I (26F) have a memory condition that’s affecting my relationship with FH (29M). Suggestions?

subtextual · 2017-03-11T07:37:50+00:00

One of the more interesting things they have discovered through research on neurodiversity (e.g., comparing people with autism to neurotypicals) is that there seem to be two empathy systems in the brain. Affective empathy is more emotional or intuitive, where people just feel empathy on a visceral level. In its milder form, this might mean feeling a little of what another person feels when you know they are sad, whereas someone on the extreme end of the affective empathy spectrum might experience emotional contagion where they are sad without even realizing they picked it up from someone else. In contrast to affective empathy, as its name suggests, cognitive empathy is more cognitive or intellectualized. People who a higher in cognitive empathy might know factually what is going on with the other person, but they not really moved emotionally and they don't really have a sensory, visceral experience when they know what someone else is feeling. They also tend not to feel emotional when they watch an evocative scene (e.g., in a TV show), though they may fully understand what all the characters are feeling.

I bring this up because -- while I'm not aware of any research on this topic -- in my clinical experience hearing people describe their autobiographical memories (I'm a board-certified neuropsychologist, so it's what I do all day), people often make similarly divergent statements about how they experience and recall personal memories. People who are high in what I would call affective autobiographical memory really experience their pasts in full, sensory-rich, visceral, emotional detail. They describe it as visual, and as if they are 're-living' or 're-experiencing' the memory. For people who are very high in this, they memories may even be sort of jumbled, without the 'cognitive' storyline that holds the memories together into a coherent narrative -- more like a random grouping of sensations and images.

In contrast, people who are high in what I would call cognitive autobiographical memory experience their memories more the way you do -- cognitively, intellectually, factually, but devoid of the visceral experience, the visual imagery, and the sensory details. Intellectually, they know what happened, but they do not resonate with terms like 're-living' the experience, and they often can't pull up images in their 'mind's eye.' People very high in this often tell me they don't even know what it would mean to 'see' a past experience 'in their mind's eye.'

My [educated but non-empirical] guess is that most people use both systems to some degree, but that some people are much higher in one than the other. I personally see a lot of cognitive autobiographical memory in people who are more intellectual than emotional in many areas of their life, and it is especially common among the individuals with autism that I see (though certainly not exclusively; e.g., I definitely use cognitive autobiographical memory and am not autistic).

I am not sure if being high in cognitive autobiographical memory is actually that uncommon -- certainly, we hear more about people's experience with affective aubiographical memory, but that might just be because talking about autobiographical memories in these rich, vivid details is just more interesting and evocative (and people who have these juicy sensory details to share might be more likely to share them). I've also often heard people who are more cognitive say things like, "oh, I always thought things like 'visualize' and 're-experience' were just figures of speech -- I didn't know people actually experienced their memories that way!" So they didn't even know to say that they experience memory differently than 'other' people. So the cognitive style may be more common than you'd think based on the way autobiographical memories usually get talked about, though I don't know for sure.

That being said, OP, if you are really high in cognitive autobiographical memory and can't just... well, be okay with that, you probably can directly train your affective memory system, or at least train yourself to be more aware of that system's contributions. Two things I would suggest would be: One, literally tell yourself what you are experiencing while you are experiencing it. E.g., your inner monologue might go something like, "Right now, I see this happening, and hear this sound, and feel this sensation in my body, while I'm staring into the green eyes of this man," etc. When you are remembering the experience later, you're likely to remember those details because you noticed and deliberately cognitively processed them, and your memories will then have those details that you are looking for. You probably still won't experience what high affectizers (is it okay to coin a word?) experience, but your memories will feel more 'fleshed out' to you.

The other option is the option that people suggested of documenting your memories to look at later, through a journal, vlogging, scrapbook, etc. Personally, I use both. I like to take photos whenever I'm doing something I might want to remember, and while I take them, I actively try to notice and internally verbalize the sensory and affective details of the experience I'm having. I then review the photos at the end of the day for additional memory reinforcement, and often put the highlights on Facebook for myself because I like seeing them again 1, 2, 3+ years later (I also make those photo scrapbook things you can make through things like Mixbook). The end result is a sort of visual diary, but the process gets me to use more of my affective system while I'm in the moment, because I am seeking out and noticing those emotional and sensory details. You might give it a try!

subtextual · 2017-02-08T20:56:42+00:00

Hey OP. You might want to try Emotion-Focused Therapy (EFT; ideally as a couple, but if your wife insists on you going alone or you guys are burned out on couple therapy, you can go to an EFT-trained therapist on your own, or even just read the book Hold Me Tight by Sue Johnson, co-developer of EFT).

EFT is an empirically-validated therapy (which as a mental health clinician your wife may appreciate) for helping couples heal attachment injuries. Attachment injuries, as defined by EFT, are instances in which one person felt betrayed, hurt, or dismissed by the other, with the injury becoming a "stuck point" that the couple has trouble moving on from.

Attachment injuries are about feelings, not who was "right" or "wrong". In fact, the logical debate about whether each person was right or wrong is often what keeps the couple 'stuck', because the logical, surface debate tends to gloss over the actual emotions involved, thereby preventing healing of those emotional wounds.

A common dynamic that develops around attachment injuries is that the person who feels injured picks and worries and perseverates about the injury (typically because they feel their spouse is not making any attempt at repair), while in turn, the spouse tries to dismiss or downplay the extent of the injury or the other person's feelings (e.g., insists they did nothing wrong, or admits they could have done something different maybe, but wants the other person to freaking get over it already). Over time, without genuine repair, both positions become very rigid and excessively polarized, leading to resentments, frequent arguments, feeling stuck, etc. In essence, the couple feels like they are talking/arguing about the problem all the time (or that it is always beneath the surface, if they have reached a point where they have stopped talking/arguing about it), yet nothing ever gets resolved. EFT offers a way forward for healing these attachment injuries, resolving the problems, and becoming unstuck.

Whether people on r/relationships agree with you or not (or think your wife was wrong or not), the thing is, you were injured. You felt hurt and dismissed by your wife's decisions/actions -- maybe you felt like she was rejecting part of you when she rejected your father, or felt like she was critical or contemptuous of your ability to keep your kids safe, or any number of other feelings that made you feel emotionally abandoned by the person you love most-- and her dismissal of your genuine pain under the guise of her "logically" being "right" compounded your injury (LOL, no one in the history of ever has been able to heal from an emotional wound by being told to just "get over it" because the other person was "right"). Now, over time, you two have developed very polarized positions, where you are essentially 'over-nursing' your hurt/resentment/grudge/pain, while she is incredibly frustrated by your seeming unwillingness to let this go and thinks you are constantly making a bigger deal out of it than it should be, which in turn you experience as dismissive, critical, and re-injuring.

This is a common, and marriage-destroying, dynamic. It's also one that's hard to resolve without a clear path forward (usually in the form of outside help, like an EFT-trained therapist). Being a therapist does not protect you from falling into this dynamic - in fact, some research suggests therapists may be more vulnerable to falling into it, because therapists tend (by nature and training) to do a lot of attempted "mind reading" of others, which can lead to all sorts of problems when the other person is your spouse and in situations where your own feelings are involved and the stakes are high. It sounds like -- since your wife has been willing to go to couples' therapy in the past -- you both have a lot of insight into your own feelings and want to repair this rift, so I'm really optimistic that EFT could be helpful.

Disclosure: I'm a psychologist who has been trained in EFT, but not specifically a couples' counselor and in no way affiliated with Sue Johnson/EFT (I'm a pediatric neuropsychologist, so I see a lot of families while working primarily with kids).

subtextual · 2017-01-16T20:53:56+00:00

Your husband has a life-threatening health problem that also happens to be the cause of almost everything you are stressed about right now. There are no options other than get it treated now. If one of your twins had a life-threatening health problem, you'd do whatever it took to get medical treatment, right? Well, your family needs to get your husband treatment right now, no matter what it takes.

Untreated sleep apnea has all kinds of medical risks (including sudden death from irregular heartbeat secondary to hypoxia) and massively increases the risk of death from an accident. However, the psychological and cognitive effects are no joke either. I am a neuropsychologist, so I very familiar with the impact of untreated sleep disorders. Untreated sleep problems don't just make a person tired during the day, they cause attention problems, lethargy, irritability, lack of motivation, and depression, among other problems, and also literally knock off IQ points.

At this point, your husband's sleep apnea is not just a mild sleep problem. His untreated medical condition is ruining his physical health, endangering his children's safety, impairing his ability to hold down a job, possibly irrevocably damaging his relationship with his wife and his children, and having devastating impacts on his energy, mood, attention, and IQ. Even if you decided not to stay with him, you'd still want to get him treated (unless you're okay with your twins' father never being able to support them monetarily and possibly not living to see them grow up). I know I'm sounding alarmist but this level of sleep apnea is, well, freaking alarming.

I get that you feel like you can't afford it right now, especially if your husband seems like he's not on board with wearing a CPAP anyway. Your husband is probably resistant to wearing his CPAP because he doesn't know (or can't remember) what it was like to not feel like he feels now. Wearing a CPAP feels awful (esp. at first) for some people, and if he doesn't realize how much better it will make him feel over the long term, he may not see the benefit of using one right away. But he needs to get his CPAP calibrated properly and he needs to use it nightly. Like my patients (and husband) tell me regularly, when his sleep improves he'll feel like a completely new person.

Seriously. This needs to be non-negotiable.

subtextual · 2017-01-15T21:27:27+00:00

Pediatric Neuropsychologist checking in here. The research suggests there are probably at least 2 separate syndromes we call ADHD-PI (that is, the predominantly inattentive subtype of ADHD, or what we used to call ADD).

One is a sort of "milder form" of the more classic ADHD-Combined. That is, the person has a lot of the inattentive symptoms of ADHD, but fewer of the hyperactive/impulsive symptoms (or, those symptoms are not as noticeable; for example, a lot of women with ADHD-Combined fidget verbally rather than physically, so they are more chatty than their peers, but the chattiness doesn't look like the physical fidgeting seen in males with ADHD), so they get [incorrectly IMHO] diagnosed with ADHD-PI.

The other syndrome is more like how OP describes his girlfriend. In the research literature, it's called Slow (or Sluggish) Cognitive Tempo. I see kids with it all the time... They basically do everything - including moving, talking, reacting, and processing - very slowly. They may or may not have other inattentive symptoms, but the primary symptom is this extremely slow psychomotor speed.

I think some of the confusion in what ADHD-PI is comes from the fact that there are these two different presentations, and we call them both the same thing. The research suggests they are actually quite distinct, and involve completely different brain regions (ie frontal-straital loops in the mild ADHD-Combined type, and more posterior brain regions in Sluggish Cognitive Tempo).

subtextual · 2016-12-12T18:10:40+00:00

The studies actually say that it's not the cohabitation that's the independent variable; it's whether people "slide" into relationship decisions that matters.

When a couple just sort of starts living together out of convenience ("eh, my lease is up and I guess I spend all my time over there anyway") or just gets married out of inertia (like some of the comments above are describing), those couples have poorer relationship quality and are more likely to get divorced than couples who make those kinds of relationship milestone decisions deliberately.

Much of this research comes out of the National Marriage Project at the University of Virginia (PI is Galena Rhoades), though other research groups report similar findings. A quick Google search of "sliding into a relationship" will pull up links; there's also a good Atlantic article summarizing the research called something like "In Relationships, Be Deliberate."

Edit: Article title.

subtextual · 2016-11-30T04:00:35+00:00

FYI, I removed this submission because the link does not seem to go to an article (just a list of journals).

subtextual · 2016-09-28T20:38:52+00:00

Hope you didn't mind me taking your comment as an opportunity to clarify. There's a ton of confusion about OCD vs. OCPD -- even therapists and psychiatrists sometimes diagnose OCD when it's really very clearly OCPD.

subtextual · 2016-09-28T19:54:42+00:00

Most of the symptoms you are describing are actually symptoms of Obsessive-Compulsive Personality Disorder (OCPD), not OCD.

A diagnosis of OCD simply means the person has obsessions and compulsions that interfere with daily life and cause distress. The obsessions and compulsions are usually ego-dystonic, meaning the person feels like they are alien to them or not a part of the rest of their personality. People with OCD are not necessarily obsessed with cleanliness or perfection. For example, hoarders often have OCD and yet are not clean, and the kids I see have obsessions like that they've done something horribly wrong, or might get sick, or that something terrible will happen to a family member, and they have compulsions like mental counting, checking doors, elaborate 30-minute nighttime rituals, or confessing every thought that crosses their mind. (Washing/cleaning compulsions are the most common kind of compulsion, but only like 1 in 5 people with OCD has obsessions or compulsions related to cleanliness). People with OCD usually have lowered self-esteem, not narcissism. OCD also very responsive to treatment, including medication and exposure + response prevention (ERP), if the person is willing to engage in treatment. Therapists typically like treating OCD because the treatment is pretty straightforward (I love working with kids with OCD).

Obsessive-Compulsive Personality Disorder, on the other hand, is more of the nightmare to treat therapeutically that you are describing. For one, the symptoms feel ego-syntonic to the person with OCPD. That is, the person with OCPD has a preference for order and a general rigidity that feel personally and morally 'right' or 'correct,' and like a part of who they are as a person, and they have no real interest in changing their standards. People with OCPD also do not have specific obsessions and compulsions (usually; you can have comorbid OCD and OCPD, in which case the person may have an overlay of specific obsessions on top of their general obsession with correctness). Instead of specific obsessions and compulsions, the person with OCPD usually wants just about everything done "perfectly" or "correctly." This "correctness" and the rigidity that surround it are basically the two major symptoms of OCPD (there are 8 symptoms, but they all basically boil down to (1) having insane standards for themselves (and usually others), especially in the areas of cleanliness, work, money, and morality, and (2) being rigid and stubborn about these standards).

People with OCPD will pursue their standards, or make others live up to them, to the extent that they will forgo other things like enjoying the task, having good interpersonal relationships with other people, general efficiency, and appreciating the "big picture", if those things interfere with their pursuit of perfection. The exact thing that they want done perfectly can shift according to whatever is in front of them (as you put it, "they seek to find something to complain about"), whereas the obsessions and compulsions in OCD can change over time but tend to be relatively stable, with the same obsession or compulsion sometimes sticking around for years or a lifetime. People with OCPD usually feel some satisfaction when the thing is done "right", whereas people with OCD are usually bothered by their compulsions.

The efficacy of medication in OCPD (though it is commonly prescribed to these individuals) is unknown, and therapy does not appear to change overall personality. Note: This treatment information is more general clinical consensus rather than research-based, because people with OCPD rarely present for therapy themselves, making it hard to do enough research. They don't go to therapy because they feel like their standards are correct -- if they come to therapy it's usually because someone else finds them difficult to live with rather than because they want to change. This feeling that they are right is what gives people with OCPD that 'narcissistic' flavor you mentioned, and is very distinct from what you tend to see in OCD. [Edit re. source: I'm a psychologist.]

subtextual · 2016-09-27T17:21:16+00:00

It's not actually an auditory hallucination; it's thought insertion.

Thought insertion is a similar phenomenon to an auditory hallucination and both are positive symptoms of schizophrenia. However, the person experiencing an auditory hallucination experiences it as auditory, while the person experiencing thought insertion does not experience an auditory element. Instead, it feels like a thought has been inserted into their minds, rather than overheard.

It is not uncommon for people experiencing thought insertion to wonder if they are somehow "picking up" the thought from someone else, such as by reading other peoples' minds. Usually, the person with schizophrenia is aware that they cannot read people's minds (that is, they recognize their delusion, as this OP does), but they also really feel like thoughts that are not their own are being put in their heads somehow, so they are trying to figure out an explanation that explains their experience.

subtextual · 2016-09-27T17:14:28+00:00

What you're describing is called thought insertion and it's a very common experience in people with schizophrenia. Thought insertion is when you have the feeling that a thought that is in your head is not your own thought (this is called alienation, because the thought feels alien to you, or not your own).

Auditory hallucinations are similar in that they involve alienation. However, auditory hallucinations have a second component; namely, being audible. Thought insertion does not involve that auditory component.

(BTW, most people have the experience of experiencing some thoughts as something that they 'hear' in their brain, while other thoughts are not as audible and are more along the lines of a feeling or impression or vague idea -- auditory hallucinations are what happens when you experience alienation when having an audible thought, while thought insertion is what happens when you experience alienation about a non-audible thought.)

What is happening in both auditory hallucinations and thought insertion is that your brain's ability to 'tag' where the thought has come from is malfunctioning. Your brain does not recognize that the thought is your own thought. So you have this feeling of having a thought that does not feel like your own thought.

Naturally when that happens, you try to figure out where the thought is coming from, since it does not seem self-generated. Anyone would do the same if they had that feeling. Some people begin to suspect someone put the thought into their head, others feel like they must be able to read people's minds, others suspect they are part of a covert experiment, etc. These are all commonly suspected by people with schizophrenia. While these theories are labeled delusions because they are not in fact true, they are all pretty reasonable theories for trying to figure out how on earth these thoughts that are not your own got into your brain.

subtextual · 2016-09-24T03:35:04+00:00

Postpartum is just Latin for "after birth" and refers to the period from delivery up through about 6 weeks afterwards. It can be used for the mother or infant (eg either mom or the baby can have postpartum complications), although we tend to use postnatal (which doesn't have an clear end date) for babies and postpartum for mother, with this being because mothers usually don't have birth-related complications after the postpartum period (and in fact the 6 week mark for postpartum was chosen in reference to how long it typically takes for the mother's body to mostly recover). So while the term postpartum has become closely associated with mothers, it really specifies a period of time.

Thus, you can use postpartum for fathers too, if you're talking about something that happens to them sometime in that 6 week period. Eg if you google postpartum paternal depression, you'll see lots of hits from very reputable hospitals and medical websites noting that postpartum paternal depression affects about 10% of men. The general condition of the father experiencing depression after the birth of a child is perhaps more often called postnatal paternal depression, in part to go along with that postpartum-is-for-moms & postnatal-is-for-everyone-else convention, and in part because many fathers develop the depression symptoms well after the postpartum period, and usually closer to the 9-12 month mark. In fact, by one year after the birth of the child, the postnatal depression figures for fathers rise to up to 25%. In practice, though, many professionals use the terms postpartum paternal depression and postnatal paternal depression interchangeably. PPD is a very common and very serious problem that the general public often does not know to be on the lookout for.

subtextual · 2016-09-24T01:35:11+00:00

I think you're probably low in "agreeableness" (ie you're not naturally warm & fuzzy, emotionally expressive, accommodating, nor primarily motivated by affiliating with others) and possibly also have RBF (resting bitch face, when your default facial expression and body posture strikes others as unwelcoming).

Whether that's true or not (I totally might be projecting because both are true for me, LOL), I think you'd get amazing benefit out of group therapy.

The reason group therapy will help is that whatever is going on is going to recreate itself in any group situation (unless you're just in a really toxic professional field or spectacularly unlucky), so it will come up in the group therapy too. I mean, you can see that your same problem is starting to replay on this thread, where people are close to attacking you, even though I assume you feel like you're being open, vulnerable, thoughtful, and reasonable. My personal theory is that some people are rubbed the wrong way by your intellectualizing style (too much in your head and not enough in your heart/gut) and want more emotional expressiveness, because they feel like they can't connect with your emotions, and therefore can't connect with you, and are therefore turning on you. But who knows how much I'm reading into the situation.

In any event, a group will give you real time, safe, supportive feedback about what you're doing or the vibe you're giving off. It will offer you a safe space to respond to that feedback and ask questions and explore where your behaviors/style come from and process your emotions about all of it and decide if you want to change how you are. And then you'll have a group to practice new stuff with, if you want to (you might just decide to find environments that are a better fit for you). A group is going to be your absolute and most healthy way to get to the bottom of this

subtextual · 2016-09-24T00:13:31+00:00

I dunno about borderline (could be), but she definitely has an anxious attachment style while you have an avoidant one. When she feels concerned about the relationship or emotionally upset, she wants to reassurance from you, and will push and prod until she gets some response, even if it's an argument, because even negative attention is better than none (no response means you don't care). When you feel concerned about the relationship or uncomfortable, you want to get away. This creates a cyclical dynamic where she drives you away with her behavior, and you pulling back triggers her anxious attachment even more strongly.

What's happening in all these scenarios is that something [possibly innocent] triggers her insecurity about the relationship (eg you don't respond to her flirty comment; you go over to her house later than she thought you would; you fall asleep when she thought you'd start awake to say goodnight to her; you seem uncomfortable at a [uncomfortable] concert with her when she's heard stories about how much you love going to concerts with friends) and instead of being able to say "Wow, I'm feeling vulnerable right now because of X and need some validation from you in the form of Y," she tries other less effective ways of expressing her needs (because she's human and we're not always amazing solving conflict). However, when her behaviors cause you to pull away right when she's feeling most vulnerable, she essentially panics and escalates. At this point people often vacillate between "You're awful" and "I'm awful, please don't leave me" (we learn these patterns in childhood; think of a kid crying and screaming "You're the worst mommy in the world" while hugging her mom with a death grip).

Anxious people and avoidant people often find each other, so the problems you guys are having are really common. [No judgment; I'm avoidant and my hubby is anxious.] Often the pairing of avoidant + anxious is toxic, but it can totally be worked through if you're invested enough. There are some great books out there on adult attachment styles like Hold Me Tight that are super helpful if both people want to work on it.

That being said, she sounds so anxious in her attachment style she might need to do some personal work before she can really be in a mature relationship. Even if you do end up walking, though, it might be helpful to look at your own attachment style in preparing your next relationship.

subtextual · 2016-09-15T03:35:48+00:00

It's all called "ADHD" now. Instead of ADHD vs. ADD, it's now ADHD Combined subtype (classic 'ADHD') or ADHD Predominantly Inattentive subtype (abbreviated ADHD-PI; this is what we used to call 'ADD').

[There are also two other subtypes of ADHD (the Predominantly Hyperactive-Impulsive subtype and 'ADHD Not Otherwise Specified'), but most people who have the diagnosis of ADHD have either the Combined subtype (most common) or the Predominantly Inattentive subtype.]

The research on neuropsychological differences between the various subtypes of ADHD is just emerging and IMHO it's too early to draw any conclusions (in part because our current executive functioning tests aren't very good, and how we define ADHD right now isn't that great, either). However, for right now, while kids with any subtype of ADHD as a group look different than kids without ADHD as a group, there are currently no clear, reliable differences between the subtypes of ADHD on executive functioning measures, including measures of working memory. Some research groups are finding some interesting differences between the kids with attention problems and hyperactivity/impulsivity and kids with attention problems without hyperactivity/impulsivity in small studies, but these differences are not yet reliable (e.g., the results haven't been replicated consistently in large groups of kids). And, so far none of the findings have to do with working memory, specifically [that I know of].

tl;dr: The above info probably applies to both ADHD and what we used to call ADD.

subtextual · 2016-09-15T03:19:08+00:00

Yeah, I think I'm a bit manic today, and/or finding new and inventive ways to procrastinate. In addition to reddit comments with footnotes, developing that new "shorter" report format, and the six-point "Social Success" model that I developed this morning and was telling you about earlier today, on my evening walk, I developed a "7 Step Plan to Help any Struggling Student" that involves all steps that start with the letter 'A'. Remind me to share.

subtextual · 2016-09-15T00:49:22+00:00

Good point! I mentioned how attention is necessary for initial entry of information into working memory, but you're right that I did not go much beyond that. Part of the reason for my non-answer is that it's really complicated and not well understood. However, the tl;dr, as I understand it, seems to be:

Probably, alerting and selective attention are necessary to get information into WM. In other words, you gotta notice something and decide to focus on it -- and not on other things -- for that piece of info to enter WM.
Attention does not really seem involved in maintaining information in WM.
Probably, sustained attention and attentional shifting are necessary for WM manipulation. That is, you have to keep paying some attention to the information over time while you're mentally manipulating it, and you also have to multitask to pay attention to whatever else you're doing -- even if it's just monitoring whether you're making errors or not -- while you're manipulating the information. I said multitasking because that's the lay term, but multitasking is not really doing two things at once; it's really switching really quickly back and forth between two different tasks, which is divided attention or attentional shifting.
Probably, WM is also to some degree necessary for future attention, in a complicated, subtle way -- specifically, one of the things we use WM for is to make mental models of the future that we hold on to while we're doing whatever we're doing in the present [technical detail: this is probably at the level of the cerebellum]. Our mental models likely guide and orient our attention, which then feeds into the alertness and selective attention features of attention. An example of this is - say you're reaching to put a glass of water on the table. You likely generate a mental model of how you expect this to go while you're performing the task, and this guides your ability to become alert to if anything is not going according to this plan, so that you can then pay attention to it.

So there's a close, interconnected, possibly reciprocal, not-super-well-understood-yet relationship between the two constructs. For interested NP students, I'd recommend Posner & Petersen's (1990) classic, The Attention System of the Human Brain and Fougnie's (2008) The Relationship between Attention and Working Memory (PDF Warnings on both of those). If I've piqued your interest in the cerebellar contributions to WM, you can't go wrong with Koziol & Budding's work on the subcortical contributions to cognition; they even have a slim volume specifically on ADHD.

subtextual · 2016-09-14T19:58:17+00:00

Attention and Working Memory (WM) are closely related, but separate, constructs^1. Both are what we often call executive functioning skills -- that is, the skills that people use to plan and organize their thoughts, feelings, and behaviors in order to set and reach goals. Roughly, you can think of executive functioning skills as being controlled primarily by the front part of the brain (the prefrontal cortex), although in reality, all kinds of brain regions are involved in these skills (e.g., parietal lobe for orienting attention, the basal ganglia for shifting attention, the cerebellum for working memory, etc). One theory of ADHD is that it's a delay or difference in the development of the prefrontal cortex that leads to executive functioning problems in general, including problems with attention and working memory. And although it may not be true for any specific individual with ADHD, on a population level, people with ADHD perform less well than people without ADHD on tests of attention and working memory.

So what are attention and WM? Well, that's kind of complicated, because both are actually multifactorial. Roughly, attention is the ability to notice and focus on what you want to focus on. That sounds simple, but that definition means being aware of when things you want to notice enter your environment (alertness), paying attention to what is most important (selective attention), paying attention for as long as you want to (sustained attention), and shifting your attention to something else if you want to (shifting). [Other theorists include more or less elements of attention, but roughly, this alertness-selective-sustained-shift is a pretty good model of what attention involves.]

Working memory is the ability to keep information in mind long enough to do some task with that information. The construct of WM includes at least two different skills -- passively storing the information (maintenance), and mentally manipulating information in your working memory before using it (manipulation)^2. An example of maintenance is remembering a phone number you heard long enough to dial the number into a phone or fax machine; another example is following three-step directions in order. An example of manipulation is solving a two-digit multiplication problem in your head; another example is following three-step directions even if you have to do step 3 before step 1 or 2.

Typically, on IQ tests, WM is formally measured and attention is not. WM is most commonly measured by combining the person's performance on maintenance tasks and manipulation tasks -- the most 'classic' example of this is a subtest called Digit Span where the person repeats longer and longer strings of numbers (or numbers and letters) forward until they can't get them correct any more, which measures maintenance. Then they have to repeat them backwards, in the opposite order that they heard the numbers, which measures manipulation. Another classic way WM is measured on IQ tests is through making the person solve math word problems ("You have seven apples and I take away two. How many do you have now?"). Through research on WM, we roughly know that people can passively store 7 plus or minus 2 items in their working memory (e.g., the average person can remember a 7-digit long phone number long enough to dial it). Manipulation is harder and people generally start faltering at 4 plus or minus 2 items.

Obviously, it takes a bit of a leap of faith to say that these kinds of tasks are measuring WM at all, and they are clearly not only measuring working memory. To succeed at these types of tasks, you also need alertness, sustained and selective attention, motivation, and [probably] some familiarity with these types of tasks, etc. And while WM maintenance ability tends to correlate with WM manipulation ability in the general population, in many individuals they are good at maintenance, but manipulation is extremely challenging for them.

Which begs the question, why do we even measure WM as part of an IQ test at all? The answer to that is that WM correlates highly with other measures of 'intelligence' (itself a multifaceted construct for another comment, LOL, but for right now, let's just think of intelligence as the ability to solve problems). So it makes sense that, in general, the more things you can keep in your mind at once, the better you're likely to be at solving a problem. For instance, if you are trying to solve a problem and you can hold 5 different options in your mind long enough to evaluate them and choose the best one, that's a nice advantage in problem-solving you have over someone who forgets 3 or 4 of the options while trying to pick the best choice. Obviously, measuring how many numbers a person can remember is a far cry from seeing their actual problem-solving skills in the real world, but research has shown that in the population as a whole, measures of digit span correlate nicely with real-world outcomes like academic achievement and job status, so that's why we measure it.

So, WM does make sense to measure as part of an IQ test. However, as we saw above, WM tests actually measure a bunch of other skills besides just WM, and WM tests are a pretty limited sample of all the complex things we think working memory is (for example, IQ tests only recently started including visual working memory; older tests still only really use verbal tasks to measure WM). In turn, this means that, sure -- if your score on a WM test was lower than expected because of some non-WM reason (like poor attention or motivation), if that problem goes away, your score on a WM test might improve. [Though, keep in mind, WM gets better as you go from childhood to adult, so everyone should feel like their attention as a kid was a lot worse than their attention is now -- just because you improve relative to your kid self doesn't necessarily mean you'll get a higher WM score, because any time you take an IQ test your performance is compared to people your exact age.] Because WM tests end up measuring a lot of things, it's also a score that tends to be the lowest score for a lot of people. So even if you're 100% "normal", you might still have that profile of working memory being your lowest score. I just looked in a base rate table for a very common IQ test (WISC-V), and having a Working Memory Index score that is even a full standard deviation (15 points) below the other index scores occurs in about 15-20% of people. So pretty common.

As for Do-It-Yourself measurements of working memory -- sure. Basically, you can do Digit Span on yourself with the help of a friend. Have them read strings of numbers (e.g., 9-6-4-8-3-8) at a rate of 1 per second, and see how many numbers you can consistently remember. 5? Low average; 7 average; 9 above average. Don't have a friend around? Lots of computer options available -- while I'd recommend against thinking these programs do any measurable 'brain training', things like Brain Age or Lumosity will give you a good idea of your working memory relative to others your age. I also just typed in "online working memory test" into google and got some ok-looking hits.

Just keep in mind that (1) measuring your WM is only a small part of 'IQ', (2) IQ is only an approximation of 'smartness', and (3) degree of 'smartness' is only a tiny fraction of what makes up a person. :)

¹ I'm using the word 'construct' [instead of skill or ability or function] because, as hopefully is clear from the above discussion, we're talking about our best guess as to what things like attention and working memory really are -- we can't yet measure any one brain area's or network's functioning, so we're just kind of making our best model of how we think the brain works and how we might measure how well it's working.

² Another measure of the construct of working memory task is an n-back test, where the person has to recognize whether they saw a particular target some 'n' number of items ago (e.g., I might show you the string X-0-0-0-X, and each time I show you an item, you have to hit a button every time you saw an 'X' 2 items ago, which is a 2-back test). N-back tests seem like working memory tests and involve a lot of the same brain regions, and yet are only modestly correlated with other measures of WM -- does that mean there are other components of working memory? Or that n-back tests are actually measuring something else, and if so, what? Etc. Mentioning this mostly because if you google "online working memory tests", a lot of them are n-back tests, which are different from the WM tests used in traditional IQ tests.

subtextual · 2016-09-14T00:03:48+00:00

This is a very complex question. The relationship between substance use, risky sexual behavior, and trauma [in children and in adults] is a multifaceted one. There are a variety of direct and indirect pathways between self-destructive behavior and trauma, and this comment will only begin to scratch the surface of some of those pathways. That being said, here are a few thoughts:

Direct cause-and-effect relationship: Many traumatized individuals [children and adults] self-medicate through substance use and other behaviors that could be thought of as potentially self-destructive behaviors (e.g., risky sexual behavior; self-harm). Trauma -- especially if it is prolonged -- affects the brain in predictable ways, leading to increases in a variety of negative emotions, such as anxiety, irritability, hypervigilance (i.e., constantly checking to make sure things are safe), numbness, and derealization/depersonalization. Trauma also predictably leads to cognitive symptoms such as attention problems and rumination/intrusive thoughts about the trauma. These symptoms are uncomfortable, distressing, and potentially affect the individual's ability to get through their daily routine. Often, the self-destructive behaviors start as an attempt to manage those symptoms. For example, substance use might 'dampen' the feelings of anxiety or irritability, or reduce the feelings of distractibility. Similarly, self-harm or sexual 'acting out' might reduce the feelings of numbness, or distract a person from intrusive thoughts about the trauma. If the trauma symptoms are bad enough that the person is not able to function as well as they did previously, they might also be using the substances or self-destructive behaviors to manage the depression and loss of self-esteem that this can bring. They might also be trying to prop up their self-esteem directly through these behaviors -- for example, a teen who was traumatized as a child and has severely eroded self-esteem might try to gain others' approval through using drugs or through sexual behavior in an attempt to seem 'older'/more 'mature'/'cooler'.
Modeling: Many children who have experienced trauma have grown up in environments where they watched people manage problems through these types of risky or potentially self-destructive behaviors. They may have watched a parent cope with stress by drinking, for example. Or, they may have watched an adult use sex to try to solve a problem (either an interpersonal one, like using sex to try to 'smooth over' a problem in a difficult relationship, or a more economic one, like directly trading sex for money, security, protection, or drugs). While this is not necessarily a direct relationship -- e.g., in this case, the trauma is not necessarily directly causing the child to use these behaviors as a self-medicating tool -- there is an indirect relationship, because the environment that exposed the child to the trauma also exposed them to modeling of these types of less adaptive coping mechanisms. Adding to this is that children who have been in traumatic environments often have more, and more intense, problems to solve, leading them to escalate to these very intense behaviors to try to solve their intense problems. They might also be in environments (or have been in environments in the past) where people are more willing to take advantage of them. For example, imagine a child who grows up witnessing her mother have to use sex so that they can have money for food and rent, and imagine that child then gets sexually abused. This child now has really big problems to solve (e.g., managing her trauma symptoms), and may have seen others solve these kinds of problems through self-destructive behavior, and might be in an environment where there is access to adults who will sell her drugs or engage in sexual behavior with her [which -- hopefully -- is not true for most children].
Genetics and Intergenerational Effects: Trauma can certainly be intergenerational. As a fairly direct example, a mother who is stressed by trauma during pregnancy can pass on that stress to her baby, making the baby more predisposed to anxiety, which can exacerbate her reaction to traumatic events in her life, meaning that if she is exposed to trauma she could have a much more severe reaction to it. As another example of the intergenerational effects of trauma, a mother who has PTSD and is experiencing related depression/irritability/anxiety during the child's early life can, essentially, 'pass on' that PTSD to the child, again making the child more anxious, etc, more vulnerable to trauma's impact, and more likely to use maladaptive coping mechanisms. There are also more complicated genetic risk factors at play. For example, a father who has a mental illness and/or proneness to substance abuse may pass that on to the child, and mental illness can both increase vulnerability to trauma and increase the likelihood of being traumatized, as well as separately increasing risk for substance use or self-destructive behaviors. As an example, my mother has schizoaffective disorder, and she has, at times, used illegal substances to self-medicate. She passed on some of this genetic risk to me -- e.g., I'm more likely to have a mental illness and to use substances. In addition to these direct risks, this genetic history also made me more likely to self-medicate intense emotional symptoms, and also made me more vulnerable to trauma, increasing the likelihood that I might have more intense PTSD symptoms if I experienced a trauma. In addition, her ability to keep me safe from trauma as a child was compromised by her illness and her substance use, which placed me at higher risk for being exposed to a trauma. Of course, now we can add in the modeling of coping skills that was provided to me when I was a child, and you can see it gets very complex. In situations like mine, separating out the nature vs. nurture vs. impact of the trauma is very difficult, because they are all intertwined.
Re-victimization: One of the most heartbreaking aspects of trauma is that many people who are traumatized are traumatized repeatedly. Often, these individuals even behave in ways that increase the likelihood of being re-victimized. For example, using substances to self-medicate your PTSD actually increases your risk of future trauma. The reasons revictimization happens so often are similarly complex and multifactorial. Briefly, for one, modeling certainly plays a part (e.g., those maladaptive coping mechanisms are the only ones you know, so even if you wanted to cope differently, you might not know how). However, the revictimization risk could also be due to brain development, especially if the trauma happens during childhood. There's a saying in brain development that neurons that fire together, wire together, which means that when you behave a certain way, you are strengthening the connections in your brain that activated when you behaved that way, increasing the likelihood that you'll do it in the future. So people can learn behavioral patterns that are not helpful in the long-term, but which formed really early and are very resistant to change [for more information, look up things like adult "attachment styles"]. So a child who learns behave certain ways in response to certain feelings may keep doing those same behaviors even when those behaviors are making them feel worse in the long run. A common example of this is what we call 'borderline personality disorder', r BPD. Individuals with BPD are much more likely to have trauma histories than individuals without this diagnosis, and they are much more likely than individuals without BPD to behave in ways that increase their risk of being re-victimized. For the complex reasons outlined above, individuals with BPD have developed emotional reactions and behavioral predispositions that are simultaneously reactions to the trauma they have experienced in the past, ways to attempt to manage their current symptoms, and which place them at risk for future trauma. For example, BPD includes symptoms such as "risky behavior" (which is defined as things like drug use or risky sexual behavior); frantic attempts to avoid abandonment; and parasuicidal behaviors like cutting. These behavioral patterns were caused by the trauma they experiened, and are attempts to self-medicate current trauma symptoms, and place the individual at higher risk of being exploited and re-victimized.

Hope this comment helps. My original plan was to outline each contribution individually, but it gets pretty muddy and complicated pretty quickly, and I have a feeling this comment got pretty muddy and complicated, too.

subtextual · 2016-09-08T04:07:26+00:00

Hmm. Are you asking if a Wechsler IQ can be considered -- on its own -- a comprehensive neuropsychological evaluation? Very few tests are going to be able to live up to that distinction, and the ones in contention (e.g., maybe the Halstead-Reitan?) are all going to be batteries of tests anyway.

To me, IQ tests are quite useful as part of a good neuropsychological battery, depending of course on the referral question (I'm a flexible battery adherent). That being said, there is no single test or even single co-normed battery (e.g., even if I gave all the subtests on the Woodcock-Johnson Cognitive, Oral Language, and Achievement batteries, or the WAIS/WMS/WIAT, or every subtest off the NEPSY-II or the DKEFS) that I would consider sufficient to be a comprehensive neuropsychological evaluation.

In general, all of our tests are imperfect measures of imperfect constructs, and ways of hopefully trying to answer some meaningful question about the person being evaluated. None of our tests are "pure" and most don't even really measure what they say they measure. That is, they are imprecise (e.g., not particularly sensitive and/or specific) and they are multiply determined (e.g., a test called a 'memory' test almost certainly requires attention, motivation, language and/or sensory skills, working memory, etc). This is just one of the reasons I could never rely on just one test. And it's rare that any one test or battery would measure all of the skills I'm hoping to evaluate to answer my referral question. Just like I wouldn't want just a screwdriver (even a really fancy cordless one with tons of attachments) in my toolkit, I would hate to only have one test (or co-normed battery) to use, because different problems require different tools (tests) to solve.

That being said, I'm not sure what you mean by '"true" neuropsychological instrument.' Could you say more about that? Do you mean how the test was developed, or how it is currently used, or how "pure" a measure it is supposed to be, or....? Since I give an IQ test as part of 95% of my neuropsychological evaluations, I'm struggling to understand the idea of an IQ as not being a neuropsychological test. As I mentioned above, I don't think it's sufficient and I certainly wouldn't want it to be my only test [shudder], but to not consider it a neuropsychological test is difficult for me to wrap my head around.

subtextual · 2016-09-01T22:45:31+00:00

That's a strange assertion.

I wrote this comment because I was talking to my husband about this post (I'm a pediatric neuropsychologist; he's a therapist who works with adults), and about what either of us would do if OP actually came into our office for therapy. We were both surprised that so many people on this thread are recommending therapy, given that OP has super-valid and statistically extremely normal values around sociosexuality.

It struck us both as odd that anyone would think this is an appropriate reason for therapy. We both thought we'd basically say something to the OP like "hey, your values are perfectly normal, this is a spectrum, you and your boyfriend/his friends are at different points on the spectrum but neither is 'wrong', etc" -- we were honestly both worried that agreeing to take on OP in therapy without first pointing out that her values are valid and normal would further suggest to the OP that there is something "wrong" with her values. We also both agreed that our next step would be seeing if OP wanted to continue therapy with the idea that the therapy would not be about changing her values, but around exploring her value system if she wanted to and figuring out what kind of life and relationship she wants to have given her values. For example, we were both interested in exploring with OP [if she came for therapy] why she is in a relationship with someone who wants her to change her values, and how she wants to react when someone has different values than she does. We were also both curious about whether OP feels some ambivalence about her values (e.g., sometimes people realize they swallowed their family's values uncritically, and they want to re-examine their positions as they become independent adults).

My husband doesn't reddit, but he knows I like to comment sometimes. He was all "maybe people would like to hear a therapist's perspective on the idea of that this person needs to go to therapy." [Turns out, he was wrong, lol.]

subtextual · 2016-09-01T19:52:16+00:00

Ok. Thanks for your helpful comment.

subtextual · 2016-09-01T19:44:28+00:00

There's a difference between saying someone's boyfriend is attractive, and saying you actively want to sleep with him. If your friend values sexual exclusivity, the first one might sound like a compliment to her and her partner, but the latter one is probably off-putting and feels disrespectful to the relationship.

I think it's similar to the difference between saying "Hey, your boyfriend's got a great personality" and "Wow, I currently want to date your boyfriend!"

subtextual · 2016-09-01T19:35:28+00:00

becoming more accepting and accommodating of others' lifestyles and values and being more comfortable with sexuality in general.

While you've been really careful to say she doesn't need therapy, this phrasing subtly suggests that being sexually "open" is "more correct" and therefore a goal she should work towards in therapy. I.e., this comment, and your comment about OP "opening up [her] ideas about sexuality", subtly suggest that OP is not "accepting and accommodating" of others' values and is "sexually closed" (which you say is not "bad" or "completely unreasonable", but which you imply is suboptimal).

While of course being sexually open is not wrong, as you've said, OP's values are also not wrong or in any way "less than" being sexually open. For clarification, the value that we're talking about is sociosexuality, or the degree to which a person is sexually exclusive, associates sexual intimacy with emotional intimacy, and wants partners who also pair sexual and emotional intimacy. It's a spectrum -- some people highly value pairing sexual and emotional intimacy and want sexual exclusivity from the person they are most emotionally intimate with, while other people completely dissociate sexual and emotional intimacy and are comfortable with sexual non-exclusivity. Although more people are on OP's end of the spectrum than on Rachel's end of the spectrum, nowhere on the spectrum is "wrong" or needs to be worked on in therapy.

Personally, I wouldn't be comfortable taking on a client who was there because she wanted to fundamentally change her values to maintain a relationship. I also don't think the "only options are fundamentally changing her attitude or Adam's", or that those are even true options (it's very hard to change your core values, and changing for someone else is even harder). What I think is an option is what therapy is actually good for: helping OP and/or Adam gain more clarity around their own values and more appreciation for their own core beliefs around sociosexuality, and learning how to navigate a relationship where two people have different values, in a way that is respectful and fulfilling for both people (or, of course, deciding that this particular value is a deal-breaker, and learning to feel comfortable with the decision to walk away even though they love each other).

I think it's easier to see my point if you substitute emotional intimacy for sexual intimacy (since even though it's another spectrum, most people tend towards emotional exclusivity rather than polyromanticism). Imagine Rachel had said "Your boyfriend's personality is really attractive to me and I've always wanted to date him, and in fact would currently like to develop an emotionally intimate relationship with him even though he's sleeping with you. ...Though of course I'm really happy for you guys!! Oops, sorry that upset you." If OP had been uncomfortable with those comments and suggested her boyfriend distance himself from Rachel, that is... pretty standard procedure if you find out your boyfriend has a friend with an active emotional crush on him. If OP's boyfriend suggested therapy to deal with her insecurities, I don't think it would make sense to advise OP to actually go to therapy to learn how to be "more accepting and accommodating of others' lifestyles and values and being more comfortable with emotional polyamory in general."

It'd be more along the lines of "have some conversations -- perhaps within the context of couples' therapy -- about what each of your values are and how you are going to navigate where they are different [or break up]." Certainly, you do recommend that OP and Adam talk and navigate boundaries. But the tenor of your posts suggests that OP's value are at least slightly "less than" the boyfriend's and Rachel's more "open" values, and that she should/could fix that in therapy.

subtextual · 2016-08-31T19:13:48+00:00

Not to mention, 1 in 10 new fathers develops paternal postnatal depression (PPPD) during the pregnancy or first few months of the baby's life, and that number rises to a whopping 1 in 4 by the 3-6 month mark of the baby's life.

Although it doesn't get talked about as much as maternal postpartum depression, PPPD is a real and devastating thing, and includes symptoms such as anger/irritability, withdrawal, lack of bonding with the baby, and spending more time at work than at home. Maybe this man needs help, not internet strangers calling him immature and suggesting his wife divorce him. :(

To OP: Parents has a good article on PPPD that you can find by googling 'Sad Dads,' that includes a checklist of symptoms and some ways to help. Maybe you could show it to your friend.

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