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Whether a patient's difficulties stem from conflict between incompatible mental structures or from ego deficits caused by trauma and neglect was the source of much debate in psychoanalysis in the latter half of the twentieth century, the two sides epitomized, respectively, by Kernberg and Kohut. More recent discussions have tended to integrate these competing paradigms, but it can remain a tension in clinical practice to decide the degree to which interpretation will help a given problem, or the degree to which the problem is due to an area of ego deficit in the patient. In an article published in Biological Psychiatry, McLaughlin and colleagues enrich this discussion with new evidence of how early life stress affects brain development.
These investigators studied a sample of children participating in the Bucharest Early Intervention Project (BEIP), a longitudinal study of children raised in institutional settings in Romania and a comparison group of children reared in the community. One hundred thirty-six institutionalized children participated in BEIP, which randomly assigned them to foster care placement or continued institutional care. Children had resting electroencephalogram (EEG) assessment at baseline and at 30, 42, and 96 months after starting the study. The presence of psychiatric disorders over time was measured using structured clinical interviews of the children and interviews with institutional caregivers.
The primary measure of interest was lateralization of EEG activity in the frontal cerebral cortex. In normal individuals, frontal areas of the cerebral cortex are lateralized to subserve different functions, such that the left frontal region is activated by positive emotional stimuli and promotes approach behavior, and the right side is activated by negative stimuli and underlies withdrawal and avoidance behavior. Earlier studies have shown that adults with right > left frontal EEG asymmetry (FEA) are more inhibited and experience greater negative affe