Is it Possible to be Addicted to Attention?

Someone asked me that this afternoon. I answered thus: 

There's a name for it in the DSM and the ICD: "Histrionic Personality Disorder."

Regular attendance at the Evolution of Psychotherapy conferences (and a fair amount of post-doctoral research; see the Resources & References below) makes it clear (to me, anyway) that current thinking and research point back to a subtler form of child abuse in which children experience repeated instances of parental failure to understand what they child is trying to communicate to a parent or parents at best... and wholesale lack of concern for what the child is trying to tell them (e.g.: "Hey, dammit! I'm scared shitless here.") by a parent who is depressed, substance-addicted, workaholic or otherwise so distracted they cannot see, hear or sense their children at worst.

The child grows up stuck in insecure attachment -- which usually includes at least mild to moderate symptoms of Complex Post-Traumatic Stress Disorder and developmental disturbances including Learned Helplessness with Compensatory Narcissism -- and prone to doing anything he or she can to get people to Pay Attention and, well, understand, even when it's no longer necessary. Because the child's mind has become an adolescent and then adult mind that is conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” to continue to do what it did as a frightened and desperate infant, toddler or pre-schooler. And the entire schema is stuck in an immense default mode network in the person's brain.

IME (coming from lengthy previous experience in addiction treatment), the result is literally an addiction to possible, hopefully securitizing attachment via attention-seeking... with a considerable component of codependency.

Is this a stress related response?

Autonomic imbalance into near-constant Fight / Flight / Freeze / Faint / Feign (or Fawn) Responses that can lead to allostatic overload and sustained Fry and Freak are waaaaaay common in people with HPD.

Looking back on 32 years in the trenches, I'd say I've seen it hundreds of times.

Resources & References

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Behary, W.; Young, J.; Siegel, D.: Disarming the Narcissist: Surviving & Thriving with the Self-Absorbed, 2nd Ed., Oakland: New Harbinger, 2013.

Benjamin, L. S.: Interpersonal Diagnosis and Treatment of Personality Disorders, Second Edition, New York: Guilford Press, 1996.

Bowlby, J.: A Secure Base: Parent-Child Attachment and Healthy Human Development, London: Routledge; New York: Basic Books, 1988.

Branden, N.: The Psychology of Self-Esteem, New York: Bantam Books, 1973.

Brazelton, T.; Cramer, B.: The Earliest Relationship: Parents, Infants and the Drama of Early Attachment, Reading, MA: Addison-Wesley, 1990.

Brown, N.: Children of the Self-Absorbed: A Grown-Up's Guide to Getting Over Narcissistic Parents, 2nd. Ed., Oakland, CA: New Harbinger, 2008.

Burgo, J.: Why Do I Do That?: Psychological Defense Mechanisms and the Hidden Ways they Shape our Lives, Chapel Hill, NC: New Rise Press, 2012.

Cassidy, J.; Shaver, P., eds.: Handbook of Attachment: Theory, Research and Clinical Applications, New York: Guilford Press, 1999.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Courtois, C.: It's Not You: It's What Happened to You: Complex Trauma and Treatment, Dublin, OH: Telemachus Press, 2014.

Erikson, E.: Childhood and Society, New York: W. W. Norton, 1950, 1967, 1993.

Erikson, E.: Identity and the Life Cycle, New York: W. W. Norton, 1959, 1980.

Erikson, E.: Identity: Youth and Crisis, New York: W. W. Norton, 1968. 

Gibson, L.: Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, Oakland, CA: New Harbinger, 2015.

Khantzian, E. J.: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence, in American Journal of Psychiatry, Vol. 142, 1985.

Khantzian, E.J.: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Magid, K.; McKelvey, C.: Reactive Attachment Disorder, an online presentation, October 1999, synopsizing and updating their book, High Risk: Children Without Conscience, New York: Bantam Books, 1989.

Mahler, M.; Pine, S.; Bergman, A.: The Psychological Birth of the Human Infant: Symbiosis and Individuation, New York: Basic Books, 1975.

Mate, G.: Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder, Toronto: Alfred Knopf / Canada, 1999.

McEwen, B: Mood Disorders and Allostatic Load, in Journal of Biological Psychiatry, Vol. 54, 2003.

McEwen, B.; Lasley, E. N.: The End of Stress as We Know It, Washington, DC: The Dana Press, 2003.

McGowan, J.: The Microanalytic Precursors of Secure vs. Insecure Attachment: A Brief Report, in Archives of the Department of Counseling and Clinical Psychology at Columbia University, Vol. 10, 2008.

Meewisse, M.; Reitsma, J., et al: Cortisol and post-traumatic stress disorder in adults: Systematic review and meta-analysis, in British Journal of Psychiatry, Vol. 191, 2007.

Mehta, D.; Klengel, T.; Conneely, K.; et al: Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder, in Proceedings of the National Academy of Sciences, Vol. 110, No. 20, May 2013.

Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New York: Jason Aronson, 1984.

Meissner, W.: Treatment of Patients in the Borderline Spectrum, New York: Jason Aronson, 1988.

Mellody, P.; Miller, A. W.: Facing Codependence: What It Is, Where It Come From, How It Sabotages Our Lives, San Francisco: Harper, 1989.

Millon, T.: Personality Disorders in Modern Life, New York: John Wiley & Sons, 2004.

Millon, T.; Grossman, S.: Overcoming Resistant Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2008.

Molina, P.: Neurobiology of the Stress Response: Contribution of the Sympathetic Nervous System to the Neuroimmune Axis in Traumatic Injury, in Shock: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches, Vol. 24, No. 1, July 2005.

Morey, R.; Dunsmoor, J.; Haswell, C.: Fear learning circuitry is biased toward generalization of fear associations in posttraumatic stress disorder, in Translational Psychiatry, Vol. 5, No. 12, December 2015.

Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.

Panksepp, J.: Affective Neuroscience: The Foundations of Human and Animal Emotions, New York: Oxford University Press, 1998.

Parsons, T.: Family structure and the socialization of the child, in Family: Socialization and Interaction Process, Parsons & Bales, eds., New York: Free Press, 1955.

Payson, E.: The Wizard of Oz and other Narcissists: Coping with One-Way Relationships in Work, Love and Family, Royal Oak, MI: Julian Day, 2002.

Perry, B.: Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture, in Brain and Mind, Vol. 3, 2002.

Perry, B.; Szalavitz, M.: The Boy Who was Raised as a Dog…, New York: Basic Books, 2007.

Porges, S.: The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology), New York: W. W. Norton, 2015. Schore

Schore, A.: The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health, in Infant Journal of Mental Health, Vol. 22, 2001.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Selye, H.: Stress Without Distress, Philadelphia: J. B. Lippencott, 1974.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Shaver, P.; Mikulincer, M.: Psychodynamics of Adult Attachment: A Research Perspective, in Journal of Attachment and Human Development, Vol. 4, 2002.

Siegel, D.: Toward an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight,” and neural integration, in Infant Mental Health Journal, Vol. 22, 2001.

Skowron, E.; Cipriano-Essel, E.; Benjamin, L. S.; et al: Cardiac vagal tone and quality of parenting show concurrent and time-ordered associations that diverge in abusive, neglectful, and non-maltreating mothers, in Couple and Family Psychology: Research and Practice, Vol. 2, No. 2, 2013

Spreen, O.; Risser, A.; Edgell, D.: Developmental Neuropsychology, New York: Oxford University Press, 1995.

Sroufe, L. A.; Cooper, R.; DeHart, G., Marshall, M.: Child Development, 3rd Ed., New York: McGraw-Hill, 1996.

Stern, D.: The Interpersonal World of the Infant: The View from Psychoanalysis and Developmental Psychology, New York: Basic Book, 1985.

Stern, D.: The First Relationship: Infant and Mother, Cambridge, MA: Harvard U. Press, 2002.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

Sullivan, H. S.: The Interpersonal Theory of Psychiatry, New York: W. W. Norton, 1968.

Thomaes, S.; Brummelman, E.; et al: When Narcissus Was a Boy: Origins, Nature, and Consequences of Childhood Narcissism, in Child Development Perspectives, Vol. 7., No. 1, March 2013.

Twenge, J.; Konrath, S.; Foster, J.; et al: Egos Inflating Over Time: A Cross-Temporal Meta-Analysis of the Narcissistic Personality Inventory, in Journal of Personality, Vol. 76, No. 4, August 2008.

Vaknin, S.; Rangelovska, L.: Malignant Self Love - Narcissism Revisited, Prague: Narcissus, 2003.

Vaillant, G.: Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, 1st Ed., Arlington, VA: American Psychiatric Publishing, 1992.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.

Whitfield, C.: The Child Within: Discovery and Recovery for Children of Dysfunctional Families, Deerfield Beach, FL: Health Communications Inc., 1987.

Widom, C.: Posttraumatic stress disorder in abused and neglected children grown up, in American Journal of Psychiatry, Vol. 156, 1999.

Winnicott, D.: The Child, The Family and The Outside World, 2nd Ed., San Francisco: Da Capo, 1992.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

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Do the Boomers deserve the Blame? Or does Someone Else?

The Boomers (born between 1946 and 1964) take a lot of heat here and elsewhere for All Our Problems today... including the pretty obviously suspect beliefs propagated by so many priests and politicians. But considering what was going on in the decades leading up to and during their youth, are they really The Bad Guys?

The Boomers were parented by those who'd lived through the Great Depression (30% unemployment in 1932) and the biggest war in the planet's history (40-50 million killed). They were afraid. (I know. I was there to see it.) And they were looking for HOPE before the explosion of college education -- and rational empiricism -- that didn't get underway until those parents were in their 40s and 50s. Too late for the vast majority of them.

The vast majority of Boomers themselves were conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” to unquestioning belief before they became the first generation ever to hit college en masse. And found themselves as perplexed and confused by freshman philosophy and critical thinking as they were afraid of sharing it with their closed-minded parents.

Fulton J. Sheen, Billy Graham, Kathryn Kuhlman, Garner Ted Armstrong and Robert Schuler were the big names On The (parents') Toob on Sunday mornings. The messages may have been dismissed or ignored by many young people. But in the absence of the alternatives grasped by about 10% of the so-called "hippies," most of whom were either swilling down watered down beer or smoking pot to try to escape their introjected and infected sin, shame and guilt. Alan Watts, Jiddu Krishnamurti, Richard "Ram Dass" Alpert and Timothy Leary were around, as were Alan Ginsberg, Tom Hayden and Jerry Rubin, but their impact was far more limited, mostly very brief, often contaminated, and largely lost in the smoke.

So about 75% of the Boomers grew up as Blinded. Deafened. Dumbed down. And Sense-less. With Consequences. as their frightened parents. And then... they became parents... and knowing no other way to be parents, imitated their abusers.

One may or may not seek to rectify one's unfortunate conditioning, of course. But they have to be able to see, hear and sense that it even occurred before they even think about tackling what was done to their minds by the agents of The 1% who Know What's Up and want to make damned sure their Big Secrets are well kept because of the tremendous advantages that provides to them.

Follow the path back to the money that has financed the growth of the huge mega-churches of the Millennial Era? And be careful about judging a previous generation when one's own is being so rapidly brainwashed? Something to think about, anyway.

Resources

If interested in pursuing the notions offered here, one may benefit from looking into the books from A Basic Cult Library and On Religion from Outside the Box, as well as some of the selection from the long, three-section list that begins right here. 

Further, one may wish to look into the following articles:

The Political Purpose of Evangelical Totalism in "not-moses's" replies to the original posters on this Reddit thread, as well as this one.

Religion as the Principal Force for Civilization... At a Price in "not-moses's" ;lenghty discussion with the original poster on that Reddit thread. 

The Religiofication of Politics and Economics

The Unquestioned Power of the Priest or Guru (as explained by Erich Fromm in Psychoanalysis and Religion)

CPTSD & The Very High Cost of Struggle & Agitation

CPTSD is Complex Post-Traumatic Stress Disorder. It's typically what one "catches" from having been traumatized in various ways over time rather than by any single "overwhelming" event. (This is an update of an article written many months ago with substantial added material on causes, conditions and treatments.) 

IME (which is plenty since hitting the wall in August of 1994, and finding my way further and further out of the maze since 2003), most of us appear to have been so deeply conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” into a default mode network of Martin Seligman's "learned helplessness and victim identity" since childhood that we continue to struggle with life in pretty obvious ways.

We drive ourselves mercilessly -- and mindlessly -- to solve problems in a chronic fight-flight-freeze response, which can lead over time to allostatic overload and breakdown of our immune systems. Experts on stress like Hans Selye, Joseph Wolpe, Herbert Benson, Bruce McEwen, Sonya Lupien, Robert Sapolsky, Stephen Porges and Pat Ogden have known for decades that "stressaholics" tend considerably toward greater incidence and severity of viral infections, as well as susceptibility to both elective and accidental self-harm. (See the list of books at the end here.)

In my empirical-observation-based opinion, as well as my own personal experience, the conditioned, habituated and normalized tendency to struggle leads to agitation of the autonomic nervous system in the manner described below:

Chronic amygdalar stimulation > relentless triggering of the hypothalamic-pituitary-adrenal axis > secretion of cortiocotropin releasing factor > secretion of adrenocorticotropic hormone > secretion of adrenaline > increased intensity of the general adaptation (fight / flight / freeze) response of the sympathetic branch of the autonomic nervous system > imbalanced polyvagal stimulation > rebounding levels of cortisol in the brain > allostatic loading throughout all striated muscle tissue > increased STRESS on the immune system > a continuous feedback loop between stress and the experience of AGITATION.

One of the most damaging types of struggle & agitation I see so often in a certain category of patient with CPTSD is what I will call "righteous victimhood." Believe me, I understand that "rage is a stage." And moreover, that Kubler-Ross was 100% correct in asserting that it is a stage one must go through and not around. But if one lingers there too long because they have developed an attachment to it -- even an identity with it as a primary defense mechanism, as some people definitely do -- it can become extremely costly in terms of repeated, allostatic overload. 

The cure for stressaholism is often, IME & IMO, the cure for Complex PTSD. The cognitive-behavioral therapies -- especially including Albert Ellis's Rational-Emotive Behavior Therapy and Stanley Block's Mind-Body Bridging Therapy -- and the new, mindfulness-based cognitive therapies like Jon Kabat-Zin's Mindfulness-Based Stress Reduction, Marsha Linehan's Dialectical Behavior Therapy, Peter Levine's Somatic Experiencing and Pat Ogden's polyvagal-theory-driven Sensorimotor Processing for Trauma appear to be the most effective and research-verified at this time. (All of these are easily found online.) I have developed a combination of Ellis's REBT and Ogden's SP4T; others have also developed combinations of the CBTs and MBCTs.

In my own first-hand experience, as well as experienced derived for working with and learning from many other CPTSD sufferers and mental health professionals (including all of those listed in the first paragraph of this article), the development of self-awareness via mindfulness meditation -- or Choiceless Awareness for Emotion Processing --is the foundation of this cure. 

Books on Stress and treatment thereof (in the order of publication): Joseph Wolpe's Life Without Fear: Anxiety and it's Cure, Hans Selye's Stress Without Distress, Herbert Benson's The Relaxation Response, Bruce McEwen's The End of Stress as We Know It, Robert Sapolsky's Why Zebras Don't Get Ulcers, Stephen Porges's The Pocket Guide to the Polyvagal Theory, and Pat Ogden's Trauma and the Body.

Related articles:

Stress Reduction vis Distress Tolerance & Emotion Regulation

Dis-I-dentifying with Learned Helplessness & the Victim Identity (in not-moses's reply to the original poster on that Reddit thread)

How Self-Awareness Works to Digest Emotional Pain

Threat, Stress, COVID-19 & Meditation: Useful, Useless, Or...?

A CPTSD Library