Childhood maltreatment (specifically, physical, sexual and emotional abuse, and physical and emotional neglect) exerts a prepotent influence on trajectories of child brain development and constitutes a major risk factor for adult psychopathology.
Brain alterations resulting from maltreatment are highly specific, depend on the type and timing of exposure, and probably were once phenotypic adaptations that enhanced species survival and reproductive success but are now associated with substantial medical and psychiatric disadvantages.
Maltreatment reduces the volume of the hippocampus (particularly in adults), as well as the volume of anterior cingulate and ventromedial and dorsomedial cortices; affects the development of key fibre tracts (including the corpus callosum, superior longitudinal fasciculus, uncinate fasciculus and cingulum bundle); and appears to alter the development of sensory systems that process and convey stressful experiences.
This Review reveals consistent reports of augmented amygdala response to threatening stimuli, diminished ventral striatal response to anticipation or receipt of reward, diminished connectivity between prefrontal regions and the amygdala, and increased volume and network centrality of the precuneus in maltreated individuals.
Maltreated and non-maltreated individuals with the same primary psychiatric diagnoses differ clinically, neurobiologically and genetically, such that maltreated individuals seem to represent distinct ecophenotypes of established psychiatric disorders. Thus, maltreatment may be an unrecognized confound in psychiatric neuroimaging studies.
Maltreatment-associated brain changes are frequently reported in resilient individuals who show no past or current symptoms of psychopathology. Other neurobiological or molecular alterations are probably present that enable these individuals to effectively compensate for stress-related neurobiological alterations.
Maltreatment-related childhood adversity is the leading preventable risk factor for mental illness and substance abuse. Although the association between maltreatment and psychopathology is compelling, there is a pressing need to understand how maltreatment increases the risk of psychiatric disorders. Emerging evidence suggests that maltreatment alters trajectories of brain development to affect sensory systems, network architecture and circuits involved in threat detection, emotional regulation and reward anticipation. This Review explores whether these alterations reflect toxic effects of early-life stress or potentially adaptive modifications, the relationship between psychopathology and brain changes, and the distinction between resilience, susceptibility and compensation.
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Studies in the authors' laboratory have been supported by RO1 awards (MH-091391, DA-017846 and HD-079484 to M.H.T.) from the US National Institutes of Health (National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA) and National Institute of Child Health and Human Development (NICHD)), the Harvard Clinical and Translational Science Center (UL1 TR001102) and donor support from S. Miller. The authors thank former and present staff members including S. L. Andersen, E. Bolger, J. Choi, C. E. McGreenery, A. Khan, A. Tomoda and G. Vitaliano for their myriad contributions.
The authors declare no competing financial interests.
Able to withstand stress and trauma so as to maintain or rapidly regain physical and mental well-being.
Observable outward characteristics or traits that result from adaptation to environmental agents and that may closely mimic more-intrinsic, genetically determined phenotypes.
- Voxel-based morphometry
(VBM). An unbiased technique to identify brain anatomical differences in regional density of grey or white matter between groups.
- Tract-based spatial statistics
(TBSS). An unbiased global analysis for assessing group differences in fractional anisotropy and other diffusion measures in white-matter pathways.
- Fractional anisotropy
(FA). The degree to which the diffusion of molecules is directionally dependent. Its measures reflect the integrity (involving fibre density, axon diameter and myelination) of white matter.
- Sensitive-period analysis
A statistical procedure used to identify time periods when exposure to a particular experience most strongly influences a future outcome.
- Negative valence system
A functional construct domain involved in responses to acute threat, potential harm, sustained threat, frustrative non-reward and loss.
- Monetary incentive delay task
A task in which individuals respond to target stimuli that are presented after incentive cues to win or avoid losing indicated rewards.
- Approach–avoidance situation
A situation in which the same goal has elements that both attract and repel. Behavioural responses depend on the disparity between the drive to approach versus the drive to avoid.
- Bucharest Early Intervention Project
A randomized, longitudinal, controlled trial of high-level foster care as an intervention for children placed in one of six institutions in Bucharest, Romania, at birth.
- Probe auditory evoked potentials
Electroencephalogram responses to irrelevant auditory probes such as clicks. The degree to which these responses are attenuated reflects the level of brain involvement in a competing cognitive task.
- Graph theory
The study and use of graphs — collections of vertices (points or nodes) connected by edges (lines) — to represent, for example, brain regions and their interconnectivity.
A graph-theory measure that indicates the importance of nodes in a graph or network.
- Theory of mind
The ability to attribute mental states such as beliefs, intentions and desires to ourselves and others, and to recognize that the mental state of others is different from our own.
- Default-mode network
(DMN). A network of brain regions that are activated when the brain is resting and not engaged in cognitive or goal-directed tasks.
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Teicher, M., Samson, J., Anderson, C. et al. The effects of childhood maltreatment on brain structure, function and connectivity. Nat Rev Neurosci 17, 652–666 (2016). https://doi.org/10.1038/nrn.2016.111
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