influences: The;9:99G'1000.{. & Simonoff,iew of research

P. & Bailey, A.rirical findings.

,rplay and psy-

Psychology and

s ol cognition:328.

and individual

(1996) Attach-rst year of life.

,n: Oxford Uni-

in securely and

'ic conditions in

attachment. Intonships (Vol. 5,

oks.

r of separation-Psychiatry, 133'.

g on attachmentrsiveness among457-t477.vI.J. (1999) Dis-rsors, concomi-

In J. Cassidy &clinical applica-

ton, G.G. et al.

0+135r.rsick, R. (2008)

r Cummings.

c acids. Nature,

Chapter 2

Ref ational traum a and thedeveloping right brainThe neurobiology of brokenattachment bonds

Allon N. Schore

Over the past two decades I have integrated ongoing scientific studies andclinical data in order to construct regulation theory, a neuropsychoanalyticmodel of the development, psychopathogenesis, and treatment of the implicitself. Towards that end, in 2001 I edited an issue of the Infant Mental HealthJournal, and in it I offered an article, 'The effects of early relational traumaon right brain development, affect regulation, and infant mental health'. Inthis chapter I build on that work and provide very recent interdisciplinarydevelopmental data that allow for a deeper understanding of the psycho-logical and biological effects of early relational trauma. A particular focuswill be on current studies of the early developing right brain, the biologicalsubstrate of the human unconscious and the site of the highest cortical-subcortical regulatory centers. This interpersonal neurobiological modelexplicates the mechanisms by which attachment trauma negatively impactsthe developmental trajectory of the right brain/mind/body system over thecourse of the lifespan. Also discussed is the etiology of pathological dissoci-ation, the bottomline defense of all early-forming severe developmentalpsychopathologies. Pierre Janet (1889) defined pathological dissociation as aphobia of memories, expressed as excessive or inappropriate physicalresponses to thought or memories of 'old traumas'. It is now clear that these'old traumas' specifically refer not just to childhood traumas but also torelational trauma occurring in infancy, the critical period of attachment. Thistheoretical perspective has direct clinical applications for models of bothtreatment and prevention.

Developmental interpersonal neurobiology ofsecure attachmentThe essential task of the first year of human life is the creation of a secureattachment bond of emotional communication and interactive regulationbetween the infant and primary caregiver. There is now agreement that'learn-ing how to communicate represents perhaps the most important develop-mental process to take place during infancy' (Papousek & Papousek, !997),

I

20 Schore

and that 'In one sense we can consider the whole of child development to be

the enhancement of self-regulation'(Fonagy & Target, 2002).In line with theessential attachment elements of affect communication and affect regulation,Schore and Schore (2008: 10) now suggest that:

In line with Bowlby's fundamental goal of the integration of psycho-logical and biological models of human development, the current clinicaland experimental focus on how affective bodily-based processes are non-consciously interactively regulated . . . has shifted attachment theory to aregulation theory.

Secure attachment depends not on the mother's psychobiological attunementwith the infant's cognition or behavioq but rather on her regulation of theinfant's internal states of arousal, the energetic dimension of the child'saffective state. Through nonverbal visual-facial, tactile-gestural, and auditoryprosodic communication, the caregiver and infant learn the rhythmic struc-ture of the other and modify their behavior to fit that structure, thereby co-creating a specifically fitted interaction. During the bodily based affectivecommunications of mutual gaze, the attuned mother synchronizes the spatio-temporal patterning of her exogenous sensory stimulation with the infant'sspontaneous expressions of endogenous organismic rhythms. Via this contin-gent responsivity, the mother appraises the nonverbal expressions of herinfant's internal arousal and affective states, regulates them, and communi-cates them back to the infant. To accomplish this, the sensitive mothermust successfully modulate nonoptimal high or nonoptimal low levels ofstimulation that would induce supra-heightened or extremely low levels ofarousal in the infant.

In order to enter into this communication, the mother must be psychobio-logically attuned to the dynamic crescendos and decrescendos of the infant'sbodily based internal states of autonomic nervous system (ANS) peripheralarousal. Indeed, the intersubjective dialogue between mother and infant con-sist of signals produced by the autonomic, involuntary nervous system inboth parties. The attachment relationship mediates the dyadic regulation ofemotion, wherein the mother co-regulates the infant's postnatally developingANS, and thereby its internal homeostatic state. Also known as the vegetativenervous system (from the Latin vegetare, to animate or bring to life), it is

responsible for the generation of what Stern (1985) calls vitality affects.

Research now clearly demonstrates that the primary caregiver is not alwaysattuned and optimally mirroring, that there are frequent moments of mis-attunement in the dyad, ruptures of the attachment bond. The disruptionof attachment transactions leads to a regulatory failure and an impairedautonomic homeostasis. In this pattern of interactive repair' followingdyadic misattunement (Tronick, 1989) or 'disruption and repair' (Beebe &Lachmann, 1994), the 'good-enough' caregiver, who induces a stress response

'). I

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22 Schore

&Galaburda,1987;Schore,|gg4)-whichisdeeplyconnectedintothelimbic,yri"- (Tucker, 1992; Gainotti, i000) - is undergoing a growth spurt at this

time, attachment communications specifically impact lim!1c -and

cortical

u..u, of the developing right cerebral brain (Cozolino' 2002; Henry' 1993;

Schore, 1994, 2000,2005; Siegel, 1999)'_ rnoeea, in |997 Chiron u-no n.' colleagues published a .developmental

neurobioiogical study entitled ,The right brain hemisphere is dominant in

human infants'. ln subsequent neuropsychological research on-emotional

lateralization in the second year oflife, Schuetze and Reid (2005:207) stated,

;Attt ougt the infant brain was historically reported to be undifferentiated in

terms of cerebral lateralisation until 2 years oi ug., evidence has_ accumulated

ln]ilutmg that lateralised functions are present much earlier in development''

They fuiher observe .lateralisation oi negative emotional .production

to

,tr" ilgft, hemisphere in infants as young as 12 months of age" and 'a devel-

opmental enhancement of right hemisphere control of negative emotional

.ipi.rrlon that is evident by 2? month'i' Mott recently' Howard and Reggia

(zool:tl2)conclude,'Earliermaturationoftherighthemisphereissupportedby both anatomical and imaging evidence''

-In my ongoing work I

"-onlinu. to offer data which indicate that the

attachment mechinism is embedded in infant-caregiver right-hemisphere-

to-right-hemisphere affective transactions, and that this interpersonal neuro-

biological model is supported by a large !"91. :f recent.dwelopmental

,.r.ui.r, (Schore, piq,'iooo,2003b, in press). with respect to visual-facial

attachment communications, it is now established that the development

oiin. .upu.ity to efficiently process information from faces requires visual

input to the right (and not ieit; tremisptrere <luring infancy (Le Grand et al.,

2003). Developmental neuroscience documents that at two months of age'

the onset of a critical period during which synaptic connectio-ns in the devel-

oping occipital cortex are modified by visual experience (Yamada et al''

zbOOi, infunts show right hemispheric attivation when exposed to a woman's

face'lTrorrrio-Mazoyeretal',2002)'Recentnear-infraredspectroscopyi.r.ur.n (perhaps the most suitable of all neuroscience techniques applicable

tohumaninfants)revealsthatspecificallythefive-month-olds'righthemi-,prr.i. responds to images of adult female- faces (Nakato et al., 2009; Otsuka

et aL.,2007).Closertoaninterpersonalface-to-faceperspective'anelectroencephal-

ography GEG) study by Grossmann et al' (2007) reports. that four-month-

oia intuni, presented wiih i-ug.t of a female face gazingdirectly ahead show

enhanced gu*-u electrical actlvity over right prefrontal areas. These authors

conclude ihat the brain mechanisms underlying eye gaze perception show a

tigt a"g."e of specialization early in ontogeny, recruiting areas in the right

n.l-irpi"r.. other researchers have established that mutual gaze activates

face-piocessing areas ofthe right hemisphere (Pelphrey et aI" 2004)'

In terms of tactile-gestural-attach-"nt "o**unications, Nagy (2006: 227)

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iiic cilccts of- toticit on tirc cil'eiti1.rit.rl,. t'ight heruisilltcrc. atrcl asselt thltt thc

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|u-1ci t6 titc lcli sirlc oiiire bociy. Siuciic: i.llso (ir''monsilatc titat sllollilillcoil-q

1:cs'Lnr'.'s lhai cx1'ri css lcciing sitil,cs coinnilrniclttccl rvititirt it Ci'itci ltc'.ir'.Lte

ligii'. hcrnisithcrie sir''.tcii-trcs (Galllli:her' & I'r'ith. 2004). And tl.tii't'oi ilcilloill'csculciicls 1to$'coniclrcl 1.hat cl:i,cloiringi chikil'cn i'ci1, ott a 'rigitt hcn'risphcrc-

rnii'ioiilt!: rncclianislir intcl'1'acir.rg rvittr tirc irubic sysicm iltai l.lt'oce:sr-: iiltrr.rcaninl: o1'obsclvcci oi ir,tiiaicd ctnotion^ (Dllpi ctlo ;t al.. 2.00(r).

As tot' ai-lciitoly ltiosoclic atiaclurrciri coinr.i.rr-ll.ticrttion:. i-lt'osociic l"lt'oeess'

i;!: ilt thlcc-r.iion"rir-oici iniari: activuics tirc rigiti tctitnot'<t1t:lt'ietiii l'c3.iotr

(llontac ci ai." 2006). ;\t ii nton'Lirs lhc voicc oi'u rvotiriut's chilci-c1ir'-c1cci

:,1'rclch (i.t. rviiii somui'liut cra-r1:ciatcci ul'osciei1,) clicits a iight-iatelitlizedcvcl.rt-r'cirtcr.i polci'rtial (t:[{P) ( i'iriclri'c'. r11.. ?-003). Accolciing io l}t,'!:o1c1lova

ailci ):laloico'a (2(X)l: 353):

ihc ligiri ireitrisoircre of'tirc ncorutc is activcl)'invoivccl in i1-,c t.t.'r'cc1-',iott

o1' sl'rcccil mcloci;' ilild thc itltotriliiotls o1' tit,.- voiccs ot' lrolilcl' i)llci

s'.tlroiltciiur,l ltco1t1i:. i-irc lrrc-spcech siitgc ol'chi1d clcveloptt.tct'li is citllr--

itcielizeci bY ilicl'uctior.rs <tf titc clescl'iptir,e zrtirl cn.totioltai cotrtl.rottcirts

cii-ic nt1iit11' to iurtchanisrls olrcilLr.lilg rvitirin litc iicnispitct'cs oli iircpli ncipic o i- t.tou-" citril l corutt-ttt tiicai io il.

.Anri tll ihc olircl siclc ot'thc uttachll'iclt clyitti. tcscilicitcrs noii' cicsciibc ijrcmotircr"s i.lir.rccssing capacitics: '.2\ nrurbct' oi' litnciioits locaiccl r-;itltiir titcri1:iri hcir.lisliiclc n'oil' togciircl-lo llii tr.rotlitorirlg oi- ll blibl'. As *,'.:11 iis

ct-itotion a;rci lircc i-l'oc;-.sing lire iighl iicilisnhclc ts alstt sttcciaiizcti irr

itilciitoif itclccl.riictit. thc l;r'ccption oi ii.ttott.Liion. ;.1'.',ctirirttr" liticl illclilcinlirnraiiori' (Ilounic &'lbcici" ?.(\(\4: ),?, 23).

-Ihis iighi iatcraiizcci s)'s1clu storcs a r'ocilbtiiary ol'trotrvctbal ai]'cctivc

tirciul r.ritlrssioi.rs. LrcstLlrcs. arci plosocly^ r'ight braiir siltnliis ttscri in lrllilicitlltuchutcl.rt ct>rnl.r.rLinicutions (scc Schorc's inoclel ol'aficct r-cgt-iilttiori llritiiig[t blairr clcr'cloprnent iir Iiiiric 2.1). 'firc oLltput o1'tirc ligitl irctt.iisDllct'c.'lilc ciitotioltitl i>t'ltil.r^. is a cottsciotrs aliect.'l'hc highcsi ccilicls of this

licr"irisplicrc. csltcciaill' tirc ol'bitolloiriui (r'cn'tt'ourcclial) corte\" iitc loctrs ofllori'Ib1,^: allaciuitcill sysiL-n.]" act as thr- .'['iiiil"s li. osi cotnplcr. ailcct atrel stt'css

lcgriiator'1' sysictil (Schor';, i99,i. 2.003a. 2(X)3b; Sr,riijvau & Glaiton. 2002).'Iilc oi'gut:izatioil oi'ricuriiitic aircl syiriiptic tcinot"i.s iir tltc orbiiolt'orltai(1nc1 ui-ricl'iol cir:llliluic) coiicx^ iuciticling iis coirneciioirs iltto liic iimbic:

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28 Schore

Confirrning this right-brain-to-right-brain interpersonal neurobiologicalmodel, in very recent lunctional magnetic rcsonance imaging studies ofmother-inf'ant emotional communication Lenzi et al. (2009) offer data .sup-

porting the theory that the right hemisphere is more involved than the lefthemisphere in emotional processing and thus, mothering', and Noriuchi et al.(2008) show activation of the mother's right orbitofrontal cortex duringmoments of maternal love triggered by viewing a video of her own infant. Anear-infrared spectroscopy study of inf ant-mother attachmen t ar 12 monthsconcludes, 'our results are in agreement with that of schore (2000) whoaddressed the importance of the right hemisphcre in the attachment system'(Minagawa-Kawai et al., 2009: 289).

At the end of the first yeaq right cortical subcortical circuits imprint inimplicit-procedural memory, an internal working model ol attachmentwhich encodes strategies of affect regulation that nonconsciously guide theindividual through interpersonal contexts. This working model generatcsunconscious 'procedural expectations' of the emotional availability of othersduring stress (cortina & Liotti. 2007). Although these cxpectations are notexperienced as left-brain conscious thor,rghts, they arc consciously experi-enced as subjective right-brain affectively chargcd, cmbodiecl cognitions('gut feelings'). At all points of the lifespan attachment communicationsare expressed not in lcft-brain secondary process but in right-brain primaryprocess cognitions (Dorpat,2001; Schore & Schore,200g; Schore, in press).

Attachment neurobiology of relational traumaoptimal attachment communications directly affect the maturation of thecentral nervous system (cNS) limbic system that processes an<I regulatessocial emotional stimuli and the autonomic ncrvous system IANS) thatgenerates the somatic aspects of emotion. It is important to stress that agrowth-faciliterting emotional environment is required for a child to developan internal system that can adaptively regulatc arousal and an u.roy ofpsychobiological states (and thercby affect, cognition, and behavior). Thegood-enough mother offers her securely-attachcd infant access to her aftera separation; she tends 1o respond appropriately and promptly to his/heremotional expressions. She also allows high levels of positive affect to begenerated during co-shared play states. Such events scaffold and support anexpansion olthe chiid's right-brain regulatory coping capacities and unclerliethe developmental principle that secure attachment is the primary defenseagainst trauma-induced psychopathology.

In contrast to caregivers who foster secure attachment, an abusive orneglectful caregiver not only plays less but also induces encluring negativeaffect in the child. Such caregivers provide little protection against otherenvironmental impingements, including that of an abusive father. In contextsof relational trauma this carcgiver is emotionally inaccessible, given to

)9

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iniiltl.lt'ct1.l'iuic itltd/or ruljcctiiri: r;iDonsc.; ict hct' iitittlti"t; !\i)1'ci:;ioiis ol cino-iiol:s i:ncl, s',Lc:s. ancl il'ovicies ninin'vli o;' lLirll'cilicilt.ttc :'clrtrllittoll ot- iilaiiriiritl"s s'.uies o1'uvci'-liiouslil. insl.ca<i. .ltc iilclilcls c\iie1\te luve is oi'siiirlltirl-iioir aiici uloiisai (i.c.. tirc ieil'hiirir siili.r-iia'rioir cj'itJLi'iJ:lttci/o,'ihc vci)'ioii':ii;nlililiol ct' negiccl). Aiicl 1nuli1,. blclliite sitc ttt.oi'iclcs tto itll.i.tcilt,-'|ei-lllii'^ sirc icltvcs l,lc illiirrli to ct'tciiLt'; t:"'t-''t'ittci\':l'iics-sj'Lti iiliclt:c 'l''u':iirlsiaics iix' ionli ircliocis ot'iiir.rc.

-l itclc is ltow c\iL'nsi\c evicicrrc; 'riilil sit'css is ii ciilicli lilc',ol' :rtili itiicct:;socil:i intel'liciiotis. cstrccilili)'ihc i-,rolilct cillici ittlciticiiolt (Sirlcr-c'i 1t1..

2007). Orci'rioliitri iitc iir.cilirLiie. tlresc l'c:calcirers:'cpoli iitill cliltilt!: \i1it.i\'iiLi iii.' ;lti:otl;. '::tri.lt.-;- lt.':i ll.- :;l -iiirc. i'r't;; i'"ii ''rie. e,'itlt.t: llil'.'lu.i;titive. lincl silorlcci icss n,i:i'ttriir.litci llcriblliif iil il',lt'ilctioil: r','iiir iiieilchilcileli. l'itcY cor.rcittcie.'Or'.'rlii1. sircsi' rcrill: io lr,; ll ii:ciol'lirili las tireilo\\Ji'.o 11i:l'Ltiti i)lli'Jltl.ilig riitciiccs scilousi)'lit(i, lcsitiis iir tt lttnc, t,'.Lr:ii,.1

oi"rlic r:rotlrct chiici iuicluction^(SrLicl c: ir1.^ l0()'/: ,16). Ilt rl icvi!-w oi'llili.ili-i:r1r issucs ibi lnc-'iitci: *'lio trllilrili: ji ctli ollic Str'.':':, ci1'si'.'!'ililii iorl arlci iil''lcirilol.!ctscci u'itii bolclcllinc llDl')ollriii,t' ciisorclcis. \cri'tttlll.t lttt(i Siiv.':),.()ll(200:;: 392) conciLi(i.. 'C'ietil'1t'" ii:is Ltrottlr oi'u'otl.lct.t llle vcl'1" il-ltg.iic irllci

clit;rict'rc.; itiliit iu'r'cis of ill'rci' t ri1'11o11. -l ius riisilcss. oiicil il lllclciLict oi'

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2002" 2009u. 2009b" in t-lcss). iu'tcldi:;ciirliitl'1, ci,icicncc ;l-rciir,'lircs titi:l iltciulilitt^s l.ts\cirobioiol:ictii :'caciiol io ii\rii) iiitct'irli:;cilii site:;st'rts c():i-;1t'i\.\i\i,o scpliniie rg')il()1tsil i)i:tr.cl'ns. iryp.'i ulo,tsiti ltnci eii..socilrirlrrt. Ilc.:ltc (2(X)0:

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lrs t.riircl1'-tic!I1cc ircllci llvct'siott" lttclti;lt: i)\\'ll\' . . . oi sci'cii1'lirlg. tilcnoihci l:.cl:r: !:oiir!r.

Iir'riic cullictii stlltc ol iilcu'1. tirc ciiii<.i'l; sittlclctt itiiil'lii ot-sitliiit' l.'.ielioili:'<i:caics ucli\'liiolt oi'iitc itriitrl'-": r'ililii ilr'trisi.rilcl.c (iil'l:t'iiel' ct tli.. i996).

Iil-.. il iLriu. cvoi,cs u s'"icirlcu i;rcicasc oi'lirc s1,n'i'liiiic'Lic i-rilt:tcit oi illc,'\NS. rc::tlLing il sigltiiicait-.ly cicr'll;cil lrclit'i l'itiu (crliei;lic :lcciieilllioll)"itlooli olc.sitic. ill.rci icsi)iiiition. l)is1i.c:s i.; "-r.i.t:'.'sscci iit ciyitrl-. littci iltcll:iC l'C.l lll i ilg.

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il-oiti1 r'ciciisinli il:cior' (Citi ) iirc 'Ll'uiir^:, r-rra.ior s'rt'css ircti'ittr.ritc. Clli;lcsiliulcs :1'npalitciic caiccitoiiilttiilc i:ctivil)' (iilo',','ir ci iii.. 19112). I'iri:s.

30 Schore

brain adrenaline, noradrenaline, and dopamine levels are significantly ele-

vated, creating a hypermetabolic state within the developing brain. In add-

ition, there is increased secretion of vasopressin, a hypothalamic neuropeptide

that is released when the environment is perceived to be unsafe and chal-

lenging (Kvetnansky et al., 1990).

dut a second, later forming reaction to relational trauma is dissociation, in

which the child disengages from stimuli in the external world - traumatized

infants are observed to be 'staring off into space with a glazed look'. Tronick

and Weinberg(1997:66) note that:

when infants' attempts fail to repair the interaction infants often lose

postural control, withdraw, and self-comfort. The disengagement is pro-

iound even with this short disruption of the mutual regulatory process

and break in intersubjectivity. The infant's reaction is reminiscent of the

withdrawal of Harlow's isolated monkey or of the infants in institutions

observed by BowlbY and SPitz.

winnicott (1958) holds that a particular failure of the maternal holding

environment causes a discontinuity in the baby's need for 'going-on-being'.

Kestenberg (1985) refers to dead spots in the infant's subjective experience.

an operational definition of dissociation's restriction of consciousness.

The child's dissociation in the midst of terror involves numbing, avoidance,

compliance and restricted affect. This parasympathetic-dominant state of

conservation-withdrawal occurs in helpless and hopeless stressful situations

in which the individual becomes inhibited and strives to avoid attention in

order to become 'unseen' (Schore, 1994,2003a,2003b). In writings on psy-

chic trauma and 'emotional surrender', Anna Freud (1951/1968,196411969)

also referred to helplessness, defined as a state of'disorientation and power-

lessness' that the organism experiences in the traumatic moment. This state

of metabolic shutdown and cardiac deceleration is a primary regulatory pro-

cess that is used throughout the lifespan. In conservation-withdrawal, the

stressed individual passively disengages in order'to conserve energies . ' ' to

foster survival by lhe risky posture of feigning death, to allow healing ofwounds and restitution of depleted resources by immobility' (Powles, 1992:

213). This parasympathetic mechanism mediates the 'profound detachment'

(Baiach, pet; of dissociation. If early trauma is experienced as 'psychic

catastrophe' (Bion, 1962), then dissociation is a'detachment from an unbear-

able situation' (Mollon, 1996), 'the escape when there is no escape' (Putnam,

1997),'a last resort defensive strategy' (Dixon, 1998)'

The neurobiology of dissociative hypoarousal is different from than ofhyperarousal. tn ihis passive state of pain-numbing and pain-blunting,

.niog..tout opiates are elevated. The dorsal vagal complex in the brainstem

medulla is activated, which decreases blood pressure' metabolic activity,

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'liritlilillillil:11 t):"sillili: \ciliiii-\lil'iiis\':r:u;llil"iii:c:iiici:i:silillbi!r''ll:r'c-rlil'''''COittilllalti :OC:lli trticlaC'ritlll: liil'.i :ic:iia il.ii e'llllL1li tl'lil'::f iO'ls liii iil;

ti:liif1 '.tt COillillt'.:\iCil.C riiiir lltcilli er;llc':',t)li- r11'-111;7'i1'trll: ilrl(i 1)'sllll'"i'

O:: '.i:.- ,,iil-, itl: :ii irl. .'l"l\ tl" -lt:;'l'l': ;' '' :ii' ' ')' \': r iri\" '\: ';: "1

i^r-'titrt.l:l ill()r(), lltiL';w.'\ ')! til ' 1"11' r'1'11' tltr\'il r'"':"rtl';c' ei:\':'\ ''i:"''iltc;t.l s()ciiti sir!15\. :iuiLciiliillll lilr:l:oi;iiizllil()il eicliiil :cirllliilr:' ll;l<i 'llcrll:3

ir;ll:l,ictis (l)r,.l1its. 1997). ,\: otll..loslti i6 iilc 1llili1ll':liiilll \'11'!11'li \'llr-:lli

coi-ltltic\ ,i,li cit. l':tttidirl rciltlllila ciii(illlc ol;ilr':'L i''r lil:ici cil!llir'llir1--il' : 'l(

Cit.*rgligCllc.ti,,.,,i',l.i'.ilc:OCiili Ci,ril'tl:li'i:lill^ 1'lC tiOi.tlil lillliil C()i-'i;llJ;r'COiL'

i:'iit-ii.:: iC i,'\Jl'a.'iilOilOlllli s'illics ll:-tci llliiy l"' ''Ciilre(i l:tl e:'-to"ior'l:':i::'r':'' tl1'

'"ri,:1]io:lilizlliit,'l'.'" :,ilci: i]s L'\':'clrrc 1'liioi" (X)oigc:' 1t)9'l: 7:)'

I itCtC tS 1iO\\,iirti'rj,'1r1rlr1i .illili )\'1,]-Oiliileli{j li.r1 \irti: \) It-1''l 'lUl'r iit l-rl:llli'C-t:S

ll.i.,ir,.iri eitrr::r.tailcrj'i ri'l1il iilC il\rtr;)ill Cll\';i()ilillJili i::lti il 'rigil i;rcl i'' cil'-!r'\'

r,r.riiiizlttiitilult'l i:iili,rlliioil. *'rllc illc ;lrti'll:'1'tllpeliliii(l c():ri)orle!-'i (:"1\"

tli-.l.:ltttltt,;ittllli il'i)i'l iilC Ci,:i tilli \-l1l1ii-O'il1lf il'' l:r'll ii'iiiiz'l:l iCrr'" ieyci:' rli'

ii.[cililii cltJLli\' (]i{ccorciitii. 2(X)3). i-1lc i1.lllr,l:l.izari i'liliili's jtl(i(icrl :\'i1'ci'

lt'orn ililili-,'llli1'1I) -\\'lrllllliil':lie ll)'rl''r'il'oi::' i io i<ln-cilcli.i)'-r)iii'l::r\'iili):lllrctic

rri-'.'ccilt;ittit l. t'ci1ct:'rcti '-l i)oi;r::;^(1997: '15)clll:lllciciiz;'ltloil 0i':

lltC -ri:riti;,t lttl(i lll;litl il'liilsiiio;l ll'tlil liil l.:11-ii-"(lCiSSiiii:"r'lt";91''i)l s1'1"iiiI'

r:llilS iccili'ilili i't-tl::;siic s)'l-!11-'aiilciic i:cii\'ilii()il ic ill': llltlril-:;0ilcliiiV co;i-

*,:ir]lir. 11n1-obillzcti :ill',,: lllil.,lici;i;l1r t1cll,1l i:ss()eiill'cli'"rir1: illL: cioltll'

Yi:!rill coi Il)ll\.

'-.;11ii,,.';1. trr, '..1,,1 1 . t)S;':

1r;'1-r;l'lit'c,:t:;;11 :ciitll' itlilJll)le -sit c-s-r:

ii I io\\,':l

silir 01

i'r1,'i5) clc;cl'lil;s'iirc sni'.ciL irol'l :i\'illllili'lrliic

l)i if ii:l) illirlli ilct iC lli.' I roili'()t'sCd I 10'i Ji')-'1 :C)s :l' I t

i ltt ,q,itc,t li-Oi1 llitriu-l1, lO ilrC CililliOllo:Ci :'.':illOil:;") i: illC s''iLllce 'rr'levliiititli.0lt Oi'iirt- il-,tl--ncilil,: tiltng''i'i.t: oira lJili. ellt'l''<''i 'lu l.'tOiciCci ol'

r,rociliicti. Wiiir 11rc n.,r..1-,ii,rtt oi'iililti ii':i',llc.srlc,ts i:l'.i-c !l:c': oi-

alL-sif ilcir\,,-) (iii1l:lci^ oilc silil..ild!1':l .io ii'

32 Schore

prolongcd dorsal vagal parasympathetic activation explains the lengthy

'voicl' states that are associated with pathological dissociative detachment

(Allen et al.. 1999).

Developmental neuroPsychology of dissociation

How arc the trauma-induced alterations of the developing right brain

expressed in the socioemotional behavior ol a traumatized toddler? Main and

Solomon's (1986) classic study of attachment in traumatized inlants revealed

a new attachment category. Type D, an insecure disorganized/disorientedpattern that occurs in 80,X, of maltreated infants (Carlson et al.. 1989) and is

associated with prenatal and/or postnatal maternal alcohol or cocaine usc

(Espinosa ct al.. 2001). Hesse and Main (1999) note that Type D disorganiza-

tion and disorientation is phenotypically similar to dissociative states. Mainand Solomon (1936) conclude that Type D infants have low stress tolerance

and that their disorganization and disorientation indicate that the infant is

alarmed by the parent. Because infants inevitably seek the parent when

alarmecl, these authors assert that frightening parents places infants in an

irresolvablc bind wherein they cannot approach the mother, shift their atten-

tion, or flee. These infants are utterly unable to -qenerate a coherent strategy

to actively cope with their frightening parents.

Main and Solomon detail the uniquely bizarre behaviors of l2-month-oldType D infants in the Strange Situation procedure. These infants displayed

brief (frequently only 10-30 s) but significant interruptions of organized

behavior. At such times, Type D infants may exhibit a contradictory behaviorpattern such as 'backing' towards the parent rathcr than approaching face to

face. Main and Solomon (1986: I l7) note that:

The impression in each case was that approach movements were continu-

ally being inhibited and held back through simultaneous activation olavoiclant tendencies. In most cases, howcver' proximity-seeking suf-

ficiently'over-rode' avoidance to permit the increase in physical proxim-

ity. Thus, contradictory patterns were activated but were not mutually

inhibited.

Maltreated infants cxhibit apprehension, conlusion, and very rapid shifts ofstate during the Strange Situation. Main and Solomon (1986: 119) describe

the child's entrance into a dissociated state:

One infant hunched her upper body and shoulders at hearing her

mother's call, then broke into extravagant laugh-like screeches with an

excited fbrward movemcnt. Her braying laughter became a cry and

distress-face without a new intake of breath as the infant hunched

forward. Then suddenly she became silent, blank and dazed'

ngtli)'lrncnt

blrrinn anci

citi,-'tl

cntecl

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iC LlSe

tntt',t-

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u'hcn

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cribc

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lh au

ancl

Lche ci

'fhcsc bclurvlois alc lloi l'cstrictccl io thc iliilnt's iirtct'ac'rions n'liit ',irc

ltoiiicr'. Irrcic;ci. tirc intcn:,i',1' oi tirc lleb1''s ci1'slcltiiilicci afl'cclir c .t:,lc i.olicu hci3hicncci u'hcir thc illl:r1 is o.irosccl io tirc uciciccl :,ti,:-.s cli' lilriiliiiii.itilitil-i)Jisoit. Ai l: stirilrg"'r': ,';l'.r'.rirc... tu'o inilirls nroveci lI., ltV llOti.i

Lroili ll-roihet'ilncl s'r.r'ani:cr-1o iircc lirc iiali: uiroillct"lcitncci iil'chcati .li:.lr:t.1iire ri'lli 1b;' scvcl'ui scconcls. iooi.iiirg blicir in allirli'.lli icnor". I hc:c inllil.ii:;crltibit 'bchaviol'ai stiiillg" thai is. 'cl:rzcri' ir..iravio;' ur.ii-l crcllcsst-ti r,iti'et"bchuvioral ntanil-cstutions ot'ciissociililou. Onc iiriitnt 'irccllrrtt iiti' lt ltro!itL-lttcrccssit,cly s'.i11. stuling inio :;oac"' a\ iirougir coiirirlcicll oiii oi-eoir:ltcl ti'itliscil-. cnviloiuncnt. ilnti paicni". Anoillci' sitou'eci 'a ciltz,--ii 1l:cilll ltrlitcal'il;re.l... uccolllltinlco b1'll siiliill: oi'lril 'bo<lf novt'ncnt^ iii.ici s,ol'tctit',tcs u il'ccz-ini: o1'linbs u'iricli i'racl becir in rnotion". Yci unoihcr''icii lacc-ciott'lt ott ilic1'looi iu ir clclrrcsscci il():tiLlc 1-rliol itr srir::r'.rtio'r^ stiliinri lill bociy lttovciltcitis'Gr-rcrtcircl'uncl I--cl'nlinian (200i)olicr an ulliLt-l ciisirc,ss sc:l1e tltitl tlsscssr.ts

thc siistainecl x,itircl'ar-,'iii that is u:sociatecl with ciisor!ri:nizecl attitclltitciti.'l'iris u'itircilarval statc is crirr.essccl ir lloz:en" ubseut iitcirii c:'irr'.':siort. l.rrtli

In'oicianc.' ol'c1'c- coutaci. iininobiiiil,. abscrrcc oi'r'ocaiiziitiot-r. iiltscttcc o1'

l'clutirrli io ctiicr',.. lind tirc implcssiou iirai thc chiicl is itlt1'onci lcacit.Dissociation in iiriirnts hus ulso becr.r stuciieci u'ith ihc Stiii-l:acc ltiocctlttl'e.

ait c\ltcf ilncitlul palucligur oi-1r'iiumatic ncgiecl. Iir tiris 1-rt'occciiit'c. liic iniiitr'.is criro:;ccl 1o a scvcrc rclitiiollitl sii'c:;sot': ihc tloihcr n'iaitttliil.t: c]'c coi)tirc'.

ri'iih ihc initini^'irr.ri,ihe silclclcllf inhibits ull vocalizli'riott auci susitctttis liiicmoiionaliy cxltlcssivc f acial cxprc:sioirs ai.t<l iresturcs. tr'iris sevcic iniribitioirol nortr'ei'itiil cornmi.u.rication anci iulcl'uctivc afteci icgirluiiotr tl'i!tgtcls art

ir.iiiiui incr'..asc o1- inlcluctir'e bchll'iol lir.rci ulotrsll ilr ihc ilfuitt. ,,\ccolciiitgto-il'oiticl; (200,i). tire iiilirni's contuslor.i iiurl iiitriiilncss rtl lltc biciil',irconuectic'xi is accortrilrnicri b1'tirc itica tllat'ihis is iiilca'.cling^. i'iiis liroitsllliir'ien-silicuiioir is ullin'urteiy 1'olloi','cc1 bi' bodii;, co11lii'l-.c. ioss oi- irostiilriiconiiol. r.,'i'rirci-iau,ai. rriizc livL'rsiol" sac! iircial elprcssiol. linti :;t11'-.ccti'.tlb:tlttr'

bchlivior'.Furthclilorc^ tiris bcirai'ioL is uccomi.xrniccl by a 'clisslpiltion oi'thc lltllint's

siaic o1'cousciousr.rcss^ aiicl u cilrinisirnrclit oL scil'-orlranizing altiliiict 1ha:

lcllcct 'clisorqunizaiiorr of iiranl' o1- ihe lorvct' 1n'cl ns;'cirobioiogical .il:tcs.sricir as nciiibolic s),stcrrs'. l{cciiil that ciissociution. li ii5'ltol.t.tctabolic stltic.irirs irccr.r ciciinccl in thc Amcr'icun Psychilltlic As;ociiition^s .1)ragrio,stit' uttrl

Stt lIslitttl ,l'luirtrul as 'ii ciist'uDtioir. irt tiic tisitall,r' irttcgl'atctl lirnctio;ls o1'

cctr.rsciot-rsncss' anci ricscl'iireri as "il iriotcctivc aciii.'itiion oi-aiieicel statcs o1'

coirsciotisncss in icaction to ovcl'rvirclr"iriuri 1'rs1'clloiogiclii initil.)iil" ([-ocri'clr-sicir" i99(r). llonicil (200.i) sugllcsts tha'L influrts tvlto nll'c .l iris'rol'1' 1,'i'

ciir"onic bi,--alis oi' eonlicctions !-xiribit ur-i 'crtt'ctircly i-iliiiroiogtcltl slaic^ oi'cllotiolal apuiliy. I.trc ecluutcs this siute li'rth Spitz's collcci)l ol'liosltitalislnanci I{or.nanilii.r ctlirliaus ri'lio liiii to srtxi arrrl clcvciotl. Stich iniituls r-ri1 il-,t:liciv

aclopi a ct'rr.nrrtuiricution stylc oi'"stay rnvit1,. clon'i conncct". l-hi: cL-tcrtsivc

staltcc is u vcly r'aiiv-ir.riiriil'rg" yct alrcacil,chi'oiiic. nrthoiogical clis:ttcilliiotr

34 Schore

that is associated with loss ol ventral vagal activation and dominance ofdorsal vagal parasympathetic states.

The strange Situation and Still-Face biphasic induction of arousal andaffect dysregulation occurs in face-to-face communications with the mother.The mother's face is the most potent visual stimulus in the child's worlcl. butit is well known that direct gaze can mediate not only loving but also aggres-sive messages. Hesse and Main (1999: 5l l) describe the mother's frighteningbehavior: 'in non-play contexts, stiff-legged "stalking" of inlant on all foursin a hunting posture; exposure of canine tooth accompanied by hissing; deepgrowls directed at infant'. Thus, during the trauma, the infant is presentedwith an aggressive expression on the mother's face. The image of this aggres-sive face and the associated alterations in the infant's bodily state are indel-ibly imprinted into limbic circuits.

Main and Solomon (1986) document that Type D infants often encountera second kind of disturbing maternal behavior: a maternal expression offear terror. This occurs when the mother withdraws from the infant asthough the infant were frightening. Indeed, studies show that the caregiver ofType D infants exhibits dissociated, trancelike, and fearlul behavior. currentresearch underscores a link between frightening maternal behavioq dissoci-ation, and disorganized inlant attachment (Schuengel et al., 1999). In recentwork, Hesse and Main (2006: 320) observe that when the mother enters adissociative state, a fear alarm state is triggered in the infant. The caregiver'sentrance into the dissociative state is expressed as 'parent suddenly com-pletely "freezes" with eyes unmoving, half-lidded, despite nearby movement;parent addresses infant in an "altered" tone with simultaneous voicing anddevoicing'. In describing the mother as she submits to the iieeze state, theynote (321):

Here the parent appears to have become completely unresponsive to.or even [un]aware of, the external surround, including the physical andverbal behavior of their infant . . . we observed one mother whoremained seated in an immobilized and uncomfortable position with herhand in the air, blankly staring into space for 50 sec.

In an early history of traumatic attachment the developing infant/toddler istoo frequently exposed to a massively misattuning primary caregiver whotriggers and does not repair long-lasting intensely dysregulated states. Thegrowth-inhibiting environment of relational trauma generates dense and pro-longed levels of negative affect associated with extremely stressful states ofhyperarousal and hypoarousal. And so for self-protective purposes it severelyrestricts its overt expressions of an attachment need for dyadic regulation.The child thus significantly reduces the output of its right-rateralizedemotion-processing, limbic-autonomic attachment system. When one isstressed, defensive functions are rapidly initiated that quickly shift the brain

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Ncurobiology oi attachmcnt 35

irotn inlcractivc i'egLrlatoly rrocics into long-clciut'ittg. iess conpicr alttoicgtt-latot'l,r'nocles. l'ircsc pattet'ns arc plimitivc stratcgiics fbi st"il'vivai thiit t'r'tt.lltinonlinc lbr longi iutcrvals oltimc. pcliods in rvhicli thc det'clopirtg brairl is lu ithypornctabolic statc. detrimcntal to tlic suirstat.rtiiil aii-iottttts of ctlct'91'

rcquirccl lbl clitical pcliocl biosytttirctic l)roccss!-s.I)uring thcse cltisodc-s. tltc inlant is uratcliiug tlie rltf ilimic structitt'cs o1'

ihc molhcr's dyslcgulatcd statcs. ancl tltis s1'ncht'onizaiion is rcllistilrc(l iiltiic fir:ing pattcrl-rs o1' tire stless-sci.rsiiivr: coltical aitd liirrbic icltiotrs o1' tiicintrlt^s blair.r. csltecialll' rn thc nght bi'ain ivhiclt is in rt critical itclioci of'

groivth. lntants dcsigttatcci iis '\'cf)' fearl'u1' ai scvcll moulils shorv lltigcrIRPs ovcr thc right hcmisitirelc u'hcn vio.,'ir.tg i'carlLri fitcial criticssions(Dc IIaan ct a1..2004). An EIrG stucly ot'iivc-montli-c'rld inlirnts obsct'vcs

iircrcascd tlicta activity ovcl thc light postcrior tcurporal alell rvliiic tltcy arc

looking at a biank t'acc (Bazhcnova ct ai.. 2007).

It is uou'cstablish.-ci that nraternal carc infltienccs both thc inf lrnt^s t't'licli\'-

ity (Mcnald ct al.. 2004) ancl the ililant's dcl-cnsivc responscs to tlrrcat (llat'cui

ct a1..2005).'I'hcsc ci)'arlic proccsscs'scrvc a:' tlic basis for tirc transtnission of'

inclividual clillcrcnccs in strcss rcspouscs li'olir mothcr to olfslli'irtg' (Wcrl'ci'

ct ai.^ 2004: ii47). Ilccausc mally mothcls suflcr liour Lurrcsolr,scl tt'ar.rma. tlicir-

chaotic anci dysrcgulatccl altcrations ol stiltc bccollrc impriniccl irito the

cicveloping braitt ancl scl1'-systetl o1-thc child. I-ltis iutetsubicctivc psycito-

plthogcnetic r.ncclianism thns rlccliates thc psychobioiogical intcrgcircra-

tional it'ansrrission ol both lclational trailtnir ancl thc clissocialivc dei'cnsc

asainst overrvhclrning and ciysrcgtriatitlg all-cctivc statcs. In accorcl lviththis nodcl. rcsciirch nou' inclicatcs i.hat scvct'c cat'1y tnatcltial clysltrlctiotlis associatccl ivith high tlissociatiou iti psyciriatric paticuts (DraiJcr' &I-a1gcl1nc1. 1999)" anci that ph;'sical abusc alcl paicirtltl ci1'slituctioit otltire part cli' thc rlotircr not thc llither is associiited rviili sotrtatolilrildissociativc syurl-rtotls (Roe1oli ct ai." 2002).

Irrom a cievclopmcntal psychology vicivpoint. tilc prolbund llegitti\'( psy-

chological cti:ct of rclational tLatttna (carly abusc atlci neglcct) is tirc gcl'rct'-

irtion of' a disorgauizt:ci disoliciltcil attachr,icnt that cudttres ovcr .ihc

latcr stagrcs ol chilclhoocl. acioicsc,-'ucc atcl adultltood. ancl acts as a l'isl<

fi:ctor ior latcr psychiatric disordcr:s (Schorc.200i.2002.2003a). F-r0m a

cleyelopmcr.rtal ncuroscicnce pcrspcclivc. tire imr.nccliatc delriurciltai itnllact 'rs

oir thc altcleci n-rctabolic proccsscs tirat noolly sustain critical pcliod grorvtli

ol thc clcvcloping right blain. anci tirc lusting irnpailrlcnt is an immatr.tt'c aucl

lunctionally lirnitecl right-brain capacii)' to rcgriiatc latcr iil-'^ strcsstlt's thal

gcncratc intensc all'cct siates. Rclational trautnrtlic L'\p!-l'icnces at'c stot'ccl in

imagistic proccclr,rral lncmory of ihe visuospatiai rigirt hcmisphcrc (Schil]'cr

ct a1.. 1995). the locr-rs of'irnplicit (Ilu.gciairl. 1995) and ar-rtobioglaphical(Marliorvitsch ct al.. 2000) ircmory. 'l'ltcsc psychological and biological pct'-

spcctiv!-s cou!cIgc on a basic dcvclgDmcntal u'irlciplc of'rcgulation thcorl'that carly trautnatic sunclcrinli of attachu-rcnt trotrcls is critical to tlic- g,--trcsis

36 Schore

ol an enduring predisposition to a varicty of early forming severe psycho-pathologies that characterologically acccss the auto-regulating, affect-deadening defense of pathological dissociation.

Enduring effect of relational trauma on right braindevelopment: lmpaired emotion processing andpathological dissociationNeuropsychoanalytic authors now contend that 'If children grow up withdominant experiences of separation. distress, fear and rage. then they willgo dorvn a bad pathogenic developmental pathway, and it's not just a badpsychological pathway but a bad neurological pathway' (Watt, 2003: 109).

Current workers in the field of developmental traumatology now agree thatthe overwhelming strcss of maltreatment in childhood is associated withadverse influences on not just behavior, but also brain developnent (dc Belliset a1.. 1999), espccially the right brain which is dominant for coping withnegative affects (Davidson et al., 1990) and for 'regulating stress- andernotion-related processes' (Sullivan & Dufresne. 2006). Describing the essen-

tial survival lunctions of this lateralized system, Schutz (2005: 15) notes:

The right hemisphere operates a distributed network lbr rapid respond-ing to dangcr and other urgent problems. It preferentially processes

environmental challenge. stress and pain and manages self-protectiveresponses such as avoidance and escape. Emotionality is thus the rightbrain's 'red phone,' cornpclling the mind to handle urgent matterswithout delay.

In states of pathological dissociation the right brain's 'red phone iine'is dcad.The right brain is fundamentally involved in an avoidant defensive mechan-ism for coping with emotional stress. including the passive survival stratcgyof dissociation. Thcsc adaptive right brain functions are impaired in historiesof early relational trauma. A large body of psychiatric. psychological.and neurological studies supports the link between childhood trauma andpathological dissociation (e.g.. Dikel et al., 2003; Diseth, 2005; Liotti. 2004;Merckelbach & Muris.2001; Macfie et al.,2001).

Recent neurobiological data can also be utilized to create models of thepsychopathogcnctic mechanism by which attachment trauma negativelyimpacts right brain development. Adamec and colleagues (2003) reportexperimental data that 'implicate neuroplasticity in right hemispheric limbiccircuitry in mediating long-lasting changes in negative affect following briefbut severe stress'. According to Gadea et al. (2005), mild to moderatenegative affective experiences activate the right hemisphere, but an intenseexperience 'might interfere with right hemisphere processing, with eventualdamage if some critical point is reached'. Tliis damage is specifically

IO-

0t-

Ncurobiolcgy of attachment 37

hyoclalor-rsal-inciuccci alloptoiic ccli clcatii ir-r thc li1'pct'titciaboiic i'igirt blain.'firu-.^ via u switcir in.io li irypoaroi-l-qai. a h1'potnciaboiic stilic aliorvs tbr ccll

sLilvival at titnes of intensc crcitotoric sti'cs:j (Scliol'c. 200 l.2002).I{ccali tliat light coilical arcas anri thcil cot.incctiot.ts rvi'iir light sribcorticill

iitLrictrlrcs arc itr ir, clitical pclioci oi'giorvtir cluritrs cartrf i'ir-ular.r clcl'clopmctrt.'i'irc ir-nssivc ltsycirobioiogicirl sii'css as-sociatctl n'itli attaclmcrlt trliLlilliiir.ppails thc cicvcioltrncnt of'this systcnr. iinci scis thc stagt ibl thc clttirltctcro-

iglticai usc o1' r'ighi-blain itatirologicnl ciissociaiion u'hctl encortt.ticrirlg latcl'

sl1'cssoi's. C'onvcrg:ing o'iclcncc iiiciiclLLc: ihat elir'ly abtise ncgatir'cif illlpitctsliilbic systcm rnrt'irrratior.r. ploilucingi cncluliug ncut'obitllo-sical alt.-r'tti.orls

ihlt gi.rcicrlic ail'cctir'c instability. incliicicnt stt'css tolcraucc. lllL'mol'y

implili.ircr.rt. ulcl clissociativc ciistuibances. Itt titis tnlttrttet'. tt'alttlaiic stt't-ss itt

cirilcliroocl icacls to sc11',r.noclulation of paurlui ali'cct by ciii'cctirlg lLttcrltiou

lil'a1' 11'ot.n intcrtrai r-inotiontll staics (Llttlc ct al.. 199'/). Iirc righi brain.

ciominant ibr attcr-rtiolt (l{a2.2004) and ilaiti 1-rt'occssin-u (Synioncls ct al..

2006) thLis gencl'atcs riissocitition. u clciinsc b1'u,hich ilttensc ncgativc all-ccts

associiitccl r','ith cn.rotional pliin a|c blocliecl il'oi.t-i etlit:e ioUsllcss.

Col.rgt'itcui u'itli this cicr,clopl"r.rcirtai uocici. Spitzcr ci lii. rci.rot't a iralls-cilinial i.nagnclic stimLtiirtiorL stucil' o1'uclulis anci cc'rttcl,-tclt-, 'lti ciiss,rc:irrlion-

pl'rxtc incliviciLtals" li trarilna that is pei'ccivcd lttlci pt-c.rc.-sseci b1' the liglit|cltisphclc q,iil lcacl to a 'clisintrtion in tltc '.rstritlh' iiiiL-grated lttnctions of'

co!t\eioy:ltc::'(lOt)i: i6S; Irr itrnctior;rrl nlitr-Illjtie les()ilirllcr irrrltgirrr:

rcsculch" Lalius ct a1. (2005) shorv lrlcdominiintiy rigirt hcrlisplicl'ie acti-

vaiiou in ps1'chiatric paticnis tvhiic thcl' alc ciissociittin-u^ aitcl conch.rdc ihat

clissociar,ioi.r. rrlt cscapc ll'om thc o"'elr',,hcitniug cluor.ioiis a-.sociatcci li'ith thc

iraul1a1ic ilellor)/. catt bc itrtcrpictccl as rcprciclltiilg a nollycrbal lcspor.rsc

to thc tlar,rmlilic t"itcutot'1'. Ill tire ciinicrl litclaiut'c. Ih'onbcrg (2006) links

rigirt-biain iiaLtuta to lttitottonric hypct'arousai^ 'a chaotic ancl tclril,vinglloodiltg of'aliect tltzil- caii iittcaterl to ovcru'liciln sanity ailcl impct'il psycho-

logicul sr,rrvit'ai'. Dissociutioir is tirct-i altioiliiticalll'aitcl inmcciiatclytliggclccl us thc lirnciai"ncltal clclcnsc -io iirc itt ons:r1 d1'sl'cgulaiicltl of'

ovcru'hcintiug: a l'icct ivc statcs.

IJoiit icscuiclie rs anci cliniciiins arc no\\' r'xploring tl-rc cvoiutiot-l of a clo'cl-

opn-rcntaliy iltpai-,'ccl rcg'.rlzrtor'1's1'stcn't llitcl providc';r'iclctlce thiit plcli'onta1

cortical anci iin-rbic ar"cas o1'tirc ligirt ircrnisphclc at'c ccntiitllf invoiveci itt lirecicljcits ii"r lirincl and bodl'associiiicci u'ith a patirological cii:sociativc rcsponse

(Sciro1u..2002^ 2009a.2-009b. in 1-ricss).'I'iris ltcmislthct'c. urotc than thc icli. is

clcnsciy lcciplccally inici'connccteti rvi'iir L'inotiolr-processing lirnbic l.csiotts.

as rvcii us rvirh subcoltical arcas lhat l'cncraic botit tlic at'ortsai atlcl auto-

nomic boclily-basccl aspccts ol cn'rotions. I{ccall. SNS aclivit)' is illaniftsi intigfit cngilgcll.rcr.rt rvith thc crtelnai cil'iioument ar"rc1 a high l*,cl ol cilcrgy

ruobiiizaiiou^ ri'hilc thc itallisyrnpu'.hctic conllloltcitt c1t'ivcs cliscngallcnrcilt

fl'oin thc extclrrai environu.ict'rt ancl utilizcs !ou' lcvcls of iiitct'uai cllcl'Ll)'.-i'ilc:;c ANS componetis ut'c r.rncor-rirlcci iirl iong pctiotis oi'time iu stlcssttil

irhr'ili,ilCl

9).

rat

ithili s

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38 Schoreener

sud(collithetandandpar

IsutStiI

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interpersonal experiences in infants' children' adolescents and adults who

have histories or uttutiilt;; ;;;;;' and thus thev are expressed in bodilv

t ?'"1 J:ill:ii :il$ :: il [:"::ilfi Le nl re

| 1e s e nt s a b o tt o m I ine <leren s ive

state driven uv rear_tJ.r"r. lr-rrr*r, the stressed individual copes by per-

vasively and cliffusely Ji'"ngaging attention"from both the outer ond inner

worlds' (Allen .t "l', ;;;''i??'^t"-prtutis added)' I have suggested that the

.innerworld,ismore,n""."g"i.lons,thereulm,ofbodilyprocesses,central

components of t'notio'ili 'i"-'"t-tstriore' 1994;' Kalsched (2005) describes

operations of defensive dissociative processes used by thc child during

traumatic expe'encc ;;;i;lRn^ttt in the hoclv is severed from its corrcs-

oonding images in tht'tinJ onJ tn"'"uy un unbto'ubly painlul meaning is

tbliterated,. Nijenhui"s ?ffi.; ;r;;,, ,r.ru, 'somatoform dissociation' is an

outcome of early or"o i'uu-atization t*p^'*J as a lack of integration of

sensorimoto, .^p"ri.l..;, ;ii;;;, ana'frrr,"tior.ts of the inclividual's self-

representatiot. Di";;;;;i"^ttt-;;dta nii"iJ"uls are not onlv detached

rrom the .nulron*tn'l;;;;i'"-r; 11 '3ii - in"ir bodv' their actions' and

their sense ot ra.nt,tyi,iit.n'"i ur , r999t- This is expressed as a deficit in the

right hemispt,eric .coli'or".;i;;ii to."intr.y 2000t. crucian ct al' (2000)

describe 'a dissocratronlt'*ttn rhe emotional evaluation of an event and the

ohvsiologicat ,"u"ti#^tlo'itui-"u.n,, with the process being dependent on

iniol, tigit hemisphere lunction"

In a numbe, "f *;;k;^i-r1uu. or.r.o interdisciplinary evidence that the

implicit selt, equated *lti'' pttt'a's system

-U"' i' iocated in the right brain

(Schore, 1gg4,200.3;,ZOoll Thg.lSwer tuU*ititut levels of the right brain

(the deep .tn"on'"toJ"i"o"tuin all the major motivational systems (including

attachment, r.ur, ,.i*iiiy, uggr.rrro',,.etc.) and generate the somatic auto-

nomic expressions "r;^"""rr"r intensities of aliemotional states' on the

other hand. high";';;i;iror.,*r-ri-uic levels of the right hemisphere

senerate a conscious emotional state tlrat t^p""t' the affective output of

ihesemotivationalsystems.Inanopttmalaitachmentscenario.thisrightlateralized niera'ct'ical prefrontal system' the system Pt's performs an essen-

tial adaptive nlrti"uillriJi,rn.tion - trr. t.iutiu.rv fluid switching of internal

bodily based states;;;;""" to changes in the external environment that

are nonconsciously upp'oit"a to be.p.ersonallv meaningful'

In contrast, '"rutillt'uiiiuuma elicits more-than'a di::'p1t^"^1''"f conscrous

cognition and a. Oil"'g""i"tion .of overt behavior; it negatively impacts

the early o'run"uiiJ'i oilignt brain-survival mechanisms that operate

beneath levels of t"""i*t uiu"n""' raihological dissociation is manifest

in a maladaptive highly defensive 'igla' tfotti self system' one that responds

to even to* t.u"tr'oi intersubjectiu. ,ir.tt with parasympathetic dorsal

vagal parasvmpatieiic ;;;;;;;;;!1.1"" rate deceleration' and passlve

disengagement' This fragite ""ton'"io"'!.tvtlt- is susceptible to relational

stress-induced #;i;?f metabolic :;i6;t and therebv a loss of

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Ncurobiology of attachment 39

cnergl'-clcpcnclcnt synaptic conucctivity rvithin thc right brain. erprcsscd in asr-rcidcr.r irnpiosior.r ol thc in-rplicit scll and a rupiulc o1' sclf-continuity. 'l hiscollapsc o1'thc implicrt sclf is -.ignalccl by the ampiiflcation ol the ltaritsyrnpa-thetic aficcts of' sharrc ancl disgust. ancl by tlic cognitions ol' hopclcssncssilnd ltclplcssucss. Bccaltsc thc light hcrnisplic-r'c incciiates tho cornn'runicatiouancl rcgr.ilatiot.t oicutoiioiral siatr-s. thc ruirttilc of intcrsuLrjcctivity is acconr,ilir-ricr1 by an instant dissiltaiior-r o1'sai'ct1, uncl tiust.

I)issociatiou thus icllccts thc inability of iirc i'ight bliiin corticalsubcoitical intplicit sclf s1'51g111 io adaptivcly rcco-rnizc rincl ploccss extcrluistirrruli (crtcrocclttivc infbrrratiou coning Il-out tirc rclational cnvilonrlcnt)iiud ot't a lrlolrcltt*to-11-lomcl.]t basis intcgratc tircrr rvith inlcrnill stimuli(inteloccptivc inforn.ration fl'oi.i-r thc bod;,. somlir,ic uralkcls^ thc 'tclt expcri-cncc'). I'his lailurc ol itttcgratioir of thc highcr right hcmisphcrc rvitir thclolet' r'ight bt'ain inch-iccs an instant collalrsc ol both subjcctivity anci intcr-sr-rbjcctivtty. Stiesshtl allccts. cspccially thosc associatccl rvith ernotionaipaitt. arc thlrs not cxpcricnccci in cousciousncss. l)issociatcd affcct is thusitttcot'tsciotts allcct. clcsct'ibccl by l;r'ei-rd: 'Unconscious ideas cclntinuc tcl cxisraiicl rcprcssion as actual structriles ir.r thc systcrn Lc'1. rvirclcas all thatcoircspotlcls itr that s)'slcnl to t-rtrcouscior"rs allects is a ltotcntial bcginnintlvhicli is pr*'entecl 1r'orn clcr.'clopin-s' (1915: 178).

,/\t ali poinls <t1'thc lil-cspan. although clissocilition rcprL'sct.rts un clllctivcsitorL-tct't.t-l strate g1," ii is detrincntal to iong-tclrl functioning. spccilicaiiy byptcvcntin!: cxposurc to potcntial ligirt-brain sociocrnotional attachmentobjcct lcarning cxpcricnccs cmbcddccl iu intirlaic inicrsubjcctivc contcxtsthat arc ncccssal')/ lbl cmotional glorvth. 'rlie cndpoint of clrloirically cxpcri-ct.tcir.tg catastrophic statcs o1-rclational iritLrna in car:ly lifc is a progrcssir'c.iupairlnctrt of thc ability to acijust. taiic clcl-cnsivc action. or oct on oirc's owllbcltalf" ancl a blockingi o1'lhc capacit;'to rcgistcl ulicct ancl irain. a1l criiical tosut'viva1. Clinical rcscarcli sirou's palhological dissociation. a priuritii,,-.clef'cnsc auainst ol'cllr'ircin.rirrg allccts. is a Lcy 1'calure ol not only lcactivcatiachl.t-tcIlt clisorcler of inliurts and pcdiatric maltreatntr-nt clisordcr. br-rtaiso dissociutivc idcntity clisordcr, posttnnu.natic stlcss disorder. psychoticclisortlcls. e'ating ciisoldcrs. substiir.rcc abusc and alcohoiism. sontatolormdisorders auci socioltathic uncl bordcllinc pcrsonality disordcr.s.

Ps;,cirothcrapy ll,ith sucir patietris ncccls to littcnd to tlorc thau thcsigniiicar-rt clysrcguiatiou of allcct that chalactc-ri;ucs thcsc s*,crc sclf irath-ologics. It tlltst also acldrcss the carly lbi'miug clcfcnsc that blclcks tlicscovclrvhclmirrg a{Tccts from rcacliins consciousncss. thclcby dcnying thepossibility ol intct'activc rcgulation anci lhc organizatior.r ol rlorc complcxlighi-blain stl'css rc-cLrlation. Ilrombcrg (2006) obscrvcs tliat in tiic clinicalcncoLlutcr pathological clissociation acts lis an 'caily rvalnir.r-9 system" thatarticipatcs potcntiai alicct ciyslceLrlation bclorc thc traurna alrivcs. 'l hccurrenl paracligm shilt from cognition to aiiect also inch;dcs a shift lrornt'cpt'essiott to tlic sitt'vivai stt'atcgy of'clissociation as thc n-rajol mcchar.ristrl ril'

40 Schore

psychopathogenesis. It thus rcpresents a major obstacle to the intersubjective

change process in all all-ectively lbcused psychotherapies (Schore,200l , inpress), and to the effectiveness of early intervention programs. a major theme

of this book.

ReferencesAclamcc. R.E., Blundcll. J. & Burton, P. (2003) Phosphorylatcd cyclic AMP rcspouse

clement boncling protein expression induced in the periaclueductal gray by preda-

tor stress: Its rclationship to the stress cxpericuce. bchaviottr, ar.rd limbic neural

plasticity. Progres.r in Neuro-P,sycltophurnucology & Biological P,sychiatr1,. 27:

1243 1267.

Allen. J.G.. Console. D.A. & Lcrvis, L. (1999) Dissociative detachrnent and memory

impair.mer-rt: Reversible amnesia or cncoding lailurc? Cottqtrcltcnsit'e P,s1'tltialry,

40:160 171.

Barach, P.M.M. (1991) Multiplc personality disorcler ets an attachment disorder.

Dissot:iut ion, 4: 117'123.Bazhenova. O.V.. Stloganova. T.A.. Doussard-Rooscvelt. J.A.' Posikera. I.A' &

Porgcs, S.W (2007) Physiological responses ol 5-montl.r-old inhints to smiling and

blank faces. ht t e rn ut i o n al Jour n u I o f P s t, c h o p I t1' t 1 o 1. *t', 63 : 64-7 6.

Beebc. B. (2000) Coconstructing mother infirnt distress: The miclosychrony olmaternal impingcment and ir.rfant avoidance in the face-to-face cncountcr. PS1'cho-

an u 11, 1 ig In qui'y, 20 412440.Beebc. B. & Lachmann, F.M. (1994) Represcntations and intcrnalization in infancy:

Three principles of saliencc. Ps1't'hoanal.v'tic Pt1't'hologl'.11 12'7 165.

Bion, W.R. (1962) Learning.frorn expericircc. London: Heincmann.

Bock. J.. Murmu. R.P.. Fredman. N., Leshcm. M.. & Braun. K. (2008) Relinement

of dendritic and synaptic networks in the lodcnt anterior cingulate and orbito-

lrontal cortex: Critical impact of early and late social cxpericnce. Developntental

N eurobiologl,. 68: 685 695.

Bogolcpova, I.N. & Malofccva. L.l. (2001) Characteristics ol the development ofspeech motor arcas 44 and 45 in the left and right hemispheres of the humar.r brain in

early post-natal ontogene sis. Neru'oscicnte oul Bclrut,iour\l Plry,.si0la191,,31 349'354.

Bourne. VJ. & Tocld, B.K. (2004) When lcft means light: An explanation of thc lelt

cradling bias in terms ol right hemisphere spccializations. Devclopnrcrttal Science .

7:19 24.

Bo\vlby. J. (1988) A sat'u'c hsse; Parcnt clild uttaclntrcnt ond lrcultht' lnntatt

tleveloprnent. Ncw York: Basic Books.

Bradley. M.. Cuthbert. B. N. & Lang, P J. (1996) Latcralized startle probes in the

study of emotton. P,sycltopl4',siolog)',33: 156 161.

Bradshaw G.A. & Schore. A.N. (2007) Horv clephants are opcning doors: develop-

mental neuroethology, attachment and social context. Ethologl'.ll3:426436.Bromberg. P.M. (2006) An'altening the dretnner: Clinical journeys. Mahwah, NJ:

Analytic Press.

Brown, M.R., Fisher, L.A., Spiess. J.. Rivier, C.. Rivicr, J. & Vale. W. (1982)

Corticotropin-releasing factor: Actions on thc sympathetic nervous system and

rnctabolism. Endocrinology', 1 1 1: 928 931.

ntersubjectivehore, 2007, inl major theme

AMP responsegray by preda-i limbic neuralPsychiatry,2T:

rt and memoryrive Psychiatry,

.ment disorder.

sikera, I.A. &to smiling and

:rosychrony olcunter. Psycho-

;ion in infancy:5.

)8) Refinementrte and orbito-Developmental

evelopment ofhuman brain in7y,31:349-354..tion of the leftnental Science,

healthy human

: probes in the

loors: develop-):426436.Mahwah, NJ:

ale, W (1982)

us system and

Neurobiology of attachment 4l

Carlson, V., Cicchetti, D., Barnett, D. & Braunwald' K. (1989) Disorganizedl

disoriented attachment relationships in maltreated infants. Developmental Psych-

ology, 25: 525-531.Chiron C., Jambaque, I.,

(1997) The right brain1057-106s.

Cortina, M. & Liotti, G.

processes: Implicit andanalysis, 16:204-212.

Nabbout, R., Lounes, R., Syrota, A. & Dulac, O.

hemisphere is dominant in human infants. Brain, 120:

lZtiOZ; New approaches to understanding unconsciousexplicit memory systems. International Forum of Psycho-

Cozolino, L. (2002) The neuroscience of psychotherapy. New York: Norton.Crucian, G.P., Hughes, J.D., Barrett, A.M., Williamson, D.J.G., Bauer, R.M., Bowres,

D. et al. (2000) Emotional and physiological responses to false feedback. cortex,36: 623-647.

Dapretto, M., Davies, M.S., Pfeifer, J.H., Scott, A.A', Sigman, M., Bookheimer, S.Y

et al. (2006) Understanding emotions in others: Mirror neuron dysfunction in

children with autism spectrum disorders. Nature Neuroscience,9: 28 31.

Davidson, R.J., Ekman, P., Saron, C., Senulis, J. & Friesen, W.V. (1990) Approach/

withdrawal and cerebral asymmetry: 1. Emotional expression and brain physi-

ology. Journal of Personality and Social Psychology,58: 330-341.

de Bellis, M.D., Baum, A.S., Birmaher, B., Keshavan, M.S., Eccard, C.H., Boring,

A.M. et al. (1999) Developmental traumatology Part I: Biological stress systems.

Biological Psychiatry, 45:. 1259-1270.

De Haan, M., Belsky, J., Reid, V., Volein, A. & Johnson, M.H. (2004) Maternalpersonality and infants' neural and visual responsivity to facial expressions ofemotion. Journal of Child Psychology and Psychiatry,45:. 1209-1218.

Devinsky, O. (2000) Right cerebral hemisphere dominance for a sense of corporeal

and emotionalself. Epilepsy & Behaviour, l:60-73.Dikel, T.N., Fennell, E. & Gilmore, R.L. (2003) Post traumatic stress disordeq

dissociation, and sexual abuse history in epileptic nonepileptic seizure patients.

Ep ile p s y and B ehav iour, 4: 644-650.Diseth, T.H. (2005) Dissociation in children and adolescents as reaction to trauma -

an overview of conceptual issues and neurobiological factors. Nordic Journal

of Psychiatry, 59: 79-91.Dixon, A. K. (1993) Ethological strategies for defense in animals and humans: Their

role in some psychiatric disorders. British Journal of Medical Psychology, Tl:41744s.

Dorpat, T.L. (2001) Primary process communication. Psychoanalytic Inquiry, 3:

448463.Draijer, N. & Langeland, W (1999) Childhood trauma and perceived parental

dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

American Journal of Psychiatry, I 56: 379-385.

Espinosa, M., Beckwith, L., Howard, J., Tyler, R. & Swanson, K' (2001) Maternalpsychopathology and attachment in toddlers of heavy cocaine-using mothers.

Infant M ental H ealth Journal, 22: 316-333.Field, T., Pickens, J., Fox, N.A., Nawrocki, T. & Gonzalez, J. (1995) Vagal tone in

infants of depressed mothers. Development and P sychopatholo gy, 7 : 227 -231 -

Fonagy, P. & Target, M. (1997) Attachment and reflective function: Their role inself-organization. D ev e I o pmen t and P s ychop at ho lo gy, 9 : 61 9 -7 00.

42 Schore

Fonagy. P. & Target. M. (2002) Early intcrvention and the dcvelopment ofself-regulation . Psychorrtlrtit' Inquiry. 22: 307 335.

F-onagy, P & Target, M. (2005) Bridging the transmission gap: An end to an importantmystery of attachment research? Attat'hnrcnt & Hunun Detelopment.l: 333 343.

Freud, A. (1951/1968) Notes on the connection between the statcs of negativism andpsychic surrender. ln Tlte x,ritings of Anna Freud (YoI. 4, pp.256 259). New York:International Universities Press.

Freud, A. (196411969) Comments on psychic trauma. ln The vriting,s o/' Anna Freud,(Vol. 4. pp. 221 241). New York: Intcrnational Universiites Prcss.

Freud, S. (i915) The unconscious. Standanl Edition (Vol. 14. pp. 159-205). London:Hogarth Press, 1957.

Gadea, M., Gomez, C., Gonzalez-Bono, R.E. & Salvador, A. (2005) Increasedcortisol and decreased right ear advantage (REA) in dichotic listening following a

negative rnood induction. P.sychoneuroendocrinology, 30: 129- 138.

Gainotti, G. (2000) Neuropsychological theories of emotion. In J. Borod (Ed t, Theneuropsyclrclogy of enrction. New York: Oxlord University Press.

Gallagher. H.L. & Frith, C.D. (2004) Dissociable neural pathways lor the perceptionand recognition of expressive and instrumental gestures. Neuropsychologia, 42:1725 1736.

Geschwind, N. & Galaburda, A. M. (1987) Cerebral laterali:ution: Biologiccil ntechan-istrr.s, a.gsociation,s, and patholog1,. Bor,on, MIT Press.

Grossman, T., Johnson, M.H., Farroni, T. & Csibra. G. (2007) Social perception in theinfant brain: Gamma oscillatory activity in response to eye gaze. Sot,ictl Cogttitit,eand Afrbctive Neuro.rcience, 2: 284 291.

Guedeney, A. & Fermanian. J. (2001) A validity and reliability study ol assessmentand screening lor sustained withdrawal in infancy: The alarm distress scale. InJantMental Health Jounnl,22:559 515.

Gunnar, M.R. (2000) Early adversity and the development of stress reactivity andregulation. In C.A. Nelson (Ed.), fhe Minne,sota Symposiunr on Child Psyt'hology:Vol. 31, The fficts o/ curly udver,sitl, on netrobehaviotu'al de,-elopntent (pp. 163-200).Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Henry, J.P. (1993) Psychological and physiological responses to stress: The righthemisphere and the hypothalamo pituitary- adrenal axis, an inquiry into problemsol human bonding. Integrative Physiological & Behavioural Science. 28 369-387 .

Hesse, E. & Main, M.M. (1999) Second-generation effects of unresolved trauna innonmaltreating parents: dissociated, frightcned. and threatening parentalbehaviour. Psychoanalytic Inquiry, 19: 481-540.

Hesse, E. & Main, M. (2006) Frightened, threatening, and dissociative parentalbehavior in low-risk samples: Description, discussion, and interpretalions. Devel-opment and Psychopathology, l8(2): 309 343.

Homae. F.. Watanabe, H., Nakano, T., Asakawa, K. & Taga, G. (2006) T'he righthemisphere ol sleeping infants perceives sentcntial prosody. Neuro.scienceResearch.54:276 280.

Howard, M.F. & Reggia, J.A. (2007) A theory of the visual system biology underlyingdevelopment ol spatial frequency lateralization. Brain and Cognition, 64 lll 123.

Hugdahl, K. (1995) Classical conditioning and implicit learning: The righthemisphere hypothesis. In R. J. Davidson & K. Hugdahl (Eds.), Brain asl,mntetry(pp.235-267). Cambridge, MA: MIT Press.

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ir!curobioiogy of attachnrent 43

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Vir\oirLc>:in. lit .1.C. I)oIicr' & D. .lczoYa (I:d:.)' ('iitrrl;rrirtq rt:qrt!ttttt;.', fttt lrtr'; ttttt/

,rr'ttr,,r'irr!,,r rittt' fiurt lirr't(pp. 1 13 13'i) \*v Ybll;: l'1;iltttli Pl-ets'

i_rue. R.l)..,\irc*r. (].t..^ Scl*r.it t.G.l:...t iiirrztriitli. r\.\\l (1997) i:.ir'riili1'nrie ilic

cnroilollrri c..1uii,aicnt 1;1'fli111i5ig1li ! DiolosiLttl I's.l'clriutrl ^ 42: fl3'i li'14-

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iLurir.r'ltic st1.c\s (iiioLCicl.: A lirirctionll ma!nctic risonunct itnltl:iug itlve 'ii:l.tti'rtt'

B t o I r t.q i t tr I P s.\' t I t i tt / t .r " 57 : il'li [i[j";'

x-c Grailri^ l{.. \,Ioilliocir. c'.. }lrLr.it-cr'^ D. ct Br.ent. Ii. P (2003) L xpc|t tac; pti'ei'sitttl

requircs visrial iltp'.rt io thc |igli',t hcrr-iisphclc citil'inrr illlitilc1' Nrltltit'tVt'rririltttrrtc'

6:1108 1ii2.Lenzi. i)..'licntini. C.^ i)untano. 11. Nlrrcaliiso. I:.. Iacaironi. NI.. i-cnzi. Glct il1'

(2-0i)9) \ctir.1l basis c'ri ruaicl uli coir-rii.runicirtiorl lttrci ill-lotioillil lrprcssiotl il1-oce ss-

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l.iotti. G. (20()+) li'auillli. cii-s:ociation. llttci tiisoiillttti;'.cri ltitlichtnii-tt:'Iilicc

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\licirrrclso1l & \\1.tr. I{a1, i:.ti>.). Ilttirlltr;rsli ttf tli.sttttitriittit; l'ltt'rrt'liLul'

urttl tlittitrrl ltt'l \1ra'.'1lr'.'\ (ilp. 3()7 336) No'i' Yotii: l)icll''lt:i'

\,iacfic. .1.. Cicciteiti. o. &'rirt|. s.1,. (2()0i ) i)issociatio' ilt 'r:llt.caicci

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\ilLin. \1. & Solot-uotl. j. (i986) i)iscovcrl' o1- :itt itisccttie disoitrltnizccl/ciisolit't'rtct1

aitachfir;nt lllltcrn: Ptocccltir;s. linciiils. linci inlpiicliions 1bi ihc cias-'iiication of

bchirviorri. Irr '1.B. IJtazcirou .t. ivI.W. Yogr-uiut (i,ti.'.). ,lllcttit't' tlttclrttttti'ttt itt

ittlirtr'.t' (pp.95 124). \or.wooti. N'i: "\bler'

NIaLi,orvitsc'li. ILJ.. Rcinxcn,.ei;r'. A.. Kcs-sici'. i., lio)'ltrc''i"'\' & Iici:s' W-D (2000)

Ilig:itt amygclulil| und icttllle t()1i,-Iiilri .rciiYiilioil tiuriaii arrtobiogilriliricai' bilt rro"

iiciiti.trs i.,.r.r.to.1' r-ctrie'ul. litlttn'i.trrul Ncurolttgt.l?-: illi i90.

I,4cnar.ci. J.i-.. chantilrlrnc. I).L. it trIeitnc1'. NI..l.l). (200',1) VaIia'Lions o1'tllrttcrulll

csie cliilcr.cntiallv itrilucl-rcc'icur" iclctii,itl,irr respotl:c to titc shocli-p|obc iru|yiilg

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44 Schore

Merckelbach, H. & Muris, P. (2001) The causal link between self-reported trauma anddissociation: A critical review. Behat'iour Resecnch and Therupy,3g:245 254.

Minagawa-Kawai, Y, Matsuoka, S.. Dan, I., Naoi, N.. Nakamura, K. & Kojima. S.(2009) Prelrontal activation associated witl.r social attachmcnt: Facial-emotionrecognition in mothers and infants. Cerebral Cortex,19 284 292.

Mollon. P. (1996) Multiple sel,res, multiple voice.s; workittg rvith traunru, violation unddi:; sot' iat iort. Chichester, UK: Wiley.

Nagy, E. (2006) From imitation to conversation: The first dialogues with humanneonates. InJunt and Child Development. l5'.223 232.

Nakato. E.. Otsuka, Y., Kanazawa. S.. Yamaguchi. M.K.. Watanabe, S. & Kakiga, R.(2009) When do infants differentiate profile lace fiom frontal facc? A near-inlraredspectroscopic s|urJy. Iltmtan Brain Mupping.30 462472.

Newman, L. & Stevenson, C. (2005) Parenting and borderline personality disorder.Clinical Child Psyt'hology and P.tychiutry, l0: 385-394.

Nijenhuis, E.R.S. (2000) Somatoform dissociation: Major symptoms ol dissociativcdisorders. Journal of Truwttrt & Dis:sociation. l: 7 32.

Noriuchi, M., Kikuchi, Y. & Senoo, A. (2008) The functional neuroanatomy ofmaternal love: Mother's response to inlant's attachment behaviours. BioktgicalPs yc h iat r y, 63 : 41 5423.

Otsuka, Y., Nakato. E., Kanazawa, S., Yamaguchi, M.K., Watanabe, S. & Kakigi, R.(2007) Neural activation to upright and inverted faces in infants measured by nearinlrarcd spectroscopy. N e ur o hn u ge, 34: 399 406.

Papousek, H. & Papousek, M. (1997) Fragile aspects of early social integration. h.rL. Murray & PJ. Cooper (Eds.). Postpartun deprcs.sion and child del,elopnrent(pp. 35 53). New York: Guillord Press.

Parent. C.,Zhang, T.-Y.. Caldji, C., Bagot, R.. Champagne. F.A.. Pruessner, J. et al.(2005) Maternal care and individual differences in defensive rcsponses. CurrentD i r e c t io ns in P s.y' c h o b g ic u I S c i c n t e. 12: 229 233.

Pelphrey. K.A., Viola, R.J. & McCarthy, G. (2004) When strangers pass: processing

of nrutual and averted social gaze in the superior temporal sulcus. psychologicalScience. l5: 598 603.

Porges, S.Vl (1997) Emotion: An evolutionary by-product ol the ncural regulationof the autonomic nervous systcm. Annals o.f' tha New York Acadentl, o./' St:iences,807:62 17.

Powles, vlE. (1992) Human tlevelopnrent and homeo,srusi.r. Madison. cr: InternationaiUniversities Press.

Putnam, F. W (1997) Dissociatiut in cltildren arul udole.trtnts: a deyelopntentalper,tpective. New York: Guillord Press.

Raz. A. (2004) Anatomy of attentional networks. Anatonicul Rec'ortl,28lB: 21 36.Recordati, G. (2003) A thermodynamic model of the sympathetic and parasympa-

thetic nervous systems. Autonotrtic Nettroscience; Busic and Clinical,103: I 12.Roelofs, K.. Keijcrs, G.P.J., Hoogduin, K.A.L.. Naring. G.VlB. & Moenc, F.C. (2002)

Childhood abuse in patients with conversion disorder. Americcut Journal of'Psyt'hiarry, 159: 1908 1913.

Schiffer, F., Teicher, M. & Papanicolaou, A. (1995) Evoked potentials evidencefor right brain activity during recall of traumatic memories. Jotrttttl of Neuropsy-cltiutrv and Clinical Neuro,science. T: 169 175.

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ct .:;li:.1 llarlrJiic lrIPrtl:cl:. .toititiul of t\tt-t!iol)\I(liittii.,,'rrtitl (!;itittii ,\'c1li,rrr1, r,r."I5 I5:t ,6).

46 Schore

Stern, D.N. (1985) The irterper'sontil vorlcl ttl'rhe l'rllrl' New York: Basic Books'

Sullivan. R.M. & Gratton, i. (zoozl prcfrontal cortical reguiation of hypothalamic-

pituitary adrenal l.unciion in the rat and implications lor psychopathology: Side

matters. P s 1' t:h one ru' tt e n do cr in o I o 91" 21 : 99 I 1 4'

Sullivan. R.M. & Dutresne, M.'-ivI. (2006) Mesocorrical dopamine and HPA

axisregulation:Roleoflateralityandearlyenvironment'BruinResetu'ch'1076:49 59.

Sutcr. S.E.. Huggenberger H'J & Schachinger' H' (2007) Cold pressor sttess reduces

lelt cradling prel'erence in nulliparous human fernalcs St|ess' 10: 45-51'

Symonds, L.L., Gordon' N.S. Bixby. JC' & Mandc' M'M' (2006) Right-lateralized-'

puir processing in the human .ori.*, An lMRI sttdy. Journol of'Neurophysiologl'.

95:3823 3830.

Thierry'G..Vihman.M.&Roberts.M.(2003)Familiarrvordscapturctheattentlonof i1-month-olds in less than 250 ms' NeuroReport' 14"2301 2310'

-Trcvarthen. C. (2001) The neurobiology of tutly totnt'nication: Intersubjective

regulationsinhumanbraindevclopment.InA.F.Kalverboer&A.Gramsbcrgen(Eds.), Handblok on brairt und bihuviour in lnuntut de|elopnrcnt (pp 8a1 882).

Dorclrecht' The Netherlands: Kluwer'

Tronick'E.2,(|gs9)Emotionsan<lemotionalcommunicationininlants.AlnericattP sycho lo gi'st. 44 I l2-1 19'

Tronick' E.Z' (2004) why is conncction with others so critical.? Dyadic nreaning

making, messiness ani complexity govcrned selective processes rvhich co-create

and expand individuals' staies of consciousness. In J. Nadel & D. Muir (Eds.)'

Errtotiinal dcvelopment. New York: Oxlord University Press'

Tronick,E.Z.&Weinberg,M'K'(1997)Depressedmothersandinfants:Failureto form dyadic states of consciousness' In L' Murray & P'J' Cooper (Eds')'

Po.stparttun tlepressirtn in child cletclopmcnt (pp' 54 81)' Nc1 Yo-rk1 Guilford Press'

Tucker'D.M.(1992)Developingemotionsandcorticalnetworks.InM.R.Gunnar&C.A' Nelson (E<Js'). Minne'sttttt s.Y'tttposiutrt ttn child ps1't:lnlogy' Wtl' 24' Devclop'

ntetttal behuvioural nenrrt'tcience (pp' ZS-fZS)' Mahwah' NJ: Lawrence Erlbaum

Associates. Inc.Tzourio-Mazoyer.N.,DeSchoncn.S.'Crivcllo'F.'Reutter.B..Aujard.Y.&Mazoyel.

B. (2002) Neural correlates of woman face proccssing by 2-month-old inlants'

N e uro Imuge, 15: 454461'Watt'D.F.(2003)Psychotherapyinanagcofneuroscicnce:Bridgestoaffectivc

neuroscicnce. In J. Co'rigafi b H. Wilkinson (Ecls.), R.''olutionor!' to,tttctiuttt'

Psycltotherapl' antl neru'otcicnce (pp' 79 115)' London: Karnac'

Weavcr, I.C.G.. Cervoti, i'- Cftttipagne' n'A" D'Alcssio' A'C'' Sharma' S ' Seckl'

J.R. et a1. (200a) Epigenctic programming by maternal behaviour' Nuture

Neuro,Yciance, 7 : 847 854'

Winnicott. D.W. (1958i iht tuputity to be alonc' Internulional Journul of

P syclrc- AnulY s i s, 39: 41 6 420'WismerFries,A.B..Ziegler.T'E"Kurian'J'R"Jacoris'S'&Pollak'S'D'(2005)

Early cxperience in himans is associated with changes in neuropeptides critical

lor regulating social behavio ur' Proceed[ngs of the Ntttional Acutlenry, o.f'science's o.f

the Llnited States o.f Anrctica' 102 11237 17240

Yamada. H.. Sadato, N., Konishi, Y" Muramoto' S'' Kimura' K" Tanaka' M' et al'

(20

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Relational Trauma in Infancy

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