Developmental Disorders - Assignment Example

Jessica Shuk Yi Kan Final Exam Part I (a, b, c, e, f) Eating Disorders are directly related to the developmental changes of adolescence. Adolescenceis a time when abstract thinking starts to emerge and their self consciousness increases as a result. For example, they may look at a supermodel and wish that he/she can be as thin as the model and then feel disgusted by their own body because it is not quite like that of the supermodel itself. It is also a time of social changes for them. Instead of mostly being with their parents, they will now spend more time with their friends. Their peer group therefore, has a lot of influence on them. They will start comparing themselves to their peers and try to “fit in” and be like them. For example, if many of a teen’s friends are thin, the teen may therefore feel that she is fat and that she will need to be slim like her peers to fit in. Adolescence is a time where teens form their own identity basis. Appearance is a part of their identity, although it isn’t everything, it is the easiest part to decipher. It is easy to look into a mirror and label yourself as being fat, skinny or fit. Puberty, cognitive and social changes all play a part in influencing how the teen sees him/herself and what part of the same the teen sees when one looks into the mirror. Personality traits make people vulnerable to developing Eating Disorders. People with Borderline Personality Disorder traits are more vulnerable in developing Eating Disorders. Because they do not know how to regulate their feelings, they cope with their feelings by binging or starving themselves. For example, Chhaya unconsciously regulates her feelings by starving herself. When she found out that she was not being valedictorian, it caused her to feel like she is a failure and that she cannot gain control of her life. By starving herself, she now feels like she is gaining control because she can control her weight and how much food she eats. She uses starvation to cope with her negative emotions. Like many of the Borderline Personality Disorder patients, Chhaya does not know how to regulate her feelings by monitoring and adapting to behaviors. She does not know how to tolerate and cope with her feelings. So as a result she jumps into impulsive actions, which in this case, is by starving herself. Substance abuse in adolescence is often a way of coping with other problems. Adolescents tend to abuse drugs to cope with their emotional and behavioral problems. For adolescents, other problems seem to come first and substance abuse appears as an additional problem for them; substance abuse usually appears at a later stage as a coping mechanism to regulate their emotions. For example, Tracy, who has drug abuse problems, is also diagnosed with Borderline Personality Disorder, Depression and Anxiety Disorder; which is very common in girls with substance abuse issues. She started doing drugs when her emotional problems were starting to really bother her (e.g. wanting to fit in with the “cool girls” in school, feeling unconnected with her mother, and when her mother neglected her feelings.) Substance abuse for Tracy was a way to gain power in her life. It gives her an identity and a sense of self. It is something she has complete control over. The impulsive behaviors associated with Borderline Personality Disorder reflect deficits in emotion regulation. People with Borderline Personality Disorder lack the ability to self-regulate their feelings. There is a high correlation between childhood sexual abuse and Borderline Personality Disorder. Borderline Personality Disorder usually begins with emotional invalidation; with one being constantly told that one’s feelings are wrong. As a result, they lose trust in their own feelings and do not learn how to label their feelings and tolerate these because they don’t even know “what” they are feeling in the first place. It becomes easy for them get overtaken by their emotions, and they tend to lap right into action to make their feelings go away because they do not know how to cope with their feelings. This becomes a negative reinforcement and in long term, they never learn to regulate their emotions, instead just jumping right into impulsive behaviors. For example, whenever Tracy gets upset and experiences intense negative emotions, she would start cutting herself. It is her way of regulating her emotion without having to think about her feelings. Borderline Personality Disorder is characterized by splitting of object-relations. People with Borderline Personality Disorder usually do not have one clear identity of themselves. Their sense of identity tends to be unstable. Because their feelings have been constantly invalidated while their care and emotional needs have not been constantly fulfilled, they become unclear of their environment, and their sense of self and identity split as a result. For example, Tracy has a split object-relation of hers and her mother. On one side she idealizes her relationship with her mother as being all good (e.g. she sees her mother as a loving and comforting one and herself as a loved and comforted daughter), on the other side she devalues her relationship with her mother as being all bad (e.g. she sees her mother as an aloof and distracted mother and herself as an unimportant and insignificant daughter). She sees the idealized side of the relationship when her mother validates her feelings and fulfills her needs. On the other hand, she sees the devalued side of the relationship when her mother does not validate her feelings and neglects her needs. Because the two are constantly shifting, Tracy becomes unclear of who she is and what she means to her mother. As a result, she experiences dramatic mood swings, and her interpersonal relationship tends to be unstable and intense because of the constant alternation of her self-states. Part II Seung-Hui Cho exhibited many traits from different DSM-IV Personality Disorders. He displayed a few Narcissistic traits. He presented himself as being very high when actually he felt very small of himself. For example, in the final note that he sent to NBC, he devalued everyone else and glorified himself as “dying like Jesus Christ”. By devaluing everyone else, he is able to label himself as “different” in a good way; because now he is better than everyone. By glorifying himself, he is able to cover his low self-esteem and his sense of insignificance to the world. He wants to feel good about himself but he couldn’t, so as a way to make his own self feel better or as a way of “lying to himself” that he is significant, he presents himself as being very high even thought he does not feel it. Another Narcissistic trait that Cho displayed is his demand of attention. He demanded to be the center of attention yet he did not show it. For example, he wore reflective sunglasses and a hat to class, and refused to take them off when asked to. He is clearly asking for attention in this case but when he was talking to the professor, he told the professor that he seemed to be getting more attention that he asked for. His action shows the demand for attention yet he denies it. He does not want to show that he wants attention and that he needs people. Narcissistic traits are not the only Personality Disorder traits that Cho exhibited. Cho also displayed emotional deregulation, which is a classic sign of Borderline Personality trait. Cho has trouble regulating his emotion. For example, when his suitemates brought him to another girl’s room, Cho took out a packet knife and started stabbing the carpet. A reason could be that considering that Cho has social phobia, he might have been nervous and felt anxious being in a new environment around new people and not knowing how to regulate his feelings, he reacted with impulsive actions as a way to regulate his emotions. He didn’t know what he was feeling and he didn’t know how to cope with it so he lapped right into action to cope with his feelings, and in this case, it is stabbing on the carpet. Cho also had a split object-relation of himself; which is a Borderline Personality trait. On one side, he sees himself as being a social phobic boy, who feels inferior, isolated, rejected and sad. On the other side, he sees himself as being an assassin, who feels superior, powerful, vengeful and invulnerable. He is unsure of his own identity. For example, he would label himself as “question mark” when speaking to others. It is clear that he is confused about his identity and does not know who he is. Cho also displayed anti-social traits. Even thought Cho showed a sense of guilt by trying to rationalize his action, the action itself shows Cho’s lack of conscience. He lacked a conscience to stop him from carrying out a massacre like this; the lack of concern for those whom he killed. Cho had an extremely shy temperament which caused him to withdraw and not speaking ever since he was a child. This is something that his parents did not pick up right away and therefore they could not accommodate him and cater to his needs. This in turn led him into feeling invalidated; which is a big risk factor for abnormal development. At age 3, Cho’s doctor found a hole in his heart and many medical procedures and tests were done on Cho to better examine his heart. Ever since then, Cho did not like to be touched. This might have made Cho felt invaded, adding on to his shy temperament; this might have made Cho to be more withdrawn. With Cho’s pre-existing genetic and biological diathesis, Cho did not benefit from his parents. One of his psychological diathesis is the poor fit with his parents. His parents lacked the parental skills that were needed to handle Cho’s deficits. They couldn’t correctly identify Cho’s deficits and cater to his needs, and instead they blamed Cho for not opening up and speaking to them. This invalidation of feelings made Cho’s condition worse. Cho’s peer environment was another psychological diathesis for Cho. As an immigrant, Cho was humiliated and bullied in school. Although there weren’t many records of bullying in school, but due to his social phobia, any amount of bullying and humiliation would intensify his condition. Two developmental deficits that are associated with Cho’s psychological diatheses above are deficits in his social skill and his self-image (self-esteem). Cho was constantly blamed by his parents for not speaking in front of relatives; this led him into thinking that it is his fault, when in fact he really did not have much control over the same. This invalidation of emotion caused Cho to feel low about his own self. Being humiliated and bullied by his peers did not help his self-esteem either. Because his parents lacked the parental skills to cater to Cho’s need, Cho never learned any social skills. He did not learn how to socialize with others. Part III In a functional analysis of cognition and behavior of this case, the conditioned stimulus would be the sight of the judges sitting in the audience. Seeing those judges triggers a panic attack, which is the conditioned response, in the patient. Looking at the judges while playing the piano unconsciously triggers an automatic thought in the patient’s mind, “You know what part is coming next – that really hard part that you screw up. You’re going to screw it up.” This is a maladaptive schema of the patient. Whenever the familiar situation (e.g. sight of the judges) comes up, patient automatically processes this maladaptive schema that he will screw up. This thought in turn creates fear and anxiety for the patient and triggers the panic attack. As an operant behavior, patient develops methods for bringing the symptoms under a degree of control before actually taking the stage. This method did not work too well as the symptoms continue to significantly impair him as he plays for the judges. The patient only experiences panic when he plays at competitions, and not when he plays at concerts for a much larger audience of thousands. This is because of the judges that are present at competitions. Controlling the uncomfortable and distressing symptoms before setting onto stage isn’t going to help him much in getting rid of his panic attacks because the source of his anxiety (the judges) are still there. In a psychodynamic formulation of the patient’s panic attacks, the primary dynamic conflict that underlies the panic attacks is the conflict between the patient’s conscience of being a good son and bringing his mother over to live with him and taking care of her once he graduates, his wish of being free and his fear of living with her mother. The panic attack is caused by the patient’s unconscious wish of not wanting to graduate so he won’t have to bring his mother over to live with him. The patient does not want his mother to come live with him because he fears of losing his freedom and does not want to live under his mother’s criticism and control again, yet he feels guilty for feeling that way. There is his moral belief that he needs to be a good son and take care of his mother in her old age. This creates an internal conflict for the patient under his consciousness. As a result he dissociates the thought out of his mind. He denies having thoughts of not wanting to live with his mother. He states that it doesn’t matter, when in fact it does matter, and what “matters” is his “mother”. The panic activates the patient’s object-relation of his mother as the intrusive, controlling, critical and unloving mother and himself as the unloved, anxious, unworthy, controlled son. The relationship that the patient had with his mother was not a positive one. Read More