Neurological roots of emotional ambivalence: from brain networks to clinical implications

Introduction: Emotional ambivalence - the coexistence of conflicting positive and negative feelings toward the same object, event, or person - has been historically emphasized in psychiatry and psychoanalysis and is increasingly studied in affective neuroscience. While Bleuler identified ambivalence as central to schizophrenia and Freud described its coexistence of love and hate, contemporary psychology extends the concept to mixed emotions, decision-making, and attitudes such as nostalgia. This review aims to synthesize evidence on the neural basis of ambivalence, clarify its distinction from uncertainty, and explore its clinical and therapeutic implications.

Methods: A narrative review methodology was adopted, integrating findings from functional neuroimaging, electrophysiology, and meta-analyses. Studies of ambivalent evaluation, decision-making under conflict, and mixed affective states were examined. Analyses focused on distributed neural networks and their dynamic spatiotemporal organization, including oscillatory EEG and ERP dynamics.

Results: Ambivalence consistently engages a distributed network involving the anterior cingulate cortex (conflict monitoring), insula (interoception), prefrontal regions (valuation/regulation), and salience circuits, together with temporoparietal and posterior midline regions involved in meta-cognitive and social-cognitive integration. Evidence from electrophysiological studies further indicates that ambivalence unfolds dynamically over time, reflecting rapid interaction between positive and negative affective representations rather than static co-activation. Pharmacological and neuromodulatory interventions show potential to recalibrate dysfunctional circuits.

Conclusions: Ambivalence represents a distinct neurobiological state whose dysregulation contributes to psychopathology. It can be conceptualized as a transdiagnostic dimension of affective integration, reflecting the capacity to integrate competing emotional representations. Therapeutic strategies may enhance tolerance of ambivalence and improve clinical outcomes.