Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect.
Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect.
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DOI：
10.1111/jcpp.12507
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Samson JA
中科院分区：
文献类型：
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作者：
Teicher MH;Samson JA
儿童期虐待是精神病理学最重要的可预防原因，约占儿童期发病精神疾病风险人群的 45%。一个关键的突破是发现虐待会改变大脑发育的轨迹。本综述旨在综合经历过照顾者忽视的儿童的神经影像学发现，以及经历过身体、性和情感虐待的儿童、青少年和成人的研究。在此过程中，我们对暴露类型和时间的重要性、性别差异、可逆性以及大脑变化与精神病理学之间的关系等问题提供了初步答案。我们还讨论这些变化是否代表适应性改变或压力引起的损伤。父母的言语虐待、目睹家庭暴力和性虐待似乎专门针对大脑区域（听觉、视觉和体感皮层）以及处理和传达厌恶体验的通路。虐待与前扣带回、背外侧前额叶和眶额皮质、胼胝体和成年海马的可靠形态改变有关，并与杏仁核对情绪面孔的反应增强和纹状体对预期奖励的反应减弱有关。越来越多的证据表明，这些区域和互连路径在最脆弱的时候具有敏感的暴露期。早期的剥夺和后来的虐待可能会对杏仁核体积产生相反的影响。最初归因于精神疾病的结构和功能异常可能是虐待的更直接后果。童年虐待对大脑发育产生显着影响，并且在几乎所有精神病学神经影像学研究中一直是一个未被认识到的混杂因素。这些大脑变化可以最好地理解为在逆境中促进生存和繁殖的适应性反应。它们与精神病理学的关系很复杂，因为它们在有虐待史的易感个体和复原力个体中都很明显。培养复原力的机制需要成为未来研究的主要重点。
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development. This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage. Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable. Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.