What Happens to Your Nervous System After Long-Term Narcissistic Abuse: A Trauma Therapist’s Clinical Guide

NARCISSISTIC & TOXIC RELATIONSHIP DYNAMICS • April 12, 2026

LAST UPDATED: APRIL 2026

Last reviewed: June 2026 by Annie Wright, LMFT

In short: Long-term narcissistic abuse dysregulates the HPA axis and amygdala, producing chronic hypervigilance and a persistent sense of threat that continues after the relationship ends.

The Morning Her Body Made the Decision

Amy was brushing her teeth at 6:14 a.m. on a Wednesday when her left hand started shaking. Not a subtle tremor. A visible, rhythmic shake that made her toothbrush clatter against her molars. She put the toothbrush down. Held her hand in front of her face. Watched it move as if it belonged to someone else.

She was forty-three. She was the general counsel of a publicly traded biotech company. She had argued before federal judges without a single quaver in her voice. She ran five miles every other morning. There was no medical explanation for her hand shaking at 6:14 a.m. on a Wednesday while she was doing something she had done ten thousand times before.

Except there was. Two years earlier, Amy had ended a seven-year relationship with a man who she now understood was a narcissist. The relationship had been characterized by everything the clinical literature describes: the intoxicating idealization phase, the slow erosion of her reality through gaslighting, the intermittent warmth that kept her bonded, the isolation from friends that happened so gradually she didn’t notice until it was complete.

She’d done what driven women do: she left, she reorganized her life, she threw herself into her work. She hadn’t missed a single day. She’d been promoted. She looked, by every external measure, like someone who had moved on.

Her nervous system had not moved on. Her nervous system was still living in that relationship. Scanning for danger in every interaction, bracing for the next devaluation, interpreting neutral cues as threats. The hand that shook while she brushed her teeth was a nervous system that had been running in survival mode for seven years and had never been given permission to stop.

“I thought I was fine,” Amy told me in our first session. “I thought I was over it. But my body didn’t get the memo.”

Amy’s experience is among the most common things I see in my practice with driven women recovering from narcissistic relationships. The mind moves on. The career continues. The performance doesn’t falter. But the nervous system. The body’s ancient, pre-verbal threat-detection apparatus. Remains stuck in the past. And it will stay stuck until someone addresses it directly.

What Is Nervous System Dysregulation?

To understand what narcissistic abuse does to your nervous system, you first need to understand what a healthy nervous system does. And what it means when that system stops functioning as it should.

Your autonomic nervous system operates largely beneath conscious awareness. It regulates your heart rate, breathing, digestion, immune function, sleep cycles, and. Critically. Your capacity for social engagement. It’s the system that decides, in milliseconds, whether the person in front of you is safe or dangerous, whether you should fight, flee, freeze, or collapse.

In a relationship with a narcissist, your autonomic nervous system is subjected to a particular kind of stress that is uniquely damaging: chronic, unpredictable relational threat. The narcissistic partner isn’t dangerous all the time. That would be simpler. They alternate between warmth and cruelty, between idealization and devaluation, in patterns that are deliberately or unconsciously designed to keep you off-balance. Your nervous system can’t habituate to the threat because the threat isn’t consistent. It’s intermittent, unpredictable, and embedded in a relationship you depend on.

This is the worst possible combination for nervous system health. Consistent threat is damaging, but the nervous system can at least organize around it. Intermittent, unpredictable threat from someone you love and depend on creates a state of perpetual defensive mobilization. Your system can never fully stand down because it can never predict when the next attack will come.

The Neurobiology of What Narcissistic Abuse Does to Your Brain and Body

The neurobiological effects of long-term narcissistic abuse are not metaphorical. They are measurable, documented, and. This is the part that matters most. Reversible. Let me walk through the specific changes, region by region, because understanding what happened to your biology is often the first step toward believing that what you’re experiencing isn’t your fault.

The amygdala: your brain’s smoke detector.

Bessel van der Kolk, MD, psychiatrist and trauma researcher at the Trauma Center at Justice Resource Institute and author of The Body Keeps the Score, uses the metaphor of a smoke detector for the amygdala. The almond-shaped structure deep in the brain that processes threat signals. In a healthy brain, the amygdala detects actual threats and triggers appropriate defensive responses. After prolonged narcissistic abuse, the amygdala becomes hyperactive. It starts sounding the alarm for everything: a coworker’s tone of voice, an ambiguous text message, a partner’s silence, a slightly furrowed brow. (PMID: 9384857)

Neuroimaging studies have shown that individuals with complex PTSD. The form of post-traumatic stress most associated with narcissistic abuse. Show increased amygdala reactivity compared to non-traumatized controls. The amygdala isn’t broken. It learned, through years of experience, that relational cues often precede pain. So it responds to all relational cues with the alarm that, inside the abusive relationship, was actually appropriate.

This is why you startle when someone raises their voice, even if that someone is a barista calling your name. Your amygdala doesn’t distinguish between past and present. It responds to pattern matches.

The hippocampus: your brain’s timestamp.

The hippocampus is responsible for contextualizing memories in time and space. It’s the part of your brain that tells you whether something happened yesterday or three years ago, and whether it’s happening now or in a memory. Research from a Stanford University team, including studies cited by Robert Sapolsky, PhD, neurobiologist and primatologist at Stanford University and author of Why Zebras Don’t Get Ulcers, has demonstrated that chronic cortisol exposure. Exactly the kind produced by sustained narcissistic abuse. Can physically shrink the hippocampus.

The practical consequence: your memories become fragmented and poorly organized. You might struggle to sequence events from the relationship (“Did the silent treatment come before or after the vacation? Was it winter or spring?”). You might experience flashbacks. Intrusive, present-tense re-experiencing of traumatic moments. Because your hippocampus can’t properly tag those memories as “past.” They feel like they’re happening now because, to your brain, they functionally are.

This is also why you might have difficulty describing what happened in a coherent narrative. The gaslighting damaged your confidence in your perceptions, yes. But the hippocampal changes also made the memories themselves harder to access in ordered, linear form. When you struggle to “tell the whole story” clearly, it isn’t because you’re confused or unreliable. It’s because chronic stress physically impaired the brain structure that organizes narrative memory.

The prefrontal cortex: your brain’s executive.

The prefrontal cortex is the most recently evolved part of your brain, responsible for rational thinking, emotional regulation, planning, and. Crucially. The ability to override the amygdala’s alarm signals with conscious assessment. It’s the part that should be able to say: “This text message is not a threat. This is just your coworker asking about a meeting.”

After prolonged narcissistic abuse, the prefrontal cortex shows reduced functional connectivity with the amygdala. In plain terms: the part of your brain that calms the alarm system down has a weaker connection to the alarm system itself. This is why you can know, intellectually, that you’re safe. And still feel terrified. The knowledge is in the prefrontal cortex. The terror is in the amygdala. And the communication between them is impaired.

This disconnection also affects decision-making, which many women after narcissistic abuse describe as feeling impossible. Not because they lack intelligence or judgment, but because the neural circuits that integrate emotional information with rational analysis are weakened. You might agonize over small decisions. What to order for dinner, what to wear to a meeting. In ways that feel disproportionate. That’s the prefrontal cortex struggling to do its job under conditions of chronic autonomic activation.

The HPA axis: your stress thermostat.

The hypothalamic-pituitary-adrenal (HPA) axis is the neuroendocrine system that manages your stress response. The cascade that produces cortisol, the primary stress hormone. In a healthy system, the HPA axis activates during stress and then deactivates when the threat passes. After long-term narcissistic abuse, the HPA axis can become chronically dysregulated. Either stuck in a state of cortisol overproduction (resulting in anxiety, insomnia, weight changes, and immune suppression) or depleted to the point of cortisol underproduction (resulting in fatigue, brain fog, and difficulty mounting an appropriate stress response).

Research published in Psychoneuroendocrinology has documented that individuals with complex trauma histories show altered cortisol rhythms. The normal diurnal pattern of cortisol (higher in the morning, tapering through the day) is flattened or inverted. This has downstream effects on virtually every body system: immune function, digestive health, sleep architecture, reproductive hormones, and cardiovascular function.

This is why narcissistic abuse doesn’t just hurt emotionally. It makes you physically ill. The chronic fatigue, the unexplained GI issues, the autoimmune flares, the hormonal disruptions. These aren’t separate from the emotional trauma. They’re direct consequences of a stress response system that was pushed beyond its design parameters for years.

How Nervous System Damage Shows Up Differently in Driven Women

What I see consistently in my practice is that the nervous system effects of narcissistic abuse manifest differently in driven women than in the general population. And the differences matter for recovery.

Rachel was a neurosurgeon. She’d been out of her narcissistic marriage for two years when she came to see me, referred by a colleague who had noticed something Rachel herself couldn’t see: she was running her operating room like a war zone.

“My residents are afraid of me,” she told me, matter-of-factly, in our third session. “I’m not yelling. I’m not being cruel. But I’m told that the atmosphere in my OR is. Tense. That everyone is walking on eggshells.”

It took weeks to help Rachel see what was happening. Her hypervigilant nervous system. Calibrated by seven years of marriage to a man who could shift from charm to cruelty in a single sentence. Had been exported into her professional environment. She was scanning every interaction for microthreat signals. She tracked her residents’ facial expressions with the same intensity she’d once tracked her husband’s moods. She interpreted hesitation as incompetence, questions as challenges, and silence as withdrawal. Her body was running the same survival software in the OR that it had run in her kitchen.

And because she was a neurosurgeon. Because her hypervigilance manifested as clinical precision and her control responses manifested as thoroughness. Nobody identified it as trauma. They just thought she was “intense.”

This is the particular trap for driven women. The nervous system adaptations that narcissistic abuse produces. Hypervigilance, anticipatory scanning, emotional suppression, need for control. Are the same qualities that professional environments reward. Your dysregulation looks like competence. Your survival mode looks like ambition. And because it “works”. Because it produces results. Nobody identifies it as a problem. Including you.

The specific ways nervous system damage hides in driven women:

Hypervigilance disguised as attention to detail. You notice everything. Every shift in tone, every micro-expression, every email that’s slightly shorter than usual. People compliment your perceptiveness. What they don’t see is that this “perceptiveness” is a trauma response. Your nervous system learned to scan for threat signals in the narcissistic relationship, and now it scans everywhere. The cost is exhaustion. Maintaining that level of environmental monitoring takes enormous energy, even when it’s automatic.

Emotional numbing disguised as composure. You don’t cry in meetings. You don’t lose your temper. You maintain a steady, measured presence regardless of circumstances. What appears to be emotional intelligence is often dissociation. A protective disconnection from your emotional experience that developed as a survival strategy in the relationship. You learned that feeling emotions was dangerous (they could be used against you), so you stopped allowing yourself to feel them. The cost is disconnection from yourself. You don’t know what you want, what you need, or what you actually feel about the decisions you make daily.

Control responses disguised as leadership. You manage every variable. You don’t delegate well. You work longer hours than anyone else to ensure nothing goes wrong. This looks like dedication. Underneath it is a nervous system that learned, inside the narcissistic relationship, that relinquishing control meant vulnerability to attack. The cost is burnout. The unsustainable energy expenditure of trying to control an environment that can’t be fully controlled.

People-pleasing disguised as collaboration. You read rooms instantly. You adjust your behavior to what each person needs. You’re described as “easy to work with” or “a natural diplomat.” What’s actually happening is the fawn response. A nervous system strategy that evolved to manage the narcissist by being whatever they needed you to be at any given moment. The cost is the loss of your own preferences, opinions, and identity. You’ve become so skilled at reading and meeting other people’s needs that you can’t locate your own.

The Polyvagal Map: Where Your Nervous System Is Stuck

Stephen Porges, PhD, neuroscientist and developer of the Polyvagal Theory at the Kinsey Institute at Indiana University, has provided the most clinically useful framework for understanding where a trauma-affected nervous system gets stuck. His theory describes three hierarchical states of autonomic function, and understanding which state (or states) you’re cycling between can clarify what’s happening in your body and what kind of intervention you need.

The ventral vagal state (social engagement). This is where you want to be most of the time. It’s the state of calm alertness, open curiosity, genuine connection with others. In this state, your face is expressive, your voice has prosody (natural rhythm and inflection), your digestion is working, and your immune system is functioning optimally. After narcissistic abuse, this state often feels foreign. Or frightening. Because the narcissist used moments of connection to set up the next devaluation, your nervous system may have learned that the ventral vagal state (feeling safe and connected) is actually the most dangerous state to be in.

The sympathetic state (fight-or-flight). This is the mobilization response. The state of hyperarousal, anxiety, vigilance, and activation. Many driven women after narcissistic abuse live primarily here. It’s the state that keeps you productive, alert, and “on.” It’s also the state that produces insomnia, panic attacks, irritability, difficulty concentrating, muscle tension, elevated heart rate, and the constant, low-grade dread that something bad is about to happen. You don’t necessarily feel panicked. You might just feel wired, restless, unable to settle.

The dorsal vagal state (shutdown). This is the most ancient autonomic response. The collapse response. When the nervous system determines that fight and flight are both impossible, it shifts into conservation mode: everything slows down. Heart rate drops. Digestion stops. Emotional experience flattens. You feel numb, heavy, foggy, disconnected. This is the state that produces the “I can’t feel anything” experience that many women describe in the months after leaving a narcissistic relationship. It’s also the state that underlies dissociative experiences. Those moments when you “leave” your body in meetings or conversations.

After narcissistic abuse, most women aren’t stuck in just one state. They’re cycling rapidly between sympathetic activation and dorsal vagal collapse. Between panic and numbness, between hypervigilance and dissociation. This oscillation is exhausting and disorienting. You can go from anxious overwhelm to flat emotional deadness in minutes, with no transition between the two. Other people experience you as unpredictable. You experience yourself as broken.

You aren’t broken. Your nervous system is doing exactly what it was designed to do in response to chronic threat. The problem isn’t that it’s malfunctioning. The problem is that it hasn’t received the signal that the threat is over.

Both/And: Your Body Is Broken and Your Body Is Brilliantly Adaptive

Here’s the paradox that I hold with clients every day, and that I want to hold with you now:

Your nervous system is damaged. The hypervigilance, the dissociation, the cortisol dysregulation, the narrowed window of tolerance. These are real injuries with real neurobiological substrates. They cause real suffering. They impair your capacity for connection, rest, and pleasure. They are not imaginary.

And: your nervous system did something extraordinary. It adapted to an impossible situation. It kept you alive and functional inside a relationship that was systematically dismantling your reality. The same nervous system responses that now cause you suffering. The scanning, the numbing, the control, the performance. Are the responses that protected you when protection was what you needed most.

Both of these things are true simultaneously. The damage is real and the adaptation was brilliant. Honoring both truths is essential for recovery, because collapsing either one creates problems.

If you only see the damage. If you see your nervous system responses as purely pathological. You risk shaming yourself for the very strategies that kept you alive. The fawn response wasn’t weakness. It was survival intelligence. The hypervigilance wasn’t anxiety disorder. It was an accurate assessment of a dangerous environment. The emotional numbness wasn’t cold detachment. It was a protective measure that allowed you to continue functioning when full emotional engagement would have been unbearable.

If you only see the adaptation. If you minimize the damage and celebrate the “resilience”. You risk bypassing the genuine suffering and the genuine need for intervention. You are resilient. You also need help. Needing help isn’t a failure of resilience. It’s the appropriate response to an injury that exceeds what your system can repair on its own.

In my clinical work, I find that this both/and framing is often the moment when women begin to soften toward themselves. When they can hold “my body was damaged” and “my body was doing its best to protect me” at the same time, the self-blame that narcissistic abuse installs begins to loosen. And that loosening. That first, tentative compassion toward your own nervous system. Is itself a therapeutic intervention. Because compassion toward your body is a signal of safety. And safety is what your nervous system needs to begin its repair.

The Systemic Lens: Why Nobody Told You This Was Happening

If the neurobiological effects of narcissistic abuse are this well-documented. If we know, with neuroimaging evidence, what happens to the amygdala, hippocampus, prefrontal cortex, and HPA axis. Why don’t more people know? Why did you have to discover this information on your own, likely at 2 a.m., likely through a Google search that started with “why can’t I stop being anxious after leaving”?

The answer is systemic, and naming it matters.

Medicine still separates mind from body. The division between “physical health” and “mental health” is deeply embedded in medical training, insurance structures, and cultural understanding. When you go to your primary care physician with insomnia, GI problems, heart palpitations, and chronic fatigue, they will run blood panels, check your thyroid, and possibly refer you to a gastroenterologist. They are far less likely to ask about your relationship history. The neurobiological effects of narcissistic abuse produce symptoms that present as medical problems. Because they are medical problems. But they’re caused by relational trauma, and the medical system isn’t structured to identify relational trauma as a root cause of physical symptoms.

Mental health training doesn’t adequately cover neurobiological trauma responses. Many licensed therapists. Even experienced ones. Have limited training in the specific neurobiology of complex relational trauma. They may understand trauma conceptually without understanding the autonomic nervous system changes, the cortisol dysregulation, or the polyvagal framework that explains why their client’s body is responding the way it is. This means that therapy can sometimes address the cognitive and emotional dimensions of narcissistic abuse without ever touching the nervous system changes that maintain the symptoms.

The “strong woman” narrative obscures the damage. Driven women are culturally rewarded for powering through difficulty. The narrative of female strength and resilience. While valuable in many contexts. Can function as a barrier to recognizing the genuine neurobiological harm that narcissistic abuse produces. If you’re “strong,” you shouldn’t need help. If you’re “resilient,” the damage can’t be that bad. This narrative is weaponized. Sometimes by the women themselves, sometimes by the people around them. To minimize symptoms that deserve clinical attention.

Insurance and workplace structures don’t accommodate the recovery timeline. The neurobiological repair process for complex trauma takes months to years of consistent therapeutic work. Insurance companies typically authorize six to twelve sessions before requiring reauthorization. A structure designed for acute symptom management, not for the deep nervous system recalibration that narcissistic abuse requires. Workplaces offer EAPs with three to six sessions. Neither of these structures is remotely adequate for what the neuroscience tells us is needed.

Narcissistic abuse isn’t yet a diagnostic category. There is no DSM-5-TR diagnosis for “nervous system damage from narcissistic abuse.” There’s C-PTSD (recognized by the ICD-11 but not yet the DSM), there’s PTSD, there’s adjustment disorder. None of these fully capture the specific neurobiological profile that long-term narcissistic abuse produces. Without a diagnostic category, there’s no standardized treatment protocol, no insurance code, and no clinical pathway that connects the abuse directly to the nervous system consequences. This isn’t an accident. It reflects the broader systemic failure to take relational trauma as seriously as other forms of harm.

The fact that you had to piece this information together yourself. From blog posts, from social media, from late-night internet searches. Is a systemic failure, not a personal one. You deserved to be told, by your doctor or your therapist or someone with clinical authority, that what’s happening in your body has a name, a mechanism, and a treatment. The fact that you weren’t told doesn’t mean the damage isn’t real. It means the systems that should be supporting your recovery aren’t yet equipped to do so.

How to Begin Rewiring: The Path to Nervous System Restoration

The neuroplasticity research is unequivocal on this point: the nervous system changes produced by narcissistic abuse are reversible. The amygdala can recalibrate. The hippocampus can regenerate. The prefrontal-amygdala connectivity can be restored. The HPA axis can be rebalanced. Your window of tolerance can expand.

But reversal requires specific conditions, sustained over time. It doesn’t happen through insight alone. You can’t think your way to a regulated nervous system. The repair happens through the body, through relationship, and through repeated experiences of safety.

1. Somatic therapy that works directly with the nervous system. Somatic Experiencing (developed by Peter Levine, PhD, psychologist and trauma researcher, author of Waking the Tiger), sensorimotor psychotherapy, and other body-based approaches work directly with the autonomic nervous system rather than routing through cognition. These approaches help you complete the defensive responses that were thwarted during the abuse. The fight impulses that were suppressed, the flight impulses that were blocked, the rage that was swallowed. Completing these responses discharges the stored survival energy and allows the nervous system to shift toward regulation. (PMID: 25699005)

2. EMDR for processing specific traumatic material. Eye Movement Desensitization and Reprocessing, developed by Francine Shapiro, PhD, psychologist and creator of EMDR therapy, uses bilateral stimulation to facilitate the processing of traumatic memories that are “stuck” in the brain’s implicit memory system. For narcissistic abuse survivors, EMDR can be particularly effective for reducing the emotional charge associated with specific incidents. A particular act of gaslighting, a specific moment of betrayal, a scene of devaluation that plays on repeat. EMDR within a phased treatment model that includes stabilization first tends to produce the best results for complex trauma. (PMID: 11748594)

3. Vagal toning practices. The vagus nerve. The primary nerve of the parasympathetic nervous system. Can be strengthened through specific practices that increase vagal tone and support the shift from sympathetic activation to ventral vagal engagement. These include: slow, extended exhale breathing (inhale for four counts, exhale for eight); cold water exposure on the face and neck; humming, singing, or chanting (which vibrate the vagus nerve); gentle movement practices like yoga, tai chi, or walking; and social engagement with safe, regulated others.

4. Co-regulation with safe others. Your nervous system didn’t get dysregulated alone. It was dysregulated in relationship. And it won’t fully recalibrate alone, either. Co-regulation. The experience of being in the presence of someone whose nervous system is calm and regulated. Is a direct neurobiological input that helps your system learn that connection can be safe. This happens in therapy (which is why the therapeutic relationship matters so much). It also happens in friendships, in safe family relationships, and in community. Seeking out people who are calm, consistent, and trustworthy isn’t just emotionally soothing. It’s neurobiologically therapeutic.

5. Sleep, movement, and basic physiological care. This isn’t optional or secondary. Sleep is when the brain does its repair work. Consolidating new learning, processing emotional material, and restoring hippocampal function. Movement (particularly bilateral movement like walking, swimming, or running) supports nervous system regulation and neurotransmitter balance. Nutrition affects the microbiome-gut-brain axis, which directly influences mood, cognition, and stress response. These aren’t wellness platitudes. They’re the physiological conditions that neuroplasticity depends on.

6. Time. And patience with the timeline. Neuroplasticity is real but not instant. The brain rewires through repetition, not through single epiphanies. Every time you have a moment of regulation. Every time your nervous system experiences safety and doesn’t immediately brace for the next threat. You’re building a new neural pathway. Every time that pathway gets used, it gets stronger. The old pathways (the hypervigilance, the numbness, the scanning) don’t disappear. But they become less automatic as the new pathways become more established. This process takes months to years. That isn’t a failure of the process. It’s the process.

Your nervous system adapted to survive something extraordinary. It protected you at a cost. And now it’s time to pay attention to that cost, to honor what it did for you, and to give it the conditions it needs to come back to baseline. The foundations can be rebuilt. Not overnight. Not through force of will. But through consistent, body-level, relationally supported work that meets your nervous system where it actually is.

If you’re reading this and recognizing your own body in these descriptions. The startle response, the flat emotional landscape, the exhaustion that sleep doesn’t fix, the hand that shakes while you brush your teeth. I want you to know something: this makes sense. All of it. Your body is responding to what happened to it, and it’s doing so with the exact mechanisms that neuroscience predicts. You aren’t crazy, you aren’t weak, and you aren’t making it up. You’re carrying neurobiological consequences of real harm. And those consequences respond to treatment. Specialized, trauma-informed, nervous-system-focused treatment. The kind that works with your body, not just your mind. That work exists. It’s available. And it works.

Related Reading

van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.

Porges, Stephen. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W.W. Norton, 2011.

Levine, Peter. Waking the Tiger: Healing Trauma. Berkeley: North Atlantic Books, 1997.

Siegel, Daniel. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford Press, 2012.

Sapolsky, Robert. Why Zebras Don’t Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping. New York: Holt Paperbacks, 2004.

Dana, Deb. The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W.W. Norton, 2018.

References

Peer-Reviewed Research (Vancouver)

1. van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
2. Payne P, Levine PA, Crane-Godreau MA. Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Front Psychol. 2015;6:93. doi:10.3389/fpsyg.2015.00093. PMID: 25699005.
3. Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. Clin Neuropsychiatry. 2025;22(3):169-184. doi:10.36131/cnfioritieditore20250301. PMID: 40735382.
4. Reisz S, Duschinsky R, Siegel DJ. fearful-avoidant attachment and defense: exploring John Bowlby's unpublished reflections. Attach Hum Dev. 2018;20(2):107-134. doi:10.1080/14616734.2017.1380055. PMID: 28952412.

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