Tag: Environmental

What is Narcissistic Supply?

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Introduction

In psychoanalytic theory, narcissistic supply is a pathological or excessive need for attention or admiration from co-dependents, or such a need in the orally fixated, that does not take into account the feelings, opinions or preferences of other people.

The concept was introduced by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support or sustenance drawn by an individual from his or her environment and essential to their self-esteem.

Brief History

Building on Freud’s concept of narcissistic satisfaction and on the work of his colleague the psychoanalyst Karl Abraham, Fenichel highlighted the narcissistic need in early development for supplies to enable young children to maintain a sense of mental equilibrium. He identified two main strategies for obtaining such narcissistic supplies – aggression and ingratiation – contrasting styles of approach which could later develop into the sadistic and the submissive respectively.

A childhood loss of essential supplies was for Fenichel key to a depressive disposition, as well as to a tendency to seek compensatory narcissistic supplies thereafter. Impulse neuroses, addictions including love addiction and gambling were all seen by him as products of the struggle for supplies in later life. Psychoanalyst Ernst Simmel (1920) had earlier considered neurotic gambling as an attempt to regain primitive love and attention in an adult context.

Personality Disorders

Psychoanalyst Otto Kernberg considered the malignant narcissistic criminal to be coldly characterised by a disregard of others unless they could be idealised as sources of narcissistic supply. Self psychologist Heinz Kohut saw those with narcissistic personality disorder as disintegrating mentally when cut off from a regular source of narcissistic supply. Those providing supply to such figures may be treated as if they are a part of the narcissist, in an eclipse of all personal boundaries.

Functions in Narcissistic Pathology

In their adolescence, the narcissist internalises a “bad” recipient (usually their parent). They regard feelings that are socially discouraged towards this recipient, including types of aggression such as hatred and envy, among others. These perceptions reinforce the self-image of the narcissist as immoral and corrupt. They eventually create a feeling of self-worth that is dysfunctional. Their self-confidence and self-image become unrealistically low and distorted. In an attempt to repress these “bad” feelings, the narcissist also suppresses all emotions. Their aggression is channelled into fantasies or outlets that are socially lawful like extreme sports, gambling, reckless driving, and shopping. The narcissist sees the environment as a place that is hostile, unstable, unfulfilling, morally wrong, and unpredictable.

Narcissists generally have no inherent sense of self-worth, so they rely on other people, via attention or narcissistic supply, to re-affirm their importance in order to feel good about themselves and maintain their self-esteem. They then turn other people into operations or objects in such a way that others do not pose any emotional threat. This reactive pattern is pathological narcissism.

The narcissist projects a false self to elicit a constant stream of attention or narcissistic supply from others. The false self is an unreal façade or cover they show to the world that involves what the narcissist intends to be seen as – powerful, elegant, smart, wealthy, or well-connected. The narcissist then ‘collects’ reactions to this projected false self from their environment, which may consist of their spouse, family, friends, colleagues, business partners, and peers. If the expected narcissistic supply (adulation, admiration, attention, fear, respect, applause, or affirmation) is not forthcoming – they are demanded or extorted by the narcissist. Money, compliments, a media appearance, a sexual conquest are all merely different forms of the same thing to a narcissist – narcissistic supply.

Sources

The attention they receive from the “supply source” is essential to the narcissist’s survival, without it they would die (physically or metaphorically) because it depends on their fragile ego to handle their unstable self-esteem. There are distinctive forms of narcissistic supply to attain them with two separate sources. Scholars and researchers generally recognise two main kinds of narcissistic supply:

  • Primary, acquired through more publicly directed forms of attention; and
  • Secondary, generally acquired through attention attained through interpersonal relationships.

Primary

The primary narcissistic supply is based on attention in both its public forms such as recognition, fame, infamy, stardom, and its private, more interpersonal, types of praise, admiration, applause, fear, and repulsion. It is crucial to realise that the primary narcissistic supply represents attention of any kind–positive or negative. Their “realisations” may be imaginary, fictional, or only evident to the narcissist, as long as others believe in them. Appearances qualify more than the content; it is not the truth that matters, but their perception of it. Therefore, as long as they receive the expected reaction or attention that they had projected through their false self, the connotation attached to it is inconsequential.

Triggers

A main narcissistic supply trigger is an individual or object that causes the source to provide narcissistic supply by confronting the source with information about the false self of the narcissist. Narcissistic supply is the source’s response to the trigger. If the false self is projecting admiration and the narcissist finds an environment that feeds into their need, then it becomes a trigger of primary narcissistic supply.

Publicity (celebrity or notoriety, being renowned or being notorious) is a narcissistic supply trigger because it causes individuals to pay attention to the narcissist, thus moving sources to provide narcissistic supply to the narcissist. Publicity can be acquired through exposure, creation of something, or by provoking attention. The narcissist continually resorts to all three, much like what drug addicts are doing to guarantee their regular dose. One such cause of narcissistic supply is a partner or a companion.

Secondary

Secondary narcissistic supply involves projecting the image that they live a good life (a worthy cause of pride for the narcissist), maintaining a safe existence (financial security, personal acceptability, upward growth), and acquiring companionship. Thus, having a partner, possessing significant property, being creative, operating a company (converted into a pathological narcissistic space), having a feeling of anarchic liberty, being a part of a community or society, having a skilled or other reputation, being prosperous, owning land and displaying one’s status signs-all represent secondary narcissistic supply as well. Whatever would be a status symbol in the community of friends of the narcissist and would be considered a secondary source as achievement in that community. Secondary supply is about the overall image that the lives of the narcissist brings to their friends and relatives. However, if it is to endure, this type of supply requires to be positive, any display of negativity would end up hurting the person, no matter who they may be. It is this type of supply that is also the reserve source for short primary narcissistic supply. However, the narcissist uses both in much the same manner.

What is the Differential Susceptibility Hypothesis?

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Introduction

The differential susceptibility hypothesis proposed by Jay Belsky is another interpretation of psychological findings that are usually discussed according to the diathesis-stress model.

Both models suggest that people’s development and emotional affect are differentially susceptible to experiences or qualities of the environment. Where the Diathesis-stress model suggests a distinct and mostly negativity-sensitive group, Belsky describes a group that is sensitive to negative experiences but also to positive experiences. These models may be complementary, if some individuals are dually or uniquely positivity-sensitive, while other people are uniquely negativity-sensitive.

Differential Susceptibility versus Diathesis-Stress

The idea that individuals vary in their responsivity to negative qualities of the environment is generally framed in diathesis-stress or dual-risk terms. That is, some individuals, due to their biological, temperamental and/or behavioural characteristics (i.e. “diathesis” or “risk 1”), are more vulnerable to the adverse effects of negative experiences (i.e., “stress” or “risk 2”), whereas others are relatively resilient with respect to them (see Figure 1, an adaptation of Bakermans-Kranenburg and van IJzendoorn’s (2007) Figure 1). A fundamentally different, even if not competing view, of the very same phenomenon is central to Belsky’s differential susceptibility hypothesis and Boyce and Ellis’ (2005) related notion of biological sensitivity to context: Individuals do not simply vary in the degree to which they are vulnerable to the negative effects of adverse experience but, more generally, in their developmental plasticity.

On this hypothesis, more “plastic” or malleable individuals are more susceptible than others to environmental influences in a for-better-and-for-worse manner. That is, susceptible to both the adverse developmental sequelae associated with negative environments and the positive developmental consequences of supportive ones. Less susceptible individuals, in contrast, are less affected by rearing conditions, be they presumptively supportive or undermining of well being (see Figure 2, an adaptation of Bakermans-Kranenburg and Van IJzendoorn’s (2007) Figure 1).

Figure 1. The diathesis-stress/dual-risk model. Developmental outcome as it relates to environmental quality. A “vulnerable” group experiences negative outcome when exposed to a negative environment, although this group is identical to the other, “resilient” group in a positive environment.
Figure 2. The differential susceptibility model. The lines depict two categorical groups that differ in their responsiveness to the environment: the “plastic” group is disproportionately more affected by both negative and positive environments compared to the “fixed” group.

Theoretical Background

Belsky suggests that evolution might select for some children who are more plastic, and others who are more fixed in the face of, for example, parenting styles.

Belsky offers that ancestral parents, just like parents today, could not have known (consciously or unconsciously) which childrearing practices would prove most successful in promoting the reproductive fitness of offspring – and thus their own inclusive fitness. As a result, and as a fitness optimising strategy involving bet hedging, natural selection might have shaped parents to bear children varying in plasticity. This way, if an effect of parenting had proven counterproductive in fitness terms, those children not affected by parenting would not have incurred the cost of developing in ways that ultimately proved “misguided”.

Importantly, natural selection might favour genetic lines with both plastic and fixed developmental and affective patterns. In other words, there is value to having both kinds at once. In light of inclusive-fitness considerations, children who were less malleable (and more fixed) would have “resistance” to parental influence. This could be adaptable some times, and maladaptive other times. Their fixedness would not only have benefited themselves directly, but even their more malleable siblings indirectly. This is because siblings, like parents and children, have 50% of their genes in common. By the same token, had parenting influenced children in ways that enhanced fitness, then not only would more plastic offspring have benefited directly by following parental leads, but so, too, would their parents and even their less malleable siblings who did not benefit from the parenting they received, again for inclusive-fitness reasons. The overall effect may be to temper some of the variability in parenting. That is, to make more conservative bets.

This line of evolutionary argument leads to the prediction that children should vary in their susceptibility to parental rearing and perhaps to environmental influences more generally. As it turns out, a long line of developmental inquiry, informed by a “transactional” perspective, has more or less been based on this unstated assumption.

Criteria for the Testing of Differential Susceptibility

Belsky, Bakermans-Kranenburg, & Van IJzendoorn, (2007) delineated a series of empirical requirements – or steps – for evidencing the differential susceptibility hypothesis. Particularly they identify tests that distinguish differential susceptibility from other interaction effects including diathesis-stress/dual-risk.

While diathesis-stress/dual-risk arises when the most vulnerable are disproportionately affected in an adverse manner by a negative environment but do not also benefit disproportionately from positive environmental conditions, differential susceptibility is characterised by a cross-over interaction: the susceptible individuals are disproportionately affected by both negative and positive experiences. A further criterion that needs to be fulfilled to distinguish differential susceptibility from diathesis-stress/dual-risk is the independence of the outcome measure from the susceptibility factor: if the susceptibility factor and the outcome are related, diathesis-stress/dual-risk is suggested rather than differential susceptibility. Further, environment and susceptibility factor must also be unrelated to exclude the alternative explanation that susceptibility merely represents a function of the environment. The specificity of the differential-susceptibility effect is demonstrated if the model is not replicated when other susceptibility factors (i.e. moderators) and outcomes are used. Finally, the slope for the susceptible subgroup should be significantly different from zero and at the same time significantly steeper than the slope for the non- (or less-) susceptible subgroup.

Susceptibility Markers and Empirical Evidence

Characteristics of individuals that have been shown to moderate environmental effects in a manner consistent with the differential susceptibility hypothesis can be subdivided into three categories:

  • Genetic factors;
  • Endophenotypic factors; and
  • Phenotypic factors.

Bakermans-Kranenburg and Van IJzendoorn (2006) were the first to test the differential susceptibility hypothesis as a function of Genetic Factors regarding the moderating effect of the dopamine receptor D4 7-repeat polymorphism (DRD4-7R) on the association between maternal sensitivity and externalising behaviour problems in 47 families. Children with the DRD4-7R allele and insensitive mothers displayed significantly more externalising behaviours than children with the same allele but with sensitive mothers. Children with the DRD4-7R allele and sensitive mothers had the least externalising behaviours of all whereas maternal sensitivity had no effect on children without the DRD4-7R allele.

Endophenotypic Factors have been examined by Obradovic, Bush, Stamperdahl, Adler and Boyce’s (2010). They investigated associations between childhood adversity and child adjustment in 338 5-year-olds. Children with high cortisol reactivity were rated by teachers as least prosocial when living under adverse conditions, but most prosocial when living under more benign conditions (and in comparison to children scoring low on cortisol reactivity).

Regarding characteristics of the category of Phenotypic Factors, Pluess and Belsky (2009) reported that the effect of child care quality on teacher-rated socioemotional adjustment varied as a function of infant temperament in the case of 761 4.5-year-olds participating in the NICHD Study of Early Child Care and Youth Development (NICHD Early Child Care Research Network, 2005). Children with difficult temperaments as infants manifest the most and least behaviour problems depending on whether they experienced, respectively, poor or good quality care (and in comparison to children with easier temperaments).

Table 1: List of Proposed Susceptibility Factors that emerge across studies, according to Belsky and colleagues.

Book: Like-Minded – Externalism and Moral Psychology

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Book Title:

Like-Minded – Externalism and Moral Psychology.

Author(s): Andrew Sneddon.

Year: 2011.

Edition: First (1st), Illustrated Edition.

Publisher: MIT Press.

Type(s): Hardcover.

Synopsis:

A proposal that the cognitive processes that make us moral agents are partially constituted by features of our external environments. What are the psychological foundations of morality?

Historically, the issue has been framed as one of emotion versus reason. Hume argued that reason is the slave of the passions and so morality must be based on them; Kant argued that moral law is given by rational agents to themselves in virtue of their rationality.

The debate has continued in these terms to the present day. In Like-Minded, Andrew Sneddon argues that “reason” and “passion” do not satisfactorily capture all the important options for explaining the psychological foundations of morality. He proposes a third possibility: that the cognitive processes that make us moral agents are centrally constituted by features of our external environments.

Sneddon calls this the Wide Moral Systems Hypothesis (WMSH). The WMSH fits within an array of positions known as externalism or the Extended Mind Hypothesis, according to which the world outside our bodies is not just input to cognitive processes located within our brains but partially constitutes those processes.

After explaining the WMSH, Sneddon presents a series of more particular hypotheses about distinct aspects of our moral psychology: moral judgment, moral reasoning, the attribution of moral responsibility, and production of action. Sneddon revisits overlooked externalist aspects of moral psychology, noting the integration of agent and environment found in existing research.

With Like-Minded, Sneddon offers an innovative contribution to work in both moral psychology and the Extended Mind Hypothesis.

Linking Environmental Factors and Mental Health

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Research Paper Title

From Family Surroundings to Intestinal Flora, A Literature Review Concerning Epigenetic Processes in Psychiatric Disorders.

Background

Some behaviours or psychiatric conditions seem to be inherited from parents or explain by family environment.

The researchers hypothesised interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics.

Methods

The researchers searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota.

They searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships.

Results

Some gene polymorphisms interact with negative environment and lead to psychiatric disorders.

Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic.

Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics.

Conclusions

The findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders.

Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic.

These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations.

Reference

Dubois, T., Reynaert, C., Jacques, D., Lepiece, B. & Zdanowicz, N. (2020) From Family Surroundings to Intestinal Flora, A Literature Review Concerning Epigenetic Processes in Psychiatric Disorders. Psychiatria Danubina. 32(Suppl 1), pp.158-163.

Components & Principles of Effective Treatments in Mental Health

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For interventions (to at least be perceived) to be effective in the treatment of mental health conditions, from the perspective of the service user, there are a range of components that one must understand and appreciate.

  • Facilitative service environment(s):
    • Understand how the environment can affect a service user’s experience of treatment.
    • Prioritise good relationships between staff/volunteers and those using the services.
    • Taking a genuine interest in the service user.
    • Being respectful.
    • Helps service users feel at ease and prevent relapse.
  • Access to appropriate treatment(s).
  • Compassionate and non-judgemental support.
    • This can include peer, practical, and emotional support.
  • Interventions that are long enough in duration:
    • Treatment needs to be long enough in duration for the service user to avoid relapse and/or move into recovery.
    • Need for ongoing support.
    • Aftercare programme as a way of ensuring a supportive network to prevent relapse.
  • Interventions that offer stability.
  • Choices (in terms of treatment).
    • Service users like to feel they have a choice in their treatment.
    • Want to be treated as individuals.
    • Individualised care means provider must have flexibility in service delivery.
  • Opportunities to learn (or relearn) how to live.
    • Treatment should be seen as providing opportunities for service users to learn (vocational/life) skills to support them to live their lives.
    • This can aid service users to steer away from problematic patterns of behaviour by providing structure and purpose, alleviating boredom, and distraction from their condition.

The above should be provided with the following three principles in mind:

  1. Within the context of good relationships.
    • You are not there to be the service user’s best friend, but good/positive relationships aid effectiveness of treatment and perceptions of service.
  2. Person-centred care.
    • Where appropriate and practicable, the service/treatment should fit around the service user, not the service user around the service/treatment.
  3. Understanding the complexity of the service user’s (both personal and professional) circumstances.
    • Understanding of the service user’s circumstances can aid adherence to treatment and their journey through their condition.

Finally, remember that the way in which services and treatment are delivered, is considered by many service users, to be more important than the type of treatment provided.

An Examination of Environmental Influences on Genomic Variations, Neurodevelopmental Trajectories & Vulnerability to Psychopathology, with a Focus on Externalising Disorders

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Research Paper Title

Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA): A developmental cohort study protocol.

Background

Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries.

The Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalising disorders.

Methods

cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up.

Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges.

10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the family) have been assessed using age-appropriate instruments to capture socio-demographic information, temperament, environmental exposures, parenting, psychiatric morbidity, and neuropsychological functioning.

Blood/saliva and urine samples have been collected for genetic, epigenetic and toxicological (heavy metals, volatile organic compounds) studies.

Structural (T1, T2, DTI) and functional (resting state fMRI) MRI brain scans have been performed on approximately 15% of the individuals.

All data and biological samples are maintained in a databank and biobank, respectively.

Discussion

The cVEDA has established the largest neurodevelopmental database in India, comparable to global datasets, with detailed environmental characterisation.

This should permit identification of environmental and genetic vulnerabilities to psychopathology within a developmental framework.

Neuroimaging and neuropsychological data from this study are already yielding insights on brain growth and maturation patterns.

Reference

Sharma, E., Vaidya, N., Iyengar, U., Zhang, Y., Holla, B., Purushottam, M., Chakrabarti, A., Fernandes, G.S., Heron, J., Hickman, M., Desrivieres, S., Kartik, K., Jacob, P., Rangaswamy, M., Bharath, R.D., Barker, G., Orfanos, D.P., Ahuja, C., Murthy, P., Jain, S., Varghese, M., Jayarajan, D., Kumar, K., Thennarasu, K., Basu, D., Subodh, B.N., Kuriyan, R., Kurpad, S.S., Kalyanram, K., Krishnaveni, G., Krishna, M., Singh, R.L., Singh, L.R., Kalyanram, K., Toledano, M., Schumann, G., Benegal, V. & cVEDA Consortium. (2020) Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA): A developmental cohort study protocol. BMC Psychiatry. 20(1):2. doi: 10.1186/s12888-019-2373-3.

Causes of Mental Illness

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Currently, mental illness is thought to be caused by a complex interaction of factors, including the following:

  • Hereditary;
  • Biologic (physical factors);
  • Psychologic; and/or
  • Environmental (including social and cultural factors).

Research has shown that for many mental health disorders, heredity plays a part. Often, a mental health disorder occurs in people whose genetic make-up makes them vulnerable to such disorders. This vulnerability, combined with life stresses, such as difficulties with family or at work, can lead to the development of a mental disorder.

Also, many experts think that impaired regulation of chemical messengers in the brain (neurotransmitters) may contribute to mental health disorders.

Brain imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), often show changes in the brains of people with a mental health disorder.

Thus, many mental health disorders appear to have a biologic component, much like disorders that are considered neurologic (such as Alzheimer disease).

However, whether the changes seen on imaging tests are the cause or result of the mental health disorder is unclear.