RELATIONAL TRAUMA

FROM SCHORE AD

2-17-07

massive attachment dysfunctions

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“The efficient functioning of this coping system is central to the infant’s expanding capacity for self-regulation, the ability to flexibly regulate stressful emotional states through interactions with other humans – interactive regulation in interconnected contexts, and without other humans —  interactive regulation in interconnected contexts, and without other humans – autoregulation in autonomous contexts.  The adaptive capacity to shift between these dual regulatory modes, depending upon the social context, is an indicator of normal social emotional development.  In this manner a secure attachment relationship facilitates right brain development, promotes efficient affect regulation, and fosters adaptive infant mental health.  (Schore/ad/179)”

“…field of developmental psychopathology, an interdisciplinary approach that conceptualizes normal and aberrant development in terms of common underlying mechanisms (Cicchetti, 1994).  (Schore/ad/179)”

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“And so I will present ideas on

++ the effects of traumatic attachment experiences on the maturation of brain regulatory systems

++ the neurobiology of relational trauma

++ the neuropsychology of a disorganized/disoriented attachment pattern

++ the inhibitory effects of early trauma on the development of control systems involved in affect regulation

++ the links between early relational trauma and a predisposition to postraumatic [sic] stress disorder

++ a neurobiological model of dissociation

++ the connections between traumatic attachment and enduring right hemisphere dysfunction

++ and implications for early intervention.  (Schore/ad/180)”

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“Development may be conceptualized as the transformation of external into internal regulation.  This progression represents an increase of complexity of the maturing brain systems that adaptively regulate the interaction between the developing organism and the social environment.  (Schore/ad/180)”

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“…the primary caregiver of the securely attached infant affords emotional access to the child and responds appropriately and promptly to his or her positive and negative states.  She allows for the interactive generation of high (Schore/ad/180) levels of positive affect in coshared play states, and low levels of negative affect in the interactive repair of social stress, that is, attachment ruptures.  (Schore/ad/181)”

copied to play file

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“Because stable attachment bonds are vitally important for the infant’s continuing neurobiological development, these dyadically regulated events scaffold an expansion of the child’s coping capacities, and therefore adaptive infant and later adult mental health.  (Schore/ad/181)”

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“In contrast…the abusive caregiver not only shows less play with her infant, she also induces traumatic states of enduring negative affect….This caregiver is inaccessible and reacts to her infant’s expressions of emotions and stress inappropriately and/or rejectingly, and shows minimal or unpredictable participation in the various types of arousal regulating processes.  Instead of modulating she induces extreme levels of stimulation and arousal, either too high in abuse or too low in neglect, and because she provides no interactive repair the infant’s intense negative emotional states last for long periods of time.  Such states are accompanied by severe alterations in the biochemistry of the immature brain, especially in areas associated with the development of the child’s coping capacities….  (Schore/ad/181)”

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“There is agreement that repetitive, sustained emotional abuse is at the core of childhood trauma (O’Hagan, 1995), and that parental maltreatment or neglect compromises cognitive development (Trickett & McBride-Chang, 1995).  (Schore/ad/181)”

peritrauma

“…a context of very early relational trauma serves as a matrix for maladaptive infant (and later adult) mental health.  Current developmental research is delving into the most severe forms of attachment disturbances, reactive (Boris & Zeanah, 1999) and disorganized (Lyons-Ruth & Jacobvitz, 1999; Solomon & George, 1999) attachment disorders and are offering neurobiological models that underlie these early appearing psychopathologies (Hinshaw-Fuselier, Boris, & Zeanah, 1999).  Such massive attachment dysfunctions are clearly prime examples of maladaptive infant mental health.  (Schore/ad/181)”

Reactive and disorganized attachment disorders – early appearing psychopathologies – massive attachment dysfunctions

That is what I have had since my birth, then – and still do have

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“It has been said that “sexual trauma and childhood abuse may simply be the most commonly encountered severely aversive events inherent in our culture” (Sirven & Glosser, 1998, p. 232).  Trauma in the first two years, as at any point (Schore/ad/181) in the life span, can be inflicted upon the individual from the physical or interpersonal environment.  It is now established, however, that social stressors are “far more detrimental” than nonsocial aversive stimuli (Sgoifo et al., 1999).  For this reason I will use the term “relational trauma” throughout this work.  (Schore/ad/182)”

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“In light of the fact that the brain growth spurt begins in the third trimester in utero…, genetic-constitutional factors can be negatively impacted during this period by adverse conditions within the uterine maternal-infant environment.  (Schore/ad/182)”

“…certain maternal stimuli that impinge upon the fetus negatively impact the hypothalamo-pituitary-adrenocortical (HPA) axis….and thereby produce an enduring neurophysiological vulnerability.  (Schore/ad/182)”  alcohol and tobacco

“Various maternal behaviors may severely dysregulate the homeostasis and even future development of the developing fetus, yet these are not usually considered to be instances of trauma.  On the other hand, caregiver abuse and neglect of the postnatal infant are viewed as clear examples of relational trauma.  (Schore/ad/182)”

“…in neonatal phases, both genetic factors that influence stress responsivity and detrimental environmental effects interact to contribute to a behavioral outcome, that is stress exaggerates the effects of a developmental lesion….  This biopsychosocial model suggests that high-risk infants born with delayed brain development and poor interactive capacities, and thereby a vulnerable predisposition, would experience even low levels of relational stress as traumatic, while an infant with a more durable constitution would tolerate higher levels of dyadic misattunement before shifting into dysregulation.  (Schore/ad/183)”

“There is no one objective threshhold [sic] at which all infants initiate a stress response, rather this is subjectively determined and created within a unique organismic-environmental history.  Even so, the severe levels of stress associated with infant abuse and neglect are pathogenic to all immature human brains, and the latter [neglect] may be even more detrimental to development than the former.  (Schore/ad/183)”

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“These principles suggest that caregiver-induced trauma is qualitatively and quantitatively more potentially psychopathogenic than any other social or physical stressor (aside from those that directly target the developing brain).  (Schore/ad/183)”

“In an immature organism with undeveloped and restricted coping capacities, the primary caregiver is the source of the infant’s stress-regulation, and therefore sense of safety.  When not safety but danger emanates from the attachment relationship, the homeostatic assaults have significant short- and long-term consequences of the maturing psyche and soma.  (Schore/ad/183)”

“The stress regulating systems that integrate mind and body are a product of developing limbic-autonomic circuits (Rinaman et al, 2000), and since their maturation is experience-dependent, during their critical period of organization they are vulnerable to relational trauma.  (Schore/ad/183)”

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“The nascent psychobiological structures

that support the primordial motive systems to attach

are located in subcortical components of the limbic system.

These brain stem neuromodulatory and hypothalamic neuroendocrine systems that regulate the HPA axis

are in a critical period of growth pre- and postnatally,

and they regulate the maturation of the later-developing cerebral cortex….(bunch of refs)…

Severe attachment problems with the caregiver negatively impact the postnatal development of these biogenic systems (Kraemer & Clarke, 1996).  (Schore/ad/183)”

Copied to brain damage schore ad

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“In human infancy, relational trauma, like exposure to inadequate nutrition during the brain growth spurt…, to biological pathogens or chemical agents that target developing brain tissue…, and to physical trauma to the baby’s brain…, interferes with the experience-dependent matura- (Schore/ad/183) tion of the brain’s coping systems, and therefore have a long-enduring negative impact on the trajectory of developmental processes.  (Schore/ad/184)”

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“…a central finding of developmental science – that the maturation of the infant’s brain is experience-dependent, and that these experiences are embedded in the attachment relationship….  (Schore/ad/184)”

“…attachment transactions occur in a period in which the brain is massively developing….  (Schore/ad/184)”

1. (Schore/ad/184)”

“…De Bellis and colleagues writing on developmental traumatology, concluded on developmental traumatology, “the overwhelming stress of maltreatment in childhood is associated with adverse influences on brain development” (1999, p. 1281).  (Schore/ad/184)”

“…the primary caregiver acts as an external psychobiological regulator of the “experience-dependent” growth of the infant’s nervous system….  These early social events are imprinted into the neurobiological structures that are maturing during the brain growth spurt of the first two years of life, and therefore have far-reaching effects.  Eisenberg (1995) referred to “the social construction of the human brain,” and argues that the cytoarchitectonics of the cerebral cortex are sculpted by input from the social environment.  The social environment can positively or negatively modulate the developing brain.  (Schore/ad/184)”

“Early relational trauma…is usually not a singular event but ambient and cumulative…(Schore/ad/185)”  peritrauma

“Terr has written that “literal mirroring of traumatic events by behavioral memory [can be] established at any age, including infancy” (1988, p. 103).  (Schore/ad/185)”

“We are beginning to understand, at a psychobiological level, specifically how beneficial early experiences enhance and detrimental early histories inhibit the development of the brain’s active and passive stress coping mechanisms.  (Schore/ad/185)”

“…these early dysregulating experiences lead to more than an insecure  attachment; they also trigger a chaotic alteration of the emotion processing limbic system that is in a critical period of growth in infancy….  (Schore/ad/186)”

“The early maturing right cerebral cortex is dominant for attachment functions…and stores an internal working model of the attachment relationship.  An enduring developmental impairment of this system would be expressed as a severe limitation of the essential activity of the right hemisphere – the control of vital functions supporting survival and enabling the organism to cope actively and passively with stressors….  (Schore/ad/186)”

“In studies of a neglect paradigm, Tronick and Weinberg (1997) wrote:

When infants are not in homeostatic balance or are emotionally dysregulated (e.g., they are distressed), they are at the mercy of these states.  Until these states are brought under control, infants must devote all their regulatory resources to reorganizing them.  While infants are doing that, they can do nothing else.  (p. 56).

(Schore/ad/186)”

“…there is…a pernicious long-term consequence of relational trauma – an enduring deficit at later points of the life span in the individual’s capacity to assimilate novel (and thus stressful) emotional experiences.  (Schore/ad/187)”

“…van der Kolk (1996) asserted that under ordinary conditions traumatized individuals adapt fairly well, but they do not respond to stress the way other do….  (Schore/ad/187)”

“All of these all [sic] descriptions characterize an immature right brain, the locus of the human stress response (Whittling, 1997).  (Schore/ad/187)”

“I further suggest that significantly altered early right brain development is reflected in a “type D” pattern…, the disorganized/disoriented attachment seen in abused and neglected infants….  This severe right brain attachment pathology is involved in the etiologies of a high risk for both posttraumatic stress disorder… and a predisposition to relational violence….  . Main (1996) argued that “disorganized” and “organized” forms of insecure attachment are primary risk factors for the development of mental disorders.  (Schore/ad/187)”

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“This portrait of infancy is usually not presented by the media, or even in current books on the effects of early experience on brain development (e.g., Bruer, 1999; Gopnik, Meltzoff, & Kuhl, 1999).  This is not the image of a “scientist in the crib,” but rather of “ghosts in the nursery” (Fraiberg, Adelson, & Shapiro, 1975).  In fact, this infant was depicted in Karr-Morse and Wiley’s Ghosts from the Nursery:  Tracing the Roots of Violence (1997).  (Schore/ad/184)”

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“A 1997 issue of Pediatrics contains a study of covert videorecordings of infants hospitalized for life-threatening events, and it documents, in a most careful and disturbing manner, the various forms of child abuse that are inflicted by caregivers on infants as young as 3 months while the are in the hospital (Southall, Plunkett, Banks,Falkov, & Samuels, 1997).  These experiences are recorded and stored in the infant.  (Schore/ad/185)”

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MOTHERING

“Mothers of children with disorganized attachment describe themselves as unable to care for or protect their infants, inflicting harsh punishments, feeling depressed, and being out of control.  In general, high-risk and physically abusive mothers, relative to comparison mothers, differ in the types of perceptions, attributions, evaluations, and expectations of their children’s behavior, engage in fewer interactions and communicate less with their children, use fewer positive parenting behaviors, and use more aversive disciplinary techniques….  Role reversal…and a subjective feeling of helplessness… are commonly foundmothers of disorganized infants.  In light of the fact that many of these mothers have suffered from unresolved traua themselves…, this spatiotemporal imprinting of the chaotic alterations of the mother’s dysregulated state may be a central mechanism for the “intergenerational transmission [of] child abuse: (Kaufman & Zigler, 1989)  (Schore/ad/195)”

“Research on the neurobiology of attachment is revealing that the early experiences of female infants with their mothers (or absence of these experiences) influence how they respond to their own infants when they later become mothers, and that this provides a psychobiological mechanism for the intergenerational transmission of adaptive and maladaptive parenting styles and responsiveness (Fleming et al., 1999).  This psychobiological principle is advanced in the clinical writings of Silverman and Lieberman, who concluded that although the mother’s caregiving system has an instinctual basis, it is expressed through the filter of her own representational templates, “which derive from her sense of being cared and protected in her relationship with her own parents” (1999, p. 172).  This experience did not occur in the abusive mother’s early attachment.  (Schore/ad/195).”

“In a recent biosocial model of the determinants of motherhood, Pryce (1995) viewed parenting as varying on a continuum between the extremes of maximal care and infant/abuse and neglect.  Expanding on these ideas, (Schore/ad/195)  Maestripieri (1999) asserted that although models of parenting are often presented in terms of social and cognitive processes, recent biological studies in primates of the neurobiological regulation of parental responsivess [sic] and the determinants of infant abuse indicate that human parenting is much more sensitive to neuroendocrine mechanisms than previously thought.  (Schore/ad/196)”

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