Childhood maltreatment: Sensitive exposure periods and the importance of type and timing of abuse

Exposure to childhood adversity markedly increases the risk of developing mood, anxiety, personality, substance abuse and psychotic disorders. Recent studies suggest that clinical sequelae may stem, at least in part, from enduring adverse effects on brain development. Generally, early onset and longer duration of abuse have been associated with greater brain changes, but this may be an oversimplification. An alternative hypothesis is that stress-susceptible brain regions have their own unique sensitive periods (or windows of vulnerability) to the effects of early stress. Further, some of the adverse consequences of exposure to early stress may remain hidden until they are unmasked by subsequent maturational events. Research will be reviewed highlighting the effects of childhood abuse on the development of the hippocampus, white matter tracts, and cortical regions. Evidence will be presented identifying sensitive periods when specific brain regions are most vulnerable to the effects of early stress. Further, findings will be presented showing that sensory systems and pathways that convey the adverse experience of the abuse are selective targeted by the type of abuse experienced. These findings will be placed into context illustrating how exposure to abuse affects multiple components of the brain circuit responsible for threat detection and response. Finally, the case will be made that individuals with histories of substantial childhood maltreatment with DSM psychiatric diagnoses differ clinically, neurobiogically and genetically from non-maltreated individuals with the same diagnosis. We refer to the disorder in the maltreated cohort as an ‘ecophenotype’ and show that it is associated with earlier age of onset, more severe course, more comorbid diagnoses and poorer response to first-line treatments. Recognition of this distinction may markedly enhance treatment algorithms and facilitate studies examining the biological bases of psychopathology.

Conference

English

Martin H. Teicher

Teicher, M. H. (2017, June). Childhood maltreatment: Sensitive exposure periods and the importance of type and timing of abuse. Keynote (Peter Liebermann, Chair) at the 18th EMDR Europe Association Conference, Barcelona, Spain