Affect Theory and the Neurobiology of Affective Dysregulation

What governs our moods? Why do we feel the way we do? These questions are ancient, older than both neurobiology and psychoanalysis. They were, and still are, the domain of poets, writers, and philosophers. But these very questions have been a focus of psychoanalytic inquiry from the start. Recently, they have also become the object of targeted neurobiological investigation. In this article, I briefly review Freud's views on affects and their regulation and compare them to a contemporary non-analytic model. I then review some recent neurobiological data that illuminates the role of serotonin and the prefrontal cortex in affective regulation and dysregulation. Last, I discuss the relevance of these biological findings to the practice of psychoanalysis and its relationship to other therapeutic approaches. Specifically, I comment on the concurrent use of medications in patients with personality disorders who are in psychotherapy or psychoanalysis.

Freud's original interest in affects was probably born of his early focus on hysteria and is intimately tied to his views on memory and his concept of repression. As a clinician, he was interested in affects because he saw certain affective states as linked to the emergence of hysterical symptoms. According to the scenario proposed by Breuer and Freud (1893), an intense affect was generated by psychic trauma, which occurred during childhood. This resulted in the formation of two distinct memory traces: a memory trace of what happened (details of the event) and an intense emotional memory of the affect (the feeling of the event). Thus, an affective memory was laid down in association with what we would now call an explicit, declarative memory of an event. These intrapsychic events, according to Freud, were not pathogenic in and of