Tag: Self-Esteem

What is Codependency?

Published on by Andrew Marshall1 Comment

Introduction

In sociology, codependency is a theory that attempts to explain imbalanced relationships where one person enables another person’s self-destructive behaviour such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Definitions of codependency vary, but typically include high self-sacrifice, a focus on others’ needs, suppression of one’s own emotions, and attempts to control or fix other people’s problems. People who self-identify as codependent exhibit low self-esteem, but it is unclear whether this is a cause or an effect of characteristics associated with codependency. Codependency is not limited to married, partnered, or romantic relationships, as co-workers, friends, and family members can be codependent as well.

Refer to Co-Dependents Anonymous.

Brief History

The term “codependency” most likely developed in Minnesota in the late 1970s from “co-alcoholic”, when alcoholism and other drug dependencies were grouped together as “chemical dependency.” The term is most often identified with Alcoholics Anonymous and the realisation that the alcoholism was not solely about the addict but also about the family and friends who constitute a network for the alcoholic.

The term “codependent” was first used to describe how family members and friends might interfere with the recovery of a person affected by a substance use disorder by “overhelping”. Application of the concept of codependency was driven by the self-help community.

In 1986, Psychiatrist Timmen Cermak wrote Diagnosing and Treating Co-Dependence: A Guide for Professionals. In that book and an article published in the Journal of Psychoactive Drugs, Cermak argued unsuccessfully for the inclusion of codependency as a separate personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R. He found that the condition could affect people close to people with any mental disorder, not just addiction.

Melody Beattie popularised the concept of codependency in 1986 with the book Codependent No More which sold eight million copies, with updated editions released in 1992 and 2022. Drawing on her personal experience with substance abuse and caring for someone with it, she also interviewed people helped by Al-Anon. Beattie’s work formed the underpinning of a twelve-step organisation called Co-Dependents Anonymous, founded in 1986, although the group does not endorse any definition of or diagnostic criteria for codependency.

Definition

Codependency has no established definition or diagnostic criteria within the mental health community. It has not been included as a condition in any edition of the DSM or ICD.

Codependency carries three potential levels of meaning. First, it can describe a didactic tool that, once explained to families, helps them normalise the feelings that they are experiencing and allows them to shift their focus from the dependent person to their own dysfunctional behaviour patterns. Second, it can describe a psychological concept, a shorthand means of describing and explaining human behaviour. Third, it can describe a psychological disorder, implying that there is a consistent pattern of traits or behaviours across individuals that can create significant dysfunction.

Discussion of codependency tends to focus on the disease model of the term, although there is no agreement that codependency is a disorder at all, or how such a disease entity might be defined or diagnosed.  In an early attempt to define codependency as a diagnosable disorder, Timmen Cermak wrote:

“Co-dependence is a recognisable pattern of personality traits, predictably found within most members of chemically dependent families, which are capable of creating sufficient dysfunction to warrant the diagnosis of Mixed Personality Disorder as outlined in DSM III.”

Timmen proceeded to list the traits he identified in self-suppressing supporting partners of people with chemical dependence or disordered personalities, and to provide a DSM-style set of diagnostic criteria.

In her self-help book, Melody Beattie proposes that, “The obvious definition [of codependency] would be: being a partner in dependency. This definition is close to the truth but still unclear.” Beattie elaborates, “A codependent person is one who has let another person’s behaviour affect him or her, and who is obsessed with controlling that person’s behaviour.” Another self-help author, Darlene Lancer, asserts that “A codependent is a person who can’t function from his or her innate self and instead organizes thinking and behavior around a substance, process, or other person(s).” Lancer includes all addicts in her definition. She believes a “lost self” is the core of codependency.

Co-Dependents Anonymous, a self-help organization for people who seek to develop healthy and functional relationships, “offer[s] no definition or diagnostic criteria for codependence”, but provides a list of “patterns and characteristics of codependence” that can be used by laypeople for self-evaluation. The organisation identifies patterns that may occur in codependency.

The Medical Subject Heading utilised by the United States National Library of Medicine describes codependency as “A relational pattern in which a person attempts to derive a sense of purpose through relationships with others.”

Theories

Under theories of codependency as a psychological disorder, the codependent partner in a relationship is often described as displaying self-perception, attitudes and behaviours that serve to increase problems within the relationship instead of decreasing them. It is often suggested that people who are codependent were raised in dysfunctional families or with early exposure to addiction behaviour, resulting in their allowance of similar patterns of behaviour by their partner.

Relationships

Codependent relationships are often described as being marked by intimacy problems, dependency, control (including caretaking), denial, dysfunctional communication and boundaries, and high reactivity. There may be imbalance within the relationship, where one person is abusive or in control or supports or enables another person’s addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Under this conception of codependency, the codependent person’s sense of purpose within a relationship is based on making extreme sacrifices to satisfy their partner’s needs. Codependent relationships signify a degree of unhealthy “clinginess” and needy behaviour, where one person does not have self-sufficiency or autonomy. One or both parties depend on their loved one for fulfilment. The mood and emotions of the codependent are often determined by how they think other individuals perceive them (especially loved ones). This perception is self-inflicted and often leads to clingy, needy behaviour which can hurt the health of the relationship.

Personality Disorders

Codependency may occur within the context of relationships with people with diagnosable personality disorders.

  • Borderline personality disorder: There is a tendency for loved ones of people with borderline personality disorder (BPD) to slip into “caretaker” roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. The codependent partner may gain a sense of worth by being perceived as “the sane one” or “the responsible one”.
  • Narcissistic personality disorder: Narcissists, with their ability to get others to “buy into their vision” and help them make it a reality, seek and attract partners who will put others’ needs before their own. A codependent person can provide the narcissist with an obedient and attentive audience. Among the reciprocally interlocking interactions of the pair are the narcissist’s overpowering need to feel important and special and the codependent person’s strong need to help others feel that way.

Family Dynamics

In the dysfunctional family the child learns to become attuned to the parent’s needs and feelings instead of the other way around. Parenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority. A parent can be codependent toward their own child. Generally, a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective, or may even do harm to a child. Codependent relationships often manifest through enabling behaviours, especially between parents and their children. Another way to look at it is that the needs of an infant are necessary but temporary, whereas the needs of the codependent are constant. Children of codependent parents who ignore or negate their own feelings may become codependent.

Recovery and Prognosis

With no consensus as to how codependency should be defined, and with no recognised diagnostic criteria, mental health professionals hold a range of opinions about the diagnosis and treatment of codependency. Caring for an individual with a physical addiction is not necessarily treating a pathology. The caregiver may only require assertiveness skills and the ability to place responsibility for the addiction on the other. There are various recovery paths for individuals who struggle with codependency. For example, some may choose cognitive-behavioural psychotherapy, sometimes accompanied by chemical therapy for accompanying depression. There also exist support groups for codependency, such as Co-Dependents Anonymous (CoDA), Al-Anon/Alateen, Nar-Anon, and Adult Children of Alcoholics (ACoA), which are based on the twelve-step programme model of Alcoholics Anonymous, Celebrate Recovery and Life Recovery a Christian 12 step Bible-based group. Many self-help guides have been written on the subject of codependency.

It has been proposed that, in attempts to recover from codependency, people may go from being overly passive or overly giving to being overly aggressive or excessively selfish. Therapists may seek to help a client develop a balance through healthy assertiveness, which leaves room for being a caring person and also engaging in healthy caring behaviour, while minimising selfishness, bully, or behaviours that might reflect conflict addiction. Developing a permanent stance of being a victim (having a victim mentality) does not constitute recovery from codependency. A victim mentality could also be seen as a part of one’s original state of codependency (lack of empowerment causing one to feel like the “subject” of events rather than being an empowered actor). Someone truly recovered from codependency would feel empowered and like an author of their life and actions rather than being at the mercy of outside forces. A victim mentality may also occur in combination with passive-aggressive control issues. From the perspective of moving beyond victim-hood, the capacity to forgive and let go (with exception of cases of very severe abuse) could also be signs of real recovery from codependency, but the willingness to endure further abuse would not.

It is theorized that unresolved patterns of codependency may lead to more serious problems like alcoholism, drug addiction, eating disorders, sex addiction, psychosomatic illnesses, and other self-destructive or self-defeating behaviours. People with codependency may be more likely to attract further abuse from aggressive individuals (such as those with BPD or NPD), more likely to stay in stressful jobs or relationships, less likely to seek medical attention when needed and are also less likely to get promotions and tend to earn less money than those without codependency patterns. For some people, the social insecurity caused by codependency may progress into full-blown social anxiety disorders like social phobia, avoidant personality disorder or painful shyness. Other stress-related disorders like panic disorder, depression or PTSD may also be present.

Controversy

Codependency is not a diagnosable mental health condition, there is no medical consensus as to its definition, and there is no evidence that codependency is caused by a disease process. Without clinical definition, the term is easily applicable to many behaviours and has been overused by some self-help authors and support communities. In an article in Psychology Today, clinician Kristi Pikiewicz suggested that the term codependency has been overused to the point of becoming a cliché, and labelling a patient as codependent can shift the focus on how their traumas shaped their current relationships.

Some scholars and treatment providers assert that codependency should be understood as a positive impulse gone awry, and challenge the idea that interpersonal behaviours should be conceptualised as addictions or diseases, as well as the pathologising of personality characteristics associated with women. A study of the characteristics associated with codependency found that non-codependency was associated with masculine character traits, while codependency was associated with negative feminine traits, such as being self-denying, self-sacrificing, or displaying low self-esteem.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Codependency >; 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.

A Brief Outline of Self-Verification Theory

Published on by Andrew MarshallLeave a comment

Introduction

Self-verification is a social psychological theory that asserts people want to be known and understood by others according to their firmly held beliefs and feelings about themselves, that is self-views (including self-concepts and self-esteem). It is one of the motives that drive self-evaluation, along with self-enhancement and self-assessment.

Because chronic self-concepts and self-esteem play an important role in understanding the world, providing a sense of coherence, and guiding action, people become motivated to maintain them through self-verification. Such strivings provide stability to people’s lives, making their experiences more coherent, orderly, and comprehensible than they would be otherwise. Self-verification processes are also adaptive for groups, groups of diverse backgrounds, and the larger society, in that they make people predictable to one another thus serve to facilitate social interaction. To this end, people engage in a variety of activities that are designed to obtain self-verifying information.

Developed by William Swann (1981), the theory grew out of earlier writings which held that people form self-views so that they can understand and predict the responses of others and know how to act toward them.

William Swann

William B. Swann (born 1952) is a professor of social and personality psychology at the University of Texas at Austin. He is primarily known for his work on identity, self and self-esteem, but has also done research on relationships, social cognition, group processes, accuracy in person perception and interpersonal expectancy effects. He received his Ph.D. in 1978 from the University of Minnesota and undergraduate degree from Gettysburg College.

Difference between Positive and Negative Self-Views

There are individual differences in people’s views of themselves. Among people with positive self-views, the desire for self-verification works together with another important motive, the desire for positive evaluations or “self enhancement”. For example, those who view themselves as “insightful” will find that their motives for both self-verification and self-enhancement encourage them to seek evidence that other people recognise their insightfulness.

In contrast, people with negative self-views will find that the desire for self-verification and self-enhancement are competing. Consider people who see themselves as disorganized. Whereas their desire for self-enhancement will compel them to seek evidence that others perceive them as organised, their desire for self-verification will compel such individuals to seek evidence that others perceive them as disorganised. Self-verification strivings tend to prevail over self-enhancement strivings when people are certain of the self-concept and when they have extremely depressive self-views.

Self-verification strivings may have undesirable consequences for people with negative self-views (depressed people and those who suffer from low self-esteem). For example, self-verification strivings may cause people with negative self-views to gravitate toward partners who mistreat them, undermine their feelings of self-worth, or even abuse them. And if people with negative self-views seek therapy, returning home to a self-verifying partner may undo the progress that was made there. Finally, in the workplace, the feelings of worthlessness that plague people with low self-esteem may foster feelings of ambivalence about receiving fair treatment, feelings that may undercut their propensity to insist that they get what they deserve from their employers (see: workplace bullying).

These findings and related ones point to the importance of efforts to improve the self-views of those who suffer from low self-esteem and depression.

Effects on Behaviour

In one series of studies, researchers asked participants with positive and negative self-views whether they would prefer to interact with evaluators who had favourable or unfavourable impressions of them. The results showed that those with positive self-views preferred favourable partners and those with negative self-views preferred unfavourable partners. The latter finding revealed that self-verification strivings may sometimes trump positivity strivings.

Self-verification motives operate for different dimensions of the self-concept and in many different situations. Men and women are equally inclined to display this tendency, and it does not matter whether the self-views refer to characteristics that are relatively immutable (e.g. intelligence) or changeable (e.g. diligence), or whether the self-views happen to be highly specific (e.g. athletic) or global (e.g. low self-esteem, worthlessness). Furthermore, when people chose negative partners over positive ones, it is not merely in an effort to avoid interacting with positive evaluators (that is, out of a concern that they might disappoint such positive evaluators). Rather, people chose self-verifying, negative partners even when the alternative is participating in a different experiment. Finally, recent work has shown that people work to verify self-views associated with group memberships. For example, women seek evaluations that confirm their belief that they possess qualities associated with being a woman.

Self-verification theory suggests that people may begin to shape others’ evaluations of them before they even begin interacting with them. They may, for example, display identity cues (see: impression management). The most effective identity cues enable people to signal who they are to potential interaction partners.

  • Physical appearance, such as clothes, body posture, demeanour. For example, the low self-esteem person who evokes reactions that confirm her negative self-views by slumping her shoulders and keeping her eyes fixed on the ground.
  • Other cues, such as the car someone buys, the house they live in, the way they decorate their living environment. For example, an SUV evokes reactions that confirm a person’s positive self-view.

Self-verification strivings may also influence the social contexts that people enter into and remain in. People reject those who provide social feedback that does not confirm their self-views, such as married people with negative self-views who reject spouses who see them positively and vice versa. College roommates behave in a similar manner. People are more inclined to divorce partners who perceived them too favourably. In each of these instances, people gravitated toward relationships that provided them with evaluations that confirmed their self-views and fled from those that did not.

When people fail to gain self-verifying reactions through the display of identity cue or through choosing self-verifying social environments, they may still acquire such evaluations by systematically evoking confirming reactions. For example, depressed people behave in negative ways toward their roommates, thus causing these roommates to reject them.

Self-verification theory predicts that when people interact with others, there is a general tendency for them to bring others to see them as they see themselves. This tendency is especially pronounced when they start out believing that the other person has misconstrued them, apparently because people compensate by working especially hard to bring others to confirm their self-views. People will even stop working on tasks to which they have been assigned if they sense that their performance is eliciting non-verifying feedback.

Role of Confirmation Bias

Self-verification theory predicts that people’s self-views will cause them to see the world as more supportive of these self-views than it really is. That is, individuals process information in a biased manner. These biases may be conscious and deliberate, but are probably more commonly done effortlessly and non-consciously. Through the creative use of these processes, people may dramatically increase their chances of attaining self-verification. There are at least three relevant aspects of information processing in self-verification:

  • Attention: People will attend to evaluations that are self-confirming while ignoring non-confirming evaluations.
  • Memory retrieval: self-views bias memory recall to favour self-confirming material over non-confirming elements.
  • Interpretation of information: people tend to interpret information in ways that reinforce their self-views.

These distinct forms of self-verification may often be implemented sequentially. For example, in one scenario, people may first strive to locate partners who verify one or more self-views. If this fails, they may redouble their efforts to elicit verification for the self-view in question or strive to elicit verification for a different self-view. Failing this, they may strive to “see” more self-verification than actually exists. And, if this strategy is also ineffective, they may withdraw from the relationship, either psychologically or in actuality.

Related Processes

Preference for Novelty

People seem to prefer modest levels of novelty; they want to experience phenomena that are unfamiliar enough to be interesting, but not so unfamiliar as to be frightening or too familiar as to be boring.

The implications of people’s preference for novelty for human relationships are not straightforward and obvious. Evidence that people desire novelty comes primarily from studies of people’s reactions to art objects and the like. This is different when it concerns human beings and social relationships because people can shift attention away from already familiar novel objects, while doing so in human relationships is difficult or not possible. But novel art objects are very different from people. If a piece of art becomes overly stimulating, we can simply shift our attention elsewhere. This is not a viable option should our spouse suddenly begin treating us as if we were someone else, for such treatment would pose serious questions about the integrity of people’s belief systems. Consequently, people probably balance competing desires for predictability and novelty by indulging the desire for novelty within contexts in which surprises are not threatening (e.g. leisure activities), while seeking coherence and predictability in contexts in which surprises could be costly – such as in the context of enduring relationships.

Tension with Self-Enhancement

People’s self-verification strivings are apt to be most influential when the relevant identities and behaviours matter to them. Thus, for example, the self-view should be firmly held, the relationship should be enduring, and the behaviour itself should be consequential. When these conditions are not met, people will be relatively unconcerned with preserving their self-views and they will instead indulge their desire for self-enhancement. In addition, self-reported emotional reactions favour self-enhancement while more thoughtful processes favour self-verification.

But if people with firmly held negative self-views seek self-verification, this does not mean that they are masochistic or have no desire to be loved. In fact, even people with very low self-esteem want to be loved. What sets people with negative self-views apart is their ambivalence about the evaluations they receive. Just as positive evaluations foster joy and warmth initially, these feelings are later chilled by incredulity. And although negative evaluations may foster sadness that the “truth” could not be kinder, it will at least reassure them that they know themselves. Happily, people with negative self-views are the exception rather than the rule. That is, on the balance, most people tend to view themselves positively. Although this imbalance is adaptive for society at large, it poses a challenge to researchers interested in studying self-verification. That is, for theorists interested in determining if behaviour is driven by self-verification or positivity strivings, participants with positive self-views will reveal nothing because both motives compel them to seek positive evaluations. If researchers want to learn if people prefer verification or positivity in a giving setting, they must study people with negative self-views.

Self-Concept Change

Although self-verification strivings tend to stabilise people’s self-views, changes in self-views may still occur. Probably the most common source of change is set in motion when the social environment recognises a significant change in a person’s age (e.g. when adolescents become adults), status (e.g. when students become teachers), or social role (e.g. when someone is convicted of a crime). Suddenly, the community may change the way that it treats the person. Eventually the target of such treatment will bring his or her self-view into accord with the new treatment.

Alternatively, people may themselves conclude that a given self-view is dysfunctional or obsolete and take steps to change it. Consider, for example, a woman who decides that her negative self-views have led her to tolerate abusive relationship partners. When she realises that such partners are making her miserable, she may seek therapy. In the hands of a skilled therapist, she may develop more favourable self-views which, in turn, steer her toward more positive relationship partners with whom she may cultivate healthier relationships. Alternatively, when a woman who is uncertain about her negative self-concept enters a relationship with a partner who is certain that she deserves to view herself more positively, that woman will tend to improve the self-concept.

Criticism

Critics have argued that self-verification processes are relatively rare, manifesting themselves only among people with terribly negative self views. In support of this viewpoint, critics cite hundreds of studies indicating that people prefer, seek and value positive evaluations more than negative ones. Such sceptical assessments overlook three important points. First, because most people have relatively positive self-views, evidence of a preference for positive evaluations in unselected samples may in reality reflect a preference for evaluations that are self-verifying, because for such individuals self-verification and positivity strivings are indistinguishable. No number of studies of participants with positive self-views can determine whether self-verification or self-enhancement strivings are more common. Second, self-verification strivings are not limited to people with globally negative self-views; even people with high self-esteem seek negative evaluations about their flaws. Finally, even people with positive self-views appear to be uncomfortable with overly positive evaluations. For example, people with moderately positive self-views withdraw from spouses who evaluate them in an exceptionally positive manner.

Other critics have suggested that when people with negative self-views seek unfavourable evaluations, they do so as a means of avoiding truly negative evaluations or for purposes of self-improvement, with the idea being that this will enable them to obtain positive evaluations down the road. Tests of this idea have failed to support it. For example, just as people with negative self-views choose self-verifying, negative evaluators even when the alternative is being in another experiment, they choose to be in another experiment rather than interact with someone who evaluates them positively. Also, people with negative self-views are most intimate with spouses who evaluate them negatively, despite the fact that these spouses are relatively unlikely to enable them to improve themselves. Finally, in a study of people’s thought processes as they chose interaction partners, people with negative self-views indicated that they chose negative evaluators because such partners seemed likely to confirm their self-views (an epistemic consideration) and interact smoothly with them (a pragmatic consideration); self-improvement was rarely mentioned.

This page is based on the copyrighted Wikipedia articles < https://en.wikipedia.org/wiki/Self-verification_theory AND https://en.wikipedia.org/wiki/William_Swann >; 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 a Narcissistic Parent?

Published on by Andrew MarshallLeave a comment

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 Supply?

Published on by Andrew Marshall2 Comments

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 Defensive Pessimism?

Published on by Andrew Marshall2 Comments

Introduction

Defensive pessimism is a cognitive strategy identified by Nancy Cantor and her students in the mid-1980s.

Individuals use defensive pessimism as a strategy to prepare for anxiety-provoking events or performances. When implementing defensive pessimism, individuals set low expectations for their performance, regardless of how well they have done in the past. Defensive pessimists then think through specific negative events and setbacks that could adversely influence their goal pursuits. By envisioning possible negative outcomes, defensive pessimists can take action to avoid or prepare for them. Using this strategy, defensive pessimists can advantageously harness anxiety that might otherwise harm their performance.

Defensive pessimism is utilised in a variety of domains, and public speaking provides a good example of the process involved in this strategy. Defensive pessimists could alleviate their anxiety over public speaking by imagining possible obstacles such as forgetting the speech, being thirsty, or staining their shirts before the event. Because defensive pessimists have thought of these problems, they can appropriately prepare to face the challenges ahead. The speaker could, for instance, create note cards with cues about the speech, place a cup of water on the podium to alleviate thirst, and bring a bleach pen to remove shirt stains. These preventive actions both reduce anxiety and promote superior performance.

Refer to Depressive Realism.

Strategy Effectiveness

Though defensive pessimists are less satisfied with their performances and rate themselves higher in “need for improvement,” they do not actually perform worse than people with a more optimistic strategy. Norem and Cantor (1986) investigated whether encouraging defensive pessimists, and thereby interfering with their typical negative thinking, would result in worse performances. Participants in the study were in either encouragement or non-encouragement scenarios as they prepared to complete anagram and puzzle tasks. In the encouragement condition, the defensive pessimists were told that, based on their GPA, they should expect to do well. Defensive pessimists performed worse when encouraged than the defensive pessimists whose strategy was not manipulated. Defensive pessimism is an adaptive strategy for those who struggle with anxiety: their performance decreases if they are unable to appropriately manage and counteract their anxiety.

Key Components

Prefactual Thinking

Prefactual (i.e. “before the fact”) thinking is an essential component of defensive pessimism. Synonymous with anticipation, it denotes a cognitive strategy in which people imagine possible outcomes of a future scenario. The term prefactual was specifically coined by Lawrence J. Sanna, in 1998, to denote those activities that speculate on possible future outcomes, given the present, and ask “What will be the outcome if event E occurs?”

The imagined outcomes are either positive/desirable, negative/undesirable, or neutral. Prefactual thinking can be advantageous because it allows the individual to prepare for possible outcomes of a scenario.

For defensive pessimists, prefactual thinking offers the primary and critical method to alleviate anxiety. Usually, this prefactual thinking is paired with a pessimistic outlook, resulting in negative/undesirable imagined scenarios. With regard to the earlier example, the public speaking defensive pessimist anticipates forgetting the speech or becoming thirsty as opposed to giving an amazing speech and receiving a standing ovation.

Anxiety

As defensive pessimism is motivated by a need to manage anxiety, it is unsurprisingly also correlated with trait anxiety and neuroticism. Negative mood states promote defensive pessimists’ goal attainment strategy by facilitating the generation of potential setbacks and negative outcomes that could arise during goal pursuit, which can then be anticipated and prevented. When defensive pessimists are encouraged into positive or even just neutral mood states, they perform worse on experimental tasks than when in a negative mood state. They are more anxious because they are prevented from properly implementing their preferred cognitive strategy for goal attainment.

Self-Esteem

Defensive pessimism is generally related to lower self-esteem since the strategy involves self-criticism, pessimism, and discounting previous successful performances. Indeed, Norem and Burdzovic Andreas (2006) found that, compared to optimists, defensive pessimists had lower self-esteem entering college. At the end of four years of college, however, the self-esteem of the defensive pessimists had increased to nearly equal levels as optimists. The self-esteem of optimists had not changed, and the self-esteem of pessimists who did not employ defensive pessimism had fallen slightly by the end of college. While defensive pessimism may have implications for self-esteem, it appears that these effects lessen over time.

Compared to Pessimism

Unlike pessimism, defensive pessimism is not an internal, global, and stable attribution style, but rather a cognitive strategy utilised within the context of certain goals. Pessimism involves rumination about possible negative outcomes of a situation without proactive behaviour to counteract these outcomes. Defensive pessimism, on the other hand, utilizes the foresight of negative situations in order to prepare against them. The negative possible outcomes of a situation often motivate defensive pessimists to work harder for success. Since defensive pessimists are anxious, but not certain, that negative situations will arise, they still feel that they can control their outcomes. For example, a defensive pessimist would not avoid all job interviews for fear of failing one. Instead, a defensive pessimist would anticipate possible challenges that could come in an upcoming job interview – such as dress code, stubborn interviewers, and tough questions – and prepare rigorously to face them. Defensive pessimism is not a reaction to stressful events nor does it entail ruminating on events of the past, and should therefore be distinguished from pessimism as a trait or a more general negative outlook. Instead, defensive pessimists are able to stop using this strategy once it is no longer beneficial (i.e. does not serve a preparatory role).

Compared to Other Cognitive Strategies

Self-Handicapping

Elliot and Church (2003) determined that people adopt defensive pessimism or self-handicapping strategies for the same reason: to deal with anxiety-provoking situations. Self-handicapping is a cognitive strategy in which people construct obstacles to their own success to keep failure from damaging their self-esteem. The difference between self-handicapping and defensive pessimism lies in the motivation behind the strategies. Beyond managing anxiety, defensive pessimism is further motivated by a desire for high achievement. Self-handicappers, however, feel no such need. Elliot and Church found that the self-handicapping strategy undermined goal achievement while defensive pessimism aided achievement. People who self-handicapped were high in avoidance motivation and low in approach motivation. They wanted to avoid anxiety but were not motivated to approach success. Defensive pessimists, on the other hand, were motivated to approach success and goal attainment while simultaneously avoiding the anxiety associated with performance. Although it was found that defensive pessimism was positively correlated with goals related to both performance-avoidance and anxiety-avoidance, it was not found to be a predictor of one’s mastery of goals.

Strategic Optimism

In research, defensive pessimism is frequently contrasted with strategic optimism, another cognitive strategy. When facing performance situations, strategic optimists feel that they will end well. Therefore, though they plan ahead, they plan only minimally because they do not have any anxiety to face. While defensive pessimists set low expectations, feel anxious, and rehearse possible negative outcomes of situations, strategic optimists set high expectations, feel calm, and do not reflect on the situation any more than absolutely necessary. Strategic optimists start out with different motivations and obstacles: unlike defensive pessimists, strategic optimists do not have any anxiety to surmount. In spite of their differences in motivation, strategic optimists and defensive pessimists have similar objective performance outcomes. For both strategic optimists and defensive pessimists, their respective cognitive strategies are adaptive and promote success.

What is Self-Handicapping?

Published on by Andrew Marshall2 Comments

Introduction

Self-handicapping is a cognitive strategy by which people avoid effort in the hopes of keeping potential failure from hurting self-esteem.

It was first theorised by Edward E. Jones and Steven Berglas, according to whom self-handicaps are obstacles created, or claimed, by the individual in anticipation of failing performance.

Self-handicapping can be seen as a method of preserving self-esteem but it can also be used for self-enhancement and to manage the impressions of others. This conservation or augmentation of self-esteem is due to changes in causal attributions or the attributions for success and failure that self-handicapping affords. There are two methods that people use to self-handicap: behavioural and claimed self-handicaps. People withdraw effort or create obstacles to successes so they can maintain public and private self-images of competence.

Self-handicapping is a widespread behaviour amongst humans that has been observed in a variety of cultures and geographic areas. For instance, students frequently participate in self-handicapping behaviour to avoid feeling bad about themselves if they do not perform well in class. Self-handicapping behaviour has also been observed in the business world. The effects of self-handicapping can be both large and small and found in virtually any environment wherein people are expected to perform.

Refer to Self-Defeating Personality Disorder and Defensive Pessimism.

Overview and Relevance

The first method people use to self-handicap is when they make a task harder for themselves in fear of not successfully completing that task, so that if they do in fact fail, they can simply place the blame on the obstacles rather than placing the blame on themselves. This is known to researchers as behavioural handicapping, in which the individual actually creates obstacles to performance. Examples of behavioural handicaps include alcohol consumption, the selection of unattainable goals, and refusal to practise a task or technique (especially in sports and the fine arts).

The second way that people self-handicap is by coming up with justifications for their potential failures, so that if they do not succeed in the task, they can point to their excuses as the reasons for their failures. This is known as claimed self-handicapping, in which the individual merely states that an obstacle to performance exists. Examples of claimed self-handicaps include declarations that one is experiencing physical symptoms.

Self-handicapping behaviour allows individuals to externalise failures but internalise success, accepting credit for achievements but allowing excuses for failings. An example of self-handicapping is the student who spends the night before an important exam partying rather than studying. The student fears failing his exam and appearing incapable. In partying the night before the exam the student has engaged in self-defeating behaviour and increased the likelihood of poor exam performance. However, in the event of failure, the student can offer fatigue and a hangover, rather than lack of ability, as plausible explanations. Furthermore, should the student receive positive feedback about his exam, his achievement is enhanced by the fact that he succeeded, despite the handicap.

Individual Differences

People differ in the extent to which they self-handicap and most research on individual differences has used the Self-Handicapping Scale (SHS). The SHS was developed as a means of measuring individuals’ tendency to employ excuses or create handicaps as a means to protect one’s self-esteem. Research to date shows that SHS has adequate construct validity. For example, individuals who score high on the SHS put in less effort and practice less when concerned about their ability to perform well in a given task. They are also more likely than those rated low self-handicappers (LSH) to mention obstacles or external factors that may hinder their success, prior to performing.

A number of characteristics have been related to self-handicapping (e.g. hypochondriasis) and research suggests that those more prone to self-handicapping may differ motivationally compared to those that do not rely on such defensive strategies. For example, fear of failure, a heightened sensitivity to shame and embarrassment upon failure, motivates self-handicapping behaviour. Students who fear failure are more likely to adopt performance goals in the classroom or goals focused on the demonstration of competence or avoidance of demonstrating incompetence; goals that heighten one’s sensitivity to failure.

A student, for example, may approach course exams with the goal of not performing poorly as this would suggest a lack of ability. To avoid ability attributions and the shame of failure, the student fails to adequately prepare for an exam. While this may provide temporary relief, it renders one’s ability conceptions more uncertain, resulting in further self-handicapping.

Gender Differences

While research suggests that claimed self-handicaps are used by men and women alike, several studies have reported significant differences. While research assessing differences in reported self-handicapping have revealed no gender differences or greater self-handicapping among females, the vast majority of research suggests that males are more inclined to behaviourally self-handicap. These differences are further explained by the different value men and women ascribe to the concept of effort.

Major Theoretical Approaches

The root of research on the act of self-handicapping can be traced back to Adler’s studies about self-esteem. In the late 1950s, Goffman and Heider published research concerning the manipulation of outward behaviour for the purpose of impression management. It was not until 30 years later that self-handicapping behaviour was attributed to internal factors. Until this point, self-handicapping only encompassed the usage of external factors, such as alcohol and drugs. Self-handicapping is usually studied in an experimental setting, but is sometimes studied in an observational environment.

Previous research has established that self-handicapping is motivated by uncertainty about one’s ability or, more generally, anticipated threats to self-esteem. Self-handicapping can be exacerbated by self-presentational concerns but also occurs in situations where such concerns are at a minimum.

Major Empirical Findings

Experiments on self-handicapping have depicted the reasons why people self-handicap and the effects that it has on those people. Self-handicapping has been observed in both laboratory and real world settings. Studying the psychological and physical effects of self-handicapping has allowed researchers to witness the dramatic effects that it has on attitude and performance.

Jones and Berglas gave people positive feedback following a problem-solving test, regardless of actual performance. Half the participants had been given fairly easy problems, while the others were given difficult problems. Participants were then given the choice between a “performance-enhancing drug” and a drug that would inhibit it. Those participants who received the difficult problems were more likely to choose the impairing drug, and participants who faced easy problems were more likely to choose the enhancing drug. It is argued that the participants presented with hard problems, believing that their success had been due to chance, chose the impairing drug because they were looking for an external attribution (what might be called an “excuse”) for expected poor performance in the future, as opposed to an internal attribution.

More recent research finds that, generally, people are willing to use handicaps to protect their self-esteem (e.g. discounting failings) but are more reluctant to employ them for self-enhancement. (e.g. to further credit their success). Rhodewalt, Morf, Hazlett, and Fairfield (1991) selected participants who scored high or low on the Self-Handicapping Scale (SHS) and who had high or low self-esteem. They presented participants with a handicap and then with success or failure feedback and asked participants to make attributions for their performance. The results showed that both self-protection and self-enhancement occurred, but only as a function of levels of self-esteem and the level of tendency to self-handicap. Participants who were high self-handicappers, regardless of their level of self-esteem, used the handicap as a means of self-protection but only those participants with high self-esteem used the handicap to self-enhance.

In a further study, Rhodewalt (1991) presented the handicap to only half of the participants and gave success and failure feedback. The results provided evidence for self-protection but not for self-enhancement. Participants in the failure feedback, handicap absent group, attributed their failures to their own lack of ability and reported lower self-esteem to the handicap-present, failure-feedback condition. Furthermore, the handicap-present failure group reported levels of self-esteem equal to that of the successful group. This evidence highlights the importance of self-handicaps in self-protection although it offers no support for the handicap acting to self-enhance.

Another experiment, by Martin Seligman and colleagues, examined whether there was a correlation between explanatory styles and the performance of swimmers. After being given false bad times on their preliminary events, the swimmers who justified their poor performance to themselves in a pessimistic way did worse on subsequent performances. In contrast, the subsequent performances of those swimmers who had more optimistic attributions concerning their poor swimming times were not affected. Those who had positive attributions were more likely to succeed after given false times because they were self-handicapping. They attributed their failure to an external force rather than blaming themselves. Therefore, their self-esteem remained intact, which led to their success in subsequent events. This experiment demonstrates the positive effects that self-handicapping can have on an individual because when they attributed the failure to an external factor, they did not internalise the failure and let it psychologically affect them.

Previous research has looked at the consequences of self-handicapping and have suggested that self-handicapping leads to a more positive mood (at least in the short term) or at least guards against a drop in positive mood after failure. Thus, self-handicapping may serve as a means of regulating one’s emotions in the course of protecting one’s self-esteem. However, based on past evidence that positive mood motivates self-protective attributions for success and failure and increases the avoidance of negative feedback, recent research has focused on mood as an antecedent to self-handicapping; expecting positive mood to increase self-handicapping behaviour. Results have shown that people who are in positive mood are more likely to engage in self-handicapping, even at the cost of jeopardising future performance.

Research suggests that among those who self-handicap, self-imposed obstacles may relieve the pressure of a performance and allow one to become more engaged in a task. While this may enhance performance in some situations for some individuals, in general, research indicates that self-handicapping is negatively associated with performance, self-regulated learning, persistence and intrinsic motivation. Additional long-term costs of self-handicapping include worse health and well-being, more frequent negative moods and higher use of various substances.

Zuckerman and Tsai assessed self-handicapping, well-being, and coping among college students on two occasions over several months. Self-handicapping assessed on the first occasion predicted coping with problems by denial, blaming others and criticising oneself as well as depression and somatic complaints. Depression and somatic complaints also predicted subsequent self-handicapping. Thus, the use of self-handicapping may lead to not only uncertainty as to one’s ability but also ill-being, which in turn may lead to further reliance on self-handicapping.

Applications

There are many real world applications for this concept. For example, if people predict they are going to perform poorly on tasks, they create obstacles, such as taking drugs and consuming alcohol, so that they feel that they have diverted the blame from themselves if they actually do fail. In addition, another way that people self-handicap is by creating already-made excuses just in case they fail. For example, if a student feels that they are going to perform badly on a test, then they might make up an excuse for their potential failure, such as telling their friends that they do not feel well the morning of the test.

Occurrence in Sports

Previous research has suggested that because in Physical Education (PE) students are required to overtly display their physical abilities and incompetence could be readily observed by others, PE is an ideal setting to observe self-handicapping. Because of its prevalence in the sporting world, self-handicapping behaviour has become of interest to sports psychologists who are interested in increasing sports performance. Recent research has examined the relationship between behavioural and claimed self-handicaps and athletic performance as well as the effects self-handicapping has on anxiety and fear of failure before athletic performance.

Controversies

One controversy was revealed in a study done at the University of Wyoming. Previous research indicated a negative correlation between self-handicapping behaviours and boosting one’s self-esteem; it was also shown that people who focus on the positive attributes of themselves are less likely to self-handicap. This study, however, demonstrates that this claim is only partially accurate because the reduction of self-handicapping is only apparent in an area unrelated to the present self-esteem risk. As a result, the attempt to protect self-esteem becomes a detriment to future success in that area.

What is Trichotillomania?

Published on by Andrew Marshall11 Comments

Introduction

Trichotillomania (TTM), also known as hair pulling disorder or compulsive hair pulling, is a mental disorder characterised by a long-term urge that results in the pulling out of one’s hair. This occurs to such a degree that hair loss can be seen. A brief positive feeling may occur as hair is removed. Efforts to stop pulling hair typically fail. Hair removal may occur anywhere; however, the head and around the eyes are most common. The hair pulling is to such a degree that it results in distress.

The disorder may run in families. It occurs more commonly in those with obsessive compulsive disorder. Episodes of pulling may be triggered by anxiety. People usually acknowledge that they pull their hair. On examination broken hairs may be seen. Other conditions that may present similarly include body dysmorphic disorder, however in that condition people remove hair to try to improve what they see as a problem in how they look.

Treatment is typically with cognitive behavioural therapy (CBT). The medication clomipramine may also be helpful, as will clipping fingernails. Trichotillomania is estimated to affect one to four percent of people. Trichotillomania most commonly begins in childhood or adolescence. Women are affected about 10 times more often than men. The name was created by François Henri Hallopeau in 1889, from the Greek θριξ/τριχ; thrix (meaning “hair”), along with τίλλειν; tíllein (meaning “to pull”), and μανία; mania (meaning “madness”).

Brief History

Hair pulling was first mentioned by Aristotle in the fourth century B.C., was first described in modern literature in 1885, and the term trichotillomania was coined by the French dermatologist François Henri Hallopeau in 1889.

In 1987, trichotillomania was recognised in the Diagnostic and Statistical Manual of the American Psychiatric Association, third edition-revised (DSM-III-R).

Epidemiology

Although no broad-based population epidemiologic studies had been conducted as of 2009, the lifetime prevalence of trichotillomania is estimated to be between 0.6% and 4.0% of the overall population. With a 1% prevalence rate, 2.5 million people in the US may have trichotillomania at some time during their lifetimes.

Trichotillomania is diagnosed in all age groups; onset is more common during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12-13. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female. Among adults, females typically outnumber males by 3 to 1.

“Automatic” pulling occurs in approximately three-quarters of adult patients with trichotillomania.

Signs and Symptoms

Trichotillomania is usually confined to one or two sites, but can involve multiple sites. The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, and legs. Some less common areas include the pubic area, underarms, beard, and chest. The classic presentation is the “Friar Tuck” form of vertex and crown alopecia. Children are less likely to pull from areas other than the scalp.

People who suffer from trichotillomania often pull only one hair at a time and these hair-pulling episodes can last for hours at a time. Trichotillomania can go into remission-like states where the individual may not experience the urge to “pull” for days, weeks, months, and even years.

Individuals with trichotillomania exhibit hair of differing lengths; some are broken hairs with blunt ends, some new growth with tapered ends, some broken mid-shaft, or some uneven stubble. Scaling on the scalp is not present, overall hair density is normal, and a hair pull test is negative (the hair does not pull out easily). Hair is often pulled out leaving an unusual shape. Individuals with trichotillomania may be secretive or shameful of the hair pulling behaviour.

An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socialising, due to appearance and negative attention they may receive. Some people with trichotillomania wear hats, wigs, false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as “pulling”) whatsoever. This “pulling” often resumes upon leaving this environment. Some individuals with trichotillomania may feel they are the only person with this problem due to low rates of reporting.

For some people, trichotillomania is a mild problem, merely a frustration. But for many, shame and embarrassment about hair pulling causes painful isolation and results in a great deal of emotional distress, placing them at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder. Hair pulling can lead to great tension and strained relationships with family members and friends. Family members may need professional help in coping with this problem.

Other medical complications include infection, permanent loss of hair, repetitive stress injury, carpal tunnel syndrome, and gastrointestinal obstruction as a result of trichophagia. In trichophagia, people with trichotillomania also ingest the hair that they pull; in extreme (and rare) cases this can lead to a hair ball (trichobezoar). Rapunzel syndrome, an extreme form of trichobezoar in which the “tail” of the hair ball extends into the intestines, can be fatal if misdiagnosed.

Environment is a large factor which affects hair pulling. Sedentary activities such as being in a relaxed environment are conducive to hair pulling. A common example of a sedentary activity promoting hair pulling is lying in a bed while trying to rest or fall asleep. An extreme example of automatic trichotillomania is found when some patients have been observed to pull their hair out while asleep. This is called sleep-isolated trichotillomania.

Causes

Anxiety, depression and obsessive-compulsive disorder (OCD) are more frequently encountered in people with trichotillomania. Trichotillomania has a high overlap with post traumatic stress disorder, and some cases of trichotillomania may be triggered by stress. Another school of thought emphasizes hair pulling as addictive or negatively reinforcing, as it is associated with rising tension beforehand and relief afterward. A neurocognitive model – the notion that the basal ganglia plays a role in habit formation and that the frontal lobes are critical for normally suppressing or inhibiting such habits – sees trichotillomania as a habit disorder.

Abnormalities in the caudate nucleus are noted in OCD, but there is no evidence to support that these abnormalities can also be linked to trichotillomania. One study has shown that individuals with trichotillomania have decreased cerebellar volume. These findings suggest some differences between OCD and trichotillomania. There is a lack of structural MRI studies on trichotillomania. In several MRI studies that have been conducted, it has been found that people with trichotillomania have more gray matter in their brains than those who do not suffer from the disorder.

It is likely that multiple genes confer vulnerability to trichotillomania. One study identified mutations in the SLITRK1 gene.

Diagnosis

Patients may be ashamed or actively attempt to disguise their symptoms. This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure. If the patient admits to hair pulling, diagnosis is not difficult; if patients deny hair pulling, a differential diagnosis must be pursued. The differential diagnosis will include evaluation for alopecia areata, iron deficiency, hypothyroidism, tinea capitis, traction alopecia, alopecia mucinosa, thallium poisoning, and loose anagen syndrome. In trichotillomania, a hair pull test is negative.

A biopsy can be performed and may be helpful; it reveals traumatised hair follicles with perifollicular haemorrhage, fragmented hair in the dermis, empty follicles, and deformed hair shafts. Multiple catagen hairs are typically seen. An alternative technique to biopsy, particularly for children, is to shave a part of the involved area and observe for regrowth of normal hairs.

Classification

Trichotillomania is defined as a self-induced and recurrent loss of hair. It includes the criterion of an increasing sense of tension before pulling the hair and gratification or relief when pulling the hair. However, some people with trichotillomania do not endorse the inclusion of “rising tension and subsequent pleasure, gratification, or relief” as part of the criteria because many individuals with trichotillomania may not realise they are pulling their hair, and patients presenting for diagnosis may deny the criteria for tension prior to hair pulling or a sense of gratification after hair is pulled.

Trichotillomania may lie on the obsessive-compulsive spectrum, also encompassing OCD, body dysmorphic disorder (BDD), nail biting (onychophagia) and skin picking (dermatillomania), tic disorders and eating disorders. These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile. In the sense that it is associated with irresistible urges to perform unwanted repetitive behaviour, trichotillomania is akin to some of these conditions, and rates of trichotillomania among relatives of OCD patients is higher than expected by chance. However, differences between the disorder and OCD have been noted, including: differing peak ages at onset, rates of comorbidity, gender differences, and neural dysfunction and cognitive profile. When it occurs in early childhood, it can be regarded as a distinct clinical entity.

Because trichotillomania can be present in multiple age groups, it is helpful in terms of prognosis and treatment to approach three distinct subgroups by age: preschool age children, preadolescents to young adults, and adults.

In preschool age children, trichotillomania is considered benign. For these children, hair-pulling is considered either a means of exploration or something done subconsciously, similar to nail-biting and thumb-sucking, and almost never continues into further ages.

The most common age of onset of trichotillomania is between ages 9 and 13. In this age range, trichotillomania is usually chronic, and continues into adulthood. Trichiotillomania that begins in adulthood most commonly arises from underlying psychiatric causes.

Trichotillomania is often not a focused act, but rather hair pulling occurs in a “trance-like” state; hence, trichotillomania is subdivided into “automatic” versus “focused” hair pulling. Children are more often in the automatic, or unconscious, subtype and may not consciously remember pulling their hair. Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels “just right”, or pulling in response to a specific sensation. Knowledge of the subtype is helpful in determining treatment strategies.

Treatment

Treatment is based on a person’s age. Most pre-school age children outgrow the condition if it is managed conservatively. In young adults, establishing the diagnosis and raising awareness of the condition is an important reassurance for the family and patient. Non-pharmacological interventions, including behaviour modification programmes, may be considered; referrals to psychologists or psychiatrists may be considered when other interventions fail. When trichotillomania begins in adulthood, it is often associated with other mental disorders, and referral to a psychologist or psychiatrist for evaluation or treatment is considered best. The hair pulling may resolve when other conditions are treated.

Psychotherapy

Habit reversal training (HRT) has the highest rate of success in treating trichotillomania. HRT has also been shown to be a successful adjunct to medication as a way to treat trichotillomania. With HRT, the individual is trained to learn to recognise their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioural versus pharmacologic treatment, cognitive behavioural therapy (CBT, including HRT) have shown significant improvement over medication alone. It has also proven effective in treating children. Biofeedback, cognitive-behavioural methods, and hypnosis may improve symptoms. Acceptance and commitment therapy (ACT) is also demonstrating promise in trichotillomania treatment. A systematic review from 2012 found tentative evidence for “movement decoupling”.

Medication

The United States Food and Drug Administration (FDA) has not approved any medications for trichotillomania treatment.

Medications can be used to treat trichotillomania. Treatment with clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to improve symptoms, but results of other studies on clomipramine for treating trichotillomania have been inconsistent. Naltrexone may be a viable treatment. Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have limited usefulness in treating trichotillomania, and can often have significant side effects. Behavioural therapy has proven more effective when compared to fluoxetine. There is little research on the effectiveness of behavioural therapy combined with medication, and robust evidence from high-quality studies is lacking. Acetylcysteine treatment stemmed from an understanding of glutamate’s role in regulation of impulse control.

Different medications, depending on the individual, may increase hair pulling.

Devices

Technology can be used to augment habit reversal training or behavioural therapy. Several mobile apps exist to help log behaviour and focus on treatment strategies. There are also wearable devices that track the position of a user’s hands. They produce sound or vibrating notifications so that users can track rates of these events over time.

Prognosis

When it occurs in early childhood (before five years of age), the condition is typically self-limiting and intervention is not required. In adults, the onset of trichotillomania may be secondary to underlying psychiatric disturbances, and symptoms are generally more long-term.

Secondary infections may occur due to picking and scratching, but other complications are rare. Individuals with trichotillomania often find that support groups are helpful in living with and overcoming the disorder.

Society and Culture

Support groups and internet sites can provide recommended educational material and help persons with trichotillomania in maintaining a positive attitude and overcoming the fear of being alone with the disorder.

Media

A documentary film exploring trichotillomania, Bad Hair Life, was the 2003 winner of the International Health & Medical Media Award for best film in psychiatry and the winner of the 2004 Superfest Film Festival Merit Award.

Trichster is a 2016 documentary that follows seven individuals living with trichotillomania, as they navigate the complicated emotions surrounding the disorder, and the effect it has on their daily lives.

Book: The Mindfulness and Acceptance Workbook for Self-Esteem

Published on by Andrew MarshallLeave a comment

Book Title:

The Mindfulness and Acceptance Workbook for Self-Esteem.

Author(s): Joe Oliver.

Year: 2020.

Edition: First (1st).

Publisher: New Harbinger, Workbook Edition.

Type(s): Paperback and Kindle.

Synopsis:

We all have stories we have created about ourselves-some of them positive and some of them negative. If you suffer from low self-esteem, your story may include these types of narratives: “I’m a failure,” “I’ll never be able to do that,” or “If only I were smarter or more attractive, I could be happy.” Ironically, at the end of the day, these narratives are your biggest roadblocks to achieving happiness and living the life you deserve. So, how can you break free from these stories-once and for all?

Grounded in evidence-based acceptance and commitment therapy (ACT), this workbook offers a step-by-step programme to help you break free from self-doubt, learn to accept yourself and your faults, identify and cultivate your strengths, and reach your full potential. You will also discover ways to take action and move toward the life you truly want, even when these actions trigger self-doubt. Finally, you’ll learn to see yourself in all your complexity, with kindness and compassion.

Book: The CBT Art Workbook for Coping with Anxiety

Published on by Andrew MarshallLeave a comment

Book Title:

The CBT Art Workbook for Coping with Anxiety.

Author(s): Jennifer Guest.

Year: 2019.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback.

Synopsis:

Using the principles of CBT, these 150 information pages and worksheets help adults to understand and manage symptoms of anxiety.

The activities follow the framework of a typical CBT course: how it works, looking at the nature of the anxiety, linking thoughts, feelings, behaviour and physiology cycles, exploring different levels of thinking and beliefs, and identifying goals and future planning.

Suitable for adults in individual or group work, this is an excellent resource to use as a standalone resource or in conjunction with professional therapy to deal with anxiety.

Book: The CBT Art Workbook for Coping with Depression

Published on by Andrew MarshallLeave a comment

Book Title:

The CBT Art Workbook for Coping with Depression.

Author(s): Jennifer Guest.

Year: 2020.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback.

Synopsis:

Using the principles of CBT, these illustrated worksheets help clients to understand and manage their symptoms of depression.

The activities follow the framework of a typical CBT course: how it works, looking at the nature of depression, linking thoughts, feelings, behaviour and physiology cycles, exploring different levels of thinking and beliefs, and identifying goals and future planning. It presents these theories in an accessible way so that clients are familiar with the foundations of CBT they will be using in the worksheets. They can complete them by writing or drawing, alongside the opportunity to colour in parts of the pages as they consider ideas.

Suitable for adults in individual or group work, this is an excellent resource to use as a standalone resource or in conjunction with professional therapy to deal with depression.