The cerebral hemispheres, the left and right sides of the brain, are not merely “safety backups” for the function of the other half. They have different functions or functional focuses. They are connected by the corpus callosum.
In most people, the left hemisphere is more dominant. The right hemisphere is more strongly associated with emotional processing, the recognition of emotions and stress reactions.
Although separation of the hemispheres by surgery has little effect on functioning in daily life, it can lead to a loss of emotional abilities (including alexithymia) or symbolic imagination and is often accompanied by a reduced cortisol stress response.
Post-traumatic stress disorder (PTSD) often causes a loss of information exchange between the hemispheres. In borderline personality disorder, it is assumed that the inability to integrate positive and negative perceptions is due to impaired communication between the hemispheres.
A disturbed bond between infant and mother or early child abuse can lead to an impairment of the right hemisphere of the brain and have a negative impact on the ability to bond and social skills.
The following article is currently based largely on a review by Henry.
1. Right and left hemispheres of the brain¶
People with a functional or surgical separation of the connection between the cerebral hemispheres (surgical: commissurotomy, callosotomy, a last resort in epilepsy) function inconspicuously in most everyday situations. Communication between the cerebral hemispheres is helpful, but not vital. Most people are characterized by a dominance of one of the two hemispheres.
In addition to alexithymia, a separation of the cerebral hemispheres causes a subtle loss of emotional abilities, e.g. with regard to symbolic imagination. PTSD is often accompanied by alexithymia and a loss of information exchange via tactile stimuli between the cerebral hemispheres.
It has been postulated that the inability to integrate positive and negative perceptions of people (black/white thinking) in borderline patients could be the result of PTSD, which impedes communication between the cerebral hemispheres. In PTSD, differences in the perception of the right and left auditory hemispheres have been found, which are attributed to a disturbance in the exchange between the brain hemispheres caused by the traumatic experience.
Gott et al. describe a subject who was able to switch between two states at will. In a left-hemispheric state, as evidenced by EEG data and task performance scores, she was a businesswoman who enjoyed business planning and meeting people, while in a right-hemispheric state she enjoyed gardening, relaxing, or experiencing an erotic mood with an intimate friend.
The brain hemispheres have different tasks in relation to attention:
- Right hemisphere:
- Maintaining alertness
- Processing new stimuli
- Left hemisphere
- Focused attention
-
Selective attention
1.1. The right hemisphere of the brain¶
The right hemisphere of the brain is
- Mostly the non-dominant hemisphere
- Seemingly more vulnerable to traumatic influences than the left
- Probably due to their closer connection with the limbic system
- More closely connected to the autonomic nervous system
- Predominant role in
- Physiological and cognitive aspects of emotional processing
- Emotions
- Recognition of emotions
- Understanding emotions
- Recognition of subtle emotional expressions
- Recognition of emotional gestures
- Richness of the emotional life
- Control of facial expression
- Control of speech melody (prosody)
- Music appreciation
- Understanding body language
- Processing negative emotions
- Control of the HPA axis (stress axis) and the autonomic nervous system (the second important stress regulation system)
- Disgust (right frontal and anterior)
- While satisfaction correlates with anterior temporal left hemisphere activity
- Recognize connections (forest, not just trees)
- Visualization of perceptions
- Non-verbal understanding
- Flashes of inspiration
- Leaps of thought
- Daydreams
- In establishing the feeling that objects such as family possessions and pets are personally familiar. Recording and maintaining personal relevant entities such as “familiar” faces, people, voices, names, linguistic expressions, handwriting, topography.
- Consolation
-
Alexithymia sufferers use comforting strategies less frequently than non-affected people, whereas PTSD sufferers use them more often.
- Affective reactions to proverbs and idioms, paraphrases, emotional expressions, swearing and slang
- More dominant in terms of activation of conditioned fear response via amygdala
- Right amygdala is more strongly involved in the storage of frightening faces and in the expression of emotionally influenced memories of aversive experiences
- Stress reactions and emotional processes appear to be closely linked to the right hemisphere of the brain.
- Early abuse in the first 2 years of life often leads to disorganized-insecure attachment, which manifests psychologically as an inability to develop a coherent strategy for coping with relationship stress. Early abuse negatively affects the development of the right hemisphere of the brain, which is responsible for attachment, affect regulation and stress modulation, thus laying a template for the coping deficits of mind and body that characterize PTSD symptomatology
- The right hemisphere of the brain is involved in the infant’s attachment to the mother and later in life to other people.
- Children with right hemispheric damage lose important social skills
In our opinion, this also applies to ADHD
- Adults with right hemispheric damage lose the associated sense of familiarity that is crucial for bonding.
In our opinion, this is not typical of ADHD, but could be a more common comorbidity
- Systems that promote right hemisphere activity appear to be resilience-enhancing and protective against socially dysfunctional behavior, substance abuse, HPA axis failure, and some aspects of chronic disease pathophysiology.
Stress reactions and emotion-related processes are also processed in the mPFC. Prelimbic and infralimbic regions of the mPFC influence visceral motor regions, autonomic functions and emotional expression and represent an important region for the integration of neuroendocrine and autonomic activity with behavioral states and cognitive processes,
Childhood abuse and other traumatic stress experiences caused by unavoidable adverse physical, emotional or social events are significant triggers in the pathophysiology of various psychiatric disorders including ADHD.
Early stress can cause developmental abnormalities in brain structures that play a crucial role in mediating the response to stress, e.g:
-
Amygdala
-
Hippocampus
-
Cerebellum
- Anterior cingulate cortex
-
Corpus callosum
- And more
Monkeys that were socially deprived in early childhood showed a deficit in recognizing the emotions of others, as did children with right hemisphere damage. Among other things, this manifests itself in a deficit in recognizing emotions in facial expressions.
Damage to the right hemisphere of the brain caused a loss of ability to grasp, store and process personally relevant and familiar elements of the environment, impairing connection to, response to and interaction with other people.
Stress reduces BDNF in the hippocampus, among other places, which can influence depression and neurodegenerative processes.
1.2. The left hemisphere of the brain¶
The left hemisphere of the brain is more strongly associated with
- Coping
- Flight/Fight
- Verbal understanding
- Verbal expression
Immediately after birth, rats showed large differences in dopamine turnover between the cerebral hemispheres, which decreased with increasing age.
2. Brain hemispheres and cortisol¶
A reduced exchange between the brain hemispheres (also in PTSD) appears to be the cause of
- Reduced cortisol stress response
-
Alexithymia.
Furthermore, a coincidence of reduced basal cortisol levels (despite a normal cortisol response to ACTH) and alexithymia has been reported in some chronic stress sufferers, from which the authors concluded that ACTH-independent mechanisms reduce cortisol levels. For example, the hippocampus is involved in inhibitory regulation of the HPA axis.
Monkeys with greater right hemispheric activation showed a higher CAR (cortisol awakening response) and higher basal cortisol levels. In contrast, monkeys with greater left hemispheric activation showed lower CAR and lower basal cortisol levels, while monkeys with balanced right/left hemispheric activation showed intermediate CAR. The CRH levels correlated with the basal cortisol levels.
3. Brain hemispheres and catecholamines¶
It is possible that interhemispheric regulation of the amygdala and hippocampus by dopaminergic ascending systems helps to keep the right and left sides of the hippocampus in harmony.
Catecholamine asymmetries in the brain could therefore have a concrete benefit. Disruption of the asymmetry of catecholamines could lead to a failure of interhemispheric communication and isolation of the HPA axis. The HPA axis appears to be more lateralized to the non-dominant hemisphere.
This could explain why corticoids do not remain elevated in alexithymic states (despite arousal of the fight/flight response).
This corresponds with our impression that alexithymic states in ADHD are more common in ADHD-HI and ADHD-C than in ADHD-I and that we suspect a frequently flattened cortisol stress response in the former and a very frequently increased cortisol stress response in the latter.
A reduction in the size of the corpus callosum correlates with reduced communication between the hemispheres.
In a study using auditory evoked potentials in adults who had been abused in childhood, none of whom had acute mental health problems or an acute Axis I diagnosis, they were asked to first actively recall a neutral or work-related memory and then a disturbing memory from childhood with impairment. In unaffected individuals, both hemispheres appeared to be equally involved in the recall. In adults with childhood trauma, there was a clear suppression of evoked potentials in the left hemisphere during recall of the neutral memory, indicating enhanced processing in the left hemisphere. During recall of the distressing event, there was a robust shift in laterality in evoked potentials. These were suppressed in the right hemisphere, indicating increased activation of the right hemisphere. Apparently, early maltreatment is associated with increased hemispheric laterality and decreased hemispheric integration.
In states of strong emotional or cognitive stress, events in the right hemisphere are functionally separated from the left hemisphere by inhibiting transmission between the brain hemispheres, even in neurologically intact people. This can trigger alexithymic states, such as reduced emotional empathy with unchanged cognitive empathy.
See also ⇒ Empathy with ADHD In the article ⇒ Complete list of ADHD symptoms according to manifestations in the chapter ⇒ Symptoms.
4. Early attachment disorder impairs self-organization of the right hemisphere of the brain¶
In infancy, the homeostatic structures between the “lower” autonomic and “higher” central brain systems develop in the right hemisphere of the brain, which serve to generate, regulate and stabilize psychobiological states.
The right hemisphere is much more strongly connected to the limbic system and the mechanisms of autonomic and behavioral arousal than the left hemisphere. The maturation of the right hemisphere is dependent on experience.
Disturbances in the bond between infant and mother can therefore cause developmental disorders in the right hemisphere of the brain, which influence the modulation of arousal and the regulation of the neurotransmitters dopamine and noradrenaline. Among other things, dopamine and noradrenaline are responsible for
The brain’s maturation processes are responsible for this.
ADHD is described as a developmental disorder of the brain in the sense of a developmental delay. Numerous studies confirm that early childhood stress experiences can cause such changes in behavior and neurotransmitters. ⇒ Stress damage due to early / prolonged stress
We see no contradiction here to the predominantly genetic cause of ADHD.
Firstly, the dopaminergic and noradrenergic changes that affect brain development can be caused by genes as well as by corresponding environmental influences during developmental spurts of the brain regions concerned.
Secondly, the assumed 75 % heritability necessarily implies 25 % other causes.
Thirdly, environmental influences can mediate their effects through epigenetic changes, which in turn can be passed on for a few generations.
Fourthly, gene-environment interactions are known, particularly with regard to the important gene candidates for ADHD DRD4-7R, COMT and MAO-A. Early childhood attachment problems can represent such an environmental influence.
