Emotion and the Autonomic Nervous System—A Two-Way Street: Insights From Affective, Autonomic and Dissociative Disorders

Brain and body are coupled by the autonomic nervous system. Emotions evoke “top-down” autonomic responses and are shaped by “bottom-up” afferent somatic feedback. This psychophysiological integration is supported by shared autonomic and emotional neuroanatomical pathways. Emotional stress disrupts normative autonomic function, typically through sympathoexcitation. Conversely, in dissociative disorders, emotional stress may suppress sympathoexcitation despite subjective emotional distress. Psychophysiological decoupling is further observed in forms of dysautonomia defined by autonomic overexcitation, resulting in emotional symptoms via interoception of dysautonomic symptoms. The study of these disorders elucidates mechanisms of psychophysiological integration and improves our pathophysiological understanding of affective, autonomic and dissociative disorders.