Maltreatment in childhood linked to more severe, less responsive mental illness in adulthood

(Medical Xpress)—Adults who were maltreated as children are more likely than adults who were not maltreated to develop psychiatric disorders, including depression, anxiety and substance abuse. Based on a review of the literature examining maltreatment as a risk factor for these disorders, HMS researchers at McLean Hospital have concluded that these disorders emerge earlier in people who were abused, with greater severity, more comorbidity and a less favorable response to treatment.

Maltreatment is characterized by sustained or repeated exposure to events that usually involve a betrayal of trust. "Active" examples are childhood sexual and physical abuse as well as some forms of emotional abuse. "Passive" examples are emotional and physical neglect.

"It is maltreatment rather than exposure to other stressors, such as natural disasters, which consistently presents as the antecedent to psychopathology," said Jacqueline Samson, HMS assistant professor of psychology at McLean. She and Martin Teicher, associate professor of psychiatry at McLean, are co-authors of the review published in the October issue of The American Journal of Psychiatry.

"This is likely due to the fact that children are dependent on the adults around them for their survival, and they can endure great hardship if they feel protected and cared for. But when the hardship is the product of their caretakers, and when it is the caretaker who must be protected against, it creates a stressor with far-reaching ramifications," Samson said.

Childhood maltreatment is linked to a wide array of medical disorders, shortened life expectancy and chromosomal abnormalities. Imaging findings associated with psychiatric disorders, such as reduced hippocampal volume and amygdala hyper-reactivity, are more consistently observed in maltreated individuals and may represent a maltreatment-related risk factor. Hence, an understanding of maltreatment as a risk factor is crucial to the development of a science of preventive psychiatry, to the design of effective therapeutic regimens and to the delineation of disease study, the authors argued.

"Further study will be needed to determine what treatments may be most effective for patients with a history of childhood maltreatment, but for now, these findings strongly suggest that all DSM diagnoses be accompanied by a specifier notation to indicate the presence of childhood maltreatment when it exists," Samson said, referring to the Diagnostic and Statistical Manual of Psychiatric Disorders. "It also suggests that studies of treatment outcome and correlates of psychopathology include childhood maltreatment as a factor."