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Book Forum: Mood and Affect   |    
Affect Dysregulation and Disorders of the Self
DONALD M. HILTY, M.D.; BLYTHE A. CORBETT, Ph.D.; PIERRE LAVENEX, Ph.D.
Am J Psychiatry 2005;162:1399-a-1400. doi:10.1176/appi.ajp.162.7.1399-a
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By Allan N. Schore, Ph.D. New York, W.W. Norton, 2003, 300 pp., $45.00.

This book, part of the Norton Series on Interpersonal Neurobiology, is a follow-up to Affect Regulation and the Origin of the Self(1), which focused on regulation theory and its relation to affect and attachment and their impact on socioemotional development and psychopathology. The current book attempts to take the topic farther, with sections on Developmental Affective Neuroscience and Developmental Neuropsychiatry. The author integrates material from social, psychological, and biological realms into a comprehensive model to provide testable psychobiological models of human brain dysfunction. In the process, he presents research from different psychiatric theoretical perspectives, including psychodynamic, behavioral, and sociological frameworks. The ideas presented will stimulate clinicians and experimental scientists to explore this important topic. Although the book appears intended for those in clinical practice, it may appeal more to theorists and researchers as a synthesis of important concepts, theories, and other data. A companion book is Affect Regulation and the Repair of the Self(2).

Section 1, Developmental Affective Neuroscience, provides an overview for the book (e.g., regulation theory, perspectives from others on the topic). The concept of self-regulatory systems is introduced and applied to brain development. Indubitably, the development of the infant’s brain occurs in the context of a relationship with another self (e.g., the mother). Thus, a central theme is the experience-dependent relationship between infant and mother for the development of self-regulatory processes. The work of Bowlby and others on attachment is integrated with neurobiological findings. In particular, the function of the right prefrontal cortex, parent-infant communication, and attachment disorders are discussed in detail. When available, functional magnetic resonance imaging findings are included. Section 2, Developmental Neuropsychiatry, discusses predispositions to psychiatric disorders. Separate chapters review how brain development, affect regulation, and health might be affected by 1) a secure attachment, 2) relational trauma, and 3) eventual affect dysregulation.

We have several suggestions for the next edition. First, we would like to see case examples to apply the information, interweave the presented theories, and "spell out" the concepts in a more relevant manner. This change would make it more readable and more directly applicable clinically. Second, the chapters could benefit from a standardized format, with an introduction, objectives, background information, and a summary of key points. This change would also make it more useful as an educational text. Third, in this complex discussion of the intersection of many fields and particularly neuroscience, it is surprising that few figures or tables are used to help the reader. Finally, particular emphasis is placed on the relation between structure and function of the right hemisphere during critical stages of development. Unfortunately, supporting neurobiological evidence is weak (e.g., regarding the specificity of abnormal development of the right prefrontal cortex), and original references are sometimes overinterpreted. This pitfall, however, surely reflects the paucity of neuroanatomical information on the normal development of the primate brain.

This is an interesting, useful integration of data from many fields—all intersecting in the areas of attachment, affect, and pathology—that makes it a very unique reference for clinicians who want to explore the theoretical underpinnings of these areas. It is an ambitious work written by a knowledgeable author. It is already good, but with the changes noted it would be outstanding in a second edition.

Schore AN: Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. New York, WW Norton, 1994
 
Schore AN: Affect Regulation and the Repair of the Self. New York, WW Norton, 2003
 
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References

Schore AN: Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. New York, WW Norton, 1994
 
Schore AN: Affect Regulation and the Repair of the Self. New York, WW Norton, 2003
 
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