ENGW3307 | Project 2 Draft 1

October 22nd, 2017

World Count: 2028

Childhood trauma and its effects on the onset and

development of psychological distress and brain
functioning in young adults

Thao Pham

[Abstract]
[to come]

[Keywords]
[to come]

INTRODUCTION
Childhood trauma has been identified as a significant risk factor for the onset and development
of psychotic disorders, which has negative long-term consequences for mental health
continuously in life, as well as influencing brain development and brain functions. Children who
experienced social stress and has heightened sensitivity for stress tend to have an early onset of
psychosis (Quide et al., 2016, Isvoranu et al., 2016, Veling et al., 2016). Consequently, these
emotional, physiological and behavioral responses to stress are the implication which lead to the
onset of psychosis and mental disorders, which could increase liability if have interaction with
genetic variants.
[ more to come ]
CHILDHOOD TRAUMA BACKGROUND
Child abuse
Child maltreatment and child abuse contribute to the onset of childhood trauma. The
physical, sexual or psychological maltreatment or neglect of the child often carried out by a
parent, or the caregiver. 6 million children in the United States each year experience
maltreatment, including physical and sexual abuse, in which poses a persistent and intractable
public health problem (Busso et al., 2017). The inadequate, affectionless control parenting style
in mothers and fathers relates positively to psychotic symptoms seen in children. Other factors
such as family history of psychosis or cannabis use were also significantly related to psychosis.
First-degree relatives who had history of hallucinations or delusions contribute to abused
children to experience pathology level psychosis nine times more likely. (Catalan et al., 2017)

Epidemiology of Abuse and Neglect

Childhood adversity, including abuse and maltreatment, is associated with about 45% of
childhood-onset mental disorders and 32% of adult-onset mental disorders. (Busso et al., 2017).
Other epidemiological studies established that environmental factors such as urban birth,
population density, neighborhood ethnic density and social minority status mediate risk for
psychosis. Patients with a history of childhood trauma had stronger affective and psychotic
responses to daily life events (Veling et al., 2016)

CHILDHOOD TRAUMA AND PSYCHOPATHOLOGY

Observation in Human
Mental disorders are now conceptualized as complex systems, where biological,
psychological and sociological components can influence each other as a result of replacing the
common cause approach. This dynamical system conceptualization of psychopathology led to
the development of network models, where correlation between symptoms are no longer
explained by the common latent factor (Isvoranu et al., 2017). A study was done on 4700 pairs of
16-year-old twins suggests that genetic influences correlate well being to internalizing symptoms
with an average 40% (Haworth et al, 2017). General psychopathology symptoms appear to
mediate the relationship between trauma and psychosis. We used data of patients diagnosed with
a psychotic disorder (n = 552) from the longitudinal observational study Genetic Risk and
Outcome of Psychosis Project and included the 5 scales of the Childhood Trauma Questionnaire-
Short Form and all original symptom dimensions of the Positive and Negative Syndrome Scale.
Our results show that all 5 types of CT and positive and negative symptoms of psychosis are
connected through symptoms of general psychopathology. (Isvoranu et al., 2017)

CHILDHOOD VICTIMIZATION
One potential causal paths linking trauma to psychosis is the way people regulate affect or threat.
Exposure to childhood victimization results in neurodevelopmental changes such as
hyperactivity of the hypothalamic pituitary axis. We respond to stress with varying degrees of
sympathetic ( ie, fight or flight) and parasympathetic (ie, flag or faint) nervous system activation,
depending on the individual and the situation. Moreover, these trauma-related affect the
regulation and the associations between trauma, hallucinations, and delusions. (Hardy et al.,
2016, Isvoranu et al., 2017). Therere clinical studies supporting that early life trauma induced
persisting hypersensitivity of the biological stress system, which results in enhanced endocrine,
autonomic and behavioral responses to stress (Veling et al., 2016). Intrusive memory in the link
between trauma and hallucinations, in which maltreated children tend to remember sensory-
perceptual than contextual informations, resulting in involuntary memory intrusions and
impaired intentional recall is a probable concept but had not yet be proven. Neither is the link
between paranoia and trauma (Hardy et al., 2016).

CHILDHOOD TRAUMA AND BRAIN FUNCTIONINGS

Neuroimaging studies showed that there are reduced overall brain volume, reduced total
gray matter, and specific reductions in the volume of prefrontal cortex in children who
experience maltreatment compared to non-maltreated children. There exists evidence supporting
childhood maltreatment is connected to widespread structural brain changes, specifically in the
mPFC (medial prefrontal cortex) and medial temporal lobe (Busso et al., 2017). The increased
activation of the left inferior parietal lobule (IPL) and the increased activation in of visual areas
have been the main effects of maltreatment (Quide et al., 2016).
 Theres a reduced cortical thickness in medial and lateral prefrontal and temporal lobe
regions. (Busso et al., 2017). The medial temporal lobe consists of the amygdala, hippocampus,
and parahippocampal cortex. The amygdala in the brain is involved in perception and associative
learning of threat-related stimuli. Although stress-related perturbations in amygdala structure are
well-researched and documented in rodents, findings in children and adults exposed to
maltreatment are mixed (Busso et al., 2017).The medial prefrontal cortex (mPFC) and medial
temporal lobe operate synergistically to initiate and to regulate physiological and behavioral
responses to environmental threats in the cortico-limbic network. (Busso et al., 2017)
The medial temporal lobe and interconnected limbic structures are involved in the
pathophysiology of both internal and external psychopathology, including ODD/CD,61 ASB,62
and depression, potentially because they reflect underlying deficits in emotion processing or
regulation that are relevant to these disorders. The thickness of the left and right
parahippocampal gyrus predicted to associate with antisocial behavior symptoms, the thickness
of the left one mediated the longitudinal association of abuse and thickness of the middle
temporal gyrus predicted symptoms of generalized anxiety disorder (Busso et al., 2017). The
parahippocampal gyrus has extensive connections with regions in the brain that involved in
memory and emotion processing, regulation which can enhance memory representations. The
elevated amygdala activity has seen to be responding to negative emotional cues, such as
displays of anger and negative facial expression stimuli in a imaging studies of maltreatment
children. Reduction in hippocampal volume has been seen following stress exposure in both
adults and children with early childhood maltreatment exposure, as well as reductions in the
volume of the parahippocampal gyrus and other regions of the medial temporal lobe (Busso et
al., 2017).
A reduction in cortical thickness in the ventromedial prefrontal cortex (vmPFC) was also
seen in patient with maltreatment exposure. The vmPFC (ventromedial prefrontal cortex) plays a
major role in inhibiting conditioned fear, thus, may play an important role in the pathophysiology
of fear-related psychopathology, including anxiety disorders (Busso et al., 2017). Following the
exposure to maltreatment, there are widespread disruptions in cortical structure. Furthermore,
these disruptions are selectively associated with increased vulnerability to internalizing and
externalizing psychopathology (Busso et al., 2017).
THE IMMUNE SYSTEM
[to come]
Neuroendocrine response to Stress [to come]
The brain immune system and normal brain functioning [to come]
Links between the immune system and the brain immune system [to come]

COMORBID DISORDERS
Childhood trauma is associated with a great number of mental disorders, such as manic or
depressive episodes, suicidality and increased comorbidity with other psychiatric disorder
(Marwaha et al., 2016).

Psychotic disorders
Childhood trauma has been identified as a potential risk factor for the onset of psychotic
disorders (Isvoranu et al., 2017), in which associated with an earlier diagnosis of psychosis and
mental illness. Theres a higher number of suicide attempts and negative outcomes, such as, drug
abuse and more severe positive psychotic symptoms in these children (Catalan et al., 2017).
Early abuse can inhibit effective social engagement and thus, an isolation from the society,
which lead to the development of psychotic symptoms (Catalan et al., 2017). A study suggests
that prolonged exposure to stressors leads to a chronic heightened glucocorticoid release, which
cause permanent changes in the hypothalamicpituitaryadrenal axis, to stay anti-inflammatory
and the immune system is then suppressed. These changes then induce an increased striatal
dopamine turnover, making a person more vulnerable for positive psychotic symptoms.
Traumatic exposure in childhood cause an enduring heightened sensitivity of the hypothalamic
pituitaryadrenal axis to stress (Catalan et al., 2017, Veling et al., 2016), which further lead to
psychosis through heightened emotional distress (Isvoranu et al., 2017).

Emotional Disorders
Childhood trauma has evidences supporting that theres an association with increasing the risk of
anxiety disorders, major depressive disorder, bipolar disorder, and personality disorders
(Marwaha et al., 2016).

Personality disorder
Borderline Personality Disorder is common in patients with childhood abuse, with symptoms
associated with psychosis, such as auditory hallucinations, delusions and paranoia (Isvoranu et
al., 2017). 30% to 90% of these patients have reported some kind of childhood trauma in
childhood, associated with BPD and have comorbidity with psychotic, severe sexual abuse
(Catalan et al., 2017).

Affective Disorder:
Childhood trauma, including emotional and physical abuse, often found in people with bipolar
disorder than the general population, and sexual abuse is often related to those with bipolar
disorder in comparison to unipolar depression (Marwaha et al., 2016). The level of affective
instability is measured by manic and depressive phases in bipolar disorders, or unipolar
depressive episodes, which ranks the highest in bipolar disorder II, followed by bipolar disorder
I, and unipolar depression (Marwaha et al., 2016).

Bipolar I, Schizophrenia, Impulsivity, etc [to come]

CONCLUSION
Childhood maltreatment is strongly associated with risk for psychopathology, and prior cross-
sectional research has been limited by an inability to disentangle the associations of maltreatment
and psychopathology on neural structure. (Busso et al., 2017)
Child abuse is associated with reduced cortical thickness in numerous regions of lateral and
medial PFC and temporal cortex. There are reduction in thickness of the parahippocampal gyrus.
(Busso et al., 2017), ventromedial prefrontal cortex (vmPFC). Interestingly, there was no
evidence about a positive association between child abuse and volume of the amygdala and
hippocampus (Busso et al., 2017). Heightened sensitivity to social stress is a mechanism by
which childhood trauma can increase the risk for psychotic and affective dysregulation later in
life, regarding the abnormalities in brain functionings.

[ more to come ]

ACKNOWLEDGEMENTS
I would like to thank Dr. Prof. Musselman for assigning this paper, so we can produce a
literature review paper dedicated to our own interest. I would like to also acknowledge Quynh
Anh Ho and Lauren Veo for their feedbacks on my annotated bibliography.
Thank you Kung Fu Tea and Argo Tea for their refreshments which help me write this draft.
 References

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Structure, and Adolescent Psychopathology: A Longitudinal Study. Journal of the American
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Catalan, Angosto, Daz, Valverde, De Artaza, Sesma, . . . Gonzalez-Torres. (2017). Relation

between psychotic symptoms, parental care and childhood trauma in severe mental disorders.
Psychiatry Research, 251, 78-84.

De Clercq, B., Verbeke, L., De Caluw, E., Vercruysse, T., & Hofmans, J. (2017).
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Hardy, A., Emsley, R., Freeman, D., Bebbington, P., Garety, P., Kuipers, E., . . . Fowler, D.
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Haworth, C., Carter, K., Eley, T., & Plomin, R. (2017). Understanding the genetic and
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