Cognitive neuropsychiatry
Week 1: Longing for touch and the vicarious perception of CT-optimal touch in
clinical outpatients
Clinical outpatients: patients who receive mental health treatment but do not stay
overnight.
Social touch is important for wellbeing.
It can reduce stress, anxiety and pain.
Touch deprivation / Longing For Touch (LFT): a mismatch between how much touch you
want and how much touch you get.
LFT is linked to negative outcomes (loneliness, depression, stress, lower quality
of life).
It was unclear whether clinical patients experience more LFT than healthy controls.
LFT (longing for touch): wanting more touch than you receive.
CT-optimal touch: slow, gentle touch that usually feels pleasant.
Vicarious touch perception: judging how pleasant touch looks by watching videos, not
by feeling it yourself.
Interpretation of results
Clinical outpatients are more likely to feel touch-deprived.
Their higher LFT seems mainly driven by less touch received, not a stronger wish for
touch.
When people currently long for touch, they see touch (even non-optimal touch) as more
pleasant when watching it.
Longer-term LFT (past week) may not match the ‘here and now’ state needed to
influence perception.
Why no diMerence in touch pleasantness between groups?
Possible reasons:
- Clinical group was very mixed (many diagnoses), so eMects may cancel out.
- They did not measure autistic traits, which earlier research suggests may explain
reduced touch pleasantness in clinical groups.
- Online study + COVID period may have influenced results.
Clinical outpatients show higher longing for touch, mainly because they receive less
touch and current longing for touch is linked to seeing touch as more pleasant when
watching it.
,Lecture 1: The body & borderline personality disorder
Types of personality disorders
Cluster A: odd thinking and eccentric behavior
- Paranoid personality disorder.
- Schizoid personality disorder.
- Schizotypal personality disorder.
Cluster B: dramatic and erratic behavior
- Antisocial personality disorder.
- Borderline personality disorder.
- Histrionic personality disorder.
- Narcissistic personality disorder.
Cluster C: severe anxiety and fear
- Avoidant personality disorder.
- Dependent personality disorder.
- Obsessive-compulsive disorder.
Borderline Personality disorder
Prevalence: 0.7 – 2.7%
In clinic there are more females.
Majority experienced (childhood) trauma/maltreatment.
DSM-5 Borderline Personality Disorder (BPD)
A pervasive pattern of instability of interpersonal relationships, self-image and aMects
and marked impulsivity, beginning by early adulthood and present in a variety of
contexts, as indicated by 5 (or more) of the following:
1. Frantic eMort to avoid real or imagined abandonment (Note: do not include
suicidal or self-mutilating behavior covered in Criterion 5).
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of
self.
4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge eating). (Note: do not include
suicidal or self-mutilating behavior covered in Criterion 5).
5. Recurrent suicidal behavior, gestures or threats or self-mutilating behavior.
6. AMective instability due to a marked reactivity in mood (e.g., intense episodic
dysphoria, irritability or anxiety usually lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or diMiculty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
You need to have 5 out of 9 symptoms, which causes a heterogeneous population (a lot
of diMerent symptoms combinations).
,Functional impairment
DiMicult to maintain stable, healthy relationships with others (romantic, work, friends,
family) and with themselves.
è Limited social network.
People with BPD (Ida’s diary):
- Have normal dreams and hopes.
- Self-harm.
- Misinterpretation of ‘sweetie-pie’ -> obsessed for a day.
- Impulsive behavior from fish to kitten.
- Dissociative episodes.
- Unstable sense of self caused by e.g. ‘will never do cut myself again’ -> ‘oh too
late, she did it’.
BPD & neuropsychology
- Not prominent in treatment.
- Mainly variations / combinations of CBT.
DiMerent symptoms studied in relative isolation.
BPD & emotion regulation
- Surprised and overwhelmed by emotions.
- Emotions are not gradual but sudden.
- Emotions are very extreme.
- So caught up in emotions that regulation is no longer an option.
What might go wrong if you are too late I regulation your emotions?
Criterion 6 of BPD: EMective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more
than a few days.
James-Lange theory of emotion:
1. Stimulus (angry dog barking).
2. Physiological response (heart rate increase).
3. Emotion (fear).
Basic idea: Emotions are grounded in the body.
To accurately perceive and regulate our emotions
we must perceive and interpret bodily and
sensory signals correctly.
Bodily maps of emotions
Study shows that people can ‘map’ emotions
onto the body (where they feel activation).
Participants colored body areas where they felt:
- More activation (warm colors: yellow/red).
- Less activation (cool colors: blue).
DiMerent emotions show diMerent patterns, not
random.
, Do body maps diMer in patients?
DiMerences in spread, but also in intensity or frequency of ‘I don’t know’ / ‘I don’t
know where I feel this’.
Longitudinal changes?
Changes in body maps after treatment?
BPD & social touch
The skin is not only a sensory organ, but also a social organ.
Touch is a major way to communicate: safety, comfort, bonding and emotional support.
Social neuroscience often focuses on vision and sound, but touch is also crucial for
social information.
BPD diagnostic criterion 1 and 6 linked to touch:
1. Frantic eMorts to avoid real or imagined abandonment.
6. EMective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than
a few days.
These features make social connection very important, but also diMicult.
Touch can be supportive, but also confusing or threating depending on the person and
context.
What is touch?
The skin is the largest organ of the body.
Touch is the only sense that you cannot fully ‘switch oM’.
Touch develops very early, already before birth.
Touch is important for:
- Bonding with caregivers.
- Emotion regulation.
- Calming stress in infants.
Touch before birth (fetal touch)
Fetuses (especially in the third trimester) respond selectively to external touch.
Fetuses show diMerent behavioral responses when the mother’s abdomen is touched
compared to no touch.
This suggests touch is already part of early social development.
Touch and stress regulation in infants
Touch is strongly connected to the stress system (e.g., cortisol).
Early physical closeness (like breastfeeding and co-sleeping) is related to later cortisol
regulation in infants.
This supports the idea that early touch helps shape how the body learns to deal
with stress.
Touch between people is important
There are 2 systems for processing touch:
1. Feeling system (social touch):
a. Processes human, emotional touch (e.g., stroking, gentle touch).
Week 1: Longing for touch and the vicarious perception of CT-optimal touch in
clinical outpatients
Clinical outpatients: patients who receive mental health treatment but do not stay
overnight.
Social touch is important for wellbeing.
It can reduce stress, anxiety and pain.
Touch deprivation / Longing For Touch (LFT): a mismatch between how much touch you
want and how much touch you get.
LFT is linked to negative outcomes (loneliness, depression, stress, lower quality
of life).
It was unclear whether clinical patients experience more LFT than healthy controls.
LFT (longing for touch): wanting more touch than you receive.
CT-optimal touch: slow, gentle touch that usually feels pleasant.
Vicarious touch perception: judging how pleasant touch looks by watching videos, not
by feeling it yourself.
Interpretation of results
Clinical outpatients are more likely to feel touch-deprived.
Their higher LFT seems mainly driven by less touch received, not a stronger wish for
touch.
When people currently long for touch, they see touch (even non-optimal touch) as more
pleasant when watching it.
Longer-term LFT (past week) may not match the ‘here and now’ state needed to
influence perception.
Why no diMerence in touch pleasantness between groups?
Possible reasons:
- Clinical group was very mixed (many diagnoses), so eMects may cancel out.
- They did not measure autistic traits, which earlier research suggests may explain
reduced touch pleasantness in clinical groups.
- Online study + COVID period may have influenced results.
Clinical outpatients show higher longing for touch, mainly because they receive less
touch and current longing for touch is linked to seeing touch as more pleasant when
watching it.
,Lecture 1: The body & borderline personality disorder
Types of personality disorders
Cluster A: odd thinking and eccentric behavior
- Paranoid personality disorder.
- Schizoid personality disorder.
- Schizotypal personality disorder.
Cluster B: dramatic and erratic behavior
- Antisocial personality disorder.
- Borderline personality disorder.
- Histrionic personality disorder.
- Narcissistic personality disorder.
Cluster C: severe anxiety and fear
- Avoidant personality disorder.
- Dependent personality disorder.
- Obsessive-compulsive disorder.
Borderline Personality disorder
Prevalence: 0.7 – 2.7%
In clinic there are more females.
Majority experienced (childhood) trauma/maltreatment.
DSM-5 Borderline Personality Disorder (BPD)
A pervasive pattern of instability of interpersonal relationships, self-image and aMects
and marked impulsivity, beginning by early adulthood and present in a variety of
contexts, as indicated by 5 (or more) of the following:
1. Frantic eMort to avoid real or imagined abandonment (Note: do not include
suicidal or self-mutilating behavior covered in Criterion 5).
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of
self.
4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge eating). (Note: do not include
suicidal or self-mutilating behavior covered in Criterion 5).
5. Recurrent suicidal behavior, gestures or threats or self-mutilating behavior.
6. AMective instability due to a marked reactivity in mood (e.g., intense episodic
dysphoria, irritability or anxiety usually lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or diMiculty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
You need to have 5 out of 9 symptoms, which causes a heterogeneous population (a lot
of diMerent symptoms combinations).
,Functional impairment
DiMicult to maintain stable, healthy relationships with others (romantic, work, friends,
family) and with themselves.
è Limited social network.
People with BPD (Ida’s diary):
- Have normal dreams and hopes.
- Self-harm.
- Misinterpretation of ‘sweetie-pie’ -> obsessed for a day.
- Impulsive behavior from fish to kitten.
- Dissociative episodes.
- Unstable sense of self caused by e.g. ‘will never do cut myself again’ -> ‘oh too
late, she did it’.
BPD & neuropsychology
- Not prominent in treatment.
- Mainly variations / combinations of CBT.
DiMerent symptoms studied in relative isolation.
BPD & emotion regulation
- Surprised and overwhelmed by emotions.
- Emotions are not gradual but sudden.
- Emotions are very extreme.
- So caught up in emotions that regulation is no longer an option.
What might go wrong if you are too late I regulation your emotions?
Criterion 6 of BPD: EMective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more
than a few days.
James-Lange theory of emotion:
1. Stimulus (angry dog barking).
2. Physiological response (heart rate increase).
3. Emotion (fear).
Basic idea: Emotions are grounded in the body.
To accurately perceive and regulate our emotions
we must perceive and interpret bodily and
sensory signals correctly.
Bodily maps of emotions
Study shows that people can ‘map’ emotions
onto the body (where they feel activation).
Participants colored body areas where they felt:
- More activation (warm colors: yellow/red).
- Less activation (cool colors: blue).
DiMerent emotions show diMerent patterns, not
random.
, Do body maps diMer in patients?
DiMerences in spread, but also in intensity or frequency of ‘I don’t know’ / ‘I don’t
know where I feel this’.
Longitudinal changes?
Changes in body maps after treatment?
BPD & social touch
The skin is not only a sensory organ, but also a social organ.
Touch is a major way to communicate: safety, comfort, bonding and emotional support.
Social neuroscience often focuses on vision and sound, but touch is also crucial for
social information.
BPD diagnostic criterion 1 and 6 linked to touch:
1. Frantic eMorts to avoid real or imagined abandonment.
6. EMective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than
a few days.
These features make social connection very important, but also diMicult.
Touch can be supportive, but also confusing or threating depending on the person and
context.
What is touch?
The skin is the largest organ of the body.
Touch is the only sense that you cannot fully ‘switch oM’.
Touch develops very early, already before birth.
Touch is important for:
- Bonding with caregivers.
- Emotion regulation.
- Calming stress in infants.
Touch before birth (fetal touch)
Fetuses (especially in the third trimester) respond selectively to external touch.
Fetuses show diMerent behavioral responses when the mother’s abdomen is touched
compared to no touch.
This suggests touch is already part of early social development.
Touch and stress regulation in infants
Touch is strongly connected to the stress system (e.g., cortisol).
Early physical closeness (like breastfeeding and co-sleeping) is related to later cortisol
regulation in infants.
This supports the idea that early touch helps shape how the body learns to deal
with stress.
Touch between people is important
There are 2 systems for processing touch:
1. Feeling system (social touch):
a. Processes human, emotional touch (e.g., stroking, gentle touch).
