Playing With Marbles

Obsessive Compulsive Disorder: When Fear Hijacks Your Brain

SupportIf you’re struggling with your mental health, you’re not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. 

Dissociative Identity Disorder: You, Plural

The term “dissociation” is a hot topic amongst those who study the brain. An example of dissociation that most of us can relate to is when you’re reading or scrolling through social media and you realize that your mind is elsewhere, that you haven’t actually absorbed the information in front of you. Some researchers have termed these momentary and fleeting moments “normative dissociation”. However, when dissociation begins to disrupt or interrupt the integration of behavior, memory, identity, consciousness, and more, so much so that a person loses recollection of random times in their day-to-day life, this might be a sign of a dissociation disorder. While some skeptics argue that these disorders are related to fantasy proneness and suggestibility, research supports dissociation as a psychobiological state that functions as a protective response to traumatic or overwhelming experiences. While there are three main dissociative disorders, the focus of this episode of Playing with Marbles is on dissociative identity disorder, or DID for short. DID is characterized by a person having two or more distinct identities as well as difficulties with remembering personal information, learned knowledge, or important parts of their childhood. Importantly, there is neurobiological evidence supporting DID as an extreme form of post-traumatic stress disorder caused by exposure to severe and chronic trauma in childhood. One study investigating the link between different symptoms of DID and the hippocampus, a part of the brain that is important for memory, learning and emotion, found that those with DID who experience the symptom of dissociative amnesia (that is, issues with recalling information about yourself or events and people around) have reduced hippocampal volumes. This study also demonstrated an association between emotional neglect in childhood and reduced hippocampal volumes, suggesting an interplay of these factors in the severity of dissociation.In this episode, our guest Nicole walks us through their experience with DID and introduces us to their different “parts” that they’ve named “Kay” and “Stripe”. You will hear about Kay, who acts child-like and plays with their cat, and Stripe, who, when they take over, causes Nicole to behave alarmingly and have lapses in memory. Shari Botwin, LCSW and Trauma Therapist, explains that, in many DID cases, these different parts can take on different personalities that embody the roles of a perpetrator, enabler or protector, they can have different genders, and even come from different age groups. Despite this, the switching from one part to another can still be subtle which can make DID hard to detect at times. Both Shari and Nicole present us with an uplifting perspective on DID that dissociating into different parts is the brain’s creative and protective way to survive in a situation that one might not have made it through was it not for this splitting into different parts. Shari Botwin's new book, Stolen Childhoods: Thriving After Abuse comes out May 7.Fast FactsDissociative identity disorder affects up to 1.5% of the global population and is often diagnosed later in life.Dissociative identity disorder is typically associated with severe childhood trauma and abuse. Because of the way it presents, people with DID are often misdiagnosed with other disorders, like borderline personality disorder.Psychotherapy is the most prominent treatment for dissociative disorders. Antidepressants or anti-anxiety medication may help treat some of the mental health-related symptoms associated with DID, but there is no medication that specifically treats this disorder.SupportIf you’re struggling with your mental health, you’re not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. Multiplied By One provides a vast list of support, resources, and information for those who struggle with dissociative identity disorder, or those who are interested in learning more about the condition. 

Borderline Personality Disorder: The Jukebox of Self Doubt

Diagnosis of personality disorders in youth is relatively new. Before the release of the Diagnostic and Statistical Manual, version 5 (DSM-V), nobody under the age of 18 could receive a diagnosis of a personality disorder, mainly due to the transitional nature of personality in youth, and the degree of stigmatization attached to such a diagnosis. Researchers have since stressed the importance of early detection and treatment for the outcomes of these disorders. In fact, almost all personality disorders diagnosed in adulthood can also be diagnosed in children under the age of 18 who have presented with symptoms for at least one year. The one exception to this rule is related to the diagnosis of antisocial personality disorder in adulthood, which must be preceded by a history of childhood conduct disorder.This episode’s guest, Sophie, mentions different ways her symptoms of borderline personality disorder (or BPD) influence her relationships and ability to trust. We hear that having BPD has instilled in her a tendency towards hyper-attunement to others. This means that Sophie connects to and takes on the emotions of others, in such a way that impacts her behavior and relationships – sometimes in good ways, and sometimes in not-so-good ways. Sophie shares with us that she often identifies and latches on to a “favorite person”, which can sometimes introduce problematic coping mechanisms when things go awry. We also learn about Sophie’s difficult struggles with trust and distrust towards other people and situations. Often common in those afflicted with BPD, researchers have been prompted to explore the link between impairments in trust processes and the disorder. One study suggests that developmental factors, like experiences of emotional neglect or a lack of trust in parents during childhood, may influence certain behaviors in interpersonal exchanges and ultimately be a risk factor for trust issues in adults with BPD. With the involvement of trust processes being so salient in those with BPD, special attention needs to be attributed to ensuring a safe and trustworthy therapeutic alliance can be established between the therapist and person that is seeking treatment for BPD. Folks with BPD have expressed that therapy simply doesn’t work for them when they are made to feel unsafe. Because of this, care providers are encouraged to consider difficulties with trust in individual treatment plans and emphasize interpersonal trust between themselves and the person seeking treatment for BPD with the goal of developing a favorable therapeutic alliance. Fast FactsCommon traits of BPD include having extreme fears of being rejected or abandoned, feeling easily rejected by others, an excessive need for reassurance from others, and more. Studies suggest that 1 to 3% of youth under 18 may have traits of borderline personality disorder.BPD is usually diagnosed in teens and young adults, though it may also be diagnosed later in life.Most youth who receive appropriate supports and services will benefit and show improvement. Youth who don’t get treatment are at higher risk for aggression, criminal behaviour, ongoing mental health problems, suicide, homelessness and problems in their relationships.Learn More about This Episode’s Cool ResearchersAs mentioned in the episode, borderline personality disorder is a much-stigmatized condition. For example, one study found that the word “difficult” can routinely be used by clinicians to label a person with BPD. Breaking through these labels and stigmas, while recognizing the need to establish safety and trust through the therapeutic alliance, many clinicians are providing compassionate care towards those with a BPD diagnosis; one such person is this episode’s expert guest, Dr. Brandon Unruh.Dr. Unruh is disrupting the status-quo of care for BPD by examining and targeting how the next generation of clinicians are being taught about the disorder. In terms of treatment, Dr. Unruh and his colleagues focus on specialized evidence-based treatments for BPD, like dialectical behavioural therapy (DBT), mentalization-based treatment (MBT),  and transference-focused psychotherapy (TFP). Dr. Unruh is particularly interested in MBT which is based on the theory of failed mentalization for BPD and refers to impairments with identifying mental states, like attitudes or feelings, in oneself or in others along with difficulties in recognizing how these mental states are influenced by each other. To improve the process of mentalization, MBT emphasizes mental states and interpersonal interactions by encouraging individuals with BPD to focus on how their own mental states affect their own behavior, and the behavior of others. Much of Dr. Unruh’s research on BPD treatment focuses on this method, including an interesting case study on the use of MBT in treating a physician struggling with BPD.SupportIf you’re struggling with your mental health, you’re not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. Though not nation-wide, the Borderline Personality Disorder Society of British Columbia provides support and resources to those struggling with BPD.

ADHD: When your brain can't sit still

The definition of Attention Deficit Hyperactivity Disorder (ADHD) has gone through many changes over the years. Interestingly, the criteria used to diagnose ADHD has actually become broader, encompassing a wider range of ages and a variety of different clinical presentations and symptoms. One thing that’s stayed the same since the release of the DSM-III in the 1980’s is the focus on problems with attention, impulsivity and hyperactivity. While it was once thought of as a disorder of childhood, the prevalence of ADHD has seen a consistent rise in more recent years, in both children and adults.With changing trends in diagnosis for ADHD comes a change in our understanding of how the condition affects those that have it. This episode’s guest, McKenna, discusses how having ADHD impacts her memory, explaining that she exerts quite a bit of effort to work around her forgetfulness. McKenna isn’t exaggerating when she says ADHD makes her forgetful: one study has shown that ADHD is associated with impairments in working memory, an executive function that plays a big role in how we process, use and remember information on a daily basis. This same study suggested that abilities in working memory may be related to the severity of ADHD inattentive and hyperactive/impulsive symptoms. What’s more, these impairments in memory, as well as the symptoms of hyperactivity/ impulsivity but not inattentiveness, can have direct effects on emotional regulation and dysregulation in children with ADHD.Many options exist for treatment and maintenance of ADHD symptoms. The use of stimulant medication can improve symptoms of attention, impulsivity and hyperactivity. Stimulants have been shown to help improve symptoms in 70% of children with ADHD. Other forms of non-prescription interventions, like education and skills training, classroom management strategies, and more can be used to support children manage their symptoms. There are even less conventional forms of treatment, like neurofeedback therapy, that are being investigated! Fast FactsGlobally, ADHD occurs among 3.1% of 10- to 14-year-olds and 2.4% of 15- to 19-year-olds.While there is no consensus on the exact cause of ADHD, there is likely a genetic link. Children born into families where there is a history of the disorder are more likely to be diagnosed with ADHD than children where there is no family history of ADHD. Eighty percent of children diagnosed with ADHD continue to qualify for a diagnosis in adolescence and at least 65% continue to be effected by symptoms in adulthood.Learn More about This Episode’s Cool ResearchersAs more is uncovered about the links between ADHD, memory and emotional regulation, there is a need to have emotional dysregulation recognized as a core, diagnostic feature of ADHD alongside impulsivity, inattention, and hyperactivity. This potential fourth core symptom might be the key to why folks with ADHD tend to make use of non-adaptive emotional regulation strategies like blaming themselves, catastrophizing, and ruminating. It also presents a new and exciting avenue for treating symptoms of ADHD, including emotional dysregulation, by implementing strategies used to regulate emotions with the goal of improving one’s emotional response. At the forefront of the inquiry into better understanding the difficulties with emotion dysregulation among young adults and adults with ADHD is this episode’s expert guest, Elizabeth Bodalski – a doctoral student at the University of South Carolina. Among other areas of research, Elizabeth is interested in how ADHD-related emotional dysregulation may affect someone’s educational experience in college. In one study, Elizabeth and her colleagues made a case for how difficulties in emotional regulation and self-esteem partially account for the relationship between ADHD symptoms and procrastination in college students. With the links between ADHD and procrastination demystified, Elizabeth moved to research effective interventions for college students with ADHD. The time- and cost-friendly intervention suggested by Elizabeth and colleagues includes a combination of group and individual therapy that focuses on building skills directly related to the symptoms characteristic of ADHD balanced with the demands of college. The skills that are honed in on through this intervention are: organizational, time management and planning, or OTMP for short. SupportIf you’re struggling with your mental health, you’re not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. The Centre for ADHD Awareness, Canada provides resources and support to those living with ADHD. 

Anxiety & Eating Disorders: When the alarm bells won't stop ringing

Anxiety is one of the body’s natural responses to stress. When a person is met with an important event or perceived danger, anxiety can help them to react to that stressor. But when symptoms of anxiety are ongoing or severe, it’s a sign of an anxiety disorder. There are several types of anxiety disorders, with each subtype categorized by how anxiety appears in the afflicted person’s life.This episode’s guest, Jess, has been diagnosed with Generalized Anxiety Disorder, or GAD. It’s the most broad and one of the most common anxiety disorders types. In this episode, Jess shares with us that she didn’t recognize her anxious episodes as symptoms of an anxiety disorder – an occurrence that is all too common. Though detection and diagnosis through self-reported measures has ameliorated over the years, anxiety disorders, like panic disorder, GAD, and social anxiety disorder, are one of a handful of disorders that often go undetected, underreported, and undiagnosed. Jess discusses her struggles with anxiety, alongside her past struggles with an eating disorder. She isn’t alone in her struggles with these two disorders, in fact, anxiety has been shown to be the most common psychiatric comorbidity amongst people who have eating disorders. Fast FactsAnxiety is the most common mental health problem in young people. It is estimated that, on a global scale, 3.6% of 10- to 14-year-olds and 4.6% of 15- to 19-year-olds experience an anxiety disorder.In addition to life-interfering fears and worries, symptoms of anxiety in children can include irritability, anger, trouble sleeping, and physical symptoms like fatigue, headaches, or stomachaches.According to the Canadian Paediatric Society, the optimal way to manage anxiety in children and youth is through a combination of psychoeducation, psychotherapy, and/ or pharmacotherapy.Learn More about This Episode’s Cool ResearchEating disorders are commonly associated with other psychiatric illnesses, like anxiety (as mentioned above) and depression. One such illness is Body Dysmorphic Disorder, or BDD, a condition where a person perceives a distorted version of their own body and becomes preoccupied with it. BDD as a common comorbidity of the eating disorder anorexia nervosa, or simply “anorexia”, has been investigated since at least the early 2000s. Thanks to the research of Dr. Jamie Feusner, who we talked to for this episode, we are gaining a better understanding of the potential mechanisms that contribute to anorexia and BDD, and how they may be linked.In a first-of-its-kind neuroimaging study, using a technology that measures brain waves called electroencephalography (EEG), Dr. Feusner found that individuals with anorexia may have abnormalities in the way they process and perceive certain types of visual information. For example, holistic, or configural, processing (e.g., seeing the face as a whole) was found to be deficient in people with anorexia while the perception of part-based, or detailed, processing (e.g., seeing the features… two eyes, a nose and a mouth… of a face) was enhanced. Taken together, these results could help explain why people with anorexia tend to fixate on particular body parts while placing less emphasis on the whole body. In people with BDD, results showed that these individuals may be experiencing abnormalities in the way they structurally encode visual information, which could contribute to the perceptual distortions that are a hallmark symptom of the disease. This research from Dr. Feusner provides an exciting avenue for the use of EEG as a biomarker of abnormal visual processing.  SupportIf you’re struggling with your mental health, you’re not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. The Canadian Network for Mood and Anxiety Treatment has a list of resources for those dealing with mood disorders, such as depression and bipolar disorder, and anxiety disorders. Anxiety Canada has resources available on their website, along with resources specifically for youth. The National Eating Disorders Information Centre provides resources and support to those in Canada affected by an eating disorder.