title: Childhood abuse and neglect and loss of self-regulation.
abstract: Secure attachments with caregivers play a critical role in helping children develop a capacity to modulate physiological arousal. Loss of ability to regulate the intensity of feelings and impulses is possibly the most far-reaching effect of trauma and neglect. It has been shown that most abused and neglected children develop disorganized attachment patterns. The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse. The capacity to regulate internal states affects both self-definition and one's attitude toward one's surroundings. Abused children often fail to develop the capacity to express specific and differentiated emotions: Their difficulty putting feelings into words interferes with flexible response strategies and promotes acting out. Usually, these behaviors coexist, which further complicates diagnosis and treatment. Affective dysregulation can be mitigated by safe attachments, secure meaning schemes, and pharmacological interventions that enhance the predictability of somatic responses to stress. The ability to create symbolic representations of terrifying experiences promotes taming of terror and desomatization of traumatic memories.
authors.affiliation: Trauma Clinic, Massachusetts General Hospital, Boston.
authors.forename: B A
authors.initials: BA
authors.lastname: van der Kolk
authors.forename: R E
authors.initials: RE
authors.lastname: Fisler
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000209:etiology; D006801:Humans; D007389:Internal-External Control; D019964:Mood Disorders / Q000209:etiology; D009769:Object Attachment; D012649:Self Concept; D016728:Self-Injurious Behavior / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D019966:Substance-Related Disorders / Q000209:etiology; D013561:Symbolism