Schore Allan N
University of California at Los Angeles School of Medicine, Northridge, CA 91324, USA.
Aust N Z J Psychiatry. 2002 Feb;36(1):9-30. doi: 10.1046/j.1440-1614.2002.00996.x.
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.
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.
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.
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.
本综述整合了依恋理论、情感神经科学、发育应激研究和婴儿精神病学方面的最新进展，以阐明创伤后应激障碍的发育前体。
利用医学索引/医学期刊数据库（Index Medicus/Medline）和心理学文摘收集现有的依恋、应激生理学、创伤和神经科学文献。这些汇聚的跨学科数据被用作理论基础，以模拟早期关系性创伤对驱动依恋功能的中枢和自主神经系统发育活动的影响。
整合神经精神病学、婴儿精神病学和临床精神病学的当前趋势正在生成更强大的模型，以解释包括创伤后应激障碍在内的精神疾病易感性的早期成因。所呈现的数据表明，以过度觉醒和解离发作表现出来的创伤性依恋被印记在早期成熟的右脑发育中的边缘和自主神经系统中。这些持久的结构变化导致了低效的应激应对机制，而这正是婴儿、儿童和成人创伤后应激障碍的核心所在。
混乱 - 迷失方向的不安全依恋是1至2岁受虐婴儿中常见的模式，在心理上表现为无法产生应对关系性应激的连贯策略。早期虐待对右脑的发育轨迹产生负面影响，右脑在依恋、情感调节和应激调节方面占主导地位，从而为创伤后应激障碍症状所特有的身心应对缺陷设定了一个模板。这些数据表明，早期干预项目可以显著改变创伤后应激障碍的代际传播。
