Henry J P
Acta Physiol Scand Suppl. 1997;640:10-25.
In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperienceing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left the right hemispheres subserve different emotional sets that correspond to "control" and "appraisal," i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a "Higher Power." They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.
除了对事件的反复重新体验外，严重心理创伤的延迟效应，即创伤后应激障碍（PTSD），呈现出一种矛盾的症状组合。自我保护的儿茶酚胺状态增强；愤怒和恐惧与一种相反的无意义感以及对物种保存至关重要的依恋行为的情感反应迟钝并存。从激素方面来看，儿茶酚胺反应显著分离，其持续升高，而下丘脑 - 垂体 - 肾上腺（HPA）轴的反应可能保持在正常水平。在病理生理学上，创伤的重新体验和唤醒可能与蓝斑、杏仁核和海马系统的功能障碍有关。本文探讨了另一种功能障碍的后果：大脑半球的分离，这似乎是导致述情障碍性回避以及严重心理创伤后经常出现的皮质醇反应失败的原因。有神经生理学证据表明，左半球和右半球分别服务于不同的情感模式，大致对应于“控制”和“评估”，即分别大致对应于自我和物种保存行为复合体。几项研究指出在述情障碍期间大脑半球功能的生理分离。这就提出了一个问题：如果在这种情况下右侧不再充分参与大脑的整合功能，会失去什么？右半球受损的儿童会失去关键的社交技能，而在成年人中，对建立联系至关重要的相关熟悉感会丧失。这种社交敏感性丧失可能解释了在反社会人格障碍和边缘型人格中发现的缺乏同理心和建立联系困难的情况：现在认为这些情况是由发育过程中反复的心理创伤导致的。另一方面，促进右半球功能的系统提供了通向“更高力量”的慰藉途径。它们似乎还能防止社会行为紊乱、药物滥用、HPA轴功能衰竭以及慢性病病理生理学的某些方面。
