Divorce and parental alienation may lead to stress‐related disorders and suicide in men . Divorced and separated men are nearly 2.4 times more likely to kill themselves than married men . Family breakdown leads to many difficulties for men including the possibility of parental alienation. Parental alienation is usually defined as a mental state in which a child, usually one whose parents are engaged in a high‐conflict separation or divorce, allies himself firmly with one parent (the preferred parent) and refuses a relationship with the other parent (the alienated parent) without legitimate justification . Fathers who have lost some or all contact with their children for a long time following separation or divorce may become depressed and suicidal.
Practitioners working with children aged 13-18 years may observe some of the key features described in the previous section. Getting help for the child and family as early as possible gives the best chance of a good outcome. Neglect and emotional abuse are often not recognised in teenagers and even where they are they may not be taken seriously by professionals. Not much is known about their personal experiences, as there is a lack of research which identifies the feelings, or experiences of this population. Many of the behaviours exhibited by emotionally abused or neglected teenagers may be interpreted by others as a lifestyle choice or ‘acting out’ when they may in fact be an indicator of neglect or emotional abuse. Consequently their conduct may lead them to enter the juvenile justice system rather than the child protection system. A better understanding of teenage neglect and emotional abuse may enable teenagers to access appropriate and timely help.
• All practitioners coming into contact with teenagers who exhibit the behaviours and issues above must actively consider neglect or emotional maltreatment, rather than simply addressing the problems they present, such as alcohol use.
• Remember, teenagers who have experienced neglect or emotional abuse may be particularly vulnerable to other forms of victimisation; therefore appropriate action should be taken.
• A sensitive exploration of teenagers’ experiences may help professionals understand their situation, and allow the teenagers to access appropriate support themselves.
• Hospital emergency departments and mental health providers need to be particularly aware that teenagers, especially the victims of violence, may be experiencing neglect or emotional maltreatment.
While early recognition and intervention are vital, it is never too late to help a child or teenager. If concerns about possible neglect or emotional abuse arise it is important you take action as soon as possible regardless of the age of the teenager.
If you have a concern you can call the police, social services or the NSPCC (0808 800 5000). And remember that children can contact ChildLine 24/7 (0800 1111; childline.org.uk).
Emotion recognition and empathy
A large body of research suggests that psychopathy is associated with atypical responses to distress cues (e.g. facial and vocal expressions of fear and sadness), including decreased activation of the fusiform and extrastriate cortical regions, which may partly account for impaired recognition of and reduced autonomic responsiveness to expressions of fear, and impairments of empathy. The underlying biological surfaces for processing expressions of happiness are functionally intact in psychopaths, although less responsive than those of controls. The neuroimaging literature is unclear as to whether deficits are specific to particular emotions such as fear. Some recent fMRI studies have reported that emotion perception deficits in psychopathy are pervasive across emotions (positives and negatives). Studies on children with psychopathic tendencies have also shown such associations. Meta-analyses have also found evidence of impairments in both vocal and facial emotional recognition for several emotions (i.e., not only fear and sadness) in both adults and children/adolescents.
A recent study using offenders with psychopathy found that under certain circumstances they could willfully empathize with others. Functional neuroimaging was performed while the subjects were watching videos of a person harming another individual. While reduced empathic brain activation relative to the controls was observed in the control condition, the empathic reaction of the psychopathic offenders initiated the same way it did for controls when they were instructed to empathize with the harmed individual, and the area of the brain relating to pain was activated when the psychopathic offenders were asked to imagine how the harmed individual felt. The research suggests that individuals with psychopathy could switch empathy on at will, which would enable them to be both callous as well as charming. The team who conducted the study say it is still unknown how to transform this willful empathy into the spontaneous empathy most people have, though they propose it could be possible to bring psychopaths closer to rehabilitation by helping them to activate their “empathy switch”. Others suggested that despite the results of the study, it remained unclear whether the experience of empathy by these psychopathic individuals was the same as that of controls, and also questioned the possibility of devising therapeutic interventions that would make the empathic reactions more automatic.
Work conducted by Jean Decety with large samples of incarcerated offenders with psychopathy offers additional insights. In one study, the offenders were scanned while viewing video clips depicting people being intentionally hurt. They were also tested on their responses to seeing short videos of facial expressions of pain. The participants in the high-psychopathy group exhibited significantly less activation in theventromedial prefrontal cortex, amygdala and periaqueductal gray parts of the brain, but more activity in the striatum and the insula when compared to control participants. In a second study, the subjects with psychopathy exhibited a strong response in pain-affective brain regions when taking an imagine-self perspective, but failed to recruit the neural circuits that were activated in controls during an imagine-other perspective—in particular the ventromedial prefrontal cortex and amygdala—which may contribute to their lack of empathic concern.
Despite studies suggesting deficits in emotion perception and imagining others in pain, professor Simon Baron-Cohen claims psychopathy is associated with intact cognitive empathy, which would imply an intact ability to read and respond to behaviors, social cues and what others are feeling. Psychopathy is, however, associated with impairment in the other major component of empathy—affective (emotional) empathy—which includes the ability to feel the suffering and emotions of others (what scientists would term as emotional contagion), and those with the condition are therefore not distressed by the suffering of their victims. Those with autism, on the other hand, often are impaired in both the affective and cognitive facets of empathy.
The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality is a book written by American psychiatrist Hervey M. Cleckley, first published in 1941, describing Cleckley’s clinical interviews with patients in a locked institution. The text is considered to be a seminal work and the most influential clinical description of psychopathy in the twentieth century. The basic elements of psychopathy outlined by Cleckley are still relevant today. The title refers to the normal “mask” that conceals the mental disorder of the psychopathic person in Cleckley’s conceptualization.
Cleckley then summarizes the material and provides a ‘clinical profile’, describing 16 behavioral characteristics of a psychopath (reduced from 21 in the first edition): 
- Superficial charm and good intelligence
- Absence of delusions and other signs of irrational thinking
- Absence of nervousness or psychoneurotic manifestations
- Untruthfulness and insincerity
- Lack of remorse and shame
- Inadequately motivated antisocial behavior
- Poor judgment and failure to learn by experience
- Pathologic egocentricity and incapacity for love
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
- Suicide threats rarely carried out
- Sex life impersonal, trivial, and poorly integrated
- Failure to follow any life plan.
Some of the criteria have obvious psychodynamic implications, such as a lack of remorse, poor judgment, failure to learn from experience, pathological egocentricity, lack of capacity for love, a general poverty in major affective reactions, and lack of insight into his own condition. Starting in 1972, newer editions of the book reflected a closer alliance with Kernberg‘s (1984) borderline level of personality organization, specifically defining the structural criteria of the psychopath’s identity integration, defensive operations and reality testing.
Fear, Obligation And Guilt: How We Allow Loved Ones To Control Us
In their 1997 book, Emotional Blackmail: When the People in Your Life Use Fear, Obligation and Guilt to Manipulate You, authors Susan Forward, Ph.D. and Donna Frazier state that “emotional blackmail is a powerful form of manipulation in which people close to us threaten to punish us for not doing what they want. Emotional blackmailers know how much we value our relationships with them. They know our vulnerabilities and our deepest secrets. They can be our parents or partners, bosses or coworkers, friends or lovers. No matter how much they care about us, they use this intimate knowledge to win our compliance.” According to Forward and Frazier, fear, obligation and guilt (“FOG”) are the tools of emotional manipulators.
“Emotional Blackmail” and “FOG”, terms coined by psychotherapist Susan Forward, Ph.D., are about controlling relationships and the theory that fear, obligation or guilt (“FOG”) are the transactional dynamics at play between the controller and the person being controlled. Understanding these dynamics are useful to anyone trying to extricate themselves from the controlling behavior by another person and deal with their own compulsions to do things that are uncomfortable, undesirable, burdensome, or self-sacrificing for others.
Borderline Personality Disorder (BPD)
What Is Borderline Personality Disorder?
As with any personality disorder,Borderline Personality Disorder(BPD) can be extremely difficult to understand and to come to grips with. BPD can also have devastating effects on the family and friends of a person who suffers with the personality disorder.
Generally, those inflicted withBorderline Personality Disorder are extremely sensitive to the way that other people treat them and they may over-react whenever they perceive criticism or hurtfulness.
A Borderline personality’s feelings about someone often shift suddenly from positive to negative within an instant, especially if they believe there is a risk of abandonment or loss.
However, this alone should not be taken as an indication of the disorder being present, as Borderline Personality Disorder goes a lot deeper than this.
What Are The Symptoms Of BPD?
Typically, the classic symptoms of a Borderline personality are unstable relationships, affective distress, impulsiveness and problems with an unstable self-image.
Borderline personalities often show extreme variability between anger, depressionand anxiety and are extremely sensitive to any and all kinds of emotional stimulation.
The negative emotional states of a Borderline personality tend to fall into four categories: destructive/self-destructive feelings, fragmentation (lack of identity), feeling victimized and generally extreme emotions.
It’s important to understand that Borderline personalities view the world as being hostile and full of dangers; living out in the big wide world is seen as being a risk. Borderline personalities may hide themselves away from the outside world in order to reduce this perceived risk factor.
Borderline Personality Disorder is also characterized by high levels of chronic stress, emotional abuse in relationships, dissatisfaction with relationship partners and even unwanted pregnancies; issues which are also often related to other personality disorders.
Impulsive behaviour is not uncommon for BPD’s and can include alcohol/drug misuse, promiscuous/intense sexual behaviour, gambling and recklessness in general.
Whilst research indicates that BPD’s can be novel, fun and that they have a high level of intimacy, studies also show that Borderline personalities are hyper-sensitive to signs of rejection and, in relationships, they often become insecure, preoccupied and/or avoidant at perceived external risk factors.
Borderline’s tend to either idealize or demonize others, often switching between one or the other (Splitting). This undermines the relationships between friends, family and associates.
The most significant trait of the Borderline Personality Disorder is the process of self-harming.
In may cases, without the right treatment and the right diagnosis, self-harming can gradually worsen over time sometimes leading (in very extreme cases) to suicide.
However, self-harming is not always carried out with the intention of suicide although it is very common.
Why Do BPD’s Self Harm?
Many BPD sufferers show mixed feelings about why they actually harm themselves, although most admit that they do not do it with the intention of suicide.
They most certainly do not do it for attention either – the self-harm is often carried out in private on a part of their body which will not be seen publicly.
Many reasons have been given for the act of self-harm including to help regulate internal memories, thoughts and emotions, to release anger, to slow down racing thoughts and to escape from emotional pain or periods of dissociation.
In terms of personal experience, many self-harmers seem to have an overwhelming sense of anger and frustration as a result of the underlying factors that contribute towards Borderline Personality Disorder.
They need to release this anger and frustration bit by bit to prevent it from sending them over the edge.
They cannot take these feelings out on other people, as other people may be innocent and ultimately other people do not deserve to be physically abused, therefore they take it out on themselves instead – it’s their only release.
Borderline’s care less about their physical self but are majorly concerned with their emotional self.
How Is BPD Diagnosed?
According to the DSM-IV-TR, there are a total of nine criteria, five of which must be present for an official diagnosis of Borderline Personality Disorder.
Although BPD was previously classed as a subset of Schizophrenia, BPD is now used more generally to explain emotional dysfunction and instability.
BPD is described as:
“a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as markedimpulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. Note:Do not include suicidal or self-injuring behavior covered in Criterion 5
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g.,promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms “
Whilst the onset of BPD (Borderline Personality Disorder) often occurs during adolescence, therapists are reluctant to offer an official diagnosis to a patient who is not yet eighteen years old.
The DSM-IV states “To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year.”
What Causes BPD?
As with most personality disorders, the causes of the disorder are not fully understood.
However, it’s not unusual for someone inflicted with BPD to have experienced abandonment, childhood trauma or abuse.
Other more diverse possibilities have also been suggested, such as genetic predisposition, brain abnormalities and neurobiological factors.
Many studies have shown a strong link between childhood sexual abuse and BPD. Incidentally, there have also been many reports of incest during the childhood of BPD sufferers.
Further research also shows how parents (of both genders) have often detached themselves emotionally during childhood and therefore the children’s emotional needs had not been catered for sufficiently.
Rather interestingly, one study showed that if one identical twin was diagnosed with BPD the other twin also met the criteria in 35% of cases therefore many of the traits present in BPD could be influenced by genes.
Rather than having just one single cause, Borderline Personality Disorder (BPD) seems to be caused by a variety of different factors.
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How Is BPD Treated?
Research shows that BPD is not affected significantly by any medication.
However, some medications were shown to subtly alter mood and help prevent the risk of suicide but the long term effects of these medications are still unknown and prescribing medication to BPD patients is not recommended.
Whilst there is a variety of treatment available for Borderline Personality Disorder, the disorder is not curable.
The most effective treatments for BPD to be analyzed so far are two forms of CBT (Cognitive Behavioural Therapy) – Dialectical Behaviour and Schema-focused – and two forms of Psychodynamic treatments –mentalization based and transference-focused.