Orbitofrontal Maturation, Somatic Markers and Early Vulnerability:
A Comprehensive Hypothesis of “Emotional Myopia” in Drug Addiction
Keywords:
Early interactions, Emotional development, Orbitofrontal córtex, Alexithymia, Drug addictionAbstract
The “emotional myopia” hypothesis is a theoretical reflection to increase the understanding of the psychological
vulnerability showed by many drug addicts Instead of an incorporation, a cooperation is proposed of levels of knowledge on
the determinants of the neurodevelopment, psychoanalytical and attachment perspectives and psychobiological models of drug
addictions. Environmental inputs that change brain morphology are highlighted, not only early trauma or care deprivation
but also others derived from the long-term use of drugs as the core of vulnerability. We propose that Damasio’s hypothesis
of somatic markers forms part of this theoretical formulation. The low quality of early social interactions may support an
increasing emotional disengagement, a poor maturation of the social brain, an increase of alexithymic patterns and noveltyseeking
behaviours, all potential triggers for searching for pleasure in drugs.
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References
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interactions in the primate prefrontal cortex. Neuroscience &
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Barbas, H., Saha, S., Rempel-Clower, N., & Ghashghaei, T. (2003).
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decision making and the orbitofrontal cortex. Cerebral Cortex,
10, 295-307.
Bernston, G. G., Cacioppo, J., & Quigley, K. S. (1991). Autonomic
determinism: The modes of autonomic control, the doctrine
of autonomic space, and the laws of autonomic constraint.
Psychological Review, 98, 459-487.
Bowers, D., Bauer, R. M. & Heilman, K. M. (1993) The nonverbal
affect lexicon: theoretical perspectives from neuropsychological
studies of affect perception. Neuropsychology, 7, 433”“ 444.
Bowlby, J. (1981). Attachment and loss (Vol. III). Loss: sadness
and depression. New York: Basic Books.
Camras, L., Grow, G., & Ribordy, S. (1983). Recognition of
emotional expression by abused children. Journal of Clinical
Child Psychology, 12, 325-328.
Chiron, C., Jambaque, I., Nabbout, R., Lounes, R., Syrota, A., &
Dulac, O. (1997). The right brain hemisphere is dominant in
human infants. Brain, 120, 1057-1065.
Damásio, A. (1999). O erro de Descartes: emoção, razão e cérebro
humano (19ª ed.). Mem Martins, Portugal: Publicações Europa-
América (Trabalho original publicado em 1994)
De Brito, S. A., Viding, E., Sebastian, C. L., Kelly, P. A., Mechelli,
A., Maris,H., & McCrory, E. J. (2013). Reduced orbitofrontal
and temporal grey matter in a community sample of maltreated
children. Journal of Child Psychology and Psychiatry, 54,
105-112.
Drevets, W. C., Gadde, K. M., & Krishman, K. R. R. (1999).
Neuroimaging studies of mood disorders. In D. S. Charney,
E. J. Nestler & B. S. Bunney (Eds.), Neurobiology of mental
illness (pp 394”“418). New York: Oxford University Press.
Dolan, R. J. (1999). On the neurology of morals. Nature
Neuroscience, 2, 927-929.
European Monitoring Centre for Drugs and Drug Addiction
[EMCDDA] (2009). Preventing later substance use disorders
in at-risk children and adolescents: A review of the theory
and evidence base of indicated prevention. Luxembourg:
EMCDDA.
Farate, C. (2001). O acto de consumo e o gesto que consome ”“ Risco
relacional e consumo de drogas no início da adolescência.
Coimbra: Quarteto.
Félix da Costa, N. (1995). Contentamento e prazer.
Toxicodependências, 1, 5-13.
Fonagy, P., Gergely, G., & Target, M. (2008). Psychoanalytic
constructs and attachment theory and research. In J. Cassidy
& P. Shaver (Eds.), Handbook of attachment: Theory, research,
and clinical applications (pp. 783-810). New York: The
Guilford Press.
Fonagy, P., & Target, M. (1997). Attachment and reflective
function: Their role in self-organization. Development and
Psychopathology, 9, 679-700.
Garavan, H., Ross, T. J., & Stein, E. A. (1999). Right hemisphere
dominance of inhibitory control: An event-related functional
MRI study. Proceedings of the National Academy of Sciences
of the United States of America, 96, 8301-8306.
Guo, J., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R.
D. (2002). A developmental analysis of sociodemographic,
family, and peer effects on adolescent illicit drug initiation.
Journal of the American Academy of Child and Adolescent
Psychiatry, 41, 838-845.
Hawkley, L. C., Preacher, K. J., & Cacioppo, J. T. (2007). Multilevel
modeling of social interactions and mood in lonely and socially
connected individuals: The MacArthur social neuroscience
studies. In A. D. Ong & M. van Dulmen (Eds.), Handbook
of methods in positive psychology (pp. 559-575). New York:
Oxford University Press.
Hofer, M. A. (1990). Early symbiotic processes: Hard evidence
from a soft place. In R. A. Glick & S. Bone (Eds.), Pleasure
beyond the pleasure principle (pp. 55-78). New Haven: Yale
University Press.
Khantzian, E. J. (1985). The self-medication hypothesis of addictive
disorders: Focus on heroin and cocaine dependence. American
Journal of Psychiatry, 142, 1259-1264.
Khantzian, E. J. (1990). Self-regulation and self-medication factors
in alcoholism and the addictions. Similarities and differences.
Recent Developments in Alcoholism, 8, 255-271.
Kolb, B., Pellis, S., & Robinson, T. E. (2004). Plasticity and
functions of the orbital frontal cortex. Brain and Cognition,
55, 104-115.
Luria, A. R. (1980). Higher Cortical Functions in Man. Nova
Iorque: Basic Books.
Lane, R., Kaszniak, A., Ahern, G., & Schwartz, G. (1997). Is
alexithymia the emotional equivalent of blindsight? Biological
Psychiatry, 42, 834-844.
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy,
childhood and adulthood: A move to the level of representation.
Monographs of the Society for Research in Child Development,
50, 66-104.
Mota-Cardoso, R. (2001). Auto-regulação dos sistemas naturais.
Revista Portuguesa de Psicossomática, 3, 39-96.
Pizzagalli, D., Regard, M., & Lehmann, D. (1999). Rapid emotional
face processing in the human right and left-brain hemispheres:
An ERP study. NeuroReport, 10, 2691-2698.
Remper-Clower, N. L. (2007). Role of orbitofrontal cortex
connections in emotion. Annals of the New York Academy of
Sciences, 1121, 72-86.
Robinson, T. E., & Kolb, B. (1999. Morphine alters the structure
of neurons in nucleus accumbens and neocortex. Synapse,
33, 160-162.
Schore, A. (1994). Affect regulation and the origin of the self:
The neurobiology of emotional development. Hillsdale, NJ:
Lawrence Erlbaum.
Schore, A. (1997). Early organization of the nonlinear right brain
and development of a predisposition to psychiatric disorders.
Development and Psychopathology, 9, 595-631.
Schore, A. (2000). Attachment and the regulation of the right brain.
Attachment & Human Development, 1, 23-47.
Schore, A. (2001). Effects of a secure attachment, relationship on
right brain development, affect regulation and infant mental
health. Infant Mental Health Journal, 22, 7-66.
Starkstein, S. E., & Robinson, R. G. (1997). Mechanism of
disinhibition after brain lesions. Journal of Nervous and Mental
Disease, 185, 108-114.
Stone, V. E., Baron-Cohen, S., & Knight, R. T. (1998). Frontal
lobe contributions to theory of mind. Journal of Cognitive
Neuroscience, 10, 640-656.
Stronski, S. M., Ireland, M., Michaud, P., Narring F., & Resnick,
M. D. (2000). Protective correlates of stages in adolescent
substance use: A Swiss National Study. Journal of Adolescent
Health, 26, 420-427.
Subic-Wrana, C., Beutel, M., Garfield, D., & Lane, R. (2011). Levels
of emotional awareness: A model for conceptualizing and
measuring emotion-centered structural change. International
Journal of Psychoanalysis, 92, 289-310.
Trevarthen, C. (1993). The self-born in intersubjectivity: The
psychology of an infant communicating. In U. Neisser (Ed.),
The perceived self: Ecological and interpersonal sources
of self-knowledge (pp. 121-173). New York: Cambridge
University Press.
Verdejo-Garcia, A., & Bechara, A. (2009). A somatic-marker theory
of addiction. Neuropharmacology, 56, 48-62.
Winnicott, D. W. (1971). Playing and reality. London: Tavistock
Publications.
Zald, D. H., & Kim, S. W. (1996). Anatomy and function of the
orbital frontal cortex, II: Function and relevance to obsessivecompulsive
disorder. Journal of Neuropsychiatry, 8, 249-261.
interactions in the primate prefrontal cortex. Neuroscience &
Biobehavioral Reviews 19, 499-510.
Barbas, H., Saha, S., Rempel-Clower, N., & Ghashghaei, T. (2003).
Serial pathways from primate prefrontal cortex to autonomic
areas may influence emotional expression. BMC Neuroscience,
4, 25.
Barbas, H., Zikopoulos, B., & Timbie, C. (2011). Sensory pathways
and emotional context for action in primate prefrontal cortex.
Biological Psychiatry, 69, 1133-1139.
Bechara, A, Damasio, H., & Damasio, A. R. (2000). Emotion,
decision making and the orbitofrontal cortex. Cerebral Cortex,
10, 295-307.
Bernston, G. G., Cacioppo, J., & Quigley, K. S. (1991). Autonomic
determinism: The modes of autonomic control, the doctrine
of autonomic space, and the laws of autonomic constraint.
Psychological Review, 98, 459-487.
Bowers, D., Bauer, R. M. & Heilman, K. M. (1993) The nonverbal
affect lexicon: theoretical perspectives from neuropsychological
studies of affect perception. Neuropsychology, 7, 433”“ 444.
Bowlby, J. (1981). Attachment and loss (Vol. III). Loss: sadness
and depression. New York: Basic Books.
Camras, L., Grow, G., & Ribordy, S. (1983). Recognition of
emotional expression by abused children. Journal of Clinical
Child Psychology, 12, 325-328.
Chiron, C., Jambaque, I., Nabbout, R., Lounes, R., Syrota, A., &
Dulac, O. (1997). The right brain hemisphere is dominant in
human infants. Brain, 120, 1057-1065.
Damásio, A. (1999). O erro de Descartes: emoção, razão e cérebro
humano (19ª ed.). Mem Martins, Portugal: Publicações Europa-
América (Trabalho original publicado em 1994)
De Brito, S. A., Viding, E., Sebastian, C. L., Kelly, P. A., Mechelli,
A., Maris,H., & McCrory, E. J. (2013). Reduced orbitofrontal
and temporal grey matter in a community sample of maltreated
children. Journal of Child Psychology and Psychiatry, 54,
105-112.
Drevets, W. C., Gadde, K. M., & Krishman, K. R. R. (1999).
Neuroimaging studies of mood disorders. In D. S. Charney,
E. J. Nestler & B. S. Bunney (Eds.), Neurobiology of mental
illness (pp 394”“418). New York: Oxford University Press.
Dolan, R. J. (1999). On the neurology of morals. Nature
Neuroscience, 2, 927-929.
European Monitoring Centre for Drugs and Drug Addiction
[EMCDDA] (2009). Preventing later substance use disorders
in at-risk children and adolescents: A review of the theory
and evidence base of indicated prevention. Luxembourg:
EMCDDA.
Farate, C. (2001). O acto de consumo e o gesto que consome ”“ Risco
relacional e consumo de drogas no início da adolescência.
Coimbra: Quarteto.
Félix da Costa, N. (1995). Contentamento e prazer.
Toxicodependências, 1, 5-13.
Fonagy, P., Gergely, G., & Target, M. (2008). Psychoanalytic
constructs and attachment theory and research. In J. Cassidy
& P. Shaver (Eds.), Handbook of attachment: Theory, research,
and clinical applications (pp. 783-810). New York: The
Guilford Press.
Fonagy, P., & Target, M. (1997). Attachment and reflective
function: Their role in self-organization. Development and
Psychopathology, 9, 679-700.
Garavan, H., Ross, T. J., & Stein, E. A. (1999). Right hemisphere
dominance of inhibitory control: An event-related functional
MRI study. Proceedings of the National Academy of Sciences
of the United States of America, 96, 8301-8306.
Guo, J., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R.
D. (2002). A developmental analysis of sociodemographic,
family, and peer effects on adolescent illicit drug initiation.
Journal of the American Academy of Child and Adolescent
Psychiatry, 41, 838-845.
Hawkley, L. C., Preacher, K. J., & Cacioppo, J. T. (2007). Multilevel
modeling of social interactions and mood in lonely and socially
connected individuals: The MacArthur social neuroscience
studies. In A. D. Ong & M. van Dulmen (Eds.), Handbook
of methods in positive psychology (pp. 559-575). New York:
Oxford University Press.
Hofer, M. A. (1990). Early symbiotic processes: Hard evidence
from a soft place. In R. A. Glick & S. Bone (Eds.), Pleasure
beyond the pleasure principle (pp. 55-78). New Haven: Yale
University Press.
Khantzian, E. J. (1985). The self-medication hypothesis of addictive
disorders: Focus on heroin and cocaine dependence. American
Journal of Psychiatry, 142, 1259-1264.
Khantzian, E. J. (1990). Self-regulation and self-medication factors
in alcoholism and the addictions. Similarities and differences.
Recent Developments in Alcoholism, 8, 255-271.
Kolb, B., Pellis, S., & Robinson, T. E. (2004). Plasticity and
functions of the orbital frontal cortex. Brain and Cognition,
55, 104-115.
Luria, A. R. (1980). Higher Cortical Functions in Man. Nova
Iorque: Basic Books.
Lane, R., Kaszniak, A., Ahern, G., & Schwartz, G. (1997). Is
alexithymia the emotional equivalent of blindsight? Biological
Psychiatry, 42, 834-844.
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy,
childhood and adulthood: A move to the level of representation.
Monographs of the Society for Research in Child Development,
50, 66-104.
Mota-Cardoso, R. (2001). Auto-regulação dos sistemas naturais.
Revista Portuguesa de Psicossomática, 3, 39-96.
Pizzagalli, D., Regard, M., & Lehmann, D. (1999). Rapid emotional
face processing in the human right and left-brain hemispheres:
An ERP study. NeuroReport, 10, 2691-2698.
Remper-Clower, N. L. (2007). Role of orbitofrontal cortex
connections in emotion. Annals of the New York Academy of
Sciences, 1121, 72-86.
Robinson, T. E., & Kolb, B. (1999. Morphine alters the structure
of neurons in nucleus accumbens and neocortex. Synapse,
33, 160-162.
Schore, A. (1994). Affect regulation and the origin of the self:
The neurobiology of emotional development. Hillsdale, NJ:
Lawrence Erlbaum.
Schore, A. (1997). Early organization of the nonlinear right brain
and development of a predisposition to psychiatric disorders.
Development and Psychopathology, 9, 595-631.
Schore, A. (2000). Attachment and the regulation of the right brain.
Attachment & Human Development, 1, 23-47.
Schore, A. (2001). Effects of a secure attachment, relationship on
right brain development, affect regulation and infant mental
health. Infant Mental Health Journal, 22, 7-66.
Starkstein, S. E., & Robinson, R. G. (1997). Mechanism of
disinhibition after brain lesions. Journal of Nervous and Mental
Disease, 185, 108-114.
Stone, V. E., Baron-Cohen, S., & Knight, R. T. (1998). Frontal
lobe contributions to theory of mind. Journal of Cognitive
Neuroscience, 10, 640-656.
Stronski, S. M., Ireland, M., Michaud, P., Narring F., & Resnick,
M. D. (2000). Protective correlates of stages in adolescent
substance use: A Swiss National Study. Journal of Adolescent
Health, 26, 420-427.
Subic-Wrana, C., Beutel, M., Garfield, D., & Lane, R. (2011). Levels
of emotional awareness: A model for conceptualizing and
measuring emotion-centered structural change. International
Journal of Psychoanalysis, 92, 289-310.
Trevarthen, C. (1993). The self-born in intersubjectivity: The
psychology of an infant communicating. In U. Neisser (Ed.),
The perceived self: Ecological and interpersonal sources
of self-knowledge (pp. 121-173). New York: Cambridge
University Press.
Verdejo-Garcia, A., & Bechara, A. (2009). A somatic-marker theory
of addiction. Neuropharmacology, 56, 48-62.
Winnicott, D. W. (1971). Playing and reality. London: Tavistock
Publications.
Zald, D. H., & Kim, S. W. (1996). Anatomy and function of the
orbital frontal cortex, II: Function and relevance to obsessivecompulsive
disorder. Journal of Neuropsychiatry, 8, 249-261.
Published
2015-09-03
How to Cite
Torrado, M., & Ouakinin, S. (2015). Orbitofrontal Maturation, Somatic Markers and Early Vulnerability:: A Comprehensive Hypothesis of “Emotional Myopia” in Drug Addiction. Psicologia: Teoria E Pesquisa, 31(1). Retrieved from https://periodicos.unb.br/index.php/revistaptp/article/view/18145
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