The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

Abstract

A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies that demonstrate childhood maltreatment is more prevalent and associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the HPA axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. We discuss several candidate genes and environmental factors, for example alcohol/substance use, that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies. "It is not the bruises on the body that hurt. It is the wounds of the heart and the scars on the mind."

Measuring childhood maltreatment: Psychometric properties of the Norwegian version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale

“…A Multiplicity score for the number of different types of maltreatments (range 0-10), where each type is required to be reported above a clinical cutoff level as calculated with reference to clinical cut-offs on CTQ (see also Statistics) v. A total Duration score, which is the number of years with exposure to at least one type of maltreatment above clinical cut-off as calculated with reference to clinical cut-offs on CTQ (range 0 to 18) vi. A total Sum-by-Duration score, derived by first making a sum score for each age level (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) by adding up scores for the 10 subscales at that age, second, adding these scores for the 18 age levels, and, third, dividing by 18 to obtain a 0-100 range scale. That is, here we use the approach outlined for the MACE Sum score in point (iii) above separately for each age level, then add together these age-level sum scores for the 18 age levels, and finally divide by 18…”

“…Since the seminal work of Felliti, Anda and colleagues [1] it is increasingly acknowledged that adverse childhood experiences are central risk factors for a broad spectrum of mental disorders including mood disorders, suicidality, post-traumatic stress disorder, personality disorders, substance use disorder, and psychosis [2][3][4][5]. This multitude has stimulated research on psychological and biological trajectories of adverse childhood experiences.…”

The clinical characterization of the adult patient with depression aimed at personalization of management

“…Specific questions continue to be explored, including associations of different types of early adversity with depression, causal mediators between early adversity and subsequent depression, and associations of early adversity with different features of de-pression 199 .…”

Psychoanalysis and public health: Potential for integration?

“…Physical punishment has an increasingly large literature, a review of which is beyond the scope here (see Holden, 2020;Holinger, 2020;Kalin, 2020;Lippard & Nemeroff, 2020;Straus, Douglas, & Medeiros, 2014;Young-Bruehl, 2012). We will instead provide a summary and context of the major issues and highlight the contributions of public health and psychoanalytic ideas to understanding physical punishment, its sequelae, and possible solutions.…”