Identity disturbance

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]

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
Main article: Borderline personality disorder

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.

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]

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. (1993). 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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