Autonomic nervous system regulation and attachment patterns in children with vasovagal syncope: a theoretical framework in light of the polyvagal theory

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.