the no think phase if there is too much activation. However, with medium activation, the word pairs are learned but able to be suppressed during the no think phase.

fMRI studies have shown two distinct patterns of brain activity during suppression tasks. The first is that there is less activity in the hippocampus, the brain area responsible for forming memories. The second is an increase of brain activity in the dorsolateral prefrontal cortex, especially in cases where suppression is harder. Researchers think that this region works to prevent memory formation by preventing the hippocampus from working.

This methodology can also be used to study thought substitution by adding an instruction during the no think phase for participants to think of a different word rather than the word being suppressed. This research shows that thought substitution can lead to increased levels of forgetting compared to suppression without a thought substitution instruction. This research also suggests that thought substitution, while used as a suppression strategy during the no think phase, may work differently than suppression. Some researchers argue that thinking of something different during the no think phase forms a new association with the first word than the original word pair, which results in interference when using this strategy, which is different than the inhibition that results from simply not thinking about something.

Dream Influence

Dreams occur mainly during the rapid eye movement (REM) sleep and are composed of images, ideas, emotions, and sensations. Although more research needs to be done on this subject, dreams are said to be linked to the unconscious mind. Thought suppression has an influence on the subject matter of the unconscious mind and by trying to restrain particular thoughts, there is a high chance of them showing up in one’s dreams.

Ironic Control Theory

Ironic control theory, also known as “ironic process theory”, states that thought suppression “leads to an increased occurrence of the suppressed content in waking states”. The irony lies in the fact that although people try not to think about a particular subject, there is a high probability that it will appear in one’s dreams regardless. There is a difference for individuals who have a higher tendency of suppression; they are more prone to psychopathological responses such as “intrusive thoughts, including depression, anxiety and obsessional thinking”. Due to these individuals having higher instances of thought suppression, they experience dream rebound more often.

Cognitive load also plays a role in ironic control theory. Studies have shown that a greater cognitive load results in an increased possibility of dream rebound occurring. In other words, when one tries to retain a heavy load of information before going to sleep, there is a high chance of that information manifesting itself within the dream. There is a greater degree of dream rebound in those with a higher cognitive load opposed to those whose load was absent. With the enhancement of a high cognitive load, ironic control theory states thought suppression is more likely to occur and lead to dream rebound.

Dream Rebound

Dream rebound is when suppressed thoughts manifest themselves in one’s dreams. Self-control is a form of thought suppression and when one dreams, that suppressed item has a higher chance of appearing in the dream. For example, when an individual is attempting to quit smoking, they may dream about themselves smoking a cigarette. Emotion suppression has also been found to trigger dream rebound. Recurrence of emotional experiences act as pre-sleep suggestions, ultimately leading to the suppressed thoughts presenting themselves within the dream. One effecting factor of dream rebound is the changes in the prefrontal lobes during rapid-eye movement sleep. Suppressed thoughts are more accessible during REM sleep, as a result of operating processes having a diminished effectiveness. This leads to pre-sleep thoughts becoming more available “with an increased activity of searching for these suppressed thought[s]”. There are other hypotheses regarding REM sleep and dream rebound. For instance, weak semantic associations, post REM sleep, are more accessible than any other time due to weak ironic monitoring processes becoming stronger. More research is needed to further understand what exactly causes dream rebound.