Epidemiology of Adult-Onset Psychopathology Following Child Maltreatment

Epidemiology of Adult-Onset Psychopathology Following Child Maltreatment

​Epidemiology studies of maltreated children (harsh abuse, rape, maternal neglect) suggest links between adult-onset psychopathologies. Note, however, that these are not one-to-one relationships but rather generalizations from large sample populations. Thus, for example, if you have been raped, you may or may not experience any one or more of these disorders.

Unfortunately, child abuse and rape are serious problems in the U.S. with an estimated annual cost of $104B (Wang and Holton, 2007) and aversive childhood events impact adult health. Altered stress responses occur in adult women following child rape (e.g., Heim et al., 2000) and police officer recruits with child trauma (Otte et al., 2005). Chronic widespread pain is associated with child hospitalization, institutional rearing or maternal death (Jones et al., 2009; Davis et al., 2005; Walsh et al., 2007; Sachs-Ericsson et al., 2007).

Not all individuals respond in the same way to trauma as some are vulnerable and others resilient. About 30% of children exposed to physical and/or sexual abuse develop posttraumatic stress disorder (PTSD; Ackerman et al., 1998). A twin study showed 18 combat-exposed twins with PTSD and 23 combat-exposed twins without PTSD (Kasai et al., 2008). In terms of pain, 24% of children surviving physical or sexual abuse have no pain, while 36% experience pain that interfered with some or most activities (Walsh et al., 2007). Finally, adults with child chronic pain more likely report physical and sexual abuse (Hassett et al., 2013). Altered stress responses and impaired sexual function occur in adult women following child rape (Heim et al., 2000; Leonard and Follette, 2002) and police officers with child trauma (Otte et al., 2001).

Child sexual/physical abuse are linked to
​
Adult-onset arthritis (Von Korff et al., 2009)
Fibromyalgia (Imbierowicz et al., 2003; McBeth et al., 1999)
Pelvic muscle problems (Postma et al., 2013)
Headache (Golding, 1999)
Migraine in children (Fuh et al., 2010; Grilo et al., 1999) and adults (Tietjen et al., 2010) Temporomandibular disorder (Campell et al., 2000)
Chronic widespread pain (Ciccone et al., 1997; Hauser et al., 2010; Jones et al., 2009) Chronic spine pain Ciccone et al., 1997)
Vulvodynia (Harlow and Stewart, 2005; Davila et al., 2003; Sadler et al., 2000)
Gastrointestinal diseases (Walker et al., 1995; Lesserman et al., 1996; White et al., 2010) Panic (Pietrek et al., 2013; Goodwin et al., 2005)
Somatic disorders (Paras et al., 2009)
Depression (Scarpa et al., 2010; Spinhoven et al., 2010; Maniglio, 2010; Wiersma et al., 2009)
PTSD (Ackerman et al., 1998; Chivers-Wilson, 2006; Kasai et al., 2008; Shipherd et al., 2009; Seng et al., 2011).

It must be emphasized that child abuse-related PTSD is the most severe form of PTSD with affect dysregulation, its neural correlates are more severe than classic PTSD and abuse severity correlates with anterior cingulate and midcingulate atrophy (Thomaes et al., 2012; van Harmelen et al., 2010).

This figure from van Harmelen et al. who used magnetic resonance imaging (MRI) to assess structural changes in the brain, show mainly midcingulate cortex volume reduction (atrophy) among patients reporting only childhood emotional maltreat-ment. Color scale reflects the extent of damage.

Ringel et al. (2008) used functional MRI to identify brain activity evoked by painful rectal stimulation in adult subjects with or without a history of abuse. The images in this figure show changes in the abuse group after removal of responses from the control group; i.e., abuse history > no abuse history. Increased activity (red) was in midcingulate (MCC) and dorsal posterior cingulate (dPCC) cortices, while reduced activity (blue) was in pregenual anterior cingulate (pACC) and ventral posterior cingulate (vPCC) cortices (note: the labelling was corrected to our standard).

These patterns are interesting for many reasons but let us just note here that the two blue areas are interconnected by bidirectional, axonal projections and assist in determining the personal relevance of objects and events; one of which would certainly be noxious stimulation of the rectum. In contrast, the MCC is engaged in motor functions and cognitive planning and the subjects may be wondering when the stimulation will stop and how to get away from it even though they are instructed not to move during the scanning session.

Child harsh physical abuse and rape impacts a large population of mainly women and its associated psychopathology lasts for decades in vulnerable individuals. Severe child pain and stress may evoke adult-onset psychopathology and enduring brain damage including that in cingulate cortex. Thus, brain changes must be viewed as permanent and untreated but it has been overlooked by experimental neuroscience. This is the mission of CNSI

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