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Dr Kirk Honda answers upper-tier patron emails.


00:00 What schema is glass child syndrome?

07:09 Why do some children compulsively lie?

16:33 What is the difference between intuition and projection?

31:01 Is it possible to fall in love with yourself?

32:12 Are somatic symptoms delusions?

42:47 OPP

44:21 What is the difference between schizophrenia and schizoaffective disorder?

45:44 Is there life after a schizophrenia misdiagnosis?

1:05:47 How can we manage intrusive thoughts?

1:08:58 Why does a psychological diagnosis take so long?


January 6, 2023

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Trigger Warning: This episode may include topics such as assault, trauma, and discrimination. If necessary, listeners are encouraged to refrain from listening and care for their safety and well-being.

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Anonymous

So happy you talked about intrusive thoughts cause I have these all the time since I was a kid and also with my cats and then when I have them with my cats I’m like oh no my cats going to think I want those things to happen

SeattleTransAndNonbinary ChoralEnsemble

Respectfully, I disagree with your characterization of distinguishing delusions vs the intrusive thoughts of OCD, which as I understand it is insight. Someone with hygiene OCD has an extremely unpleasant and strong feeling that eating a food someone else touched will give them worms (this can also overlap with orthorexia) or that a pimple on their skin is a parasite. Cognitively, they understand that this is extremely improbable and believe others when they reassure them that it’s not dangerous, but their mind keeps spinning them through loops of “but what if I’m the .01%?” Part of the distress of having OCD is the cognitive dissonance between knowing rationally that what you’re feeling is dumb and false, but not being able to stop feeling that way. Whereas someone with delusional parasitosis is fully incapable of understanding, without a major change in their mental state (dopamine antagonists etc) that the food isn’t going to contaminate them or that the bump is not a worm under their skin. People with morgellon’s can have either one of these pathologies. If after getting some sleep you can think to yourself “well maybe it’s just a pimple and I’m stressing myself out” then likely you fall in the first category and should stop looking at Morgellon’s websites written by the other category. If you fall into the second category, you know to the core of your being that Morgellon’s is a real illness and rather than being able to accept any evidence to the contrary you will attempt to invalidate it and dig through other conspiracy theories to ‘prove the scientific consensus wrong’. The ability for patients with intermittent psychosis to be able to reflect while lucid on a past time when they believed a delusion without falling back into it, is what we call insight and is one of the key indicators of whether treatment is succeeding or not, since if another delusion starts to emerge like “the cops are following me in undercover white vans” that can be leveraged into “I hear that it seems like undercover police vans are always nearby, but remember when a month ago you were talking about someone putting worms in your food which turned out to be just a trip? What are some strategies you could use to assess whether a suspicious looking car might actually be following you, such as taking a different path or even walking closer to “ask for directions” to see if there are police inside?” With the hopes that they will connect the dots between “none of the food turned out to be poison when taking my meds” and “maybe some of the white vans are just white vans who aren’t actually paying attention to me and where I’m going.” And strengthen the link between questioning perceptions and self-awareness instead of between paranoia and stimuli, in a way that won’t alienate them like laughing at them or condescending or calling them flat out wrong. Also, on the subject of drugs that cause mania, this can be a side effect of frequent nitrous oxide, pcp or ketamine abuse, that starts after these drugs have worn off but persisting for days, in combination with sleep deprivation. that is not as frequently discussed as cocaine and methamphetamine psychosis. Some of the long acting analogs like 2-meo-pcp are particularly dangerous in regards to this. But even organic hypomania has many downsides - disorganized task completion, neglect of ADLs, hypersensitivity, annoying the people around you with the constant chatter, etc, that I think that even if there were a button we could press to make us manic for a day, people would learn pretty quickly not to press it often or in situations where it would have deleterious consequences.

PsychologyInSeattle

Thanks for sharing. You know your stuff. I think I was referring to folks with OCD who might believe that god will send their family to hell if they don't pray all day.