Kozlowska Kasia
University of Sydney, Australia.
Clin Child Psychol Psychiatry. 2007 Oct;12(4):487-510. doi: 10.1177/1359104507080977.
Attachment theory offers a novel developmental framework for understanding conversion reactions as having phylogenetic roots in two different innate animal defense behaviours: The 'freeze response' and 'appeasement defense behaviours'. From this perspective, conversion symptoms reflect two distinct, threat-elicited emotional responses, which are primed in context-dependent developmental experiences (pathways) and underpinned by different neurobiological mechanisms. The first of these two developmental pathways to conversion disorder involves the organization of self-protective strategies that incorporate components of the freeze response and involve inhibition of negative affective states in the context of punishment by caregivers. The second of these pathways involves the organization of self-protective strategies that incorporate innate appeasement defense behaviours in the context of unpredictable parental behaviours that threaten children's physical safety or emotional health. Seen from this developmental perspective, children with conversion disorders are not a homogenous group but fall into two distinct functional groups requiring different types of treatment.
依恋理论提供了一个全新的发展框架，用于理解转换反应，认为其在系统发育上源于两种不同的先天性动物防御行为：“冻结反应”和“安抚防御行为”。从这一角度来看，转换症状反映了两种不同的、由威胁引发的情绪反应，这些反应在依赖情境的发展经历（途径）中被启动，并由不同的神经生物学机制支撑。这两条通往转换障碍的发展途径中的第一条涉及自我保护策略的组织，这些策略包含冻结反应的成分，并在照顾者惩罚的情境中涉及对负面情绪状态的抑制。第二条途径涉及自我保护策略的组织，这些策略在不可预测的父母行为（威胁儿童的身体安全或情绪健康）的情境中纳入先天性的安抚防御行为。从这一发展角度来看，患有转换障碍的儿童不是一个同质化的群体，而是分为两个不同的功能组，需要不同类型的治疗。
