Affect Dysregulation and Disorders of the Self

Allan Schore has for some 15 years written about the processes underlying affect regulation in normal and abnormal self-development and attachment. His best known book entitled Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development, published in 1994, was the first coherent attempt to integrate the then recent findings of neurobiology with clinical observations in children and adults and brought down barriers that had impeded the understanding of the self and its disorders. In the present volume, Schore incorporates the vast amount of data from neurosciences since 1994 and presents the reader with a truly compelling theoretical synthesis of this literature. In part I, there are 4 chapters on developmental affective neuroscience. They deal with the contribution experience expectant vs. experience dependent phenomena make to the development of affect regulation. The former are primarily gene dependent (e.g., the CNS of a newborn is equipped to function well in infants who live within a reasonably safe environment and are exposed to gradual rather than violent changes) while the latter are dependent on the care taking practices the child is exposed to. One example cited is the affective transmissions in mutual gaze transactions between infants and their mothers. These affective parental responses are the first means by which mothers can provide a model of affect modulation to their infants (e.g., mother senses when her baby is becoming overstimulated and will respond by decreasing her own stimulation, leading to calming the infant). Such soothing behaviors will secondarily effect the maturation of the orbitofrontal cortex and strengthen its regulatory abilities. Attachment behavior is likewise based on the reciprocal activation of the couple’s endogenous opiate systems but also regulates the dopamine levels in the infant’s brain. Schore brings these and other interdisciplinary findings together by citing the available evidence and at times even presenting colored PET or fMRI scans to make his point. In part II, 5 chapters deal with developmental neuropsychiatric data and their relevance on development of the right brain, secure attachment relationships and on symptoms of PTSD, borderline and antisocial personality disorders. Here again, Schore cites studies that explain important psychological processes through neuropsychiatric data. For example, he cites evidence that in the context of face-to-face interactions, mothers trigger production of corticotropin releasing factor (CRF) in their infants. The CRF, in turn raises the concentration of noradrenaline, increasing general energy metabolism but also controls endorphin and ACTH. production, leading to an elated state in the infant. When it comes to PTSD and other well-defined psychiatric disorders, the overall picture becomes more complicated. For example, Schore claims that PTSD is related to the inability of the right prefrontal cortex to sufficiently modulate amygdala (i.e., aggressive) functions. The fact that this also occurs in children with a disorganized disoriented insecure attachment pattern is then seen as proof that this particular early maternal caretaking pattern contributes to later dissociative psychopathology. One could counter that proposition by pointing out that elevated cortisol levels are important for overall stress management – but that prenatally elevated levels, especially in the third trimester of pregnancy, have been found to be especially pathogenic as they effect the developing brain at its most critical time. However, high cortisol levels can be caused by a variety of conditions. Intra-uterine growth retardation (IUGR) is a common condition associated in children born with ‘small gestational age’ (SGA). It is innately stressful for the infant, hence associated with elevated prenatal cortisol levels that are not associated to later maternal attachment patterns. Aggressive behavior disorders are also described as a consequence of a right brain system impaired for regulating aggressive affective states. Here it is said to be the low arousal state characteristic for antisocial and aggressive individuals that such individuals try to increase back to optimal or normal levels by seeking stimulation. While this may be one pathway leading to aggressive behavior disorders, there are authors such as Tremblay and colleagues in Montreal who claim that all young children are highly aggressive and must “unlearn” this behavior in the process of development. Those who do not or cannot do so will make up our clinical population. In summary, the present volume of Allan Schore provides the reader with a provocative and stimulating theoretical synthesis of multi-disciplinary work that relates affect regulation to the development of the self and its deviations. Schore’s writing style is almost poetic and transforms potentially dry data into an exciting story of discovery and multidisciplinary dependency. He also suggests, at least indirectly, preventive measures that can address the problem of violence and other dysfunctions of the developing self in children through optimal early social-emotional experiences. I highly recommend this volume to researchers and clinicians.