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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
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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)
dem,
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<ici,-iolstLnics 'iutcliiiizcci systcm tol ncolliiril imitatiol' tltlcl cotrclitrle-:^ "-l iie
u'arli,udvitutagc oi'1itc lir:lil itctt-risithci* (Cilil'orl et al.. 1997: Scholc^ 20(X);'lig'altitcn, 20t)1) iu iitc 1ir':;t f-cii'nrontirs oi 1ilc rrra;'ali'cct thc llrtct'itiizcci
ailll.aluitcc of'tirc 1lt'si intilatirc gestLlr';s". Sicraizlii ancl Woi! (i996) clcscrit'r-:
iiic cilccts of- toticit on tirc cil'eiti1.rit.rl,. t'ight heruisilltcrc. atrcl asselt thltt thc
cl.rotional iit'rpucl cli ittuch is r,-rr'rLc direct auti irnrnediatc if-itr.l. itlian'. is
|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:
s)'stcil. illc Llt'.ls dllniaticlilly, .;hl:pcei b1' earl1, t'cllttioltitl clncrtiorli:i L'\pjl icilc!'(Schoi'c. 199,j: Iloel' ct ii1..2()03).
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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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ItO
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'
titc;i oii,t.i critct'icircc.-i o1' eltiil abi-is. ilircl rtti:tchluctti (ii5i'liilii(.)il ,il :tbrisi"'c
icliitrolsiiin-r. cilll l)c ic-cltltcicci ii'i,ir ihcir' o\'"'1i iilitlllis."{ itis ie-cllcill.tclt', occul's ill cirisories oi'r'cilliional il'auit.ul (Schoi'.'. 2(X) i"
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:
,i36) cic:cl'rbc: ihc iititiul :iiiiic ol'"miiir.il:iii'csr:aillillll: ovciiliotlsili oi'll c,l:-
' )i iI:iI r;/!'(i ;:i itir-'ll :r'it'it: .,llil :
l:lcir onc cscliaicsllc iini,:. lis iirc iirlli;rl billcis',tt lt it'l:itiic clisiiess. r.lili':eicl:|1. ir;t(i. iit 1i'i<;r;;,'1rr1u. l;r:lrii1 ,iiit'i\s t:ir. ['r ''' t.t::l::.]l: o\"-'arorl:,1i i.)lritc1.n" c\'cit itiricl'c\ii'Jr,!c ciisil.css siqlliii lt'ot-:t tittr itlilllit" silch
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.
'i itc iitiunt':. s'rtt'c oi- "ll'iiitiic t'listt,':;,s^. ol' le lli lcl'io,:. is illcciiili,.:ci tlt'
s\,lltliltilclic i.i1'p;i ai'rii-tsul lilil i:, crlricss.:c1 iir incie ll.'.cci sJCl.aiiott t;i' ctlt'tlccl
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,
and heart rate - despite increases in circulating adrenaline. This elevated
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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
rnrl is
iC LlSe
tntt',t-
NIuinfaltcclnt i..:
u'hcn
in iur
rtlen-atc 11)'
h-olcl
1ii1'cc1
nizcriaviollcJ to
ttitiu-)n ()l'
sui'-
xinr-tiaii1'
l'ts ot'
cribc
I ircr'
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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ivcl olIun'cntLis:,oci-
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onc is: brain
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
it ir
nci
rcl-
scs
ir'c
lhrcfs
luci.
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.,!
Lncl
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iirc'cl)'
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'ate
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r llt
38 Schoreener
sud(collithetandandpar
IsutStiI
anl(ineni
1o'
SU
p2
u1
alc(
w
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
sl
p
c
t
il
r'hodiil'
.ivclcr-lnuthctralbes
ing:cs-
lisan
of'
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on
hc
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rin
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oiht
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Js
al
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r1'
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.
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ir!curobioiogy of attachnrent 43
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lin importuiti/- 1-1-r -\ii-1.
:giaiivi:m ai'ui)). Ncu \irrl':
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ttitrl ('ogttitivt'
ol as-.c::tncllii) )c.l1c. 1lil.//1/
lclctivitl' lntlItl I'.:itlnlor:.r;(pp 163 "2()0).
r:s: fire filtlitinto 1-noirlcnt:,2ii: 369 3[]7.
rcci trLLrnra inring puteltiltl
ati,",: llltt'.'tttltltation:. .Dor'l-
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Jarrct. l). ( 1 8f;9) L'atrlor i t tt t i.s r i t t: lt s.t t l t r t i t t g i r lt r t' P :'rri'
lillscirr'd. I). (L005) IloDc rctstrs ltoirciessitt's itl
I)rrrtle's Dit'irtL' Ct,rtit'tirL 57riirrq. I )" 161 iE'i'licsicrrbcrg. .j. ( i985) 'I.lrc ilori' oi. cluillltirl, lti..cl iritsi 11.:,irrc.:il
lni:..i.,\nthony&(i.{l.i)o11ack(i-ci-'')'1'rrrlrrtuliitl!tttittcsiit(np 117 i(r3). Iloston: l-ittle. Iilotvil'
t<i,rn.1,. FI.C.. l}.od1'. B.i\.. tiioilrin",'\.S. & Ciilic,. F.ll. (i938) Secitlc:tce oic;trttei
,.,a*,rua .1,srctl'nry.'iitraiion in lttttnl'.il iilili[rc1'. ii. Pailcf iis ot'nycliilrLliotr ill
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2r'l 23it.Iinici,melcr.. I{.C.^ Gouitu|c1. S.. Iiilng" C.^ I:r'als. D.. wiltr:i. l{. stniih-.i l(" ci ai'
(200lli sir.uctiii..rl \{il. l stur11'olirtttn::tr Lrr'.tiii dcvcioi;n]ctrt ftour Lrirth to 21'cr:t:'
,ltttrrrtttl rtf \it'rrittstit'iu r'- 2il: 12i76 i21fl2'
lir.1,"tril. i i. ( igss) Itttt,qruti0rt trtrl st'li-lttttlitt<; '1llt't t it(tt!111u tlctitltttiiitt\.i: \lr,ri) lie I)i."
Lrct11lnslil,^ I{.^.lczora. I).^ Op|s!lo!1. Z..l'oltl;s. o.. l\lichllo!s1'!ii. \.. i)oblitiror'or"l"
Nl. ci l:1. (199()) t{cguluttoit Ol-thc synlllllr.llctic ileivoLis systcrn bi'circtilatins
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-
I-iiuius. I{.;\.. williumsolt. i).c.. !}1Lrhm^ l{.1-.. Drlllsrllo|c'. \i.^ Ilokslniiil' li ' \ctitclc1'
R.\\i.1. ci ul (2(x)5) l:unctioilai conll0ctivit)' ol' ciis.ociirtivc fc)llollsi\ iir po'r-
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-
AlcrLn.
thc irsl'citolittlt'l\ iic :itirltion
nrotilci llrld chliti..
littril it ttttti tlist'ttst'
irrlr clLrrirlg inlail'r prcre|l-llil stllil; ((t1'lttul Cr'r;icr' 19(5): 112'i 1133'
l.iotti. G. (20()+) li'auillli. cii-s:ociation. llttci tiisoiillttti;'.cri ltitlichtnii-tt:'Iilicc
lt sinttic br.lrici. 1,r.ir/ro llttrtt1l.1... ..1
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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
\'"r.51:> 'o'liliL1-ti.eritciilrrcrclrooi-lii:tchiki|r;r. c'lrild;1litt:t' c! Atcg1.'r l.?-5"';251 1-)'6'1.
\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
1,r.i- Ncllr'.)\( iL'ittc^ 1t?.'):297 3()3'
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i.ir:urc;rioiogy oi r.'.tacirilcnt 45
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Siclri,'1,i..i.5. ..! \troil. il. (i996) \t"il'rio :)roihlL> t'l.ttiic i;:ib;rr o:r tit; ic1i'l llt, !.titt.'!^3.11:,./,i6 i'r'.S.
Siltz:i. C.. \,\ii;.'r'r. C.. Girrirc" il.-.1.. Iiizo.. i..t l r-'r'o."grr'. I{..i. (2{)l)'l) l)i.,Lr;i-.liorritl,t.:,t_tl:tr: lt:',:iiiit.'il.\. lrirti ciy,.:iirtr;iio,,. ol ,tc.llli,-itciic iilillltciioit: ,\ lrttii_'-
ct .:;li:.1 llarlrJiic lrIPrtl:cl:. .toititiul of t\tt-t!iol)\I(liittii.,,'rrtitl (!;itittii ,\'c1li,rrr1, r,r."I5 I5:t ,6).
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Zltbis'1. I.. I)ocgryrci. G.^ Scirrabcl" i{. & i}';lLrn. i(. (2(X)3) S:pl'liion-inrl'Lrccrl r'cc;p-itti citittt!:cs ir tirc irippocrii';rpus unci linn'gciltia <tri Otlotloit rlrgrri: Iuliriclcc of'i'rl:l-'1 il1l rocltliz:liion>. ,lotttttul rif r\itutost!tttt c. ?.3: 5329 -5336.