Thursday, May 16, 2013

Borderline Hyper-mentalism

Ever wonder why you look at a situation that’s occurring and wonder why you’re mind starts racing and over-interpreting every single facial expression? Every single voice inflection? What did that blink mean? Is he glaring at me? Or was that just dust in his eye? Is she about to cry because of something I said? Or is she simply sniffing because of allergies? Why are we so prone to emotional dysregulation and over interpretation of the emotional situations around us? In my research I found one nicely compared clue. Many of us are well aware of how Autistic Spectrum Disorders are viewed and how it’s pretty well accepted they don’t react normally or over-interpret emotional situations. In fact, they typically under-interpret emotional situations if they interpret them at all. When these studies were applied to people with BPD, they results were quite interesting. Where people on the autistic spectrum tend to be hypo-mentalistic, - deficient in mentalism… people on the BPD spectrum tend to be hyper-mentalistic… but here; check it out for yourself. It explains a lot:

Borderline Hyper-mentalism UnMASCed

A new test proves BPD adolescents hyper-mentalize
Published on June 10, 2011 by Christopher Badcock, Ph.D. in The Imprinted Brain

We have known for some time that sufferers from autistic spectrum disorders (ASDs) have mentalistic deficits--so-called mind-blindness. They tend to think in concrete, non-mental terms, and to be poor at detecting and interpreting social and emotional cues such as direction of gaze, facial expression, and body-language. And they are also poor at seeing things from another person's point of view. For example, if shown a tube of sweets which proves to contain a hidden pencil and then asked what the next child to be shown it would think it contains, many children under 3 or 4 tend to expect the next child to know what they already know, completely failing to appreciate the next child's inevitable ignorance. But much older children with ASD make the same mistake and fail this test of appreciating so-called false belief.

Thanks to specially-designed tests like this and others, researchers have been able to measure these deficits quantitatively. However, exactly the same tests have caused confusion as far as the imprinted brain theory and its distinctive, diametric model of mental illness is concerned because, when applied to those diagnosed with psychotic spectrum disorders (PSDs) such as schizophrenia, mentalistic deficits are also often found. The problem here is that the diametric model proposes that if ASD is symptomatically hypo-mentalistic--deficient in mentalism--then PSD is the opposite: hyper-mentalistic. Here are some examples (explained and illustrated at length with clinical examples in my book):

·         Gaze Awareness: deficits in ASD v. delusions of being watched or spied on in PSD

·   Awareness of and interpretation of intention: deficient in ASD v. delusions of persecution (negative intention) or erotomania (positive intention) in PSD

·       Shared Attention/group participation: deficits in ASD v. delusions of conspiracies in PSD

·         Theory of Mind: deficits in ASD v. magical ideation/delusions of reference in PSD

·      Sense of self/personal agency: deficits in ASD v. megalomania/ delusions of grandeur in PSD

·         Ability to deceive: lacking in ASD v. delusional self-deception in PSD

Other findings which fit the pattern here are the pathological single-mindedness of autistics v. the pathological ambivalence of psychotics, and the age of onset. This is early in ASD because mentalistic development is truncated but late in PSD because normal development has to be completed before mentalism can become pathologically over-developed. 

Of course, you would expect to find mentalistic deficits in both under-mentalizing and over-mentalizing minds just as you would expect to find visual or hearing deficits in people with both over- and under-sensitive eyes or ears. What you have to do is to develop tests which can tell the difference, and now for the first time techniques are beginning to appear which do indeed do this where mentalism is concerned.

New research by Carla Sharp and others published in The Journal of the American Academy of Child & Adolescent Psychiatry (50, (6), 563-73, 6 June 2011) kindly brought to my attention by my colleague, Bernard Crespi, does exactly this, with results perfectly in line with our predictions.

The study used a naturalistic, video-based instrument for the assessment of mentalism called the Movie for the Assessment of Social Cognition (MASC). Subjects watch a depiction of an interactive social scenario and are periodically asked questions about it. This approach can distinguish between under-mentalizing, involving insufficient mentalistic reasoning resulting in incorrect, reduced mental-state attribution, andnon-mentalizing involving a complete lack of mentalism in which a participant may fail to use any mentalistic term whatsoever in explaining behaviour. But crucially for the diametric model, the test can also assess hyper-mentalism, reflecting over-interpretation of mental states.

As the authors comment, this study is the first to use a mentalistic task that resembles the demands of social cognition in everyday-life to examine mentalizing difficulties in relation to borderline personality disorder (BPD) traits in adolescents. Although other studies have investigated aspects of emotional processing in young people diagnosed with BPD, this is the first to use a task specifically developed to assess mentalizing impairment in a psychiatric disorder by considering both insufficient mentalistic reasoning and a complete lack of mentalizing. The study found that neither under-mentalizing nor complete absence of mentalizing was linked to borderline traits. By contrast, hyper-mentalizing ("over-interpretive mental-state reasoning") was strongly associated with borderline features in adolescents.

According to the diametric model, BPD is a PSD and as the authors note, these adolescent BPD subjects showed the opposite tendency to ASD adolescents: where they hyper-mentalized and over-interpreted social cues, autistics symptomatically under-interpret social signs and fail to mentalize sufficiently.

In the words of the authors, "the current study adds to the growing body of evidence linking varying types of social-cognitive dysfunctions to particular psychiatric disorders and specifically linking hypermentalizing to borderline traits in adolescents. Taken together, these results confirm clinical, and theoretical evidence that, in patients with borderline personality disorder, the dysfunction of mentalization is more apparent in the emergence of unusual alternative strategies (hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing)."

They add that "Hypermentalizing, which involves overinterpreting social cues in others, in turn, derails the emotion regulation system spinning the adolescent into a vicious cycle of overinterpreting what others are thinking and being unable to regulate the anxious rumination caused by this overinterpretation"--just as the diametric model predicts.

Let's hope that many other researchers begin to use tools like MASC to test the predictions of the diametric model and resolve once and for all the confusions surrounding the true meaning of mentalistic deficits in illnesses on both sides of the autism-psychosis spectrum.

(With thanks and acknowledgement to Bernard Crespi)


So what do you think of that? Interesting, right?  I’m going to dig a little further for you and see what else I can unearth along these lines. 

Wednesday, May 15, 2013

What To Do When You Have No Emotional Support

Hello Dear Readers! Sorry my posts have been so sporadic! I’ve been working myself to the bone! Keep an eye out though. I’m going to have a Guest Post for you soon!

Today I want to talk about something I think a lot of us deal with at some point in our lives, if not for long periods of time in our lives: What to do and/or how to cope when you have no emotional support beyond yourself.

At some point in your life, for whatever reason, you might find yourself alone. Not just emotionally alone, but physically alone. In need of emotional support.

There are the professional options that many of us need and probably should seek. However due to many reasons such as financial difficulties or general lack of therapeutic resources in your area of the world this might not be an option for you. Many of us are embarrassed or don’t believe in therapy as well. Whatever your reason, this might not be an option. Maybe you want to, but you’re a single parent and you can’t leave your kids or you don’t have transportation. Maybe you have a spouse that just doesn't give you emotional support (this is a whole different bottle of badness, really). Whatever. Shit happens.

So what do you do?

You do the best you can. You will struggle. A lot. Sometimes you’ll flounder.  Sometimes you’ll think you can’t take it anymore and one more thing will be the thing that breaks you. And then that one more thing happens and miraculously you find the strength to push through.

Often times the problem is we don’t have family, or friends, or people that we know because we’re new to an area, but that doesn’t mean support doesn’t exist somewhere.

1.      Therapy - If you have the means, don’t be afraid to seek a counselor or therapist. It’s not even something off the wall anymore. It’s practically mainstream now. Everyone and their neighbor sees a therapist these days.

2.   Support Groups – They’re not as formal as therapy. Often they’re hosted at your local libraries or churches.  You can meet other people that are struggling with issues similar to what you’re dealing with. Maybe you won’t be able to find a Borderline support group, but at least look for something that hits on an issue or two that struggle with so you don’t feel so alone and that you know that there are others out there for you.

3.     Community Involvement – Even if it’s not specific to your issues, get involved. This is something that my friends don’t often realize. Just having them around is SUPER good for me. If I’m really depressed and having a hard time, I don’t necessarily talk about my problems, but just getting out and doing something that you enjoy, even if it’s with people that you don’t know yet, can be a big help.

4.    Journal – I’ve said this many, many, many times before. Write those thoughts, feelings, and emotions down. They don’t have to make sense. Just get them out. They can be so overwhelming when they’re just an intangible mass floating around up there in your mind. Get them on paper so you can look at them and really get a sense of them. Get them organized so you can deal with them and maybe do something about them. Even if you can’t do anything about them, I almost always find that when I get my feelings out on paper that they seem lessened and easier to handle. It’s a huge relief.

5.    Cry – It’s okay. Let it out. Let them go. Sometimes you really do just need to let it out. Crying can be cathartic.

6.    Exercise – This one is particularly effective when I’m sad or angry. The harder I work out, the more capable I feel of coping with whatever is troubling me.

Rescue-A-Human Program
7.      Get a Pet – This is a real and big investment. However, caring for another creature is a as much an act of self- love as it is an act of selfless love for a creature in need of a loving home.

8.      Get On-line – This world isn’t as disconnected as it once was. The internet is an amazing resource where you can form real connections with people just like you, dealing with issues just like you are. You may never meet face-to-face but that doesn’t mean you can’t form real, lasting connections with people and help one another out in times of need. I have made some absolutely astounding friends on-line. Better than many, if not most, of the people I’ve met in real life. If you only know me through this blog, you may not know my face, but odds are you know more about me than a good deal of the people that actually see me every day. You have an opportunity to find a very tailored community with people that are willing and able to listen to you. Hell, I started a FORUM just for this very reason. Right up there in that top right corner. Free. Just for you. Help is out there. It might not be perfect. But it’s something. There are so many on-line forums where you can get support. Reach out!

9.      Get informed – One of the worst feelings is not knowing what the hell is going on with you and feeling like you’re going crazy, alone. Note: The impetus for this blog. Take what you find out with a grain of salt though. You don’t want to make the mistake of misdiagnosing yourself and freaking yourself out, don’t do that… but you know, familiarize yourself with your symptoms and realize that what you’re going through has a name, or may have a name and that there are other people going through what you’re experiencing. Read up!

10.  Keep Busy – It’s the dead air, the empty times that are the worst. When our minds are allowed to roam into those bad places of darkness of doubt and self-loathing. I know it’s not possible to always remain busy, but we can do our best. Pick up a cause, volunteer, get a hobby, invest in your job, your kids, etc…. keep your mind busy and not focused on the negative as much as possible. We all know this is easier said than done, but as long as you keep trying, you’re on the right path.

11.  Be Kind to Yourself – Practice positive self-affirmations and acts of self- love. Even if you don’t always feel it, treat yourself with kindness and focus on your positive attributes. When you have no one else in your life, the only one you have to rely on is, you. You will always have you, for as long as you live, you will always have yourself. You should build yourself up as if you’re the most important person in your world, because you are. It can truly, truly suck sometimes to be on your own, but in the end you will be a stronger person for being able to take care of yourself. For as unfair as it seems (sorry, the world doesn’t care about fairness – as a concept it really doesn’t exist) you will be able to manage. And when you do, acknowledge it with a big freaking trip to the spa, or the salon, or the tattoo shop, or wherever, because you deserve it.

I find often that what we want is for others to always make the effort. We need to take some responsibility though! We need to reach out! We are responsible for our own well-being. As hard as it can be, we need to make an effort and invest in our own emotional well-being. If we sit and wait for others to do it for us, it’s probably never going to get done because other people have their own problems, and not for nothing, other people aren’t always that observant, might not know you’re in distress, or unfortunately might not care. Be proactive! Take your mental health into your own hands! 

I felt like this most of my life. In middle school and college I actually didn't have any real trustworthy support because my relationship with my family wasn't good and my friends were, well, not very healthy relationships.  In college I didn't have anyone close to me. Not really. Not until I finally moved in with my sister which pretty much changed my world for the better. Then when I moved to New York and in with Evil-Ex and was completely Alienated from everyone I had zero emotional support. Not until I moved in with xRoommate did I finally understand what it was to have real honest to goodness emotional support. And even then it took me a while to grasp this concept. With baby steps. A little at a time. I'm better at giving emotional support than receiving it, but still. This was 2 and a half years ago! I'm 32! That's a long time to go without a proper emotional support network. I've had to rely on myself for a very long time. It's not easy, but it can be done. Hopefully only for as long as you need. 

Related Posts Plugin for WordPress, Blogger...