Tag Archives: substance dependence

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.

Comparing PTSD and Somatization Disorder


Comparing PTSD and Somatization Disorder shows that there are some similarities in the symptoms but for the most part they are different.  Somatization Disorder has a lot more physical symptoms while PTSD has more symptoms leaning toward emotional.  The symptoms the two disorders have in common are headaches and stomachaches.  In both cases symptoms can be so severe and last so long that it completely disrupts the person’s life.

Do you have medically unexplained physical, or somatic, symptoms?

Somatization disorder can cause a person towards an emotional reaction such as depression or even suicide because they feel so much pain and can never get a diagnosis for it.  The symptoms often lead to substance abuse.  Thereby leaving them to feel hopeless, as if they will never get the help they need.  Somatization disorder has a wide range of physical symptoms.  A person with this disorder will report many different symptoms over a period of time with no real medical explanation.  These symptoms are often pain throughout the body, but not usually all at the same time.  Pain in the form of headaches, stomach ache, joint or muscle pain.  It could also be internal, such as vomiting, or it could come about as a sexual or menstrual problem.  Neurological symptoms are also common, often occurring as problems with balance or vision and even paralysis.

Generally for a patient to be diagnosed they will have experienced a minimum of eight symptoms.  There will be a minimum number of symptoms from a given category.  An example of this is that a patient will experience four or more symptoms from the pain category, two or more symptoms from the gastrointestinal category, one or more symptoms from the sexual symptoms category, and one or more symptoms from the pseudoneurological symptoms.  When a person is showing signs of these symptoms they will be unexplainable and a medical diagnosis is not usually possible.  Generally the person will explain the pain they are having in a fashion that makes it seem as if they are in more pain than you think they should be in, as if they are over exaggerating the symptoms.

Somatization Disorder lasts for a very long time which is one thing this disorder has in common with PTSD.  PTSD symptoms can last anywhere from months to years.   Most PTSD symptoms are different from Somatization Disorder because they come from more of a psychological background than a physical background.  PTSD symptoms are generally geared more towards an emotional aspect, some examples are worry over dying, acting younger than the chronological age, having an impaired memory or obsessiveness.  It seems that PTSD actually transforms a person’s behavior instead of changing them physically.  This is because when traumatic experiences occur, the feelings they experience, such as shock, nervousness or fear continue on for a length of time and gradually get stronger.  The stronger they get the less of a normal life the person is able to lead.

These increased symptoms can include nightmares or night terrors, hypervigilance, panic attacks, hypersensitivity, low self-esteem and shattered self-confidence or a physical or mental paralysis.  There are three categories often used by clinicians in order to type or group people who are diagnosed with PTSD.  The categories used are re-living, avoiding, and increased arousal.  The people in the re-living group are people who suffer from living through the trauma they have been through over and over again.  This can happen through a flashback or a hallucination or just by being reminded even in small ways.  The people in the avoiding group tend to try to stay away from people, places or things that can remind them of the event.  Unfortunately the person can start to isolate themselves and eventually can turn completely inward from detachment.  The people in the increased arousal group lean towards either having difficulty showing their emotions or on the other end of the spectrum showing overly exaggerated emotions.  This group is also the group who has some physical symptoms such as higher blood pressure, muscle tension and nausea.

In conclusion, it has become very apparent to me that while there are some similarities between PTSD and Somatization Disorder, there are a lot more differences.  It has also become very apparent to me that the people who suffer from these disorders are dealing with a lot of pain, and whether it is physical or emotional, this pain can cause the person suffering from it to shut down and disable them from enjoying the life they were meant to lead.

References

Netherton, S.D., Holmes, D., Walker, C.E. (1999). Child and Adolescent Psychological Disorders.   New York, NY: Oxford University Press.

Blaney, P.H., Millon, T. (2009). Oxford Textbook of Psychopathology.

New York, NY: Oxford University Press.

(2009, February 9). Anxiety & Panic Disorders Guide. WebMD.com. Retrieved October 5, 2009, from http://www.webmd.com/anxiety-panic/guide/post-traumatic-stress-disorder

(Retrieved 2009, October 5). Somatization Disorder. Intelihealth.com.  http://www.intelihealth.com/IH/ihtPrint/W/8271/25759/187986.html?d=dmtHealthAZ&hide=t&k=base

(Retrieved 2009, October 5). Posttraumatic Stress Disorder. American Academy of Child & Adolescent Psychiatry. AACAP.org

http://www.aacap.org/cs/root/facts_for_families/posttraumatic_stress_disorder_ptsd

(Retrieved 2009, October 5). Somatization Disorder. PsychNet-UK.

http://www.psychnet-uk.com/dsm_iv/somatization_disorder.htm

Kinchin, D. (2005). Post Traumatic Stress Disorder The Invisible Injury.

Didcot, Oxfordshire OX11 9YS, UK.  Retrieved October 5, 2009, from http://www.successunlimited.co.uk/books/ptsympt.htm

 

Comorbidity of Personality Disorders and Substance Abuse Disorders


There are an estimated 44%-60% of people who have been diagnosed with substance use disorder who also qualify with symptoms pertaining to a minimum of one personality disorder.  Personality disorders include antisocial personality disorder, avoidant personality disorder, borderline personality disorder, obsessive-compulsive personality disorder and schizoid personality disorder.  Each of these personality disorders have their own symptoms and characteristics, but generally speaking any personality disorder affects people cognitively, which is the way people look at themselves and the world in general, affectation, which is the level of reaction to any one thing, as well as interpersonal functioning and the level of impulse control a person has.  A person can suffer from mood swings, anger outbursts or alcohol or substance abuse.

A person who is diagnosed with a personality can also have a second diagnosis of substance abuse disorder.  This is defined as:

 

 

 

 

 

 

“A complex behavioral disorder characterized by preoccupation with obtaining                     alcohol or other drugs (AOD) and a narrowing of the behavioral repertoire towards          excessive consumption and loss of control over consumption.  It is usually also           accompanied by the development of tolerance and withdrawal and impairment in social and occupational functioning.” (www.cdad.com)

A patient must present with certain symptoms in order to be diagnosed with substance abuse disorder, the symptoms are the behaviors someone would expect from anyone with a substance abuse disorder, but they are not usually so obvious to the patient.  The symptoms include a tolerance of the substance or a need for more and more of the substance because it is harder and harder to feel the effects of the substance, withdrawal when the substance is not used on a regular basis, the substance being used for longer than the patient thought they would be using it for, the patient having a continuous desire to control the habit of using the substance but is unsuccessful at doing so, the patient spending a lot of time trying to find or use the substance or coming off of the substance, the patient giving up activities in multiple areas of their life in order to have the opportunity to use the substance, and continuing use even though it is causing health problems to the patient.

The diagnosis of substance abuse disorder comes about when the patient has become increasingly more tolerant and dependent on their chosen substance.  After the body becomes accustomed to having that substance available on a regular basis, the body will react with withdrawal symptoms which can include headaches, insomnia, and hallucinations and could include aggression, paranoia or promiscuous behavior.  Most patients live in denial when it comes to admitting they have a problem and have to get past that denial in order for any type of treatment to help them.

When a patient is diagnosed with both of these disorders at the same time it is considered co-morbidity of substance abuse disorder and personality disorder.  A little over half of patients who have been seen for substance use disorder have also been diagnosed with a minimum of one personality disorder.

There are two treatments that have been established for this type of co-morbidity.  One is called dual focus schema therapy and it combines different life skills such as functional analysis and coping skills training.  This treatment involves 24 sessions and plans for two stages.  The first of these stages is called early relapse prevention and helps the patient develop life skills that will aid the patient in dealing with temptation or actual relapses.  The second stage is called schema change therapy and coping skills work, this stage helps the patient make the changes more concrete and helps the patient develop methods for coping once abstinence is achieved.

Looking at co-morbidity of substance abuse and personality disorders has shown how difficult it can be to diagnose a patient with multiple disorders, especially when it involves substance abuse because substance use is so common and it seems there really is a fine line between the two.

References

Netherton, S.D., Holmes, D., Walker, C.E. (1999). Child and Adolescent Psychological Disorders.  New York, NY: Oxford University Press.

(Retrieved 2009, October 28). Co-occurring Mental Health and Substance Abuse Disorders. www.dshs.wa.gov.com.   http://www.dshs.wa.gov/pdf/hrsa/mh/cobestpract.pdf

(Retrieved 2009, October 28). Axis II Personality Disorders and Mental Retardation.  Psyweb.com.   http://psyweb.com/Mdisord/DSM_IV/jsp/Axis_II.jsp

(Retrieved 2009, October 28). Frequently Asked Questions (FAQ’s) About Substance Abuse Disorders.  www.cdad.org  http://www.cdad.org/FAQSubstanceUseDisorders.htm