Medizinische Universität Graz - Research portal
Selected Publication:
Fuchshuber, J.
Trauma, Personality and Substance Use Disorder: A Neuropsychodynamic Model of Addiction Etiology
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2019. pp. 150
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- Authors Med Uni Graz:
- Advisor:
- Kapfhammer Hans-Peter
- Kresse Adelheid
- Unterrainer Human-Friedrich
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- Abstract:
- Considering the high prevalence, the poor treatment outcome and the catastrophic health-related and socioeconomic consequences associated with substance use disorder (SUD), there is a strong case for intensified research on this subject. Therefore, the present thesis aims at developing a neuroscientifically informed psychodynamic framework regarding the etiology of SUD, in order to path new ways for the understanding and treatment of this potentially life-threatening condition. While traditional psychoanalysis has been criticized as insufficient for the treatment of SUD, recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse. In order to fill this gap, the original research presented in this thesis consists of seven studies investigating connections between childhood trauma, primary emotions, personality structure, attachment and neurophysiological parameters as well as their relation to addiction development and treatment. Studies indicate that SUDs are significantly associated with childhood trauma and a variety of psychodynamic personality concepts including insecure attachment, decreased personality organization and decreased primary emotion functioning. In correspondence to this, structural equation modeling and path analysis estimations suggest that the pathogenic effect of childhood trauma is mediated by its relation to impaired personality structure. On a neuroscientific level, these results are paralleled by evidence for neurological alterations associated with SUD, especially pronounced in widespread deviations in white matter fiber tracts and decreased cortical thickness predominately affecting the left insula and lateral orbitofrontal cortex. Furthermore, SUD patients showed decreased oxytocin reactivity in response to an attachment-based intervention. The results not only highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology but also present tentative evidence for the neurophysiological correlates of psychodynamic concepts. In particular, the findings underscore the conceptualization of addiction as a disorder related to dysfunctional attachment and affect regulation abilities, often caused by traumatic childhood relationships. In turn, these deficits seem to be reflected by alterations in subcortical and neocortical structures as well as reduced oxytocin reactivity. Future research should aim at mapping this relationship and in more detail.