Examination Summary - Psych & Neuro Conseq of CA
Date: 28.01.22 @ 9:00-11:00
Child Maltreatment and Risk for Psychopathology in Childhood and Adulthood: Sara R. Jaffee
Maltreatment = comprises neglect and emotional, sexual, and physical abuse
Neglect = failure to meet children’s basic needs with respect to clothing, hygiene, food, and safety
Physical Abuse = the harm by a caregiver resulting in non-accidental physical injury (even death)
2013 → 17% of victims experienced physical abuse (8% sexual, 6% psychological, 6.8% other)
2014 → 3.9 million children were investigated for abuse or neglect
How is it measured? Adults studied: childhood maltreatment measured by retrospective self-report
→ biased: subject to omission (experiences people have in adulthood also bias retrospective records)
Children who experience maltreatment are at higher risk for experiencing externalising problems:
● ADHD, conduct disorder (CD), oppositional defiant disorder (ODD), delinquency,
antisocial behaviour, some have higher rates of antisocial personality, crime, criminal arrests
Experiencing maltreatment also increases the risk of internalising problems in childhood, such as:
● Major depressive disorder, anxiety disorders, posttraumatic stress disorder (PTSD), and
internalising symptoms → this risk extends into adulthood
Childhood maltreatment & mental disorders are predictive of PTSD in adulthood, through 2 ways:
1. Children who have been maltreated have a higher risk of mental disorders in childhood and
adolescence, and a history of mental problems increases risk that an adult develops PTSD
2. Maltreatment sensitises the neurobiological response to subsequent trauma, again
increasing the risk that an adult who experiences trauma will develop PTSD
Causal Status of Effect = child → maltreatment → develops a mental disorder in
childhood/adulthood: explained by that maltreatment causes mental disorders, or that there is a
(non)genetic factor that is associated with maltreatment and with mental disorders. To test:
1. Look at adopted kids: when maltreated, do they develop mental disorders? → rules out
genetic factors → maltreatment is low in adopted children
2. Compare maltreated children to socio-demographically similar, non-maltreated youth →
maltreated children show more depressive, suicidal thoughts, etc.
,‘Cycle of Violence Hypothesis’ = adults who experience maltreatment in their childhood are at
higher risk for maltreating their own children → this trend can be broken!! However, could be a
reflection of detection bias: parents who reported engaging in abuse or neglect, 31% of those were
investigated by Child Protective Services, because they were themselves maltreated in childhood
Mediators = the how or why of an (observed) relationship between child and maltreatment
Attention Bias = tendency to focus on threats: because of childrens’ experience with anger and
other negative emotions in their families, they become sensitised to attend to threatening stimuli
→ can lead to different social information processing styles & anxiety: limbic and prefrontal activity
Emotional Socialisation = parents’ efforts to model and explain emotions → mothers who are
physically abusive produce less prototypical facial expressions of anger and vocal expressions of
anger, fear, and happiness compared to non-abusive, also engage in less coaching & validation
Maltreated children experience difficulties in emotion recognition → may affect ability to respond
appropriately when others express emotions. They also find it difficult to determine which
situations elicit positive and negative emotions → may affect their ability to predict what reactions
they will get from their environment when they perform a certain behaviour
Reward Responsiveness = maltreated children are less sensitive to cues for reward: puts them at a
higher risk for depression, and particularly anhedonic symptoms (= inability to feel pleasure)
In a task in which participants were presented with reward, loss, and no-incentives, children who
had been maltreated rated rewards as less positive → show less ventral striatum activation
Moderators = make the effects of maltreatment on the risk of psychopathology greater or lower
MAOA x Maltreatment = regulates the metabolism of dopamine, serotonin, and norepinephrine:
mutation in this gene was associated with violent behaviour among males in Dutch families
5-HTTLPR x Maltreatment = plays an important role in the regulation of serotonin uptake.
Dysregulated 5-HT is associated with both depression and aggression
● Adults who carried the short allele reported they were less able to cope with situations that
evoke strong feelings of sadness/fear than others who were homozygous for the long allele
Protective Factors = children who do not experience a lot of negative effects of maltreatment
often have high ego control, high self-esteem, high self-reliance, attribute successes to themselves
, Maltreatment in childhood increases the risk of adult depression and anxiety in prospective cohort
studies: systematic review, metaanalysis, and proportional attributable fractions: Li et. al.
Childhood maltreatment is a contributor to development of depression/anxiety disorders among
children/adults, also to emergence of psychopathology through neurobiological mechanisms:
1. Stress systems
2. Structural brain differences (e.g hippocampus, amygdala, corpus callosum, prefrontal cortex)
3. Functional brain differences (e.g hyperactivity of amygdala in response to neg. facial affect)
4. Genetics and epigenetics of resilience and vulnerability
Adding up types of maltreatment, over half (58.59%) of depression/anxiety cases are attributable to
childhood maltreatment → a 10% reduction in childhood maltreatment could prevent 31.36 million
depression/anxiety cases, and a 25% reduction could potentially prevent 80.28 milion cases
Self-Report Informant
Reliance on retrospective method May better assess the continuity and
(unreliable and biassed) circumstances of maltreatment experiences
May work better for some types of May underestimate abuse since they are based
maltreatment, such as sexual abuse, which may on reports by professionals to child protective
be more invisible to informants services and cover shorter periods of childhood
What mediates the link between childhood maltreatment and depression? The role of emotion
dysregulation, attachment, and attributional style: Schierholz et. al.
Depression following childhood maltreatment is supposed to be characterised by specific
neuroendocrine and neuroanatomical changes (e.g. glucocorticoid resistance, immune activation,
and reduced hippocampal volume) that reflect sensitisation of central stress response systems
● These changes suggested to modulate the individual’s competence to adapt to stressful life
events, thereby increasing vulnerability to depression
Childhood maltreatment leads to emotion regulation difficulties, including:
1. Problems understanding and labelling affective states
2. Low emotional acceptance
3. Preferential usage of maladaptive emotion regulation strategies
