Child Abuse Changes the Brain

Family violence creates trauma similar to warfare

/ Author:  / Reviewed by: Joseph V. Madia, MD

There is little debate that children who are abused, physically or mentally, undergo such significant trauma that they often carry it throughout their lives. Child abuse can affect a person's mental health forever, leading to depression and other psychological disorders later in life.

New studies have highlighted just how severe such childhood trauma is. In fact, children who are abused or even exposed to family violence exhibit the same patterns of heightened brain activity as soldiers who have been exposed to violent combat situations.

"Violence in childhood begets violence later in life," says Russell J. Ricci, M.D. "We are beginning to learn that the links, the causes, are organic as well as emotional."

How the Brain Changes

Dr. Eamon McCrory of the University College London in Britain led a study which used brain scans to explore the impact of domestic violence on children. McCrory's team scanned the brains of 43 children using an MRI; 20 of the children had been exposed to violence at home and had been referred to social services.

The average age of the affected children was 12 years old. The other 23 had not experienced any domestic violence.

While the children were in the MRI scanner, they were shown photographs of male and female faces showing sad, calm or angry expressions. The children who had been exposed to family abuse or violence showed increased activity in two regions of the brain when looking at the angry faces.

The two brain areas, the anterior insula and the amygdala, are the regions associated with detecting potential threats. Previous studies that did similar brain scans on soldiers who had been in combat showed the same patterns of heightened activity in these areas as the children who witnessed violence at home.

The researchers said that the findings suggest that maltreated children may have adapted to becoming hyper-aware of danger in their environment, just the way a soldier in a combat situation does.

"Exposure to family violence is associated with altered brain functioning in the absence of psychiatric symptoms and these alterations may represent an underlying neural risk factor. We suggest these changes may be adaptive for the child in the short term but may increase longer term risk," said McCrory. Such children may also be more susceptible to mental illness such as depression later in life. "We are only now beginning to understand how child abuse influences functioning of the brain's emotional systems. This research is important because it provides our first clues as to how regions in the child’s brain may adapt to early experiences of abuse in the home."

How Early Violence Sets up a Lifetime of Problems

Childhood abuse and exposure to violence in the home is one of the most potent environmental risk factors linked to mental health problems such as anxiety and depressive disorders as an adult. As many as 80 percent of young adults who have been abused meet the diagnostic criteria for at least one psychiatric disorder at age 21. And they show earlier onsets of mental illness.

Children who experience rejection or neglect are more likely to develop antisocial traits as they grow up, and to become abusers themselves. They are also at increased risk for suicide and substance or alcohol abuse. Magdalena Romanowicz, M.D. of the Mayo Clinic says that a history of child abuse makes most psychiatric illnesses worse.

At another English university, King's College London, researchers studies this relationship between childhood abuse or violence and long-term depression. Dr. Andrea Danese at the college's Institute of Psychiatry led a team that analyzed 16 studies involving more than 20,000 participants, and 10 clinical trials with more than 3,000 participants.

The combined analysis led to the conclusion that childhood maltreatment was, in fact, heavily linked to the risk of long-term depression later in life, as well as poorer response to treatments. For individuals who had been abused as children or exposed to family violence, they were twice as likely to develop both multiple and long-lasting depressive episodes throughout their lives. They were also more likely to respond poorly to medication or psychological therapy than those who had not been maltreated as a child.

For the Future

"Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective," Danese said. "Therefore prevention and early therapeutic interventions targeting childhood maltreatment could prove vital in helping prevent the major health burden owing to depression."

Researchers agree that in order to understand how early experiences bring about mental illness, future research should explore the link between it and childhood abuse, which is a global problem. One in ten children worldwide is exposed to some type of maltreatment, whether emotional, physical, sexual or neglect. The World Health Organization predicts that by 2020, depression will be the second leading contributor to the burden of disease globally.

Adding to the problem is the fact that there is an extreme shortage of child psychiatrists in the United States. Peter Jensen, M.D. of the Mayo Clinic, says if all of the child psychiatrists in the country saw every child with a mental health problem, they'd only be able to spend one hour treating each one per year.

Instead, these children are often treated by primary care doctors who aren't trained in treating mental health issues. Dr. Jensen and colleagues at the Mayo Clinic are developing a program to help train primary care physicians in handling psychiatric issues such as depression and anxiety, to help bridge the gap. The program has already had more than 30 training sessions and more are planned. 

Review Date: 
December 8, 2011