Early Trauma and Disorders of the Self

March 30th, 2011

“In the field of developmental psychology, early researchers focused on a crucial question: what needs to go right for a formless infant to differentiate into a healthy, autonomous, self-regulating entity (Greenacre, P. “Early Determinants in the Development of the Sense of Identity.” Journal of the American Psychoanalytic Association, 1958)?

When early attachment is traumatically disrupted, the outcome may manifest early in the form of Disorders of Conduct, depression, and a failure to thrive; emotionally, academically, or socially.
Later on, as adults, victims of early interpersonal trauma may present with serious “disorders of the self” (diagnosed in the DSM-IV as “Personality Disorders”).
For an individual to achieve inner well-being, he or she needs a healthy supply of sharing and validation by caregivers. In this regard, the first bonding between parent and child begins in the womb. 
A child who grows up in a warm, safe, and nurturing environment is going to carry into adulthood a feeling of security, worth, well-being, and optimism (Kohut, Heinz and Miriam Elson, ed. The Kohut Seminars on Self-Psychology. New York: W.W. Norton, 1987).
For Kohut, the ideal situation is when a child is born into an empathic, responsive human milieu. 
He regards these early caretaker relationships with others to be as essential for psychological survival as oxygen is for one’s physical survival.
The mother’s continued devotion and empathic anticipation of her child’s needs will translate, developmentally, into a child who feels more confident and empowered as an adult and will be more effective in personal relationships, interactions at work, and in society in general.
When the mother is able to resonate with the child’s needs, the latter becomes attuned to his own physical and emotional functions.
For Margaret Mahler (another influential developmental theorist), the organizing principal of developmental success is also based on the successful internalization of the nurturing “good parent.” 
Donald Winnicott, a developmental psychologist who popularized the concept of the “Good Enough Mother,” is in agreement with Kohut regarding this observation:
Winnicott describes “Disorders of the Self” as “environmental deficiency diseases” (The Maturational Process and the Facilitating Environment. New York: International University Press, 1956).
In order to simultaneously facilitate the process of the child’s individuation, the parent has to “walk through” each developmental stage with their child in a sharing and empathic way, paying attention to the child’s bonding cues.
Mature object-relationships require the right balance between nurture and graded separation.
In order to accomplish this, the “good parent” remains only as far as the child can tolerate, and is predictably available for emotional “refueling” upon recall by the child.
This process of internalizing and then self-regulating is what Masterson calls “secure attachment,” where adequate ego functioning must develop within the child to constrain the frustrations inherent to separation.
How the infant internalizes his experience of the caretaker is what determines the final outcome of how the infant will experience himself.
Resolution of the rapprochement crisis is considered by Mahler as essential developmental requirement.
In trauma research, “foraging patterns” are used to study stress responses by replicating different attachment models.
A research team led by Leonard Rosenblum and Jeremy Coplan from the Primate Behavior Laboratory at the SUNY Health Sciences Center, Brooklyn, studied infant primates nursed by mothers randomly assigned to a variety of foraging conditions. 
Using this research model, stress hormones were elevated in infants whose foraging pattern were totally unpredictable (“Nonhuman Primates Exposed to Unpredictable Early Rearing: Relevance to PTSD.” Annals of the New York Academy of Science, 1997).
By manipulating foraging conditions, these researchers created a laboratory model replicating a parent who is unavailable during the critical “rapprochement phase” of “separation-individuation” described by Margaret Mahler.
Pups that received “variable foraging” grew up to have higher CRF and cortisol stress-hormones in their CSF and were socially more timid and subordinate (Liu, et al. “Maternal Care and HPA Response to Stress.” Science, 1997: 277).
Their findings confirm the importance of consistent attachment patterns during early rearing, even in non-human primates.
In another study, pups that were frequently licked by their mothers appeared to be inoculated against subsequent stress (Meaney, et al. “Effect of Neonatal Handling on the Hippocampus.” Science, 1988: 239).
These studies lend biological support to the notion that adverse early rearing experiences have longstanding adverse effects on multiple biological mechanisms relevant to emotional regulation and social behavior.
According to Masterson, this developmental stage is required for “mature attachment.” Emotional regulation allows the individual to maintain a constant sense of “self,” even in the temporary absence of significant others (Klein, Ralph. “Introduction to Disorders of the Self.” The Masterson Approach. Ed. James Masterson and Ralph Klein. New York: Brunner/ Mazel, 1989).
Even minor lapses in attentive, empathic caretaking can create tension in children, impair their ability to tolerate distress, and interfere with ”self-functions” such as autonomy and personal sense of agency.
The point to note here is that neglected and abused children may develop a wide range of disorders beyond PTSD.
Extended caretaker failure to provide empathy may lead to deficits ranging from shyness and introversion to serious disorders of the self. 
More serious maltreatment can lead to complex trauma or disorders of the self such as borderline personality, sociopathy, or pathological narcissism.
These disorders are bundled together under “Cluster B” of the Personality Disorders in DSM-IV. 
Cases of repeated abuse can lead to a search for surrogate caretaking, infantile dependence, and abandonment-depression-characteristics of the borderline personality. 
These survivors of parental failure may develop a deep self-loathing and direct their negative emotions into self abuse (such as self mutilation or even suicide).
A thorough, well-researched review of the impact of child maltreatment across different domains of functioning was published by Cicchetti and Lynch in Developmental Psychopathology, Volume 2 (London: Wiley, 1995. 32-72).
The borderline patient responds to abandonment by engaging in the projective defenses of idealization or demonization, and a failure to retrieve the good self-object leads to an abandonment depression. 
This can lead to compulsive self-gratification via self various impulsive behaviors such as binging, promiscuity, or intoxication; or unmanageable anger can be turned inwards in various forms of self affliction.
The narcissist is unable to integrate the positive and negative elements of the parent. The child is left with an inner void. 
Rather than sustaining a sense of inner-object constancy, the unfulfilled element of unrealized good becomes projected as a “grandiose self,” and self esteem is constantly under threat. In order to fight off a sense of void, the narcissist requires constant validation, confirmation, and admiration.
This is required to hold in abeyance the mother’s empathic failures.
Having a parent who did not confirm or acknowledge is compensated by a grandiose self-object that conceals a sense of self that feels defective but presents outwardly as arrogant, quick to devaluate others.
What betrays the sense of devaluation and empathic failure is the narcissist’s reaction to criticism or disapproval: Unable to maintain a stable sense of self esteem, the internal sense of humiliation cannot be subdued, and its negative component becomes “split-off” (externalized).
The unfortunate consequence is that this disavowed negative self element becomes attached as a negative projection onto someone who can function as a reservoir for this attacking, split-off function of the self structure.
The narcissist exploits others in order to prop up a grandiose persona which conceals a vulnerable self structure. 
Beneath the façade of pride, success, and entitlement, the narcissist is in constant pursuit of admiration. He will even feign a shallow sense of empathy for others, which is rarely genuine.
When challenged, or faced with even minor criticism, the false grandiose self crumbles and is replaced with a pervasive sense of envy, rage, and impotence (Fischer, Richard. “Psychotherapy of the Narcissistic Personality Disorder.” The Masterson Approach. Ed. James Masterson and Ralph Klein. New York: Brunner/ Mazel, 1989).
The negative self-object in the narcissist cannot be integrated into a whole self. Whoever triggers these feelings of worthlessness becomes persecutory.
Self esteem can only be replenished through triumphant vanquish of this disowned element of self.
The antisocial personality manifests the most profound impairments in the capacity for empathic social attachment. Selma Fraiberg characterized sociopathy as “a disease of nonattachment.”
The narcissist also lacks true empathy, in that “others” merely serve as obedient “objects” required for the maintenance of his self esteem via indulging the projected “good” part of his self with flattery and constant affirmation.   
The recipient of the narcissist’s faux empathy results from the “good object” successfully colluding with projected self-objects through obedience, loyalty, and admiration.
One cannot consider the narcissist as conceiving the other’s wishes as being truly separate and worthy of genuine respect. These relationships are not truly mutual or symmetrical.
However, the antisocial personality is almost unable to participate in a non-exploitative relationship.
The true sociopath lacks the capacity to experience tenderness, self-reflection, or sorrow.
There is no recognition of the opinions, wishes, or needs of the other.
To the sociopath there is no concept of mutual sharing, empathy, or intimacy.
On the contrary, the victim of the sociopath becomes an inanimate, dehumanized, need-gratifier.
DSM-IV therefore links Axis I Diagnoses cases such as “Sadism” or “Paraphilia” (including pedophilia) with a required Axis II Diagnosis of Antisocial Personality, since the predator’s sexual arousal is non-consensual (clearly demonstrated in cases of “voyeurism” or “exhibitionism,” which fall under the category of the “Paraphilias”).
More severe cases of sociopathy involve “ownership” of others, infliction of pain or humiliation, and different forms of bondage.
In cases of sadism, the sociopathic predator becomes sexually aroused via subjugation and the infliction of suffering on his victim.
Most of these cases will only enter treatment when it is court-mandated.
In terms of “Intervention,” once childhood maltreatment became widely recognized there was strong social pressure on local government to remove maltreated children from their dysfunctional families.
Subsequent research showed that children receiving substitute care (such as in foster homes) often fared poorly. Institutional foster care frequently exposes these children to further neglect and abuse.
Currently there is more emphasis on rehabilitating the victimized child within the family of origin whenever possible.”

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