Autonomic nervous system regulation and attachment patterns in children with vasovagal syncope: a theoretical framework in light of the polyvagal theory
DOI:
https://doi.org/10.13129/2282-1619/mjcp-4646Keywords:
Autonomic nervous system, Children, Developmental trauma, Polyvagal theory, Vasovagal syncope.Abstract
Vasovagal Syncope (VVS) is an early onset syncope involving a transient loss of consciousness and postural tone. This article illustrates the implications of Polyvagal Theory (PVT) for understanding VVS as a consequence of autonomic regulation impairments stemming from attachment failures during childhood. Repetitive failures in early attachment relationships may hinder the development of the ability to adequately appraise internal and external stimuli and regulate one’s emotional states. In accordance with PVT, these impairments may underlie the predominant activation of phylogenetically older emotion regulation systems, including the dorsal-vagal and sympathetic systems, over the ventral-vagal system, increasing the individual’s propensity to exhibit immobilization and fight/flight reactions. In fact, inhibition of the ventral-vagal system prevents the regulation of emotional states through interactions with others and the experience of safety in social relationships. Our theoretical framework posits that VVS, including pediatric syncope, might result from altered appraisal and autonomic regulation processes. Clinical interventions aimed at fostering emotion regulation abilities and feelings of safety in social relationships might be critical for improving the well-being of patients suffering from VVS.References
Anderson, J. B., Czosek, R. J., Knilans, T. K., & Marino, B. S. (2012). The effect of paediatric syncope on health-related quality of life. Cardiology in the Young, 22(5), 583–588. https://doi.org/10.1017/S1047951112000133
Bailey, R., Dugard, J., Smith, S. F., & Porges, S. W. (2023). Appeasement: Replacing Stockholm syndrome as a definition of a survival strategy. European Journal of Psychotraumatology, 14(1), 2161038. https://doi.org/10.1080/20008066.2022.2161038
Benditt, D. G., van Dijk, J. G., Krishnappa, D., Adkisson, W. O., & Sakaguchi, S. (2020). Neurohormones in the pathophysiology of vasovagal syncope in adults. Frontiers in Cardiovascular Medicine, 7, 76. https://doi.org/10.3389/fcvm.2020.00076
Bifulco, A., & Schimmenti, A. (2019). Assessing child abuse: “We need to talk!”. Child Abuse & Neglect, 98, 104236. https://doi.org/10.1016/J.CHIABU.2019.104236
Blount, R. L., Morris, J. A. B., Cheng, P. S., Campbell, R. M., & Brown, R. T. (2004). Parent and child psychological factors in pediatric syncope and other somatic symptoms. Journal of Consulting and Clinical Psychology, 72(4), 597–604. https://doi.org/10.1037/0022-006X.72.4.597
Bonadies, M., Di Trani, M., Solano, L., Tumbiolo, F., Piacentini, F., & Ammirati, F. (2006). Le caratteristiche psicologiche dei pazienti con diagnosi di sincope vasovagale: Studio osservazionale su sessanta soggetti [Psychological characteristics of patients with vasovagal syncope: And observational study on sixty subjects]. Giornale Italiano di Cardiologia, 7(4), 273–280. https://doi.org/10.1714/698.8018
Bowlby, J. (1973). Attachment and loss, Vol. 2. Separation: Anxiety and anger. Basic Books.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Guilford Press.
Bretherton, I. (1999). Updating the “internal working model” construct: Some reflections. Attachment & Human Development, 1(3), 343–357. https://doi.org/10.1080/14616739900134191
Brignole, M., Moya, A., De Lange, F. J., Deharo, J. C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., Probst, V., Reed, M. J., Rice, C. P., Sutton, R., Ungar, A., & Van Dijk, J. G. (2018). Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope. European Heart Journal, 39(21), e43–e80. https://doi.org/10.1093/eurheartj/ehy071
Bucci, W. (1998). Psychoanalysis and cognitive science: A multiple code theory. Guilford Press. https://doi.org/10.5860/choice.35-3003
Bucci, W. (2001). Toward a “Psychodynamic science”: The state of current research. Journal of the American Psychoanalytic Association, 49(1), 57–68. https://doi.org/10.1177/00030651010490010401
Byars, K. C., Brown, R. T., Campbell, R. M., & Hobbs, S. A. (2000). Psychological adjustment and coping in a population of children with recurrent syncope. Journal of Developmental and Behavioral Pediatrics, 21(3), 189–197.
Chen-Scarabelli, C., & Scarabelli, T. M. (2004). Neurocardiogenic syncope. British Medical Journal, 329(7461), 336–341. https://doi.org/10.1136/bmj.329.7461.336
Cooke, J. E., Kochendorfer, L. B., Stuart-Parrigon, K. L., Koehn, A. J., & Kerns, K. A. (2019). Parent-child attachment and children’s experience and regulation of emotion: A meta-analytic review. Emotion, 19(6), 1103–1126. https://doi.org/10.1037/emo0000504
Cuzzocrea, G., Fontana, A., Mascanzoni, M., Manca, F., Pecora, R., Trani, L., Guido, C., Spalice, A., Versacci, P., Sideli, L., & Caretti, V. (2024). Psychopathological correlates and psychosocial functioning in children and adolescents with syncope: A systematic review. Clinical Neuropsychiatry, 21(5), 358–375. https://doi.org/10.36131/cnfioritieditore20240502
Da Silva, R. M. F. L. (2014). Syncope: Epidemiology, etiology, and prognosis. Frontiers in Physiology, 5, 125026. https://doi.org/10.3389/FPHYS.2014.00471/BIBTEX
Dale, L. P., Kolacz, J., Mazmanyan, J., Leon, K. G., Johonnot, K., Bossemeyer Biernacki, N., & Porges, S. W. (2022). childhood maltreatment influences autonomic regulation and mental health in college students. Frontiers in Psychiatry, 13, 841749. https://doi.org/10.3389/fpsyt.2022.841749
Dale, L. P., Shaikh, S. K., Fasciano, L. C., Watorek, V. D., Heilman, K. J., & Porges, S. W. (2018). College females with maltreatment histories have atypical autonomic regulation and poor psychological wellbeing. Psychological Trauma: Theory, Research, Practice and Policy, 10(4), 427–434. https://doi.org/10.1037/TRA0000342
Dana, D. (2018). The Polyvagal theory in therapy. W. W. Norton & Company.
Di Monte, C., Renzi, A., Paone, E., Silecchia, G., Solano, L., & Di Trani, M. (2020). Alexithymia and obesity: Controversial findings from a multimethod assessment. European Review for Medical and Pharmacological Sciences, 24(2), 831–836. https://doi.org/10.26355/eurrev_202001_20066
Di Trani, M., Mariani, R., Renzi, A., Greenman, P. S., & Solano, L. (2018). Alexithymia according to Bucci’s multiple code theory: A preliminary investigation with healthy and hypertensive individuals. Psychology and Psychotherapy: Theory, Research and Practice, 91(2), 232–247. https://doi.org/10.1111/papt.12158
Esposito, G., Totaro, S., Di Maro, A., & Passeggia, R. (2024). The role of epistemic trust in the relationship between attachment and mentalization: A systematic review. Mediterranean Journal of Clinical Psychology, 12(1). https://doi.org/10.13129/2282-1619/mjcp-4041
Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach to the problems of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14(3), 387–421. https://doi.org/10.1016/S0002-7138(09)61442-4
Grimaldi Capitello, T., Fiorilli, C., Placidi, S., Vallone, R., Drago, F., & Gentile, S. (2016). What factors influence parents’ perception of the quality of life of children and adolescents with neurocardiogenic syncope? Health and Quality of Life Outcomes, 14(1), 79. https://doi.org/10.1186/s12955-016-0476-9
Gunnar Wallin, B., & Sundlöf, G. (1982). Sympathetic outflow to muscles during vasovagal syncope. Journal of the Autonomic Nervous System, 6(3), 287–291. https://doi.org/10.1016/0165-1838(82)90001-7
Hainsworth, R., & Claydon, V. E. (2013). Syncope and fainting: Classification and pathophysiological basis. In C. J. Mathias, S. R. Bannister, C. J. Mathias, D. A. Low, & V. Iodice (Eds.), Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System (5th ed., pp. 690–700). https://doi.org/10.1093/med/9780198566342.003.0058
Heilman, K. J., Heinrich, S., Ackermann, M., Nix, E., & Kyuchukov, H. (2023). Effects of the Safe and Sound Protocol TM (SSP) on sensory processing, digestive function and selective eating in children and adults with autism: A prospective single-arm study. Journal on Developmental Disabilities, 28(1), 1–26.
Heyer, G. L., Dale, L. P., Kolacz, J., Mazmanyan, J., Leon, K. G., Johonnot, K., Bossemeyer Biernacki, N., Porges, S. W., Shaffer, F., McCraty, R., Zerr, C. L., Brown, R. T. R. P., Gerbarg, P. L., Kilic, A., Ozer, S., Turanli, G., Ayabakan, C., Celiker, A., Ozme, S., … Porges, S. W. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research—Recommendations for experiment planning, data analysis, and data reporting. Frontiers in Psychology, 13(1), 213. https://doi.org/10.3389/fpsyg.2017.00213
Hyphantis, T. N., Pappas, A. I., Vlahos, A. P., Carvalho, A. F., Levenson, C. J. L., & Kolettis, T. M. (2012). Depressive symptoms and neurocardiogenic syncope in children: A 2-year prospective study. Pediatrics, 130(5), 906–913. https://doi.org/10.1542/peds.2012-1379
Iwase, S., Nishimura, N., & Mano, T. (2014). Role of sympathetic nerve activity in the process of fainting. Frontiers in Physiology, 5. https://doi.org/10.3389/fphys.2014.00343
Jackson, J. H. (1884). The croonian lectures on evolution and dissolution of the nervous system. British Medical Journal, 1, 703–707. https://doi.org/10.1136/bmj.1.1215.703
Kanjwal, K., & Calkins, H. (2015). Syncope in children and adolescents. Cardiology Clinics, 33(3), 397–409. https://doi.org/10.1016/J.CCL.2015.04.008
Kara, A., & Doğan, M. T. (2021). The psychopathology, depression, and anxiety levels of children and adolescents with vasovagal syncope: A case-control study. Journal of Nervous and Mental Disease, 209(8), 547–551. https://doi.org/10.1097/NMD.0000000000001334
Khan, A. N., & Jaffee, S. R. (2022). Alexithymia in individuals maltreated as children and adolescents: A meta-analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines, 63(9), 963–972. https://doi.org/10.1111/jcpp.13616
Kolacz, J., Dale, L. P., Nix, E. J., Roath, O. K., Lewis, G. F., & Porges, S. W. (2020a). Adversity history predicts self-reported autonomic reactivity and mental health in US residents during the COVID-19 pandemic. Frontiers in Psychiatry, 11, 577728. https://doi.org/10.3389/fpsyt.2020.577728
Kolacz, J., Hu, Y., Gesselman, A. N., Garcia, J. R., Lewis, G. F., & Porges, S. W. (2020b). Sexual function in adults with a history of childhood maltreatment: Mediating effects of self-reported autonomic reactivity. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 281–290. https://doi.org/10.1037/tra0000498
Kolacz, J., Kovacic, K., Dang, L., Li, B. U. K., Lewis, G. F., & Porges, S. W. (2023). Cardiac vagal regulation is impeded in children with cyclic vomiting syndrome. American Journal of Gastroenterology, 118(7), 1268–1275. https://doi.org/10.14309/ajg.0000000000002207
Kolacz, J., Kovacic, K., Lewis, G. F., Sood, M. R., Aziz, Q., Roath, O. R., & Porges, S. W. (2021). Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders. Neurogastroenterology and Motility, 33(12), e14165. https://doi.org/10.1111/nmo.14165
Kolacz, J., & Porges, S. W. (2018). Chronic diffuse pain and functional gastrointestinal disorders after traumatic stress: Pathophysiology through a polyvagal perspective. Frontiers in Medicine, 5, 145. https://doi.org/10.3389/fmed.2018.00145
Krystal, H., & Krystal, J. H. (1988). Integration and self-healing: Affect, trauma, alexithymia. Analytic Press, Inc.
Lavi, I., Katz, L. F., Ozer, E. J., & Gross, J. J. (2019). Emotion reactivity and regulation in maltreated children: A meta-analysis. Child Development, 90(5), 1503–1524. https://doi.org/10.1111/cdev.13272
Lee, S. H., Park, S. J., Byeon, K., On, Y. K., Yim, H. R., & Kim, J. S. (2013). Prevalence and clinical factors of anxiety and depression in neurally mediated and unexplained syncope. Yonsei Medical Journal, 54(3), 583–589. https://doi.org/10.3349/ymj.2013.54.3.583
Liao, Y., & Du, J. (2020). Pathophysiology and individualized management of vasovagal syncope and postural tachycardia syndrome in children and adolescents: An update. Neuroscience Bulletin, 36(6), 667–681. https://doi.org/10.1007/s12264-020-00497-4
Longo, S., Legramante, J. M., Rizza, S., & Federici, M. (2023). Vasovagal syncope: An overview of pathophysiological mechanisms. European Journal of Internal Medicine, 112, 6–14. https://doi.org/10.1016/j.ejim.2023.03.025
Luyten, P., Nijssens, L., Fonagy, P., & Mayes, L. C. (2017). Parental reflective functioning: Theory, research, and clinical applications. The Psychoanalytic Study of the Child, 70(1), 174–199. https://doi.org/10.1080/00797308.2016.1277901
Mariani, R., Marini, I., Di Trani, M., Catena, C., Patino, F., Riccioni, R., & Pasquini, M. (2022). Emotional dysregulation and linguistic patterns as a defining feature of patients in the acute phase of anorexia nervosa. Eating and Weight Disorders, 27(8), 3267–3277. https://doi.org/10.1007/s40519-022-01456-w
Massin, M. M., Bourguignont, A., Coremans, C., Comté, L., Lepage, P., & Gérard, P. (2004). Syncope in pediatric patients presenting to an emergency department. Journal of Pediatrics, 145(2), 223–228. https://doi.org/10.1016/j.jpeds.2004.01.048
McEwen, B. S. (2000). Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacology, 22(2), 108–124. https://doi.org/10.1016/S0893-133X(99)00129-3
Midolo, L. R., Santoro, G., Ferrante, E., Pellegriti, P., Russo, S., Costanzo, A., & Schimmenti, A. (2020). Childhood trauma, attachment and psychopathology: A correlation network approach. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2418
Morton, L., Cogan, N., Kolacz, J., Calderwood, C., Nikolic, M., Bacon, T., Pathe, E., Williams, D., & Porges, S. W. (2022). A new measure of feeling safe: Developing psychometric properties of the Neuroception of Psychological Safety Scale (NPSS). Psychological Trauma: Theory, Research, Practice, and Policy, 16(4), 701. https://doi.org/10.1037/tra0001313
Musetti, A., Gori, A., Alessandra, A., Topino, E., Terrone, G., Plazzi, G., Cacioppo, M., & Franceschini, C. (2022). The interplay between problematic online pornography use, psychological stress, emotion dysregulation and insomnia symptoms during the COVID-19 pandemic: A mediation analysis. Nature and Science of Sleep, 14, 83–92. https://doi.org/10.2147/NSS.S348242
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W.W. Norton & Company.
O’Hare, C., McCrory, C., O’Leary, N., O’Brien, H., & Kenny, R. A. (2017). Childhood trauma and lifetime syncope burden among older adults. Journal of Psychosomatic Research, 97, 63–69. https://doi.org/10.1016/J.JPSYCHORES.2017.03.019
Owens, A. P., Low, D. A., Critchley, H. D., & Mathias, C. J. (2018). Emotional orienting during interoceptive threat in orthostatic intolerance: Dysautonomic contributions to psychological symptomatology in the postural tachycardia syndrome and vasovagal syncope. Autonomic Neuroscience, 212, 42–47. https://doi.org/10.1016/J.AUTNEU.2018.01.004
Owens, A. P., Low, D. A., Iodice, V., Critchley, H. D., & Mathias, C. J. (2017). The genesis and presentation of anxiety in disorders of autonomic overexcitation. Autonomic Neuroscience, 203, 81–87. https://doi.org/10.1016/J.AUTNEU.2016.10.004
Parker, J. D. A., Keefer, K. V., Taylor, G. J., & Bagby, R. M. (2008). Latent structure of the alexithymia construct: A taxometric investigation. Psychological Assessment, 20(4), 385–396. https://doi.org/10.1037/a0014262
Pinna, G. D., Maestri, R., & La Rovere, M. T. (2015). Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: Proven clinical value? Physiological Measurement, 36(4), 741–753. https://doi.org/10.1088/0967-3334/36/4/741
Poli, A., Gemignani, A., Soldani, F., & Miccoli, M. (2021). A systematic review of a polyvagal perspective on embodied contemplative practices as promoters of cardiorespiratory coupling and traumatic stress recovery for ptsd and ocd: Research methodologies and state of the art. International Journal of Environmental Research and Public Health, 18(22), 11778. https://doi.org/10.3390/ijerph182211778
Porges, S. W. (2003). The Polyvagal Theory: Phylogenetic contributions to social behavior. Physiology and Behavior, 79(3), 503–513. https://doi.org/10.1016/S0031-9384(03)00156-2
Porges, S. W. (2005). The vagus: A mediator of behavioral and physiologic features associated with autism. In M. L. Bauman & T. L. Kemper (Eds.), The neurobiology of autism (2nd ed., pp. 65–78). Johns Hopkins University Press.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W.W. Norton & Company.
Porges, S. W. (2020). The COVID-19 pandemic is a paradoxical challenge to our nervous system: A polyvagal perspective. Clinical Neuropsychiatry, 17(2), 135–138. https://doi.org/10.36131/CN20200220
Porges, S. W. (2021a). Cardiac vagal tone: A neurophysiological mechanism that evolved in mammals to dampen threat reactions and promote sociality. World Psychiatry, 20(2), 296–298. https://doi.org/10.1002/wps.20871
Porges, S. W. (2021b). Polyvagal Safety: Attachment, Communication, Self-Regulation. WW Norton & Company.
Porges, S. W. (2022a). Heart rate variability: A personal journey. Applied Psychophysiology Biofeedback, 47(4), 259–271. https://doi.org/10.1007/s10484-022-09559-x
Porges, S. W. (2022b). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227
Porges, S. W., Bazhenova, O. V., Bal, E., Carlson, N., Sorokin, Y., Heilman, K. J., Cook, E. H., & Lewis, G. F. (2014). Reducing auditory hypersensitivities in autistic spectrum disorder: Preliminary findings evaluating the listening project protocol. Frontiers in Pediatrics, 2, 80. https://doi.org/10.3389/fped.2014.00080
Porges, S. W., Davila, M. I., Lewis, G. F., Kolacz, J., Okonmah-Obazee, S., Hane, A. A., Kwon, K. Y., Ludwig, R. J., Myers, M. M., & Welch, M. G. (2019). Autonomic regulation of preterm infants is enhanced by Family Nurture Intervention. Developmental Psychobiology, 61(6), 942–952. https://doi.org/10.1002/dev.21841
Porges, S. W., Doussard-Rooseveet, J. A., Stifter, C. A., McClenny, B. D., & Riniolo, T. C. (1999). Sleep state and vagal regulation of heart period patterns in the human newborn: An extension of the polyvagal theory. Psychophysiology, 36(1), 14–21. https://doi.org/10.1017/S004857729997035X
Porges, S. W., Macellaio, M., Stanfill, S. D., McCue, K., Lewis, G. F., Harden, E. R., Handelman, M., Denver, J., Bazhenova, O. V., & Heilman, K. J. (2013). Respiratory sinus arrhythmia and auditory processing in autism: Modifiable deficits of an integrated social engagement system? International Journal of Psychophysiology, 88(3), 261–270. https://doi.org/10.1016/j.ijpsycho.2012.11.009
Reed, S. F., Porges, S. W., & Newlin, D. B. (1999). Effect of alcohol on vagal regulation of cardiovascular function: Contributions of the polyvagal theory to the psychophysiology of alcohol. Experimental and Clinical Psychopharmacology, 7(4), 484–492. https://doi.org/10.1037/1064-1297.7.4.484
Riordan, J. P. (2022). Dyadic trauma and attachment: A monozygotic twin study assessing the efficacy of Somatic Experiencing®. Journal of Applied Neurosciences, 1(1). https://doi.org/10.4102/jan.v1i1.3
Riordan, J. P., Blakeslee, A., & Levine, P. (2017). Toddler trauma: Somatic experiencing, attachment and the neurophysiology of dyadic completion. International Journal of Neuropsychotherapy, 5, 41–70.
Sahar, T., Shalev, A. Y., & Porges, S. W. (2001). Vagal modulation of responses to mental challenge in posttraumatic stress disorder. Biological Psychiatry, 49(7), 637–643. https://doi.org/10.1016/S0006-3223(00)01045-3
Salo, L. M., Woods, R. L., Anderson, C. R., & McAllen, R. M. (2007). Nonuniformity in the von Bezold-Jarisch reflex. American Journal of Physiology - Regulatory Integrative and Comparative Physiology, 293(2), 714–720. https://doi.org/10.1152/ajpregu.00099.2007
Santoro, G., Midolo, L. R., Costanzo, A., & Schimmenti, A. (2021). The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology. Bulletin of the Menninger Clinic, 85(4), 358–384. https://doi.org/10.1521/BUMC.2021.85.4.358
Santoro, G., Musetti, A., Costanzo, A., & Schimmenti, A. (2025). Self-discontinuity in behavioral addictions: A psychodynamic framework. Addictive Behaviors Reports, 21, 100601. https://doi.org/10.1016/j.abrep.2025.100601
Schimmenti, A. (2017). The developmental roots of dissociation: A multiple mediation analysis. Psychoanalytic Psychology, 34(1), 96–105. https://doi.org/10.1037/pap0000084
Schimmenti, A. (2018). The trauma factor: Examining the relationships among different types of trauma, dissociation, and psychopathology. Journal of Trauma and Dissociation, 19(5), 552–571. https://doi.org/10.1080/15299732.2017.1402400
Schimmenti, A., & Bifulco, A. (2015). Linking lack of care in childhood to anxiety disorders in emerging adulthood: The role of attachment styles. Child and Adolescent Mental Health, 20(1), 41–48. https://doi.org/10.1111/camh.12051
Schimmenti, A., Billieux, J., Santoro, G., Casale, S., & Starcevic, V. (2022). A trauma model of substance use: Elaboration and preliminary validation. Addictive Behaviors, 134, 107431. https://doi.org/10.1016/j.addbeh.2022.107431
Schimmenti, A., & Caretti, V. (2016). Linking the overwhelming with the unbearable: Developmental trauma, dissociation, and the disconnected Self. Psychoanalytic Psychology, 33(1), 106–128. https://doi.org/10.1037/A0038019
Schimmenti, A., & Caretti, V. (2018). Attachment, trauma, and alexithymia. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 127–141). Cambridge University Press. https://doi.org/10.1017/9781108241595.010
Schore, A. N. (2003). Affect dysregulation and disorders of the self. W.B. Saunders Ltd.
Sehra, R., Hubbard, J. E., Straka, S. P., Fineberg, N. S., Engelstein, E. D., & Zipes, D. P. (1999). Autonomic changes and heart rate variability in children with neurocardiac syncope. Pediatric Cardiology, 20(4), 242–247. https://doi.org/10.1007/s002469900456
Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., Sutton, R., Sandroni, P., Friday, K. J., Hachul, D. T., Cohen, M. I., Lau, D. H., Mayuga, K. A., Moak, J. P., Sandhu, R. K., & Kanjwal, K. (2015). 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm, 12(6), e41–e63. https://doi.org/10.1016/J.HRTHM.2015.03.029
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford.
Solano, L. (2010). Some thoughts between body and mind in the light of Wilma Bucci’s multiple code theory. The International Journal of Psychoanalysis, 91(6), 1445–1464. https://doi.org/10.1111/J.1745-8315.2010.00359.X
Stang, P., Köllner, M. G., Weiss, M. (2024). Social support and attachment in persons diagnosed with psychotic spectrum disorders. Mediterranean Journal of Clinical Psychology, 12(1). https://doi.org/10.13129/2282-1619/mjcp-4055
Stewart, J. M., Erb, M., & Sorbera, C. (1996). Heart rate variability and the outcome of head-up tilt in syncopal children. Pediatric Research, 40(5), 702–709. https://doi.org/10.1203/00006450-199611000-00009
Tao, C., Tang, C., Chen, S., Jin, H., & Du, J. (2019). Autonomic nervous function in vasovagal syncope of children and adolescents. Neuroscience Bulletin, 35(5), 937–940. https://doi.org/10.1007/s12264-019-00383-8
Taylor, G. J. (2010). Affects, trauma, and mechanisms of symptom formation: A tribute to John C. Nemiah, MD (1918-2009). Psychotherapy and Psychosomatics, 79(6), 339–349. https://doi.org/10.1159/000320119
Taylor, G. J., Michael Bagby, R., & Parker, J. D. A. (1991). The alexithymia construct: A potential paradigm for psychosomatic medicine. Psychosomatics, 32(2), 153–164. https://doi.org/10.1016/S0033-3182(91)72086-0
Tronick, E. (2007). The neurobehavioral and social-emotional development of infants and children. W.W. Norton & Company.
Van der Kolk, B. A. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin.
Van der Kolk, B., & D’Andrea, A. (2010). Towards a developmental trauma disorder diagnosis for childhood interpersonal trauma. In R. A. Lanius, E. Vermetten & C. Pain (Eds.), The impact of early life trauma on health and disease: The hidden epidemic (pp. 57–68). Cambridge University Press. https://doi.org/10.1017/CBO9780511777042.008
Van Dijk, J. G., & Sheldon, R. (2008). Is there any point to vasovagal syncope? Clinical Autonomic Research, 18(4), 167–169. https://doi.org/10.1007/s10286-008-0484-x
Velotti, P., Rogier, G., Mommo, G., Bizzi, F., & Cavanna, D. (2022). An exploration of home attachment representations using an adaptation of Adult Attachment Interview: Preliminary data on the Home Attachment Interview. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3249
Wang, C., Liao, Y., Wang, S., Tian, H., Huang, M., Dong, X. Y., Shi, L., Li, Y. Q., Sun, J. H., Du, J. B., Jin, H. F., & Chinese Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association; Committee of Pediatric Syncope, College of Pediatricians, Chinese Medical Doctor Association; Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association; Committee of Pediatric Cardiology, College of Cardiovascular Physicians, Chinese Medical Doctor Association (2024). Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024). World Journal of Pediatrics, 20(10), 983–1002. https://doi.org/10.1007/s12519-024-00819-w
Wang, Y., Wang, Y., Li, X., Du, J., Zhang, H., Jin, H., & Liao, Y. (2021). Efficacy of increased salt and water intake on pediatric vasovagal syncope: A meta-analysis based on global published data. Frontiers in Pediatrics, 9, 663016. https://doi.org/10.3389/fped.2021.663016
Wehrwein, E. A., Orer, H. S., & Barman, S. M. (2016). Overview of the anatomy, physiology, and pharmacology of the autonomic nervous system. In R. Terjung (Ed.), Comprehensive physiology (1st ed., pp. 1239–1278). Wiley. https://doi.org/10.1002/cphy.c150037
Wheeler, K. (2020). The Neurophysiology of Trauma and Psychotherapy. In Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-To Guide for Evidence-Based Practice, Third Edition (pp. 57–104). Springer Publishing Company. https://doi.org/10.1891/9780826193896-2
Wieling, W., Ganzeboom, K. S., & Saul, J. P. (2004). Reflex syncope in children and adolescents. Heart, 90(9), 1094–1100. https://doi.org/10.1136/hrt.2003.022996
Winnicott, D. W. (1974). Fear of breakdown. International Review of Psycho-Analysis, 1(1-2), 103–107.
Zhang, J., Zhang Y., Mao, Y., & Wang, Y. (2024). The relationship between insecure attachment and alexithymia: A meta-analysis. Current Psychology, 43(7), 5804–5825. https://doi.org/10.1007/s12144-023-04749-0
Downloads
Published
Issue
Section
License
Articles and conference papers published in Mediterranean Journal of Clinical Psychology are distributed under the terms and conditions of a Creative Commons Attribution 4.0 Unported License. Correspondingly, authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
