Now that the abused child has split off memories of abuse, they have a second equally significant problem, which is to create an illusion for themselves that they are living in a safe environment. Splitting is the perfect defense for the abused child because not only is it able to isolate the unacceptable aspects of the parents in the unconscious, but, equally importantly, it is able to create a fantasy-based view of the parent out of their neglectful, indifferent or abusive parent(s). This psychological mechanism begins when the child selectively takes those few moments of attention or tenderness that has been shown to them by their parent and magnifying them and creating a “better parent” . The process is the same, in that the few positive incidents from the real parent are split off from the actual parent, and are forced into their unconscious as well. This view of the parent (which is unrealistic) is "enhanced by the child’s unmet needs and [their] use of fantasy." The child holds a view that somewhere in their parents heart there is a hidden storehouse of love, if they only knew how to reach it. This fantasy-based view of the parent is called "the Exciting Object" in Fairbairns model, as the child feels excitement when they fantasize that they have a loving parent. The childs part-ego (or self) that relates to the Exciting Object is called "the Libidinal Ego". In Fairbairns model, Libidinal means loving.
This involves no radiation, no needles and no contrast agents that may cause allergic reactions. This test has good sensitivity and specificity.Typically duplex ultrasound scan is the only investigation required for decision making in carotid stenosis as it is widely available and rapidly performed. However, further imaging can be required if the stenosis is not near the bifurcation of the carotid artery.One of several different imaging modalities, such as a computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA) may be useful. Each imaging modality has its advantages and disadvantages - Magnetic resonance angiography and CT angiography with contrast is contraindicated in patients with chronic kidney disease, catheter angiography has a 0.5% to 1.0% risk of stroke, MI, arterial injury or retroperitoneal bleeding. The investigation chosen will depend on the clinical question and the imaging expertise, experience and equipment available.For purpose of treatment, the degree of carotid stenosis is defined as:
percent stenosis = ( 1 − ( minimum diameter within stenosis) / ( poststenotic diameter ) ) × 100%. Screening
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for carotid artery stenosis in those without symptoms as of 2021.While routine population screening is not advised, the American Heart Association and the Society for Vascular Surgery recommend screening in those diagnosed with related medical conditions or have risk factors for carotid artery disease.