Author: vaughanbell

There is a small but fascinating medical literature on delusional pregnancy that reports cases of people who, in the context of psychotic mental illness, come to believe they are expecting a child. Interestingly, the cases are not solely women of child bearing age – delusional pregnancy has also been reported in men and the elderly.

In fact, almost as many cases of delusional pregnancy have been reported in men as in women. Unfortunately, no studies have been done on how common this delusion is or what it is associated with, so it’s not clear whether men are equally as likely to have a delusions of pregnancy, or whether it’s just because these cases seem more unusual and is more likely to be published.

Below is one of the cases from a classic 1994 article on delusion of pregnancy from The British Journal of Psychiatry:

B was a 39-year-old, single, female schizophrenic patient with treatment-resistant psychotic symptoms including delusions of pregnancy of 20 years’ duration and amenorrhoea for the previous 18 years. On examination she was convinced that she had a triplet pregnancy – two boys and a girl – of four months gestational age. She reported that they moved about inside her abdomen and also talked to her.

When she was 19, her dancing partner kissed her and she believed that he had been repeatedly impregnating her by means of the same kiss. Regarding her previous pregnancies she believed that their father did not want her to deliver them and hence he ‘withdrew’ them. She did not have any physical symptoms of pregnancy other than amenorrhoea and attributed this to the ‘supernatural nature’ of the pregnancy.

In a curious twist, a recent article reported on a patient who had the delusional denial of pregnancy – where she was clearly heavily pregnant but had the delusion that she was not.

It’s important to note that these cases are not the same as ‘phantom pregnancies’, something medically named pseudocyesis, where a women can show the signs of expecting a child (swollen breasts, enlarged abdomen etc) without actually being pregnant.

This is not a delusion, as the patient can be well aware that they are not actually pregnant or will accept the possibility that they are not when the results of medical tests come though.

Indeed, ‘phantom pregnancy’ can be due to clear disturbance to the hormones – one case was due to a brain tumour that disrupted the endocrine system – but other cases seem to be related to the strong desire to be pregnant.

However, even this has its male equivalent. Couvade syndrome is where men experience some of the physical effects of pregnancy (morning sickness, aches, weight gain) in response to their partner’s pregnancy.

Link to classic 1994 paper on delusion of pregnancy.

The Boston Herald has an interesting article on perfectionism – a pathological pursuit of usually unobtainable high standards that is strongly linked to anxiety, depression and eating disorders.

Perfectionism is variously described as a personality trait or a type of dysfunctional assumption where people feel their self-worth is dependent on 100% or perfect success.

It can be quite hard to shift, owing to the fact that some people find it hard to see why doing something perfectly isn’t a useful goal to aim for. However, when a desire for perfection is over-applied it tends to lead to harsh self-criticism and is self-defeating – ironically, people often perform worse as a result.

Psychologists Roz Shafran and Warren Mansell published an influential article on the role of perfectionism in mental illness in 2001, that really opened many people’s eyes to the importance of understanding perfectionist tendencies in psychopathology.

The Boston Globe article is a little more of a gentle introduction, but does a great job of succinctly describing the personal impact of perfectionism, some of the research in the area, and current approaches to treating the problem:

“Perfectionism is a phobia of mistake-making,” said Jeff Szymanski, executive director of the Obsessive Compulsive Foundation, which is based in Boston. “It is the feeling that ‘If I make a mistake, it will be catastrophic.’ “

Striving for perfection is fine, said Smith College psychology professor Randy Frost, a leading researcher on perfectionism. The issue is how you interpret your own inevitable mistakes and failings. Do they make you feel bad about yourself in a global sense? Does a missed shot in tennis make you slam your racket to the ground? Do you think anything less than 100 percent might as well be zero?

Link to ‘When perfectionism becomes a problem’.
Link to review article on perfectionism and psychopathology.
Link to PubMed entry for same.

There’s a brief but interesting case study in the General Hospital Psychiatry journal of a patient who is described as having ‘extremely grotesque somatic delusions’.

The case was a 54-year-old man. He had no past history or family history of psychiatric disorders. His social and occupational histories were quite normal. In August of 2005, he felt that “something has stuck between under front teeth.” From September, he felt that “there is another lower jaw with teeth between the real upper jaw and real lower jaw, and there is another tongue between the false lower jaw and the real lower jaw”; “the teeth on the false lower jaw are growing steadily”; “I try to cut the false teeth off with the real teeth, but the false teeth do not stop growing”; “the false teeth melt into holes in the false lower jaw, but later grow again from those holes”; “something like spaghetti is coming into and going out from the holes” and “the false lower jaw rolls up and is coming into the throat.” Because of these annoying sensations, he had mild depressive symptoms such as depressed mood, decrease in appetite, restlessness and fatigue. Despite these symptoms, he was able to continue working.

The patient was treated with the antipsychotic drug risperidone and reportedly recovered well.

As part of his assessment he was also given a SPECT brain scan, that found reduced blood flow in the temporal and parietal lobes.

Although still not well studied, various other single case studies have found that delusions concerning body size, shape or transformation correlate with changes in parietal lobe function.

Owing to the role of the parietal lobe in maintaining our ‘body image’, it is thought that problems in this area could lead to unusual experiences of body distortion which could, in part, spark delusional beliefs.

Link to case study.
Link to PubMed entry for same.

An article on the psychological characteristic of vicious dog owners has just appeared online in the compelling academic publication, The Journal of Forensic Sciences, finding that those who who own dangerous dogs are more likely to endorse antisocial and psychopathic character traits and more likely to report criminal behaviour.

The study was led by psychologist Laurie Ragatz who collected data from 869 college students who completed an anonymous online questionnaire assessing type of dog owned, criminal behaviors, attitudes towards animal abuse, psychopathy, and personality.

It’s only a correlational study but the introduction has a nice summary of the research findings as well as a previous study on the same topic:

Each year, 4.7 million people are bitten by dogs, of which 386,000 are seriously injured and over 200 die. Several dog breeds have been labeled “vicious” or of “high-risk” for aggression. To date, only one empirical study has examined the characteristics of persons who choose to own their high-risk dogs. Barnes et al. reports that owners of Akitas, Chow-Chows, Dobermans, Pit Bulls, Rottweilers, and Wolf-mixes endorsed approximately 10 times more criminal convictions than owners of nonvicious dogs. Further, vicious dog owners reported more crimes involving aggression, children, alcohol, and domestic violence than owners of nonvicious dogs.

The current research sought to replicate and extend these findings with a college sample. The present study compared nondog owners and owners of vicious, large, and small dogs on engagement in criminal behavior, general personality traits (i.e., impulsive sensation seeking, neuroticism-anxiety, aggression-hostility, activity, and sociability), psychopathy, and attitude towards animal maltreatment.

…As hypothesized, a significant difference in criminal behavior was found based on dog ownership type. Owners of vicious dogs were significantly more likely to admit to violent criminal behavior, compared to large dog owners, small dog owners, and controls. The vicious dog owner sample also engaged in more types (i.e., violent, property, drug, and status) of criminal behavior compared to all other participant groups.

Personality traits were examined and vicious dog owners were significantly higher than controls on impulsive sensation seeking. Examining psychopathic traits, owners of high-risk dogs endorsed significantly more characteristics of primary psychopathy (e.g., carelessness, selfishness, and manipulative tendencies) than small dog owners.

Comparing owners of vicious dogs to other groups, no significant differences were found regarding secondary psychopathy (e.g., impulsiveness or self-defeating behaviors) or attitudes towards animal maltreatment.

Among the college sample, the vicious dogs were predominantly male and weighed 68 pounds. The owners had more self-reported overall criminal behaviors as well as violent criminal behavior. They endorsed significantly more sensation seeking and primary psychopathic traits.

Link to article.
Link to DOI entry for same.

The latest Trends in Cognitive Sciences has a fantastic review article on the cognitive neuroscience of eye contact, demonstrating how this fleeting social connection has a powerful impact on the mind and brain.

Past research has shown that making eye contact has an impact on social perception and subsequent behaviour.

The article notes that eye contact has been found to increase the likelihood of recognising someone and helps work out whether someone is male or female.

It also seems to increase general arousal and fixes attention – we’re less likely to notice things happening on the periphery of our vision if we’re staring at a face with eye contact than at a face where the eyes are diverted to the side.

In neuroimaging studies eye contact has been found to increase activity in a group of areas (medial prefrontal cortex, superior temporal gyrus, fusiform gyrus) that have often been associated with social interaction across a wide range of studies.

Interestingly, the authors suggest that basic eye contact information might be detected by a specific subcortical mechanism that quickly detects simple light/dark differences, presumably to pick out the direction of the pupil, which then triggers more complex social processing to make sense of its social meaning.

It’s an interesting field, not least because recognising eye contact and following the gaze direction of others are thought to be some of the most fundamental building blocks on which social communication develops in babies.

Children with autism have been found to show radically different patterns of eye contact recognition and gaze direction, and the authors suggest that one cause could be a problem with the these eye contact neural circuits which leads to slow or impaired social understanding.

Link to article on eye contact.
Link to DOI entry for same.

New Scientist has an excellent article on East-West psychological differences and why they may be more to do with local lifestyle than broad cultural generalisations.

Experiments that compare the responses of, for example, Americans and East Asians, are often used to support theories that Westerners have an analytical, individualistic world-view, while Easterners have a holistic, collectivist outlook.

This has been reported in studies that have compared how Westerners and Easterners categorise objects (shared features vs functional relationships), reasoning about causes for people’s behaviour (individual state of mind vs social situation) and, most famously in recent years, how people view visual scenes (focus on objects vs focus on background).

However, the NewSci article discusses a number of studies suggesting that these differences may not be to be with broad cultural definitions but to do with the lifestyle of the local population. In fact, these exact same differences can be found within both Eastern and Western cultures.

So it’s not all that surprising, perhaps, that other studies find that local and current social factors rather than the broad sweeps of history or geography tend to shape the way a particular society thinks. For example, Nisbett’s group recently compared three communities living in Turkey’s Black Sea region who share the same language, ethnicity and geography but have different social lives: farmers and fishers live in fixed communities and their trades require extensive cooperation, while herders are more mobile and independent.

He found that the farmers and fishers were more holistic in their psychology than herders, being more likely to group objects based on their relationships rather than their categories: they preferred to link gloves with hands rather than with scarves, for instance (Proceedings of the National Academy of Sciences, vol 105, p 8552). A similar mosaic pattern of thought can be found in the east. “Hokkaido is seen as the Wild West of Japan,” says Nisbett. “The citizens are regarded as cowboys – highly independent and individualistic – and sure enough, they’re more analytic in their cognitive style than mainland Japanese.”

Even more surprisingly, the article describes how these same cognitive tendencies are malleable – they can be changed in individuals by simply priming them with individualistic or collectivist concepts.

The article is a thought-provoking challenge to the East – West psychological stereotypes common in both the popular press and the scientific literature and discusses some intriguing studies I was completely unaware of.

By the way, the author is Ed Yong, who writes the Not Exactly Rocket Science blog we often link to.

An excellent article that is highly recommended.

Link to ‘Beyond east and west: How the brain unites us all’.

Below are a couple of strangely beautiful delusions described in a 1993 paper on ‘The reliability of three definitions of bizarre delusions’ published in the American Journal of Psychiatry:

A 22-year-old woman had the delusion that thoughts and feelings emanating from her mother’s unconscious were being carried in raindrops that fell on her air conditioner. When the raindrops hit the air conditioner they made a noise, and simultaneously these thoughts and feelings merged with her own unconscious. This merging had resulted in her own mental illness.

A 27-year-old man had the delusion that the voice he heard throughout the day was that of an invisible girlfriend. His girlfriend gave him advice and told him to do things. At night she would come to him, although still invisible, and they would make love.

Link to PubMed entry for paper.