Maturação Orbitofrontal, Marcadores Somáticos e Vulnerabilidade Precoce:
para uma Hipótese Compreensiva de “Miopia Emocional” na Toxicodependência
Mots-clés :
Psicologia, Interações precoces, Desenvolvimento emocional, Córtex orbitofrontal, Alexitimia, ToxicodependênciaRésumé
O modelo de “miopia emocional” constitui uma hipótese teórica de compreensão da vulnerabilidade psicológica identificada em muitos toxicodependentes. Trata-se de uma tentativa de estabelecer de uma forma cooperativa, mas não incorporativa, associações entre níveis de conhecimento em torno dos determinantes relacionais do neurodesenvolvimento, perspectivas psicanalíticas e da vinculação e modelos psicobiológicos explicativos das toxicodependências. Nela saliento as influências ambientais sobre as mudanças na morfologia cerebral, não apenas o trauma precoce ou a privação de cuidados e suporte afectivo mas também aquelas que derivam de consumos continuados de certas substâncias, e hipotetizo que num largo espectro de situações clínicas as primeiras poderão auxiliar as segundas. Proponho que a hipótese dos marcadores-somáticos proposta por Damásio participe numa concepção desenvolvimentista do consumo de substâncias. A qualidade das interacções precoces pode fundamentar um desligamento afectivo do indivíduo em desenvolvimento, participando na fraca maturação do cérebro social, no desenvolvimento de um padrão alexitímico e numa procura urgente de sensações, todos eles potenciais factores precipitantes para o recurso ao prazer imediato do consumo.
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Références
Barbas, H. (1995). Anatomic basis of cognitive”“emotional
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.
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.
Publié-e
2015-09-03
Comment citer
Torrado, M., & Ouakinin, S. (2015). Maturação Orbitofrontal, Marcadores Somáticos e Vulnerabilidade Precoce:: para uma Hipótese Compreensiva de “Miopia Emocional” na Toxicodependência. Psicologia: Teoria E Pesquisa, 31(1). Consulté à l’adresse https://periodicos.unb.br/index.php/revistaptp/article/view/18145
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