How Child Abuse Primes the Brain for Future Mental Illness

A brain scan study pinpoints the changes associated with child abuse that may raise people's risk of depression, PTSD and addictions later in life.

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Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse may contribute to virtually all types of mental illness.

Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of young adults who were maltreated or neglected in childhood. These changes may leave victims more vulnerable to depression, addiction and post-traumatic stress disorder (PTSD), the study suggests.

Harvard researchers led by Dr. Martin Teicher studied nearly 200 people aged 18 to 25, who were mainly middle class and well-educated. They were recruited through newspaper and transit ads for a study on “memories of childhood.” Because the authors wanted to look specifically at the results of abuse and neglect, people who had suffered other types of trauma like car accidents or gang violence were excluded.

MORE: Study: How Chronic Stress Can Lead to Depression

Child maltreatment often leads to conditions like depression and PTSD, so the researchers specifically included people with those diagnoses. However, the study excluded severely addicted people and people on psychiatric medications, because brain changes related to the drugs could obscure the findings.

Overall, about 25% of participants had suffered major depression at some point in their lives and 7% had been diagnosed with PTSD. But among the 16% of participants who had suffered three or more types of child maltreatment  — for example, physical abuse, neglect and verbal abuse — the situation was much worse. Most of them — 53% — had suffered depression and 40% had had full or partial PTSD.

The aftermath of that trauma could be seen in their brain scans, whether or not the young adults had developed diagnosable disorders. Regardless of their mental health status, formerly maltreated youth showed reductions in volume of about 6% on average in two parts of the hippocampus, and 4% reductions in regions called the subiculum and presubiculum, compared with people who had not been abused.

That’s where this study begins to tie together loose ends seen in prior research. Previous data have suggested that the high levels of stress hormones associated with child maltreatment can damage the hippocampus, which may in turn affect people’s ability to cope with stress later in life. In other words, early stress makes the brain less resilient to the effects of later stress. “We suspect that [the reductions we saw are] a consequence of maltreatment and a risk factor for developing PTSD following exposure to further traumas,” the authors write.

Indeed, brain scans of adults with depression and PTSD often show reductions in size in the hippocampus. Although earlier research on abused children did not find the same changes, animal studies on early life stress have suggested that measurable differences in the hippocampus may not arise until after puberty. The new study suggests that the same is true for humans.

MORE: Nurturing Moms May Boost Children’s Brain Growth

The findings also help elucidate a possible pathway from maltreatment to PTSD, depression and addiction. The subiculum is uniquely positioned to affect all of these conditions. Receiving output from the hippocampus, it helps determine both behavioral and biochemical responses to stress.

If, for example, the best thing to do in a stressful situation is flee, the subiculum sends a signal shouting “run” to the appropriate brain regions. But the subiculum is also involved in regulating another brain system that, when overactive during chronic high stress such as abuse, produces toxic levels of neurotransmitters that kill brain cells — particularly in the hippocampus.

It can be a counterproductive feedback loop: high levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production.

What this means is that chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases — for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers — but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD.

MORE: Boxer Quanitta Underwood’s Inspiring Fight Against Sexual Abuse — and for Olympic Gold

The subiculum also regulates the stress response of a key dopamine network, which may have implications for addiction risk. “It is presumably through this pathway that stress exposure interacts with the dopaminergic reward system to produce stress-induced craving and stress-induced relapse,” the authors write.

In other words, dysregulation of the stress system might lead to intensified feelings of anxiety, fear or lack of pleasure, which may in turn prompt people to escape into alcohol or other drugs.

With nearly 4 million children evaluated for child abuse or neglect in the U.S. every year — a problem that costs the U.S. $124 billion in lost productivity and health, child welfare and criminal justice costs — child maltreatment isn’t something we can afford to ignore.

Even among the most resilient survivors, the aftereffects of abuse may linger. Not only are such children at later risk for mental illness, but because of the way trauma affects the stress system, they are also more vulnerable to developing chronic diseases like diabetes, high blood pressure, heart attack and stroke.

We can do better for our kids.

The study was published in the Proceedings of the National Academy of Sciences.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

28 comments
allylonghorn
allylonghorn

The problem is clearly listed...but where is the help and support for these now adults? In order to receive services, there must be "warning signs" such as suicide attempts, homelessness, drug addiction. What about the people who experienced this abuse, struggle with work, and can't afford real help? Why does it have to get SO BAD before you have access to get better? 

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jadeaube86
jadeaube86

ALL MENTAL ILLNESS, I REPEAT.  ALL MENTAL ILLNESS IS CAUSED BY CHILDHOOD TRAUMA.  Go ask any person thaty is mentally ill if they were abused physically(spanked, strapped, beaten or raped) emotionally(youre a bad boy or girl)  or through neglect or imprisonment(go to your room and think about what you`ve done, and no dinner for you) The answers will be yes, yes, and YES. 

jadeaube86
jadeaube86

ALL MENTAL ILLNESS, I REPEAT.  ALL MENTAL ILLNESS IS CAUSED BY CHILDHOOD TRAUMA.  Go ask any person thaty is mentally ill if they were abused physically(spanked, strapped) emotionally(youre a bad boyégirl)  or through neglect(go to your room and think about what you`ve done, and no dinner for you) The answers will be yes, yes, and YES. 

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the-bear
the-bear

I never  understood what was wrong with and blamed myself for decades.

DonnaLynden
DonnaLynden

@the-bear  ,,,very much the same for me...thought it was all me, blamed myself for 55 years, which has made my situation worse, sadness/depression/anxiety/suicidal thoughts etc.., I  have only now realized, thru therapy, that it was the childhood abuse I have been thru for many, many years is what has totally changed me/ my mentally emotionally psychologically and physically, negatively, hence I am suffering the consequences in my life presently, from all of the above!!! Wish I had a chance to live my life all over, coz I have lost so much over the last almost 60 years, that the pain becomes unbearable, at times!!! CHILDHOOD SEXUAL ABUSE IS A TERRIBLE TERRIBLE CRIMINAL ACT,  and what makes it worse, is when your own FAMILY, TURNN THEIR BACK ON YOUM weather or not its their fault, they don't believe you, or neglect you or turn their back on you, when you finally build up all the courage and strength to finally open up to them about the abuse, after decades of sufferation, and they just turn a deaf ears on what you have to say, coz maybe of their own guilt or maybe in denial, think you making excuses for a bad past etc...makes the abuse even worse, you feel so alone, feel as though you are reliving the trauma and the abuse,,,all over again!!!


To anyone out there,, if you have ever been sexually abuse by anyone, family member/stranger/neighbor/teacher/pastor etc....be sure to tell an adult you can trust and seek help immediately, coz immediate help will be the determining  factor of how your life will ever turn out to be  in the future, or the kind of life you will lead,, or if you will ever have a life at all. Coz this type of abuse messes you up so badly, especially when you have to carry it all alone for 55 years, living in your dark little world, all by yourself,  I am just lucky to be alive today, coz I was a really messed up personfor a very long time  trying to survive a day at a time, trying to keep my head above water, so to speak, trying to show the rest of the world that I am happy go lucky, while dying inside every second of my life ie,  not realizing how much I was suffering. I did not have any kind of life because I had to carry the deep dark secret all these years is what I felt has really destroyed me  coz now that I have started to get some help after all these years, there is a huge difference in the way and also how I feel, I feel 1000 pounds lighter, and carrying all that emotional weigh.baggaget all these years is what has really destroyed me!!!


Hope I am able to help someone by telling my story!!!

DanaPaducel
DanaPaducel

What type of abuse has been investigated on those children? What means neglect in the USA? Are there children who have never been abused or neglected in their life? What is the evidence for that? A brain scan and parents' or children' declarations? I think that all children and adults are exposed to abuse and neglect in a way or another.

SunshinePurcell
SunshinePurcell

Unless you live in a box,There is a huge difference.being slapped on the hand or grounded is not neglect.we all have seen heard or felt things that are bad,hurtful or disturbing.but being raped,molested,Physical or verbal abuse.or just not shown love is neglect.degrees very,As well as the person receiving the neglect abuse.compare those that are shopaholics because they were poor to people who can't leave their house because they've been broken.life happens.its up to each individual to take responsibility.abused or not.stop the cycle.and for goodness sake show compassion for those less fortunste in life.

LindaDeir
LindaDeir

Heart breaking statistics. As an abused child myself the most frightening realization I had was the day that I became aware that my mother could kill me and no one would stop her. As a kid it's very hard to wrap your head around the fact that you could be in that much danger. For me that was the day I hit a very low - low. 


I just wrote a book titled: GUIDED. It's about my own child abuse, both psychically and mentally. In my case I had special help that I discovered as a baby that saved my life and changed the course of the rest of my life.  GUIDED will be available on Amazon November 9, 2014. www.LindaDeir.com 

email2shelley
email2shelley

I'm lucky NOT to be an alcoholic or drug abuser/user!

eddithramirez
eddithramirez

i think it's quite sad to neglect a child for it travels along with them later in life. The simple fact that when childern are alerted to "flee" then not being able to respond and to their brain signalss, only leving them in distress is quite distubing. 

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