Identity disturbance

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An identity disturbance is a deficiency or inability to maintain one or more major components of identity. These components include a sense of continuity over time; emotional commitment to representations of self, role relationships, core values and self-standards; development of a meaningful world view; and recognition of one's place in the world. [1] [2]

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It appears to be linked to emotional dysregulation, which has been shown to be a significant predictor of identity disturbance in psychiatric patients even when controlling for borderline personality disorder diagnosis, depression, and anxiety. [3] Although some researchers posit that it is the lack of consistent goals, values, world views, and relationships that lead to a sense of emptiness, [4] it is not entirely clear whether the link between emotional dysregulation and identity disturbance is because a disturbed identity creates a negative affect that is hard to regulate, because emotional dysregulation disturbs identity, because a third variable causes both (confounding), or some combination of the above.

Correlation with BPD

There are many theories about why borderline personality disorder often includes identity disturbances. One is that patients with BPD inhibit emotions, which causes numbness and emptiness. Another theory is that patients with BPD identify fully with the affective state of each moment, leaping from one moment to the next without the continuity of a narrative identity. Meeting criteria for major depressive disorder predicts identity disturbance in BPD patients, and identity disturbance is also correlated with a heightened risk for substance use disorders and high anxiety in adolescents. The syndrome of identity disturbance is encountered in all personality disorder types. [5]

Neural substrate

To understand the development of self-identity, researchers investigating the neural basis of self have examined the neural systems involved in distinguishing one's own thoughts and actions from the thoughts and actions of others. [6] [7]

One critical system implicated in this line of research involves the cortical midline structures (CMS), which include the orbital and medial prefrontal cortex, the anterior cingulate cortex, dorsomedial prefrontal cortex, and the posterior cingulate cortex including the adjacent precuneus (see insert). [8] Greater activation in these structures has been found when people made trait judgements about themselves as opposed to others, [9] [10] as well as during a resting state (see Default mode network) or self-referential activity compared to when involved in a non-self-referential task. [11] [12] In addition to this correlational evidence linking these regions to our self-identity, one study using transcranial magnetic stimulation to transiently disturb neural activity in the medial parietal region of cortex found that this disruption led to a decreased ability to retrieve previous judgements of oneself compared to the retrieval of previous judgements of others. [13]

Regions of the brain collectively known as the cortical midline structures. Scientific data suggest the CMS play a vital role in emotional and identity self-regulation. Cortical midline structures.png
Regions of the brain collectively known as the cortical midline structures. Scientific data suggest the CMS play a vital role in emotional and identity self-regulation.

Based on evidence from neuroimaging studies in clinical populations, it seems that both high activity in CMS regions during resting state and self-referential activities, accompanied by deactivation of this region during non-self-referential tasks, are critical for forming a stable and unified identity. More pronounced identity disturbance seems to be facilitated by poorer deactivation of CMS during task-related activities. [14] Activity has also been shown to be lower in the dorsal portion of the precuneus for people believed to have identity disturbance compared to controls during the evaluation of self-attributes. [15]

Moreover, researchers comparing resting-state fMRI scans of people with BPD and health controls have found reduced functional connectivity in the retrosplenial cortex and the superior frontal gyrus. [16]

Mindfulness training, a core skill in dialectical behavior therapy used in the treatment of BPD, has been linked with alterations in default mode network activity. [17]

Related Research Articles

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of intense and unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with dissociation, a feeling of emptiness, and a fear of abandonment.

<span class="mw-page-title-main">Mood swing</span> Extreme or rapid change in mood

A mood swing is an extreme or sudden change of mood. Such changes can play a positive part in promoting problem solving and in producing flexible forward planning, or be disruptive. When mood swings are severe, they may be categorized as part of a mental illness, such as bipolar disorder, where erratic and disruptive mood swings are a defining feature.

<span class="mw-page-title-main">Psychological pain</span> Unpleasant feeling of a psychological nature

Psychological pain, mental pain, or emotional pain is an unpleasant feeling of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment." There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain, spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is widely believed to be an inescapable aspect of human existence.

<span class="mw-page-title-main">Brodmann area 9</span> Part of the frontal cortex in the brain of humans and other primates

Brodmann area 9, or BA9, refers to a cytoarchitecturally defined portion of the frontal cortex in the brain of humans and other primates. It contributes to the dorsolateral and medial prefrontal cortex.

<span class="mw-page-title-main">Prefrontal cortex</span> Part of the brain responsible for personality, decision-making, and social behavior

In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46, and BA47.

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<span class="mw-page-title-main">Orbitofrontal cortex</span> Region of the prefrontal cortex of the brain

The orbitofrontal cortex (OFC) is a prefrontal cortex region in the frontal lobes of the brain which is involved in the cognitive process of decision-making. In non-human primates it consists of the association cortex areas Brodmann area 11, 12 and 13; in humans it consists of Brodmann area 10, 11 and 47.

<span class="mw-page-title-main">Ventromedial prefrontal cortex</span> Body part

The ventromedial prefrontal cortex (vmPFC) is a part of the prefrontal cortex in the mammalian brain. The ventral medial prefrontal is located in the frontal lobe at the bottom of the cerebral hemispheres and is implicated in the processing of risk and fear, as it is critical in the regulation of amygdala activity in humans. It also plays a role in the inhibition of emotional responses, and in the process of decision-making and self-control. It is also involved in the cognitive evaluation of morality.

<span class="mw-page-title-main">Nucleus reuniens</span>

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The self-reference effect is a tendency for people to encode information differently depending on whether they are implicated in the information. When people are asked to remember information when it is related in some way to themselves, the recall rate can be improved.

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<span class="mw-page-title-main">Dorsomedial prefrontal cortex</span>

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References

  1. ↑ Westen, D. (1985). Self and society: Narcissism, collectivism, and the development of morals. New York: Cambridge University Press.
  2. ↑ Westin, D. (1992). The cognitive self and the psychoanalytic self: Can we put our selves together? Psychological Inquiry, 3(1), 1-13.
  3. ↑ Neacsiu, A. D., Herr N. R., Fang C. M., Rodriguez M. A., Rosenthal M. Z. (2015). Identity disturbance and problems with emotion regulation are related constructs across diagnoses. Journal of Clinical Psychology, 71(4), 346-361. PMID   25534425
  4. ↑ Westen, D., Cohen, R.P. (1994). The self in borderline personality disorder: A psychodynamic perspective. In Z. V. Segal, & S. J. Blatt (Eds.), The self in emotional distress: Cognitive and psychodynamic perspectives (pp. 334-368). New York: Guilford Press.
  5. ↑ Modestin, Jiri Identity disturbance in personality disorders. Comprehensive Psychiatry. (11/1998), 39 (6), p. 352 - 357
  6. ↑ Farrer, C., Franck, N., Georgieff, N., Frith, C. D., Decety, J., Jeannerod, M. (2003). "Modulating the experience of agency: A positron emission tomography study". Neuroimage 18, 324–333.
  7. ↑ Astington, J. W., Harris, P. L., Olson, D. R. (1988). Developing theories of mind. New York: Cambridge University Press.
  8. ↑ Northoff, G., Bermpohl, F. (2004). "Cortical midline structures and the self". Trends in Cognitive Sciences, 8(3), 102–107.
  9. ↑ D'Argembeau, A., Ruby, P., Collette, F., et al. (2007). "Distinct regions of the medial prefrontal cortex are associated with self-referential processing and perspective taking". Journal of Cognitive Neuroscience , 19, 935–944.
  10. ↑ Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., Heatherton, T.F. (2002). "Finding the self? An event-related fMRI study". Journal of Cognitive Neuroscience, 14, 785–794
  11. ↑ Gusnard, D. A. & Raichle, M. E. (2001). "Searching for a baseline: Functional imaging and the resting human brain." National Review of Neuroscience 2, 685–694. doi : 10.1038/35094500
  12. ↑ Gusnard, D. A., Akbudak, E., Shulman, G. & Raichle, M. E. (2001) "Medial prefrontal cortex and self-referential mental activity: Relation to a default mode of brain function." Proceedings of the National Academy of Sciences 98 (7), 4259–4264. doi : 10.1073/pnas.071043098
  13. ↑ Lou, H. C., Luber, B., Crupain, M., Keenan, J. P., Nowak, M., Kjaer, T. W., Sackeim, H. A., & Lisanby, S. H. (2004). "Parietal cortex and representation of the mental Self". Proceedings of the National Academy of Sciences, 101(17), 6827–6832.
  14. ↑ Stephan Doering, S., Enzi, B., Faber, C., Hinrichs, J., Bahmer, J., and Northoff, G. (2012). "Personality Functioning and the Cortical Midline Structures – An Exploratory fMRI Study". PLOS One, 7(11), 1-8.
  15. ↑ McAdams, C. J., and Krawczyk, D. C. (2012). "Who am I? How do I look? Neural differences in self-identity in anorexia nervosa". SCAN, 9, 12-21.
  16. ↑ Kluetsch RC, Schmahl C, Niedtfeld I, Densmore M, Calhoun VD, Daniels J, Kraus A, Ludaescher P, Bohus M, Lanius RA. (2012). "Alterations in default mode network connectivity during pain processing in borderline personality disorder". Archives of General Psychiatry, 69(10), 993–1002.
  17. ↑ Farb, N. A., Segal, Z. V., and Anderson, A. K. (2013). "Mindfulness meditation training alters cortical representations of interoceptive attention". Social Cognitive and Affective Neuroscience, 8(1), 15–26. doi:10.1093/scan/nss066;10.1093/scan/nss066
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