Uncategorized – Page 17 – LIBERTY PSYCHOLOGICAL ASSOCIATION

Auditory Verbal Hallucinations (AVH), an explanation:

“PLEASE CONSULT a NEUROLOGIST, and/or a PSYCHIATRIST“

Auditory Verbal Hallucinations (AVH) are experiences of hearing voices or speech without an external sound source. The voices are perceived as real and distinct from one’s own internal thoughts.

They might be more common than many people assume and occur across multiple clinical and non-clinical populations.

What They Typically Involve

AVH can vary widely in form:

A single voice or multiple voices
Male, female, familiar, or unfamiliar voices
Speaking in second person (“You are worthless”)
Third person commentary (“He is failing”)
Command voices (“Do this”)
Conversational voices arguing or discussing the person

The key distinction is that the voice is experienced as external or not self-generated, even though no one is speaking.

Conditions Commonly Associated With AVH

AVH are most classically linked to:

Schizophrenia
Schizoaffective disorder
Bipolar disorder (with psychotic features)
Major depressive disorder (with psychotic features)

However, they are also found in:

Trauma-related disorders (especially complex trauma)
Dissociative disorders
Severe stress or sleep deprivation
Neurological conditions, CONSULT A NEUROLOGIST, PLEASE
Substance use or withdrawal

Importantly, some people experience voices without meeting criteria for a psychiatric disorder.

How AVH Differ From Normal Inner Speech

Inner Speech	Auditory Verbal Hallucination
Recognized as your own thoughts	Experienced as not self-generated
Under voluntary control	Often intrusive and uncontrollable
Occurs “inside” your mind	Often perceived as external or spatially located

CONSULT A NEUROLOGIST, PLEASE

Neurocognitively, one leading model suggests AVH may involve misattributed inner speech, where self-generated verbal thought is experienced as coming from outside the self.

Neurobiological Findings

CONSULT A NEUROLOGIST, PLEASE

Research shows involvement of:

Auditory cortex activation (as if real sound is present)
Language production areas
Reduced connectivity between speech production and self-monitoring systems

In other words, the brain may be producing speech internally but failing to label it as self-generated.

Trauma and Dissociation Connection

In trauma populations, voices often:

Reflect internalized abusers
Represent dissociated self-states
Contain shame-based or protective content

From a structural dissociation perspective, some voices may function as parts of the personality, rather than psychotic phenomena per se.

Clinical Questions That Matter

Frequency and duration
Emotional tone (hostile, neutral, supportive)
Command content (especially harmful commands)
Level of distress
Insight (does the person question the reality of the voice?)
Functional impairment

Distress and loss of control are often more clinically significant than the mere presence of voices.

Treatment Approaches

Depending on etiology:

medication: CONSULT A PSYCHIATRIST
Trauma-focused therapy
Cognitive Behavioral Therapy for Psychosis (CBTp)
Voice dialogue approaches
Grounding and self-monitoring training

Increasingly, treatment focuses not on “eliminating” voices, but on changing the person’s relationship to them.

Shervan K Shahhian

Self-Defeating Prophecy vs Self-Sabotage:

Is a self-defeating prophecy same as self-sabotage?

They are related but not exactly the same. A self-defeating prophecy is a specific psychological mechanism that can lead to self-sabotage, but self-sabotage is the broader concept.

1. Self-Defeating Prophecy

A self-defeating prophecy happens when a belief or expectation about failure causes behaviors that make the failure actually occur.

Process:

A person believes something negative will happen.
That belief changes their behavior (often unconsciously).
The behavior contributes to the negative outcome.
The outcome seems to “confirm” the belief.

Example

A student believes: “I’m going to fail this exam.”
Because of that belief, they avoid studying or feel too anxious to focus.
They perform poorly.
The failure reinforces the belief.

It’s similar to the idea of a Self‑Fulfilling Prophecy, except the outcome is negative for the person.

2. Self-Sabotage

Self-sabotage is any behavior that undermines one’s own goals, success, or well-being.

It can include:

procrastination
addiction behaviors
avoidance
destructive relationships
quitting before success

The behavior may come from:

fear of success
fear of failure
low self-worth
unresolved trauma
internal conflict

Key Difference

Concept	Core Mechanism	Scope
Self-defeating prophecy	A belief or expectation leads to behaviors that cause failure	Specific psychological process
Self-sabotage	Any behavior that undermines oneself	Broad category

So:

Self-defeating prophecy: might cause self-sabotage

But self-sabotage does not always come from a prophecy.

Psychological Insight

In clinical psychology, these patterns often link to core beliefs like:

“I’m not good enough”
“Success isn’t safe”
“Things never work out for me”

These beliefs (could be) unconsciously that might shape a certain behavior.

Shervan K Shahhian

Self-Defeating Prophecy, explained:

A Self-Defeating Prophecy is a concept in mental health and social science where a prediction or expectation about the future causes people to act in ways that prevent the prediction from coming true.

It is essentially the opposite of a self-fulfilling prophecy.

Definition:
A self-defeating prophecy occurs when:

A prediction is made about an desirable or undesirable outcome.

People believe the prediction.

They change their behavior to prevent it.

As a result, the predicted event does not happen.

Example
Prediction:
“Food shortages will happen next month.”

Reaction:
Authorities increase food production and stockpiling.

Result:
The shortage never occurs.

The prophecy defeated itself because the warning changed behavior.

Psychological Example
A therapist warns a client:

“If you keep suppressing emotions, it may lead to burnout.”

The client begins therapy, emotional processing, and stress management.

Outcome:
Burnout never develops because the warning triggered preventive action.

Key Characteristics:
The prediction motivates corrective action.

Human behavior changes in response to the warning.

The predicted outcome is prevented.

Simple Comparison
Concept Result:
Self-Fulfilling Prophecy Expectation causes the prediction to come true
Self-Defeating Prophecy Expectation causes behavior that prevents it

In Psychology
Self-defeating prophecies are important in:

Public health warnings

Risk communication

Therapy and prevention

Policy and social forecasting

Sometimes warnings work precisely because they turn out to be wrong, they motivate people to change.

Shervan K Shahhian

Birth-Order Psychology, explained:

Birth-order psychology is the theory that a person’s position in their family (firstborn, middle child, youngest, or only child) influences their personality development, behavior patterns, and life outcomes.

Core Idea

Family dynamics
Sibling competition
Parental attention patterns
Perceived role within the family

It’s less about actual order and more about the psychological position the child experiences.

Common Birth-Order Patterns

Firstborn

Often described as:

Responsible
Achievement-oriented
Conscientious
Leadership-driven
Sometimes perfectionistic

Psychological dynamic:
Firstborns initially receive full parental attention, then experience “dethronement” when a sibling arrives.

Middle Child

Often described as:

Diplomatic
Independent
Socially skilled
Sometimes feeling overlooked

Dynamic:
They may feel squeezed between older and younger siblings, which can foster negotiation skills or competitiveness.

Youngest Child

Often described as:

Charming
Creative
Risk-taking
Attention-seeking

Dynamic:
They grow up around more capable siblings, which may encourage social boldness or dependency.

Only Child

Often described as:

Mature
Verbally advanced
Comfortable with adults
Self-directed
Sometimes perfectionistic

Dynamic:
Receives undivided parental attention without sibling rivalry.

What Might Research Say?

Modern research shows:

Personality differences exist, but they are small.
Birth order may affect family roles and behavior patterns more than core personality traits.
Socioeconomic status, parenting style, attachment patterns, and temperament often have stronger effects.

Some Large-scale studies suggest birth order has minimal impact on the Big Five personality traits, but it may influence:

Achievement motivation
Political attitudes
Risk tolerance

Important Psychological Nuances

Birth order is often mediated by attachment security.
“Psychological birth order” (how a child perceives their position) matters more than actual order.
Blended families complicate the dynamic significantly.
Parental differential treatment is a stronger predictor than ordinal position alone.

Some Clinical Use

Birth-order theory can be useful for:

Exploring sibling rivalry
Understanding family-of-origin narratives
Identifying internalized roles (e.g., “the responsible one,” “the rebel,” “the peacemaker”)

But it should not be treated as deterministic.

Shervan K Shahhian

Middle Child Syndrome, an explanation:

Middle Child Syndrome is a popular term (not a formal psychiatric diagnosis) used to describe a pattern sometimes observed in second-born or “middle” children within a family system.

It comes from ideas in birth-order psychology, that birth order possibly can influence personality development.

What Is It?

“Middle Child Syndrome” refers to the idea that middle children may feel:

Overlooked or less noticed
Less special than the firstborn
Less dependent or “babied” than the youngest
Caught between older and younger siblings

Because they are neither the “trailblazer” (oldest) nor the “baby” (youngest), they may develop unique adaptive strategies.

Common Traits Attributed to Middle Children

Not universal, but often reported:

Independent
Socially skilled
Good negotiators/peacemakers
Flexible and adaptable
More likely to seek validation outside the family

Possible struggles:

Feeling invisible
Difficulty defining identity
People-pleasing tendencies
Sensitivity to comparison

Why It Happens

Firstborns often receive intense parental focus and responsibility.
Youngest children may receive protection and indulgence.
Middle children may receive less clearly defined roles.

So they sometimes:

Compete for attention
Withdraw
Develop strong peer bonds instead of relying primarily on family

What Research Says

Research on birth order shows modest effects at best. Personality is influenced much more strongly by:

Parenting style
Attachment security
Family stress
Culture
Temperament

Birth order alone does not determine personality or pathology.

Clinical Perspective (Important)

Middle Child Syndrome is:

Not in the DSM
Not a mental disorder
Not inherently pathological

However, perceived emotional neglect or sibling comparison can contribute to:

Low self-esteem
Chronic comparison patterns
Overachievement or underachievement dynamics

But those are relational experiences, not simply “birth order fate.”

A More Nuanced View

Middle children often develop strong:

Social intelligence
Conflict mediation skills
External attachment networks

They sometimes become the “observer” in the family system, which can foster psychological insight.

Shervan K Shahhian

Schizoaffective Disorder, explained:

“PLEASE CONSULT WITH A PSYCHIATRIST, MEDICAL DOCTOR.”

Schizoaffective Disorder is a psychiatric condition characterized by a combination of:

Psychotic symptoms (similar to Schizophrenia)
Mood episodes (similar to Bipolar disorder or Major depressive disorder)

It sits at the intersection of psychotic and mood disorders.

Core Features

1. Psychotic Symptoms

These may include:

Hallucinations (often auditory)
Delusions
Disorganized thinking or speech
Disorganized or catatonic behavior
Negative symptoms (flattened affect, avolition)

2. Mood Episodes

There must also be:

Manic or hypomanic episodes (if bipolar type)
Major depressive episodes (if depressive type)
Or both

Key Diagnostic Criterion

The defining feature that separates schizoaffective disorder from mood disorders with psychotic features:

There maybe at least 2 weeks of psychotic symptoms WITHOUT a mood episode.

If psychosis only occurs during mood episodes, the diagnosis is usually:

Bipolar disorder with psychotic features
or Major depressive disorder with psychotic features

Types

Bipolar Type
- Includes mania (with or without depression)
Depressive Type
- Includes only major depressive episodes

How It Differs From Related Disorders

Disorder	Psychosis Outside Mood Episodes?	Mood Episodes?
Schizophrenia	Yes	Minimal or brief
Bipolar disorder w/ psychotic features	No	Yes
Schizoaffective Disorder	Yes	Yes

Causes (Multifactorial)

“PLEASE CONSULT WITH A PSYCHIATRIST, MEDICAL DOCTOR.”

Genetic vulnerability
Dopamine and serotonin dysregulation
Neurodevelopmental factors
Trauma and severe stress
Substance use (can worsen or mimic)

Treatment: “PLEASE CONSULT WITH A PSYCHIATRIST, MEDICAL DOCTOR.”

Usually requires combination treatment:

“PLEASE CONSULT WITH A PSYCHIATRIST, MEDICAL DOCTOR.”
Social/occupational rehabilitation

Prognosis

Variable
Often intermediate between schizophrenia and bipolar disorder
Better outcomes when:
- Treated early
- Good medication adherence, “PLEASE CONSULT WITH A PSYCHIATRIST, MEDICAL DOCTOR.”
- Strong social support
- Minimal substance use

Shervan K Shahhian

Severe Major Depression with Psychosis, what is it:

“PLEASE CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR.”

Severe Major Depression with Psychosis (also called psychotic depression) is a subtype of
Major Depressive Disorder
in which a person experiences severe depressive symptoms plus psychotic features (loss of contact with reality).

Clinically, it could be referred to as:
Major Depressive Disorder with psychotic features

Core Components

A. Severe Major Depression

Profound depressed mood
Marked anhedonia
Psychomotor retardation or agitation
Significant sleep and appetite disturbance
Cognitive slowing
Intense guilt or worthlessness
Suicidal ideation (often high risk), IT NEEDS IMMIDIATE EMERGENCY ASSISTANCE
Persons presenting suicidality or homicidally should undergo a thorough medical screening examination to determine whether they have an emergency medical condition that requires timely intervention, should be stabilized in a timely manner, and should have treatment, including hospitalization for psychiatric care, initiated to ensure the safety of the person and others.

B. Psychotic Features

Psychosis occurs during the depressive episode and typically includes:

Delusions (false fixed beliefs)
- “I am responsible for the collapse of the economy.”
- “My organs are rotting.”
Hallucinations
- Often auditory (e.g., accusatory or condemning voices)

Mood, Congruent vs Mood, Incongruent Psychosis

Mood-Congruent (most common):

Themes of guilt, punishment, illness, poverty, nihilism
Example: “I deserve to die because I ruined everything.”

Mood-Incongruent:

Paranoid or bizarre themes not directly tied to depressive themes
Example: “Aliens implanted a chip in me.”
(More diagnostically complex)

How It Differs From Other Disorders

Condition	Key Difference
Schizophrenia	Psychosis persists outside mood episodes
Schizoaffective Disorder	Psychosis occurs independently of mood episodes for ≥2 weeks
Bipolar I Disorder	History of mania required

In psychotic depression, psychosis only occurs during the depressive episode.

Neurobiological Factors (Must Be Research-Supported)

“PLEASE CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR.”

HPA-axis hyperactivation (cortisol dysregulation)
Dopamine dysregulation
Serotonergic disruption
Often strong genetic loading
Frequently trauma-associated

Severity & Risk

Persons presenting suicidality or homicidally should undergo a thorough medical screening examination to determine whether they have an emergency medical condition that requires timely intervention, should be stabilized in a timely manner, and should have treatment, including hospitalization for psychiatric care, initiated to ensure the safety of the person and others.

Psychotic depression carries:

Higher suicide risk than non-psychotic depression
Higher relapse rates
More functional impairment
Greater likelihood of hospitalization

It is considered a psychiatric emergency when:

Command hallucinations are present
Delusions involve self-harm
Severe psychomotor retardation or refusal to eat occurs

Treatment (Evidence-Based)

“Please Consult with a Psychiatrist, Medical Doctor.”

Clinical Presentation Pattern

Many patients:

Do not initially volunteer psychotic symptoms
Experience intense shame about delusions
Present first with severe depressive symptoms

Careful assessment is crucial.

Shervan K Shahhian

Behavioral Neuroscience, an explanation:

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

Behavioral Neuroscience (also called Biological Psychology, Biopsychology, or Psychobiology) is the scientific study of how the brain and nervous system influence behavior, thoughts, and emotions.

It asks a core question:

How do biological processes produce psychological experience and behavior?

What It Studies

Behavioral neuroscience examines how structures like the:

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

Amygdala, fear, threat detection, emotional memory
Hippocampus, memory formation
Prefrontal cortex, decision-making, impulse control
Hypothalamus, hormones, hunger, stress regulation

affect:

Emotion
Motivation
Learning & memory
Addiction
Aggression
Sexual behavior
Stress responses
Mental disorders

Core Areas

1. Brain Structures & Function

How different brain regions coordinate behavior.

2. Neurotransmitters

Chemical messengers like:

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

Dopamine (reward, motivation)
Serotonin (mood regulation)
GABA (inhibition, anxiety control)

3. Hormones & Behavior

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

How cortisol, testosterone, oxytocin, etc., influence mood and social bonding.

4. Genetics & Epigenetics

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

How genes and environmental stress shape neural development.

5. Psychopathology

Biological underpinnings of disorders such as:

Depression
Schizophrenia
PTSD
Substance use disorders

Methods Used

“PLEASE CONSULT A NEUROLOGIST, MEDICAL DOCTOR”

Brain imaging (fMRI, PET scans)
EEG recordings
Lesion studies
Animal research
Pharmacological manipulation

How It Differs From Related Fields

Neuroscience: broader (includes cellular/molecular focus)
Cognitive neuroscience: focuses specifically on thinking processes
Behavioral neuroscience: specifically links brain biology to observable behavior
Shervan K Shahhian

Psychophysiological, what is it:

Psychophysiological refers to the interaction between psychological processes (thoughts, emotions, perception, stress) and physiological processes (brain activity, heart rate, hormones, immune function, muscle tension). “CONSULT WITH A MEDICAL DOCTOR”

It literally means:

“How the mind affects the body, and how the body affects the mind.”

Core Idea

Psychophysiology studies how mental states produce measurable bodily changes.

For example:

Anxiety: increased heart rate, sweating, muscle tension
Chronic stress: elevated cortisol: immune suppression
Trauma reminders: autonomic nervous system activation
Calm breathing: vagal activation: lowered blood pressure

Field of Study

The scientific discipline is called psychophysiology, closely related to:

Behavioral Neuroscience
Health Psychology
Neuropsychology

Researchers measure: “CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR”

EEG (brain waves)
Heart rate variability (HRV)
Skin conductance (GSR)
Blood pressure
Cortisol levels
EMG (muscle activity)

Psychophysiological Disorders

“CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR”

Sometimes psychological stress produces real physical symptoms without structural disease. These are called psychophysiological disorders, such as:

Stress-induced hypertension
Tension headaches
Irritable bowel syndrome
Some forms of chronic pain

The body is not “imagining” symptoms, the physiology is genuinely activated by psychological processes.

In Trauma & Dissociation

“CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR”

Chronic hyperarousal
Dissociative instability
Somatic flashbacks
Stress-induced autonomic oscillation

For example:
A trauma trigger activates the amygdala: sympathetic nervous system: cortisol release: muscle contraction: altered breathing: cognitive narrowing.

That entire cascade “could be” psychophysiological.

In Simple Terms

Psychological event: Nervous system response: Bodily change
Bodily state: Brain interpretation: Emotional experience

It could be bidirectional: functioning in two directions.

Shervan K Shahhian

Psychological Autopsy, an explanation:

“Consult with a trained forensic psychologist or psychiatrist“

Psychological Autopsy is a structured, retrospective investigative method used to reconstruct a deceased person’s mental state, intentions, and circumstances prior to death, most commonly in cases of suspected suicide.

It is NOT a literal medical autopsy of the body. Instead, it is a forensic psychological evaluation conducted after death.

Purpose

Psychological autopsies are conducted to:

Determine whether a death was suicide, accident, natural, or homicide
Understand the decedent’s psychological functioning
Assess intent and state of mind
Clarify ambiguous deaths (e.g., overdose, single-vehicle crash, firearm deaths)
Provide information for legal proceedings or insurance claims
Assist families seeking understanding or closure

What It Involves

A trained forensic psychologist or psychiatrist gathers data from multiple sources:

1. Interviews

Family members
Friends
Coworkers
Treating clinicians

2. Records Review

Medical and psychiatric records
Therapy notes
Medication history
Police and coroner reports
Suicide notes (if present)
Digital footprint (texts, emails, social media)

3. Behavioral Reconstruction

Investigators look for:

Prior suicide attempts
Verbalizations of hopelessness
Recent stressors or losses
Substance use
Personality traits
Major psychiatric disorders
Changes in behavior before death

Core Psychological Questions

A psychological autopsy attempts to answer:

Was there evidence of suicidal intent?
Was the individual experiencing major depression, psychosis, trauma-related distress, substance intoxication, or other impairments?
Were there protective factors?
Did the person show planning behaviors?

In Clinical & Research Context

Beyond legal investigations, psychological autopsies are used in:

Suicide prevention research
Epidemiological studies
Public health policy

They help identify patterns in:

Risk factors
Sociocultural influences
Psychiatric comorbidities

Important Distinction

A psychological autopsy:

Is retrospective
Relies on collateral data
Cannot establish absolute certainty
Is probabilistic, not definitive

It differs from:

Forensic pathology (physical cause of death)
Clinical diagnosis (which requires direct assessment)

In Context

Psychological autopsies are (Might Be) especially relevant when evaluating:

Complex trauma histories
Dissociative states prior to death
Severe depression with psychosis
Ambiguous self-inflicted injury cases

There could be growing discussion about integrating:

Trauma-informed reconstruction
Attachment history analysis
Neurocognitive vulnerability mapping
Shervan K Shahhian