Community & Communication

1. Community & Communication Age 7 - 12

2. Maslow’s Hierarchy of Needs

3. Maslow’s Heirarchy of Needs • Needs on lower levels must be met before larger identities can be sustained. • Lower identities take their places as no less important, but supporting of a larger and more powerful whole. • A.H. Maslow, A Theory of Human Motivation, Psychological Review 50(4) (1943):370-96.

4. Stage 1: Motor Functions • Foundation of security that enables self-preservation and forms the physical identity • Stage 2: Emotions • Emotional identity interested in self-gratification • Stage 3: Language • Ego identity develops inner authority and freedom • Stage 4: Social relationships • Social Identity formed to establish wider relationship models and self-acceptance • Stage 5: Creativity • Career/Self expression forms creative identity

5. Stage 5: 7 - 12 years • With the development of a sense of self, the will to act and emotional interpretation of self and reality, choice of action results with complex abstract thinking • Expansion, experimentation and creativity allow for healthy self-expression • Self is identified in relation to the world by expressing commitment • Responsibility is taken on to carry out or act on what we say

6. Stage 5: Social Contract • Child identifies self as a role – teacher, mother, artist, businessman • Child also identifies with failures and mistakes • Self is identified with social inspiration – role models • Acts of artists, poets, heroes, mythology, great creations of civilisations etc • Creativity

7. Stage 5: Comparative models • Freud: Latency period • Psychosexual dormancy, repression of sexual desires and erogenous impulses • Erikson: Industry vs inferiority • Resolution results in a sense of competence

8. Stage 5: Comparative models • Jung: Self begins to transcend into a transpersonal self (connected with collective) • Healthy ego, social confidence and compassion for society

9. Stage 5: Comparative models • Piaget: Concrete operations • Logical thought, reasoning in application to concrete objects (2 apples) • Ability to tell how other people are feeling

10. Stage 5: Trauma • Trauma may cause anxiety with speaking the truth, expressing ones truth • Pathological lying, avoidance of taboo • Clear communication may provide therapy for feeling of being lied to by authority figures

11. “It is not the traumas we suffer in childhood that makes us emotionally ill but the inability to express the trauma.” - Alice Miller (psychologist of child abuse)

12. Personality Disorders • An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the individual who exhibits it. - APA DSM

13. Personality Disorders • Odd/Eccentric Cluster • Paranoid Personality Disorder • Schizoid Personality Disorder • Dramatic/Erratic Cluster • Borderline Personality Disorder • Histronic Personality Disorder • Antisocial Personality Disorder and Psychopathy • Narcissistic Personality Disorder • Anxious/Fearful Cluster • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

14. The Five Factor Model Dimensions of personality with sample questions: • Neuroticism • – “I often feel tense or jittery” • Extraversion/Introversion • – “I really like most people I meet” • Openness to Experience • – “I have a very active imagination” • Agreeableness/Antagonism • – “I tend to be cynical and skeptical of others’ intentions” • Conscientiousness • – “I often come into situations without being prepared” • These dimensions of personality are moderately heritable • Linked to schizoid, borderline and avoidant personality disorders – all high introversion with varying neuroticism • Most personality disorders are categorised by high neuroticism and antagonism

15. A) Odd/Eccentric Cluster • Paranoid • Distrust and suspiciousness of others • Schizoid • Detachment from social relationships and restricted range of emotional expression • Schizotypal • Lack of capacity for close relationships, cognitive disortions, and eccentric behaviours

16. C) Anxious/Fearful Cluster • Avoidant Personality Disorder • Fearful of criticism, rejection and disapproval • Avoid jobs or relationships • Comorbid with depression and other personality disorders • May be considered chronic Generalised anxiety disorder • Dependent Personality Disorder • Over-reliance on others and lack of self confidence • Obsessive Compulsive Personality Disorder • Does not include obsessions and compulsions that define OCD. • Perfectionist, preoccupation with details, rules and schedules • Usually fail to finish because of obsession to detail

17. B) Dramatic Emotional Erratic cluster • Antisocial Personality Disorder • Disregard for the law and rights of others • Borderline Personality Disorder • Instability in relationships, self-image, identity and behaviour, “black and white” thinking • Histronic Personality Disorder • Pervasive attention-seeking including inappropriate sexual seductiveness and exaggerated emotions • Narcissistic Personality Disorder • Grandiosity, need for admiration, lack of empathy

18. Borderline Personality Disorder • Impulsivity and instability in relationships and mood (e.g. attitudes and feelings toward other people might vary considerably and inexplicably over short periods of time. • Intense, erratic and abruptly shifting mood and emotions • No clear or coherent sense of self • Fears of abandonment, attention-craving, chronic feelings of depression and emptiness • May experience transient psychotic and dissociative symptoms when stressed

19. Borderline Personality Disorder • 1% prevalence • More common in women • Typically begins in adolescence or early adulthood • 50% of people maintain disorder 7 years after treatment but may not show disorder 15 years after treatment • Suicidal behaviour is a concern (~7.5% commit suicide, 15.5% engage in suicidal behaviour) • Comorbidity with Anxiety disorders and substance-related disorders

20. Etiology of Borderline Personality Disorder • Social Factors: • Child Abuse • Object-Relations Theory: examines how children internalise their images of people who are important to them (strong emotional attachments) • Linehan’s Diathesis-Stress Theory:

21. Etiology of Borderline Personality Disorder • Genetics/Neurobiology • Genes account for 60% of the variance in the development of the disorder • Genes most likely relate to impulsivity and emotional dysregulation, rather than the whole disorder • Deficits in sensitivity to serotonin associated with impulsivity and dysregulation of emotions • Frontal lobes • Increased activity in amygdala

22. Antisocial Personality Disorder and Psychopathy • Antisocial personality Disorder: • A pervasive pattern of disregard for the rights of others since the age of 15. • The presence of a conduct disorder before the age of 15. Truancy, running away from home, frequent lying, theft, arson, and deliberate destruction of property • Psychopathy • Poverty of emotions. • No sense of shame • Superficial charm to manipulate others for personal gain • Lack of anxiety may make it impossible to learn from their mistakes

23. Antisocial Personality Disorder and Psychopathy • As many as 60% of children with conduct disorder develop APD • 75-80% of convicted felons meet the DSM criteria for APD • Only 15-25% meet criteria for psychopathy

24. Etiology for APD and Psychopathy • Genetics • Heritability of 40-50% for APD • 2% prevalence for APD • Hard to disentangle from family and behavioural influences • Emotional • Little experience of anxiety, which helps learn avoidance of certain behaviours (e.g. shocks) • Social Factors • Family environment and parenting patterns • Poverty • Exposure to violence

25. Treatment • Object-relations Psychotherapy • Dialectical behaviour Therapy • Cognitive behavioural Therapy • etc

26. O would some Power the gift to give usTo see ourselves as others see us!It would from many a blunder free us,And foolish notion:What airs in dress and gait would leave us,And even devotion! - Robert Burns, “To A Louse”

27. Eating Disorders • Anorexia Nervosa • Bulimia Nervosa • Binge Eating Disorder

28. Anorexia Nervosa • Anorexia: loss of appetite Nervosa: due to emotional reasons • However, most individuals with Anorexia Nervosa do not lose their appetite or interest in food

29. Anorexia Nervosa • Refusal to maintain normal body weight • Usually less than 85% of what is normal body mass index • Weight loss through diet, vomiting, laxatives or excessive exercise • Intense fear of gaining weight and being fat • No such thing as being “too thin” • Distorted body image or sense of body shape • Amenorrhea (loss of menstrual period) • Not always present, does not add differences in syndrome • Caused by diet

30. Anorexia Nervosa • Usually begins in early to middle adolescence • Lifetime prevalence is less than 1% • 10 times more likely in females • Comorbid with Anxiety and Mood disorders, as well as Personality Disorders • About 70% eventually recover • Recovery may take 6 or 7 years with common relapses • 10 times more likely to cause death than other psychological disorders • Congestive heart failure, suicide, etc

31. Bulimia Nervosa • Bulimia: ‘Ox hunger’ • Binge: eating an excessive amount of food within 2 hours. • Usually following stressful experience or negative social interactions • Loss of control during binges, loss of awareness or sense of identity • Usually followed by disgust, discomfort and fear of weight gain leading to purging • Purging: Usually self-induced vomiting, use of laxatives etc

32. Bulimia Nervosa • Binging and Purging must occur at least twice a week for 3 months • Typically begins in late adolescence, early adulthood • 1 – 2% prevalence • ~90% diagnosed are women • Comorbid depression, anxiety and personality disorders, as well as substance-related disorders • 70% recovery rate, 10% remain fully symptomatic

33. Etiology of Eating Disorders • Genetics • Eating disorders run in families • Genes account for a substantial portion of variance among twins with eating disorders • Non-shared, environmental factors also contribute

34. Etiology of Eating Disorders • Neurobiology • Hypothalamus – key in regulating hunger and eating • Animal studies not directly comparable to anorexia in humans (interest in food) • Does not account for body-image and fear of weight gain • Endogenous Opiods • Starving may increase levels of opioids, resulting in a positively reinforcing euphoria • Low levels may promote craving, increasing levels of opioids on eating

35. Neurobiology • Cortisol • Cortisol and opioid irregularities may be effects of the food disorder, not causes • Satiety (Feeling Full) • Seratonin + Dopamine • Underactive serotonin systems consistent with bulimia, but not always present in anorexia

36. Etiology of Eating Disorders • Sociocultural Factors • Increase of 400% between 1950 and 1970. • Over half of Playboy centrefolds between 1985 and 1997 had a body mass index (BMI) considered to be severely underweight. The rest (except one) were low weight. • Fat has negative connotations • Unsuccessful, little self-control, stereotyped as lonely, shy and greedy for affection • Health specialists in obesity have also exhibited beliegs that obese people are lazy, stupid, or worthless

38. Sociocultural Factors • Increase in magazine articles on weight loss • Dieting: 1950: 7% men, 14% women 1997: 29% men, 44% women • Especially common among white, upper-socioeconomic status women  same group with highest rates of anorexia • Self-objectification

39. Cross-Cultural Factors • Fear of fat is most likely a westernized symptom • Some cultures (e.g. Uganda) consider weight a sign of health and fertility • Bulimia may be a diagnosis entirely from industrialised countries • Differences within industrialised countries between whites and black

40. Etiology of Eating Disorders • Psychodynamics: • Low self-esteem and perfectionism • Fulfilling a sense of personal effectiveness • Failure of parent to correctly perceive the child’s state as being hungry or tired • Child does not identify own internal states • Does not become self-reliant • Dieting becomes a means of controlling identity

41. Psychodynamics: • Oral stage – relationships with mother. Binging and purging represent the conflict between need and rejection • Perfectionism: self-oriented, other-oriented, socially-oriented • Striving for success • Setting impossibly high standards

42. Etiology of Eating Disorders • Family Characteristics Minuchin et al (1975) • Enmeshment – extreme over-involvement where parents speak for their children • Over-protectiveness • Rigidity – avoid dealing effectively with events that require change • Lack of conflict resolution Child abuse may also be a factor

43. Treatment of Eating Disorders • Medication • Antidepressants (e.g. Prozac) Almost one third of patients drop out of treatment because of the side effects Olanzapine  body dissatisfaction, anxiety

44. Psychological Treatment • Treatment varies between depression. Often comorbid with depression and low self-esteem • Anorexia: Medical risk is high, and possibility of death means that medical treatment must be a priority • Long term maintenance of weight game is a goal • Bulimia: CBT • Normal body weight can be maintained without severe dieting • Unrealistic restriction can trigger binges • Alter the “all or nothing” thinking • Assertiveness to cope with unreasonable demands

45. Prevention of Eating Disorders • Psychoeducation approaches • De-emphasis of sociocultural influences • Risk-factor approach • Multiple sessions most effective

46. Let’s Have a Great Year!