Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-01T00:32:16.032Z Has data issue: false hasContentIssue false

Association between childhood maltreatment and adult emotional dysregulation in a low-income, urban, African American sample: Moderation by oxytocin receptor gene

Published online by Cambridge University Press:  18 April 2011

Bekh Bradley*
Affiliation:
Atlanta VA Medical Center Emory University
Drew Westen
Affiliation:
Emory University
Kristina B. Mercer
Affiliation:
Howard Hughes Medical Institute
Elisabeth B. Binder
Affiliation:
Emory University
Tanja Jovanovic
Affiliation:
Emory University
Daniel Crain
Affiliation:
Emory University
Aliza Wingo
Affiliation:
Atlanta VA Medical Center Emory University
Christine Heim
Affiliation:
Emory University
*
Address correspondence and reprint requests to: Bekh Bradley, Atlanta VA Medical Center, MHSL, Mail Stop 116, 1670 Clairmont Road, Decatur, GA 30033; E-mail: [email protected].

Abstract

The ability to effectively regulate emotions and a secure attachment style are critical for maintaining mental health across the life span. The experience of childhood maltreatment interferes with normal development of emotional regulation and dramatically increases risk for a wide range of psychiatric disorders in adulthood. The central nervous system oxytocin systems are critically involved in mediating social attachment and buffering psychophysiological responses to stress. We therefore investigated the impact of childhood maltreatment and an oxytocin receptor (OXTR) single nucleotide polymorphism (rs53576) and their interaction on emotional dysregulation and attachment style in adulthood in a sample of low-income, African American men and women recruited from primary care clinics of an urban, public hospital. Consistent with prior research, we found that the severity of childhood maltreatment was associated with increased levels of emotional dysregulation in adulthood. Childhood maltreatment was also positively associated with ratings of disorganized/unresolved adult attachment style and negatively associated with ratings of secure adult attachment style. There was no direct association between rs53576 and emotional dysregulation or ratings of adult attachment style. However, there were significant interactions between rs53576 and childhood maltreatment in predicting level of adult emotional dysregulation and attachment style. Specifically, G/G genotype carriers were at risk for increased emotional dysregulation when exposed to three or more categories of childhood abuse. In addition, G/G genotype carriers exhibited enhanced disorganized adult attachment style when exposed to severe childhood abuse compared to A/A and A/G carriers. Our findings suggest that A allele carriers of OXTR rs53576 are resilient against the effects of severe childhood adversity, by protection against emotional dysregulation and disorganized attachment.

Type
Special Section Articles
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrams, K., Rifkin, A., & Hesse, E. (2006). Examining the role of parental frightened/frightening subtypes in predicting disorganized attachment within a brief observational procedure. Development and Psychopathology, 18, 345361.Google Scholar
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion–regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217237.CrossRefGoogle ScholarPubMed
Alink, L., Cicchetti, D., Kim, J., & Rogosch, F. (2009). Mediating and moderating processes in the relation between maltreatment and psychopathology: Mother–child relationship quality and emotion regulation. Journal of Abnormal Child Psychology, 37, 831843.Google Scholar
Anda, R., Felitti, V., Bremner, J., Walker, J., Whitfield, C., Perry, B., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174186.Google Scholar
Bakermans-Kranenburg, M., & van IJzendoorn, M. (2007). Research review: Genetic vulnerability or differential susceptibility in child development: The case of attachment. Journal of Child Psychology and Psychiatry, 48, 11601173.Google Scholar
Bakermans-Kranenburg, M., & van IJzendoorn, M. (2008). Oxytocin receptor (OXTR) and serotonin transporter (5-HTT) genes associated with observed parenting. Social Cognitive and Affective Neuroscience, 3, 128134.Google Scholar
Bakermans-Kranenburg, M., van IJzendoorn, M., Pijlman, F., Mesman, J., & Juffer, F. (2008). Experimental evidence for differential susceptibility: Dopamine D4 receptor polymorphism (DRD4 VNTR) moderates intervention effects on toddlers' externalizing behavior in a randomized controlled trial. Developmental Psychology, 44, 293300.Google Scholar
Bartz, J., Zaki, J., Bolger, N., Hollander, E., Ludwig, N., Kolevzon, A., et al. (2010). Oxytocin selectively improves empathic accuracy. Psychological Science 10, 14261428.Google Scholar
Belsky, J., Jonassaint, C., Pluess, M., Stanton, M., Brummett, B., & Williams, R. (2009). Vulnerability genes or plasticity genes? Molecular Psychiatry, 14, 746754.Google Scholar
Belsky, J., & Pluess, M. (2009). Beyond diathesis stress: Differential susceptibility to environmental influences. Psychological Bulletin, 135, 885908.Google Scholar
Bernstein, D., Stein, J., Newcomb, M., Walker, E., Pogge, D., Ahluvalia, T., et al. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27, 169190.Google Scholar
Bernstein, D. P., & Fink, L. (1998). Childhood Trauma Questionnaire manual. San Antonio, TX: Psychological Corporation.Google Scholar
Binder, E. B., Bradley, R., Liu, W., Epstein, M. P., Deveau, T. C., Mercer, K. B., et al. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. Journal of the American Medical Association, 299, 12911305.Google Scholar
Blau, V., Maurer, U., Tottenham, N., & McCandliss, B. (2007). The face-specific N170 component is modulated by emotional facial expression. Behavioral and Brain Functions, 3, 7.Google Scholar
Borelli, J., Crowley, M., David, D., Sbarra, D., Anderson, G., & Mayes, L. (2010). Attachment and emotion in school-aged children. Emotion, 10, 475485.CrossRefGoogle ScholarPubMed
Bradley, B., DeFife, J., Guanaccia, C., Pfifer, J., Fani, N., Ressler, K., et al. (in press). Emotion dysregulation and negative affect: Association with psychiatric symptoms. Journal of Clinical Psychiatry.Google Scholar
Bradley, R., Binder, E. B., Epstein, M. P., Tang, Y., Nair, H. P., Liu, W., et al. (2008). Influence of child abuse on adult depression: Moderation by the corticotropin-releasing hormone receptor gene. Archives of General Psychiatry, 65, 190200.Google Scholar
Bradley, R., & Westen, D. (2005). The psychodynamics of borderline personality disorder: A view from developmental psychopathology. Development and Psychopathology, 17, 927957.Google Scholar
Calkins, S. D., & Hill, A. (2007). Caregiver influences on emerging emotion regulation: Biological and environmental transactions in early development. In Gross, J. (Ed.), Handbook of emotion regulation. (pp. 229248): New York: Guilford Press.Google Scholar
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 25, 525531.CrossRefGoogle Scholar
Cassidy, J., & Mohr, J. (2001). Unsolvable fear, trauma, and psychopathology: Theory, research, and clinical considerations related to disorganized attachment across the life span. Clinical Psychology: Science and Practice, 8, 275298.Google Scholar
Cicchetti, D., & Barnett, D. (1991). Attachment organization in maltreated preschoolers. Development and Psychopathology, 3, 397411.Google Scholar
Cicchetti, D., & Cannon, T. (1999). Neurodevelopmental processes in the ontogenesis and epigenesis of psychopathology. Development and Psychopathology, 11, 375393.Google Scholar
Cicchetti, D., & Dawson, G. (2002). Multiple levels of analysis [Editorial]. Development and Psychopathology, 14, 417420.Google Scholar
Cicchetti, D., & Gunnar, M. (2008). Integrating biological measures into the design and evaluation of preventive interventions. Development and Psychopathology, 20, 737743.Google Scholar
Cicchetti, D., Rogosch, F., & Toth, S. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623649.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Tucker, D. (1994). Development and self-regulatory structures of the mind. Development and Psychopathology, 6, 533549.Google Scholar
Cloitre, M., Stovall McClough, C., Zorbas, P., & Charuvastra, A. (2008). Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories. Journal of Traumatic Stress, 21, 282289.CrossRefGoogle Scholar
Cole, P., Michel, M., & Teti, L. (1994). The development of emotion regulation and dysregulation: A clinical perspective. Monographs of the Society for Research in Child Development, 59, 73100.CrossRefGoogle ScholarPubMed
Costa, B., Pini, S., Gabelloni, P., Abelli, M., Lari, L., Cardini, A., et al. (2009). Oxytocin receptor polymorphisms and adult attachment style in patients with depression. Psychoneuroendocrinology, 34, 15061514.Google Scholar
Cyr, C., Euser, E., Bakermans-Kranenburg, M., & van IJzendoorn, M. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22, 87108.Google Scholar
Dalgleish, T., Taghavi, R., Neshat-Doost, H., Moradi, A., Canterbury, R., & Yule, W. (2003). Patterns of processing bias for emotional information across clinical disorders: A comparison of attention, memory, and prospective cognition in children and adolescents with depression, generalized anxiety, and posttraumatic stress disorder. Journal of Clinical Child & Adolescent Psychology, 32, 1021.Google Scholar
De Pauw, S., & Mervielde, I. (2010). Temperament, personality and developmental psychopathology: A review based on the conceptual dimensions underlying childhood traits. Child Psychiatry and Human Development, 41, 313329.Google Scholar
Dodge, K., Greenberg, M., & Malone, P. (2008). Testing an idealized dynamic cascade model of the development of serious violence in adolescence. Child Development, 79, 19071927.CrossRefGoogle ScholarPubMed
Donaldson, Z. R., & Young, L. J. (2008). Oxytocin, vasopressin, and the neurogenetics of sociality. Science, 322, 900904.Google Scholar
Francis, D., Champagne, F., & Meaney, M. (2000). Variations in maternal behaviour are associated with differences in oxytocin receptor levels in the rat. Journal of Neuroendocrinology, 12, 11451148.Google Scholar
Gillespie, C., Bradley, B., Mercer, K., Smith, A., Conneely, K., Gapen, M., et al. (2009). Trauma exposure and stress-related disorders in inner city primary care patients. General Hospital Psychiatry, 31, 505514.Google Scholar
Gross, J. (Ed.). (2007). Handbook of emotion regulation: New York: Guilford Press.Google Scholar
Gunnar, M., Mangelsdorf, S., Larson, M., & Hertsgaard, L. (1989). Attachment, temperament, and adrenocortical activity in infancy: A study of psychoendocrine regulation. Developmental Psychology, 25, 355363.Google Scholar
Heim, C., Young, L., Newport, D., Mletzko, T., Miller, A., & Nemeroff, C. (2008). Lower CSF oxytocin concentrations in women with a history of childhood abuse. Molecular Psychiatry, 14, 954958.Google Scholar
Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 13891398.Google Scholar
Hertsgaard, L., Gunnar, M., Erickson, M., & Nachmias, M. (1995). Adrenocortical responses to the strange situation in infants with disorganized/disoriented attachment relationships. Child Development, 66, 11001106.Google Scholar
Juffer, F., Bakermans-Kranenburg, M., & van IJzendoorn, M. (2008). Promoting positive parenting: An attachment-based intervention. Mahwah, NJ: Erlbaum.Google Scholar
Kim, H., Sherman, D., Sasaki, J., Xu, J., Chu, T., Ryu, C., et al. (2010). Culture, distress, and oxytocin receptor polymorphism (OXTR) interact to influence emotional support seeking. Proceedings of the National Academy of Sciences of the United States of America, 107, 1571715721.Google Scholar
Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51, 706716.Google Scholar
Kinnally, E., Huang, Y., Haverly, R., Burke, A., Galfalvy, H., Brent, D., et al. (2009). Parental care moderates the influence of MAOA-uVNTR genotype and childhood stressors on trait impulsivity and aggression in adult women. Psychiatric Genetics, 19, 126133.CrossRefGoogle ScholarPubMed
Kirsch, P., Esslinger, C., Chen, Q., Mier, D., Lis, S., Siddhanti, S., et al. (2005). Oxytocin modulates neural circuitry for social cognition and fear in humans. Journal of Neuroscience, 25, 1148911493.Google Scholar
Krueger, R. F., Hicks, B. M., Patrick, C. J., Carlson, S. R., Lacono, W. G., & McGue, M. (2002). Etiologic connections among substance dependence, antisocial behavior, and personality: Modeling the externalizing spectrum. Journal of Abnormal Psychology, 111, 411424.Google Scholar
Krueger, R. F., & Tackett, J. L. (2003). Personality and psychopathology: Working toward the bigger picture. Journal of Personality Disorders, 17, 109128.Google Scholar
Lerer, E., Levi, S., Salomon, S., Darvasi, A., Yirmiya, N., & Ebstein, R. P. (2007). Association between the oxytocin receptor (OXTR) gene and autism: Relationship to Vineland Adaptive Behavior Scales and cognition. Molecular Psychiatry, 13, 980988.Google Scholar
Leve, L., Harold, G., Ge, X., Neiderhiser, J., Shaw, D., Scaramella, L., et al. (2009). Structured parenting of toddlers at high versus low genetic risk: Two pathways to child problems. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 11021109.CrossRefGoogle ScholarPubMed
Levy, K. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, 959986.Google Scholar
Lewin-Bizan, S., Bowers, E., & Lerner, R. (2010). One good thing leads to another: Cascades of positive youth development among American adolescents. Development and Psychopathology, 22, 759770.Google Scholar
Linehan, M. M., & Heard, H. L. (1992). Dialectical behavior therapy for borderline personality disorder. In Clarkin, J. F., Marziali, E., & Munroe-Blum, H. (Eds.), Borderline personality disorder: Clinical and empirical perspectives (pp. 248267). New York: Guilford Press.Google Scholar
Lucht, M. J., Barnow, S., Sonnenfeld, C., Rosenberger, A., Grabe, H. J., Schroeder, W., et al. (2009). Associations between the oxytocin receptor gene (OXTR) and affect, loneliness and intelligence in normal subjects. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 33, 860866.Google Scholar
Lyons-Ruth, K., Dutra, L., Schuder, M., & Bianchi, I. (2006). From infant attachment disorganization to adult dissociation: Relational adaptations or traumatic experiences? Psychiatric Clinics of North America, 29, 63.Google Scholar
Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence, and lapses in behavioral and attentional strategies. In Cassidy, J. & Shaver, P. (Eds.), Handbook of attachment: Theory, research, and clinical implications (pp. 520554). New York: Guilford Press.Google Scholar
Lyons-Ruth, K., Melnick, S., Bronfman, E., Sherry, S., & Llanas, L. (2004). Hostile–helpless relational models and disorganized attachment patterns between parents and their young children: Review of research and implications for clinical work. In Atkinson, L. & Zucker, K. (Eds.), Attachment issues in psychopathology and intervention (pp. 6594). Mahwah, NJ: Erlbaum.Google Scholar
MacMillan, H., Wathen, C., Barlow, J., Fergusson, D., Leventhal, J., & Taussig, H. (2009). Interventions to prevent child maltreatment and associated impairment. Lancet, 373, 250266.Google Scholar
Madigan, S., Bakermans-Kranenburg, M., van IJzendoorn, M., Moran, G., Pederson, D., & Benoit, D. (2006). Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap. Attachment & Human Development, 8, 89111.CrossRefGoogle ScholarPubMed
Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized status: Is frightened and/or frightening parental behavior the linking mechanism. In Greenberg, M., Cicchetti, D., & Cummings, E. (Eds.), Attachment in the preschool years theory research and intervention (pp. 161184). Chicago: University of Chicago Press.Google Scholar
Masten, A., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491495.Google Scholar
Masten, A., Roisman, G., Long, J., Burt, K., Obradovic, J., Riley, J., et al. (2005). Developmental cascades: Linking academic achievement and externalizing and internalizing symptoms over 20 years. Developmental Psychology, 41, 733745.Google Scholar
Masten, A., & Wright, M. (2010). Resilience over the lifespan: Developmental perspectives on resistance, recovery and transformation. In Reich, J., Zautra, A., & Hall, J. (Eds.), Handbook of adult resilience (pp. 213237). New York: Guilford Press.Google Scholar
McGowan, S. (2002). Mental Representations in Stressful Situations: The calming and distressing effects of significant others. Journal of Experimental Social Psychology, 38, 152161.Google Scholar
Mikulincer, M., & Shaver, P. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.Google Scholar
Mikulincer, M., Shaver, P., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion, 27, 77102.CrossRefGoogle Scholar
Moriceau, S., Roth, T., & Sullivan, R. (2010). Rodent model of infant attachment learning and stress. Developmental Psychobiology, 52, 651660.Google Scholar
Moriceau, S., Shionoya, K., Jakubs, K., & Sullivan, R. (2009). Early-life stress disrupts attachment learning: The role of amygdala corticosterone, locus ceruleus corticotropin releasing hormone, and olfactory bulb norepinephrine. Journal of Neuroscience, 29, 41064109.Google Scholar
Moulson, M., Westerlund, A., Fox, N., Zeanah, C., & Nelson, C. (2009). The effects of early experience on face recognition: An event related potential study of institutionalized children in Romania. Child Development, 80, 10391056.CrossRefGoogle ScholarPubMed
Nigg, J. (2000). On inhibition/disinhibition in developmental psychopathology: Views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin, 126, 220246.Google Scholar
O'Brien, R. (2007). A caution regarding rules of thumb for variance inflation factors. Quality and Quantity, 41, 673690.Google Scholar
Pollak, S., Klorman, R., Thatcher, J., & Cicchetti, D. (2001). P3b reflects maltreated children's reactions to facial displays of emotion. Psychophysiology, 38, 267274.Google Scholar
Pollak, S., Messner, M., Kistler, D., & Cohn, J. (2009). Development of perceptual expertise in emotion recognition. Cognition, 110, 242247.Google Scholar
Raineki, C., Moriceau, S., & Sullivan, R. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 11371145.Google Scholar
Ressler, K., Bradley, B., Mercer, K., Deveau, T., Smith, A., Gillespie, C., et al. (2010). Polymorphisms in CRHR1 and the serotonin transporter loci: Gene × Gene × Environment interactions on depressive symptoms. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 153, 812824.Google Scholar
Rodrigues, S. M., Saslow, L. R., Garcia, N., John, O. P., & Keltner, D. (2009). Oxytocin receptor genetic variation relates to empathy and stress reactivity in humans. Proceedings of the National Academy of Sciences of the United States of America, 106, 2143721441.Google Scholar
Rogosch, F., Cicchetti, D., & Aber, J. (1995). The role of child maltreatment in early deviations in cognitive and affective processing abilities and later peer relationship problems. Development and Psychopathology, 7, 591609.Google Scholar
Ross, H. E., & Young, L. J. (2009). Oxytocin and the neural mechanisms regulating social cognition and affiliative behavior. Frontiers in Neuroendocrinology, 30, 534547.Google Scholar
Scantamburlo, G., Hansenne, M., Fuchs, S., Pitchot, W., Maréchal, P., Pequeux, C., et al. (2007). Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology, 32, 407410.Google Scholar
Schieche, M., & Spangler, G. (2005). Individual differences in biobehavioral organization during problem-solving in toddlers: The influence of maternal behavior, infant–mother attachment, and behavioral inhibition on the attachment–exploration balance. Developmental Psychobiology, 46, 293306.Google Scholar
Schuengel, C., Bakermans-Kranenburg, M., & van IJzendoorn, M. (1999). Frightening maternal behavior linking unresolved loss and disorganized infant attachment. Journal of Consulting and Clinical Psychology, 67, 54.CrossRefGoogle ScholarPubMed
Schwartz, A. C., Bradley, R., Sexton, M., Sherry, A., & Ressler, K. J. (2005). Posttraumatic stress disorder among African Americans in an inner city mental health clinic. Psychiatric Services, 56, 212215.Google Scholar
Shamay-Tsoory, S., Fischer, M., Dvash, J., Harari, H., Perach-Bloom, N., & Levkovitz, Y. (2009). Intranasal administration of oxytocin increases envy and schadenfreude (gloating). Biological Psychiatry, 66, 864870.Google Scholar
Shaver, P., & Mikulincer, M. (2007). Adult attachment strategies and the regulation of emotion. In Gross, J. (Ed.), Handbook of emotion regulation (pp. 446465). New York: Guilford Press.Google Scholar
Shedler, J., & Westen, D. (2004). Dimensions of personality pathology: An alternative to the Five Factor Model. American Journal of Psychiatry, 161, 17431754.Google Scholar
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33, 906916.Google Scholar
Shields, A., & Cicchetti, D. (1998). Reactive aggression among maltreated children: The contributions of attention and emotion dysregulation. Journal of Clinical Child & Adolescent Psychology, 27, 381395.Google Scholar
Stolk, M., Mesman, J., van Zeijl, J., Alink, L., Bakermans-Kranenburg, M., van IJzendoorn, M., et al. (2008). Early parenting intervention aimed at maternal sensitivity and discipline: A process evaluation. Journal of Community Psychology, 36, 780797.Google Scholar
Stovall-McClough, K., & Cloitre, M. (2006). Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. Journal of Consulting and Clinical Psychology, 74, 219228.Google Scholar
Takayanagi, Y., Yoshida, M., Bielsky, I. F., Ross, H. E., Kawamata, M., Onaka, T., et al. (2005). Pervasive social deficits, but normal parturition, in oxytocin receptor-deficient mice. Proceeding of the National Academy of Sciences of the United States of America, 102, 1609616101.Google Scholar
Thompson, R. (2008). Early attachment and later development: Familiar questions, new answers. In Cassidy, J. & Shaver, P. (Eds.), Handbook of attachment: Theory research and clinical implications (pp. 348365). New York: Guilford Press.Google Scholar
Tottenham, N., Hare, T., Quinn, B., McCarry, T., Nurse, M., Gilhooly, T., et al. (2010). Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation. Developmental Science, 13, 4661.Google Scholar
van IJzendoorn, M., Schuengel, C., & Bakermans-Kranenburg, M. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225250.Google Scholar
Westen, D. (1991). Cultural, emotional, and unconscious aspects of self. In Curtis, R. C. (Ed.), The relational self (pp. 181210). New York: Guilford Press.Google Scholar
Westen, D. (1998). Affect regulation and psychopathology: Applications to depression and borderline personality disorder. In Flack, W. & Laird, J. (Eds.), Affect and psychopathology (pp. 394406). New York: Oxford University Press.Google Scholar
Westen, D., Muderrisoglu, S., Fowler, C., Shedler, J., & Koren, D. (1997). Affect regulation and affective experience: Individual differences, group differences, and measurement using a Q-sort procedure. Journal of Consulting & Clinical Psychology, 65, 429439.Google Scholar
Westen, D., Nakash, O., Thomas, C., & Bradley, B. (2006). Clinical assessment of attachment patterns and personality disorder in adolescents and adults. Journal of Consulting and Clinical Psychology, 74, 1065.Google Scholar
Westen, D., & Shedler, J. (1999a). Revising and assessing Axis II, Part 1: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156, 258272.Google Scholar
Westen, D., & Shedler, J. (1999b). Revising and assessing Axis II, Part 2: Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry, 156, 273285.Google Scholar
Winslow, J., Noble, P., Lyons, C., Sterk, S., & Insel, T. (2003). Rearing effects on cerebrospinal fluid oxytocin concentration and social buffering in rhesus monkeys. Neuropsychopharmacology, 28, 910918.Google Scholar
Wu, S., Jia, M., Ruan, Y., Liu, J., Guo, Y., Shuang, M., et al. (2005). Positive association of the oxytocin receptor gene (OXTR) with autism in the Chinese Han population. Biological Psychiatry, 58, 7477.Google Scholar
Yates, T., Obradovi, J., & Egeland, B. (2010). Transactional relations across contextual strain, parenting quality, and early childhood regulation and adaptation in a high-risk sample. Development and Psychopathology, 22, 539555.CrossRefGoogle Scholar
Yoshida, M., Takayanagi, Y., Inoue, K., Kimura, T., Young, L. J., Onaka, T., et al. (2009). Evidence that oxytocin exerts anxiolytic effects via oxytocin receptor expressed in serotonergic neurons in mice. Journal of Neuroscience, 29, 22592271.Google Scholar
Zittel Conklin, C., & Westen, D. (2005). Borderline personality disorder as seen in clinical practice: Implications for DSM-V. American Journal of Psychiatry, 162, 867875.Google Scholar