Tag Archives: Major Depression

What Effect Does Violence have on Kids? – Practical Application of Stanley Greenspan’s Theory of Emotional Development to Violent Behavior


I have chosen to apply the Theory of Emotional Development as seen by Stanley Greenspan to violent behavior.  I can see where this theory can explain how violent behavior gets embedded into a person, especially when the behavior is experienced from birth or from a young age, either by witnessing or by being victimized by violence.

Greenspan’s Theory assumes that children learn behavior by experiencing it.  The behavior would then continue into adulthood unless something drastic affects them.  It would have to be to the point that they feel they need to change the behavior.  In the case of violence, this drastic happening could be, going to jail or prison, going too far with the violence, or even being injured bad enough to be hospitalized for a while.  This of course depends on the person.

There are several assumptions from the theory that I will compare to the affects of violence on children.  I will also compare the milestones within the stages of emotional development to the stages the children go through when submerged in a violent environment.

There are also several reasons why violence would be someone’s first reaction to any situation.  There are many signs that a child could have violent tendencies, we could see these as they grow older.  Some children show behavioral problems at very young ages, their mental health status could grow worse and there are often problems academically and behaviorally throughout adolescence.

It seems that how often someone is exposed to violent behavior and the age at which they are first exposed determines the severity of the violent actions the child may eventually commit.

If a child is exposed to violence through a victim standpoint, it is most likely that as parents, the violence will be committed against their immediate family, but it is also likely that violence will be committed against outsiders as well.

If a child is exposed to violence through a witness standpoint, negative results could include becoming aggressive and having developmental challenges. Also, some criminal behavior could be seen.

There are many long-term effects that can take hold of a person when they are exposed to violence, especially if it was for a very long period of time.   These effects include depression, antisocial behavior, and substance abuse.  The child also learns to associate a positive attitude to violent behavior, if they are continually exposed.  They end up feeling as if the perpetrator is rewarded for the behavior.

In the Theory of Emotional Development one assumption is, “the capacity to organize experiences is present early in life”.  When violence is present in a person’s life, it is generally something that has been experienced from a very early time in their life.  Generally it is in the form of domestic violence toward a parent or themselves.

The violence that is experienced through the child’s life is organized when the child either accepts this behavior as normal or decides that the behavior is wrong and then fights against it.

This theory, “Assumes that initially organization is emotion based rather than cognition based”.  The research associated with violent behavior shows the learning of violence is cognition based.  It is a learned behavior in that, the more a child is exposed to various types of violence, the more likely they are to become offenders and the worse the offences become.

It also says, “Infants organize their emotions differently at different stages of ego development”.  Infants who emerge into life where violence is prevalent will organize their emotions accordingly.  These babies will startle easily, as loud noise and yelling does anyway, but then will grow into toddlers who may sense something is wrong, but will also be desensitized to the violent behavior around them.  Also, because of the actions that are prevalent in the home, they will see the violence as normal because they have no ability to compare it to others’ behavior.

This theory says, “With the maturation of the brain, interpreting progresses to higher levels of organization”.  As the child progresses into elementary school age, and they are exposed to other children’s life styles, they will begin to understand, maybe truly for the first time, that the behavior they are experiencing is wrong.

At this point, and as they grow, they will start to compare their own home life to their friends’ and then start to really organize how they feel as to whether the behavior is normal in other peoples lives.  Because they are starting to comprehend what’s happening in their household, they will generally devise a way to hide what’s happening to them in order to appear normal to everyone else.

This theory also states, “Emotional organization is acquired through relationships with those who care for the child”.  The child’s primary caretaker is generally their abuser.  Because of this, the emotions acquired in this relationship are generally those of confusion.  This is because the parent usually tells them that they are loved, but then the actions of that parent don’t agree with the words.  The child unknowingly learns to develop hate; sometimes toward the abuser and sometimes toward themselves because they feel they can never do what it takes to feel the love promised them so often.  These emotions carry through to adulthood and usually affect their own relationships, even as early as Jr. High or High School relationships.

Another assumption from this theory is, “Socialplay is the vehicle for promoting emotional organization”.  Children who live with violence in the home are more likely to try to stay away from the home as much as possible.  As soon as they realize they have an escape at a friend’s house they will make any excuse to try to go there in order to get away from either viewing the violence or becoming a victim of it.

Socialplay then becomes more and more about what their friends have access to that the child doesn’t feel they have.  These things do not necessarily have a monetary value, but emotional value.  Affection, courteousness, and other familial values are not found at home, so they take comfort in finding them in other people’s homes.

Greenspan also says, “Experiences must be age appropriate; have range, depth, and stability; and be personally unique.”  Unfortunately for children who experience violence on a daily basis there are not many age appropriate experiences.  These children quickly learn the keys to survival and how to fend for themselves.  These methods become intertwined into daily life and as the child grows, it becomes a way of life.  This is usually the start of the person committing violent acts when they are older.  It is not generally something they see as being a chosen action, but more something that just happens.

Greenspan has defined six milestones within the stages of emotional development. These milestones are self regulation, intimacy, two-way communication, complex communication, emotional ideas, and, emotional thinking.  Each of these milestones represents a phase or stage of a child’s life, and what they should accomplish during that phase where emotional development is concerned.

The first stage of emotional development is engagement.  This stage usually lasts from about three weeks of age until about eight months of age.

During this stage the “infants learn to share attention, relate to others with warmth, positive emotion, and expectation of pleasant interactions, and trust they are secure”.  This is the stage in which self regulation and intimacy are learned.  During these crucial early weeks and months of a child’s life, if they are involved in a violent environment, they would learn the opposite of what is involved in engagement.  They would eventually learn there are not many, if any, pleasant interactions and would not feel secure in their own actions.  In fact their first reaction to attention would come to be the flight reaction and then when older the fight reaction.

Two-way communication is the second stage of emotional development.  This stage usually lasts from about six months of age until about 18 months of age.  During this stage “infants learn to signal needs and intentions, comprehend others’ intentions, communicate information (motorically and verbally), make assumptions about safety, and have reciprocal interactions”.  This is the stage in which two-way communication is learned.  The children in this age group are still too young to recognize that the violence in their environment is not normal; yet, they are learning skills to survive there.  The two-way communication they are learning is how to signal their needs in the least threatening way.  Whether they are experiencing violence by witnessing it or are being abused, they learn the other person’s intentions could be painful and their safety could be compromised if not handled with care.  They carry this skill into later life when dealing with others.

The third stage of emotional development is shared meanings.  This stage usually lasts from about 18 months of age until about 36 months of age.  During this stage “children learn to relate their behaviors, sensations, and gestures to the world of ideas, engage in pretend play, intentionally use language to communicate, and begin to understand cognitive concepts”.  There are two milestones associated with this stage, complex communication and emotional ideas.  A lot of children who are exposed to violence from an early age end up learning things like complex communication at a later time than other children.  Because of this, these children sometimes develop learning disabilities which eventually become a sore spot for these children.  When other children don’t understand what is happening in that child’s life and choose to use that child’s slower development as something hurtful, the violent feelings tend to erupt as this is what that child has been taught at home.

The fourth and final stage in Greenspan’s theory is emotional thinking.  This stage usually lasts from about three years of age to about six years of age.  During this stage, “children can organize experiences and ideas, make connections among ideas, begin reality testing, gain a sense of themselves and their emotions, see themselves in space and time, and develop categories of experience”.  Emotional thinking is developed in this stage.  This is the age when children start to recognize that things in their home environment are not quite right.  They start to put together the fact that other children’s home lives do not involve violence on a regular basis.  At this point the child is still unsure of what, if anything, they can do about the violence in their own home.  This can be the turning point in a child’s life.

It can be when they subconsciously decide if they will incorporate the violence their caregiver has unknowingly taught them into their own lives and become violent with other people, or if they will become more docile and turn inward.

I feel that this theory, if taken further into research about violent behavior, would be a good one to look at in order to help predict violent tendencies in children.  If we do this we can try to incorporate treatment earlier and possibly cut out a lot of the violence we are seeing today.  The assumptions and the stages of the theory for emotional development are very helpful when looking at violence from an outside perspective.

References

Cullen, P.  (2009, May 21). Physical, emotional and sexual abuse was widespread in State institutions. The Irish Times p. 9.

Fagan, J.  (1996). The Criminalization of Domestic Violence: Promises and Limits
National Institute of Justice. Retrieved from LexisNexis database.

Nader, C. (2008, December 3). Death often tragic end to history of domestic violence.  The Age p. 11.

Murrell, A.R., Christoff, K.A., Henning, K.R. (2007, July 17).  Characteristics of Domestic Violence Offenders: Associations with Childhood Exposure to Violence.                                  J Fam Viol, 22:523-532

Appleyard, K., Egeland, B., van Dulmen, M.H.M., Sroufe, L.A. (2004. February 2). When more is not better: the role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry, 46:3, 235-245

Bergen, D. (2008). Human Development Traditional and Contemporary Theories. Pearson Prentice Hall.

Is There More Than One Kind Of Depression?


Dysthymic Disorder and Major Depressive Disorder are actually two different versions of depression.  Dysthymic Disorder is noted for chronic depression.

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The definition for Dysthymic Disorder is that it is a “mood disorder with chronic depressive symptoms that are present most of the day, more days than not, for a period of at least two years.”  (Minddisorders.com).  The symptoms are usually present for years and can include low self esteem, decreased motivation, change in sleeping patterns and change in appetite patterns.  Causes of this type of depression are things like a person’s upbringing.  If a person is brought up in a home where abuse is prevalent an adult can suffer from depression for their entire life.  Treatment for this type of depression is generally psychotherapy but sometimes is combined with antidepressants.

Similarly Major Depressive Disorder is the next level of depression and is defined as, “a condition characterized by a long lasting depressed mood or marked loss of interest or pleasure in all or nearly all activities” (Minddisorder.com).   This form of depression has an intense impact on a person’s life.  It usually comes about when a person suffers a traumatic event, but this does not always happen.  Symptoms can include a disturbed mood throughout most of the day, a change in the sleep pattern, a change in the appetite pattern, a loss of interest in things that are considered pleasurable, but then go further to include problems when trying to concentrate or think in depth, psychomotor retardation or agitation and thoughts of suicide.  If this form of depression is left untreated it can last longer than four months and recurrence is eminent.  Treatments for Major Depressive Disorder include psychotherapy or talk therapy, electroconvulsive therapy or ECT and antidepressant medications or a combination of these treatments.

Nearly everything about these two disorders are similar, the main difference is that major depressive disorder is an extension of Dysthymic Disorder in that symptoms and moods are more severe therefore treatments need to be more involved and more inclusive.

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References:

Netherton, S.D., Holmes, D., Walker, C.E., Child and Adolescent Psychological Disorders

Blaney, P.H., Millon, T., Oxford Textbook of Psychopathology.

Depression (Major Depressive Disorder) http://psychcentral.com/disorders/sx22.htm

Dysthymic Disorder. minddisorder.com.  http://www.minddisorders.com/Del-Fi/Dysthymic-disorder.html

Dissociative Identity Disorder. Psychnet-uk.com. http://www.psychnet-uk.com/dsm_iv/dissociative_identity_disorder.htm

Major Depressive Disorder. minddisorder.com. http://www.minddisorders.com/Kau-Nu/Major-depressive-disorder.html

Eating Disorders


“Eating disorders (EDs) are polysymptomatic syndromes, defined by maladaptive attitudes and behaviors around eating, weight, and body image.”  (Blaney & Millon, 2009, p. 431)  The primary disorders in this category are anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders no otherwise specified (EDNOS).  Examples of EDNOS might include “AN-like” with preoccupations with thinness, normal-weight people purging food without binging or simply binging without purging (Binge Eating Disorder, or BED).  (Blaney & Millon, 2009, p. 432)

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Epidemiological data suggests that EDs occur more often in women than in men (by a factor of roughly 10); although there is some evidence indicating that the gender gap is closing.  Although AN/BN tend to be most prevalent in late adolescence and early adulthood, BED defies the stereotype by manifesting in an older age group (typically around 40 years of age).  There is also little linkage to socioeconomic status, despite the common belief that Eds are disorders of the affluent.  (Blaney & Millon, 2009, p. 433)  This totally astounds me… how can people who are already undernourished give up what sustenance they are offered?

EDs frequently co-occur with mood, anxiety, substance-abuse, personality, and other psychiatric disorders.  There are so many comorbid mood disorders noted in individuals with EDs that it is easier to exclude mood disorder (singular) that is unrelated… bi-polar disorders.  Personally, I believe the single mood disorder that is currently excluded should be considered.  “The disorders are believe to depend on similar family/developmental determinants (e.g., attachment problems or trauma), and both have been thought to have similar neurobiological substrates.”  (Blaney & Millon, 2009, p. 434)  Social phobias and OCD were among the most prevalent anxiety related comorbid disorders.  Since anxiety disorders often precede ED onset, it has been suggested that an anxious or obsessive-compulsive attitude predisposes an individual to ED development.  (Blaney & Millon, 2009, p. 435)

Not only are PTSD and substance abuse disorders often comorbid with EDs, but they are often comorbid with each other.  “Substance abusers in an eating-disordered population show significantly more Social Phobia, Panic Disorder, and Personality Disorders.  In addition, comorbid substance abuse was found to predict elevations in Major Depression, Anxiety Disorders, Cluster B personality disorders, as well as greater impulsivity and perfectionism.”  (Blaney & Millon, 2009, p. 435)

Finally, personality disorders are frequently present in individuals whom suffer from EDs.  Restrictive type EDs seem to be associated with Anxious-Fearful PD diagnosis (anxiousness, orderliness, introversion, preference for sameness and control).  Binge-purge types have a pronounced affinity for the dramatic-erratic PDs including attention/sensation seeking, extroversion, mood lability, and proneness to excitability or impulsivity.  (Blaney & Millon, 2009, p. 435)

EDs are assumed to be multiply determined by complex interactions including constitutional factors, psychological/developmental processes, social factors, and secondary effects in the biological, psychological and social spheres of maladaptive eating practices themselves.  (Blaney & Millon, 2009, p. 443)  All of the above features generally manfest in eating-specific cognitions related to bodily appearance and appetite regulation, body image or weight considerations, and social values that heighten concerns with all of the above.  As a result, it is currently conceived that EDs represent a “tightly woven” expression of causes and symptoms that have an interrelationship between and among each other.

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Major Depression Disorder (MDD)


There are some significant differences between diagnosing a child with MDD and diagnosing an adult.  First and foremost, symptom duration must be at least 1 year (as opposed to 2 for adults).  Secondly, the presentation is likely to be different… with children exhibiting somatic complaints, irritability, and social withdrawal much more often their adult counterparts.  In both cases, one symptom must be depressed or irritable mood and/or inability to experience pleasurable emotions from normally pleasurable life events such as eating or social interaction (anhedonia).

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The likelihood that comorbid conditions will appear increases with the severity of the depression.  (Netherton, Holmes, & Walker, 1999, p. 266)  Often MDD is comorbid with anxiety disorders, ADHD, behavior disorders, eating disorders, and/or substance abuse.  There does appear to be a distinct lack of a “developmental perspective” in the DSM-IV-TR, but that is not exclusive to this particular category or disorder…  I suspect that’s just an effort to remain “atheoretical.”

I am not at all surprised that rates of depressive disorders increase with age, since frequency, duration, and severity of previous episodes seem to be an indicator of risk.  Also, for lack of a better explanation, the longer you live, the more likely you are to have to endure a negative life event.  I was surprised to see that by age 15, females are twice as likely as males to receive a depressive disorder diagnosis.

Theoretically speaking, I came to favor the interpersonal/cognitive/behavioral models of development for depression.  There was a continued lack of a developmental model, however, for all the theories.  On the whole, I got the impression that we were really selling the childhood cohort short due to lack of research (or, perhaps that’s just the Netherton text working, not sure which… will definitely check this out when I get knee deep into the journal reading).

Attachment theory rears its ugly head again, condemning insecure parental attachment as being significant in the etiology of depression related cognitive processes.  (Netherton et al., 1999, p. 269)  The text suggests that this leads to a more depressive perspective on self, world, and future… culminating in a sense of helplessness and hopelessness.  It would appear that depression is a possible marker for RAD?  I would like to see some comorbity rates.

I understand that self assessment has to be a key component for assessment, but I wouldn’t bet the house on those results alone.  I really like the idea of a multi-trait, multi-method, multi-informant approach to increase diagnostic reliability and validity.  I really believe that you need to take a big picture approach to the complete child, accessing cognitive, affective, interpersonal, adaptive, genetic, and environmental effects to be able to diagnose this disorder effectively.  In addition to a full batter of testing and semi-structured interviews, if able we should dig into a medical history and eliminate underlying organic causes… paying special attention to drug history since many anticonvulsants and some antibiotics are associated with depressive symptoms.

Although I will give treatment only cursory coverage, at this early stage I am very much in favor of cognitive restructuring and development of more adaptive cognitions.  Although the text didn’t really address it, I would also take a “top down” approach and see if I couldn’t convert this to a family intervention.  I am increasingly aware that families are systems and that children tend to play a specific role in that system.

Depression is one area where I am a proponent of pharmacological intervention, despite the fact that I have come out against the pharmacological means to the end on some other diagnosis.  It would appear to me that SSRI’s were made specifically for depression, success rates are relatively high, and side effects are minimal.  I’m not sure I could consider TCAs and MAOIs unless SSRI+CBT failed.  ECT is our last resort… but the degree of impairment would have to be pretty serious for me to suggest it.

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Reference

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.