From Childhood Maltreatment to Adulthood Psychopathology

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Defining the unthinkable

Childhood maltreatment is often thought of in terms of explicit violence toward a child, whether that be physical or sexual. But maltreatment goes beyond violence in the literal sense, it can be emotionally inflicted through direct or indirect verbal insults, threats, serial yelling, or the withholding of love and attention, even the neglectful provision of basic needs, such as food, clothing, bathing, or schooling. Maltreatment can be considered exploitation or harm committed due to ignorance, turning a blind-eye or actively facilitating abuse.

Ultimately, childhood maltreatment is often complex and insidious, not always akin to what we see in the movies or what makes the headlines. It also has no demographic or socioeconomic boundaries, so there is no specific ‘look’ of individuals who perpetrate or have suffered from abuse.

Of the mind

The classifications of mental illness or psychopathology are extensive, although, they typically reflect mood, behaviour, and anxiety or have a psychotic component. They may also manifest physically following psychological distress, which is known as somatization; represented through the scientific field of psychoneuroimmunology.

Increased vulnerability not absolute certainty

When people experience maltreatment during childhood they develop an increased vulnerability, or put another way, a higher propensity for mental illness, but this does not suggest causation, or absolute outcomes. There is a concept of ‘multifinality’ where multiple outcomes arise from common antecedents, or in this case common experiences. Therefore, this latent vulnerability from childhood is not necessarily inevitable future disorder. There are, after all, countless people who have recovered from childhood maltreatment, who go on to live healthy, functional lives. Remarkably and importantly, positive outcomes have been reported from adults who were mistreated as children but who reshaped the narrative for good (McMillen et al., 1995; McMillen, 1999).

Biological, psychological, or social causes

That said, childhood maltreatment has been associated with a plethora of long-term maladaptive outcomes that independently and collectively increase the risk of mental illness. These include substance abuse (McCauley et al., 1997); promiscuity; disordered eating (Gilbert et al., 2009); educational deprivation; homelessness (Nooner et al., 2018); and criminality (van der Put et al., 2015); to socioeconomic disadvantage (Danese et al., 2008).

There are several supposed routes through which childhood maltreatment leads to mental illness in adulthood, but among the most compelling is the biopsychosocial approach. Biopsychosocial models offer a parsimonious explanation of the complex effects of childhood maltreatment by considering physiology, perception, and the social environment.

Inflated stress response

Evolutionary survival is predicated on the ability to detect danger and mitigate threat. But chronic heightened vigilance can reflect a maladaptive calibration of risk that is developed in childhood. Repeated activation of threat develops into patterns that become increasingly more salient and resistant to change with later age (Beck, 2008). This amplified stress-sensitivity predisposes mistreated children to earlier onset mental illness, with more intractable symptoms and poorer treatment outcomes (McCrory & Viding, 2015).

Classic fear-conditioning

Fear-conditioning is when neutral stimuli [such as a scent or sound] are associated with threatening stimuli [such as violence]. These abnormal associations are learnt and remembered, perhaps unconsciously, where risk is prioritised for processing in the brain, (LaBar et al., 1995).

Dysfunctional strategies, dysfunctional ties

Dysfunctional internalisation-externalisation strategies are common in adults who were maltreated as children. It is associated with reduced decision-making skills, and an inability to fulfill normative social roles (van der Put et al., 2015). Meanwhile, compromised social functioning can reduce the social ties that would otherwise be a key protective factor against stress, rendering adults who were mistreated as children more prone to psychological vulnerability.

Stress Pathways

Developmental traumatology investigations into the neurobiological effects on the developing brains of children, have found that maltreatment disrupts the cognitive, neural, endocrinal, and immune development of children (Nooner et al., 2018). In these circumstances, the child is inadequately optimised to negotiate normative situations and everyday demands – that it, they can’t cope – and this can continue into adulthood.

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Cortisol mediated dopamine (a neurotransmitter and hormone involved in emotion) is elevated in adults mistreated as children. This occurs because negative environmental stimuli, such as neglect, can lead to hyperactivity of the HPA-axis (hypothalamic-pituitary-adrenal axis), which has been found to permanently reduce hippocampal volume. This increases the likelihood of mental illness through the increased release of dopamine (Barker et al., 2015), but this permanent hippocampal impairment is directly implicated in long-term psychological effects. Besides, stress impairs the ability of the hippocampus to facilitate an end to the stress response (through glucocorticoid feedback on the HPA-axis), which leads to an enduring heightened response to normal stressors.

The beginning, not the end

Ultimately, biopsychosocial interactions are dynamic by nature, so there are no absolutes. But science has revealed a consistent pattern of abnormal threat processing in adults who were maltreated as children. The broad biological alterations associated with childhood maltreatment suggest that the ability to negotiate everyday stresses throughout life is substantially moderated, leading to a lower threshold for mental illness, with longer duration, and intractable remission (Nanni et al., 2012). However, there remains much to learn about a range of discrete biological systems that operate in unison, to improve interventions and treatments that promote recovery (Hamilton and Steptoe, 2022).