Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder.
OBJECTIVE
This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder.


METHODS
Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions.


RESULTS
Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders.


CONCLUSIONS
Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.
Schore
Allan N
AN
University of California at Los Angeles School of Medicine, Northridge, CA 91324, USA. anschore@aol.com
D000293:Adolescent; D000328:Adult; D001143:Arousal / Q000502:physiology; D001341:Autonomic Nervous System / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology*; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019962:Reactive Attachment Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology