Main Topics Notes
In d ci n - Chapter : Tina su ered from severe sexual abuse; shows inappropriate sexual
behavior and has school problems; shows how early experiences can shape
world-view, expectation from others and oneself; im ac n e em, how can
lead e e nali ing beh and an ie
childhood - importance of good (enough parenting (emotional interactions for later
development: forms attachment, establishes sense of safety and security, learning to
regulate own emotions and understand emotional states of others, learning to trust
others, develop empathy
- empirical evidence: numerous ndings that childhood abuse and neglect have
pervasive consequences for mental and physical health
childhood maltreatment "any act of commission or omission by a parent or other caregiver that results in
harm, potential for harm, or threat of harm to a child. Harm does not need to be
intended"
- mi i n (failure to meet child's needs : physical neglect, emotional neglect, denial
of access to education
- c mmi i n (actively doing something harmful : physical, emotional, sexual,
shaken Baby Syndrome, Intimate-partner violence
- prevalence by WHO (self-report world-wide : physical abuse , emotional
abuse , physical neglect , sexual abuse ; prevalence according to
professionals is much lower than self-report!!
- in times of COVID- : increase in domestic violence increased stress amongst
parents ( nancial stress, unclear future ; less social support to children and parents;
abuse stays hidden more easily!
- DSM- : objective description of symptoms (no theoretical framework, decreased
focus on aetiology "Trauma- and Stressor-Related disorders", but also others!
- childhood abuse and neglect is important an diagn ic i k fac !!
- group with childhood maltreatment have higher prevalence of: Trauma- and
Stressor Related Disorders, but also Schizophrenia Spectrum and Other Psychotic
Disorders; Depressive Disorders; Anxiety Disorders; Dissociative Disorders; Feeding
and Eating Disorders; Disruptive, Impulsive Control and Conduct Disorders;
Substance Abuse and Addictive Disorders; Personality Disorders
- categorizing: internalizing an externalizing disorders, personality disorders,
psychotic symptoms, suicide and self-injury
- regardless of maltreatment type, symptoms are o en not bound to one single
disorder (can be very broad and debilitating in varying domains in life ; high
comorbidity ( disorders at the same time , and co-occurence of multiple forms of
abuse and neglect ( have more than one form!
(Li et al., Maltreatment in childhood substantially increases the risk of adult depression and anxiety in
prospective cohort studies (important bc current mood state a ects self-report
- systematic review with meta-analysis; o cial report of abuse in English-speaking
countries; retrospective vs prospective; self-report (way more cases; adults w/ good
functioning tend to forget parental negativity and those with poor functioning tend
to exaggerate it; associations increase w/ length of recall: recall bias!; issues of
openness/ honesty and of subjective interpretation of "neglect" vs informant
- OR prob given maltreatment/ prob given non-maltreatment: . (depression and
. (anxiety times more likely in group with reported childhood maltreatment!!;
reducing of occurrence of CM has enormous impact on prevalence of D and A
- indications for subtypes of depression and anxiety (w/ or without maltreatment
history : depressed w/ CM have more severe problems, more chronic, more
suicidality, more comorbidity, di erent neurobiology, pro t less from treatment!!
- CM is leading contributor to development of depression an anxiety disorders
, among children and adults (which account for most burden of mental illness
long-term consequences - how can events of yrs ago have such a pervasive impact on an adults' emotional,
cognitive and social well-being?? ible nde l ing ch l mechani m :
( cognitive schemata of self and others (world and self view
( emotion regulation styles problems in social interactions, rejection, stress,
impulse control
( (in secure attachment
( hypervigilance to threat
( low responsiveness to reward
( neurobiological models
(Schierholz et al., What [psychological processes] mediates the link between childhood maltreatment and
depression?
- a ib i nal le (cognitive schemata : hopelessness depressogenic attributions
(attribute negative events to internal, stable and global causes
- em i n d eg la i n: maladaptive coping with emotions (rumination,
avoidance , labeling, low acceptance and understanding
- in ec e a achmen : emotional neglect is big risk factor! avoidance in close
relationships; attachment to abusing parents occurs, but is characterized by unsafety
(unpredictable, harming ; when biological parents are not available, children can still
securely attach to another person (still learns to have safe attachment bond,
protective for resilience! ; anxious/ambivalent constantly seeking approval from
other and avoidant
- severity of m m f PTSD
- pathways: CM as a distal factor (impairs development of self-regulation on ,
interpersonal, cognitive and psychol level vulnerable to depression ; and/or as CM
is re-experienced by memories, thoughts, feelings (not well processed triggers and
maintains symptoms of depression
- these variables explain how maltreatment is related to more severe depression, and
treatment should directly target these variables
(Ja ee, Child Maltreatment and Risk for Psychopathology in Childhood and Adulthood
- CA in maladaptive family functioning is strongest predictor of disorder onset
- em i n eg la i n: de cits in recognition and understanding (what situations
elicit positive/ negative a ect
- h e igilance h ea : heightened attention to angry faces (sensitization to
threat , di culty disengaging from attention from anger cues, quicker hostile
attributions to ambivalent stimuli (bias , role of amygdala higher risk for anxiety
disorders, aggressiveness, avoidance
-l e n i ene e a d: particularly to anticipation of reward; relevant
during adolescence (time of development , motivation and reinforcing goal-directed
behavior, dopamine system (striatum de cit in learning from positive experiences
depression, substance abuse
- the consequences of emotional abuse/ neglect are at least as pervasive as physical
and sexual abuse!!
Resilience - not everyone develops long-term health problems!
- gene moderators of CM e ects (GxE : low activity variant of MAOA CM more
aggression, pattern reversed for F; -HTTLPR short allele lower serotonin
transcription more responsive to stress, depressive and anxiety symptomatology;
- have experience CM but hasn't developed psychological problems; moderators:
social support, adapted stress system, higher IQ, forming secure attachment bond,
personality
- cycle of violence is not inevitable (majority of adults victimized as children do not
perpetrate abuse or neglect
, Ne bi l gical - CM chronically alters brain function and structure: cognitive/ emotional,
C n e ence neurobiological (brain: impact of dissociation on brain; and hormones levels
- maltreatment ? psychopathology
- maltreatment can chronically increase stress-sensitivity
- methodological issue: psychopathology of the moment colors retrospective account
of CM experience, (lack of control for comorbidity!
Cognitive/ Emotional level - e.g. negative attitudes (working model 'you're worthless' , incorporated in
self-image strong social sensitivity evoked in new stressful situations
- c gni i e m del: heredity early life adversities interact, both lead to cognitive
vulnerability; together w/ current life stressor, primes negative self-inferences,
dysfunctional attitudes, low self-worth symptoms of depression anxiety
worsens cognitive vulnerability
- maladaptive cognition is implicit! quicker categorization than no CM for depression
words (useless, pessimistic, inadequate, negative, meaningless and anxiety words
(anxious, afraid, nervous, insecure, worried when associated w/ self stronger
unconscious, automatic level of negative self-association for CM group (emotional
abuse is strongest predictor of negative implicit self-associations
- another pathway: severity of childhood maltreatment emotion regulation
di culties, avoidance in close relationships (insecure attachment ,
depressogenic attributions severity of depression
Neurobiological level: brain - ( by altering b ain functions in networks important for emotional reactivity,
emotional memory and emotion regulation
- ( by chronically altering the sensitivity of h m nal stress reactions, such as
HPA-axis/ adrenergic system
- depends on brain region and iming of stress exposure, (sensitive period di er per
area, when in full development plastic and more vulnerable : maturing limbic
em in early childhood (cingulate gyrus, thalamus, hypothalamus, hippocampus,
amygdala: h ea and afe lea ning , and ef n al in puberty ( eg la i n
- amygdala (detection of salient info strongly connected to hippocampus (memory
formation , emotional memory is more strongly remembered!
- brain develops to be sensitive to detecting danger (childhood early childhood
experiences can change sensory threshold (functional for that environment
- human brain as "an anticipation machine, making future is the most important
thing it does" - using prior experiences and info to increase odds of desired
outcomes and protective from future adversities
- two pathways of reaction to visual stimuli: amygdala (quick and unconscious and
via visual cortex (slower and more elaborate ; activates locus ceruleus, triggers
release of norepinephrine throughout body; if a lot of input, lower threshold of
activating amygdala and reaching high intensity
(Herzog et al., - Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial
and Somatic Conditions Across the Lifespan
- history of CM links to co-occuring mental and somatic disorders (PTSD,
depression, borderline personality disorder, obesity, diabetes ; role of b e and
iming of CM in the development of neurobiological alterations (e.g. volumetric and
functional changes in amygdala and hippocampus for prevention and treatment of
related pathological conditions
- identifying psychosocial and somatic risk factors and diagnostic markers
improve somatic and psychological treatment options for CA-related disorders
- threat learning: emotional maltreatment increased am gdala sensitivity while
processing faces (angry, fearful, happy, sad expressions ... perhaps even when
smiling the individual is suspicious, or the amygdala is just generally more sensitive
- quicker at identifying angry faces (implicit processing, need less info/ signal
- can't determine causal link when based on retrospective memory!
- prospective design (Wingen et al., 2011 : amygdala activation higher in response to
