BID in ANOREXIA
- AN diagnosis: (A) limited food intake (B) Fear gaining weight (C) Disturbed perception/experience of body
- Body perception: see/feel/think about own body current treatment CBT (cognition/affect) not perception
(know/feel)
- AN = multisensory disorder more severe than assumed
- Body representation: abstract collection of body perceptionsintegratesuses sensory inputblueprint of
body/size conscious & unconscious main function to use & move body + protect from harm not an image
o Body cognitions: emotions/attitudes/semantics
o Body perception: visual/tactile/feeling
o Body action: planning/execute motor action
- Homunculus: somatosensory/motor representation on brain rescaled using body representation
- Body awareness: body in spacelocation/coordination based on size
- AN: disturbed body size stored in brain’s body representation affects multiple senses & modalities
o Tactile Size perception: caliper overestimated in AN different receptor density and sensitivity more
sensitive but less specificimpact tactile processing receptors relay info to brain size model of object is
projected onto size in distorted body representation feel bigger
o Body Scaled Action: move body through door/crowds rotate at 40% brain uses overestimated body size
representation (which is larger) experience self as larger
- Treatment: use perceptual distortions to improve/treat AN (RHI) synchronous = ownership estimate hand width
pre/post RHI change occurs in both conditions entire VR body overestimation normalizes and remains at FU
altered perception in body size is flexible and remains stable over time even emotional body parts & asynchronous
not linked to body ownership not treatment
- Intervention: hoop training choose fits body coach through size smaller over time direct evidence forced to
actually experience body size (think/talk/see/move/feel) = multisensory visual size estimation + tactile size estimation
+ action planning
Study 01: study full scope of body representation in 4 domains of BID (attitudes/visual/tactile/affordance perception)
visual size estimation (VSE); Tactile Size Estimation (TSE); Hoop Task (HT) HC, AN, Remitted
- Incorrect notion of body size = body image disturbance develop/maintain ED + complicates recovery remitted
- No standard treatment targeting BID in AN bodily experience persists after treatment possible trait factor (stable
pattern thoughts/emotions over long period)
- AN: stronger negative attitudes VSE: difference across groups AN/Remitted/HC TET: no difference across groups
(unclear) HT: AN overestimated more than Remitted
- Confirms BID in remitted AN in visual perception and affordance perception but not in body attitudes
- Multiple sensory domains in BID can improve efficiency of conventional treatments
Study 02: full body illusion (FBI) for emotional body parts AN showed less overestimation after FBI for circumference on
emotional/non-emotional parts also asynchronous & at FU disturbed body size experience in AN is flexible and can be
changed
- AN treatment does not target multisensory disturbance body representation: experience body & size incl. body
image (perceptual representation) + body schema (motor action)
- Overestimate tactile/haptic perception/integration of visual & proprioceptive info/ body scaled action/ interoceptive
awareness, sensitivity cross-modal integration of sensory signals is disturbed
- Seeing touch on fake body while being touched on actual body = integrates 2 separate streams
- Initial overestimation in RHI normalizes after multisensory body illusion make size estimation on most recent visual
input discrepancy between knowing & feeling their size (e.g, body experience) unaffected structural body
- Pre-FBI: AN misestimated width/circumference Post-FBI: decreased misestimation FU: size estimates normalized
change from pre-to-FU was largest in AN FBI alters body size perception positively affects persistent body size
disturbance in AN possible to change embodiment does not result in fake body being added to body
representation
- AN have weaker central coherence to HC (poor global processing) more detailed focused to specific body parts
visual processing bias (overestimates body size) by blocking visual input: body estimates normalize (shift to other
senses) illusion is not related to improved body size but experimental setting is NB.
Aetiologias of Dissociative Disorders (DID)
- Dissociation: outer body/unreality/memory lapse amnesia (forget) / absorption (focus) / derealization or
depersonalization (word/self not real) frequency & intensity = clinical threshold
- Dissociative Amnesia: cannot recall info during trauma
- Dissociative Fugue: unplanned trips cannot recall past new characteristics cannot recall the fugue state
- Reason for dissociation: sleep deprivation/trauma protection/coping high emotion intensity escape depends on
severity & duration of abuse more affected in critical periods
- Dissociative Identity Disorder (DID): how valid is identity fragmentation vulnerabilities: suggestibility/ fantasy-
proneness treatment lengthy & ineffective
, - Structural Dissociation Model (Trauma model): childhood abuse identity development dissociation don’t
develop coherent identity split to deal with trauma Treatment: map identities establish collaboration
integrate into 1
- Socio-Cognitive Model (Vulnerability model): mood swings/lack behaviour control social learning/culture factors
confused & want explanation highly suggestible play into fantasy treatment: focus on symptoms don’t
encourage separation
- Inter-Identity Amnesia: recurrent gaps in memory = inconsistent with normal forgetfulness implicit memory task
o Recall list A Recall List B objective transfer of information
o Use trauma related words recollect more negative related words (same as HC)
o Evaluative conditioning: pair neutral image with negative/positive stimulus learn words & connotations
o Affective priming: target stimuli is facilitated if prime + target have same affective valence DID = primed
o No objective evidence for inter-identity amnesia
- New treatment: Schema Therapy: rapid shift in emotion/behaviour (like BPD) operationalized as modes in DID
express dysfunctional modes aim to develop more functional modes & replace maladaptive coping transdiagnostic
focus on what function the identify shift is causing
- Trauma is not sufficient nor necessary to develop DID
- DSM-5: (1) inter-identity amnesia (unproven) (2) separate identity states (difficult to prove)
- Neuroimaging: risk of cherry picking/post-hoc reasoning reverse inference (brain activity infer function)
Study 01: DID 2/more distinct personality states + discontinuity in self + recurrent memory gaps
- Psychodynamic therapy: (1) safety/stabilize (2) trauma confronted (3) identity integrated/rehab
co-consciousness/communication/integrate need less stress, ego strength, social support
lengthy/dropout/delayed
- Schema therapy: DID experience compartmentalized identities no proof of inter-identity amnesia (intact memory
pathways) shifts in feelings/emotions/behaviour mimic BPD/PTSD/PD role of therapeutic relation for corrective
experience emphasize consequence of early neglect/abuse and explain drastic shifts normalize identities
reframe as modes robust/low dropout symptom reduction adapt protocol for DID identify identities
underlying needs imagery to process trauma early (overcome cognitive avoidance)
Study 02: Trauma model: causal link between trauma & dissociation Socio-cognitive model (fantasy-prone, suggestibility,
media, cognitive failure) strengths/limitations link dissociation & sleep disturbance, hyper-associativity, set shifts,
deficits in meta consciousness, self-regulation transtheoretical variables
- Transtheoretical/Transdiagnostic Framework: beyond TM/SCM advance etiology (metaconsciousness, cognitive
association, affective processes, emotion regulation, sleep)
- TM: dissociation = unconscious defense/coping automatic escape aversive event difference in how trauma is
defined, correlation variable, no objective evidence of abuse, overlap with other disorders
- SCM: tendency to over-report/exaggerate not objectively measured mixed findings
- Commonality: DID do not really experience multiple indwelling identities despite their subjective experience
decreased connectivity/coherence in brain (less integrated mental functioning) disorder of self-understanding
- Meta consciousness: aware and comprehend own mental state and infer state of others (ToM) link subjective
experience and behaviours, cognition, affect, situation antecedents inability to reflect fundamental attribution
error = attribute shifting cognitive-emotional-behavioural sets to multiple selves
- Self-control/self-regulation: poor executive control, self-regulation, cognitive inhibition especially in emotional
contexts poor parent-child attachments = cannot regulate emotions negative emotions disrupt cognitions
- Hyper-associativity: activation & fluency of semantically & emotionally related concepts (associational threads) rapid
shift between overmodulated & under modulated emotional states automatic cognitive-behavioural-affective
association networks associative identity disorder = integrative/associational processes
- Set switching: difficulty in sustained attention, integrating thoughts, coherent interpretations inefficient memory
inhibition forgetting avoidance based set shifts = create distance/separation
- Sleep-Wakefulness: adverse events and negative emotions disrupt the sleep-wake cycle non-trauma pathway to
dissociation longer REM poor sleep quality affects daily neurocognitive activity (EFs and emotion regulation)
- Stress/Trauma: adverse events disrupt sleep depersonalization hyperassociation
- Dissociation in BPD: unstable self image stress related paranoid ideation / dissociation / sleep problems
- Dissociation in Schizophrenia: sleep disturbance unusual experiences associational processes
- Biological etiology of dissociation: R dlPFC activated & ACC inhibited damaged connections
- DID: hypo-aroused state (overmodulated emotion regulation) – EFs/Attention/memory/learning hyper-aroused
state (under modulated emotion regulation) – failed prefrontal inhibition overmodulated state to under modulated
state triggers hyper association
Body Plasticity in Borderline Personality Disorder
- BPD: (1) intense/unstable moods (2) impulsive (3) oversimplified BW thinking unstable sense of self radical life
changes misinterpret actions of others idealization/devaluation
- Functional impairments: relationship with self & others
- Treatment: CBT symptoms studied in isolation not managed as whole
- Main symptoms: (1) identity disturbance (2) dissociative disturbance (3) extreme mood (4) avoid abandonment
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller athenahaggiyannes. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $6.95. You're not tied to anything after your purchase.
