Neurodevelopmental biology associated with childhood sexual abuse

The Relation of Familiarity With Sexual Abusers to Subsequent Developmental Adaptation in Youths Who Have Sexually Offended

The present study explored the effects of child sexual abuse (CSA) on the adaptation of male juveniles who subsequently sexually offended (JSOs; n = 178; age, M = 16.05 years, SD = 0.27, range = 12-22). It examined multiple levels of interpersonal closeness between the perpetrators of sexual abuse and their JSO victims. JSOs who were sexually abused by older children or adults who cohabitated with them for at least 3 months reported higher levels of emotional dysregulation, callousness/manipulativeness, and sexualization than did both JSOs who were sexually abused by someone they had never lived with and JSOs who reported no experiences of sexual abuse. Implications of these findings are discussed.

Neural processing of emotions in traumatized children treated with Eye Movement Desensitization and Reprocessing therapy: a hdEEG study

Eye Movement Desensitization and Reprocessing (EMDR) therapy has been proven efficacious in restoring affective regulation in post-traumatic stress disorder (PTSD) patients. However, its effectiveness on emotion processing in children with complex trauma has yet to be explored. High density electroencephalography (hdEEG) was used to investigate the effects of EMDR on brain responses to adults' emotions on children with histories of early maltreatment. Ten school-aged children were examined before (T0) and within one month after the conclusion of EMDR (T1). hdEEGs were recorded while children passively viewed angry, afraid, happy, and neutral faces. Clinical scales were administered at the same time. Correlation analyses were performed to detect brain regions whose activity was linked to children's traumatic symptom-related and emotional-adaptive problem scores. In all four conditions, hdEEG showed similar significantly higher activity on the right medial prefrontal and fronto-temporal limbic regions at T0, shifting toward the left medial and superior temporal regions at T1. Moreover, significant correlations were found between clinical scales and the same regions whose activity significantly differed between pre- and post-treatment. These preliminary results demonstrate that, after EMDR, children suffering from complex trauma show increased activity in areas implicated in high-order cognitive processing when passively viewing pictures of emotional expressions. These changes are associated with the decrease of depressive and traumatic symptoms, and with the improvement of emotional-adaptive functioning over time.

Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review

OBJECTIVE

Review literature focused on neurological associations in brain structure among individuals with a history of childhood sexual abuse (CSA).

METHODOLOGY

A review of literature examining physiological irregularities in brain structures of individuals with a history of CSA was conducted.

RESULTS

Results revealed that a history of CSA was associated with irregularities in the cortical and subcortical regions of the brain. These irregularities have been recognized to contribute to various cognitive, behavioral, and psychological health outcomes later in life. Age of CSA onset was associated with differential neurological brain structures.

CONCLUSION

Mental and behavioral health problems such as anxiety, depression, substance abuse, dissociative disorders, and sexual dysfunction are associated with CSA and may persist into adulthood. Research depicting the associations of CSA on neurological outcomes emphasizes the need to examine the biological and subsequent psychological outcomes associated with CSA. Early intervention is imperative for CSA survivors.

Sex differences in anxiety and depression clinical perspectives

Sex differences are prominent in mood and anxiety disorders and may provide a window into mechanisms of onset and maintenance of affective disturbances in both men and women. With the plethora of sex differences in brain structure, function, and stress responsivity, as well as differences in exposure to reproductive hormones, social expectations and experiences, the challenge is to understand which sex differences are relevant to affective illness. This review will focus on clinical aspects of sex differences in affective disorders including the emergence of sex differences across developmental stages and the impact of reproductive events. Biological, cultural, and experiential factors that may underlie sex differences in the phenomenology of mood and anxiety disorders are discussed.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Obesity, traumatic brain injury, childhood abuse, and suicide attempts in females at risk

PURPOSE

This study tested the hypothesis that obesity is related to history of traumatic brain injury (TBI), severity and frequency of childhood physical (CPA) and sexual abuse (CSA), and suicide attempts, adjusting for related variables in a high risk female population.

DESIGN

This cross-sectional study of 81 females compared obese to non-obese.

METHODS

All variables were verified by private interviews, physical examination, and documented evidence, then statistically analyzed with logistic regression.

FINDINGS

Obesity at the time of interview was related to history of a decreased number of TBIs per person, greater CSA, suicide attempts, and decreased CPA, adjusting for current smoking, depression, currently using selective serotonin reuptake inhibitors, and age.

CONCLUSIONS

Number of TBIs per person and CPA were inversely related to obesity, adjusting for related variables. Greater CSA frequency and severity, and having attempted suicide were significantly related to greater risk of obesity, adjusting for related variables. Though causes of obesity cannot be determined by this design, and findings should be viewed with caution, this study provides new insight into the obesity epidemic that requires further investigation.

CLINICAL RELEVANCE

Rehabilitation nurses are in ideal settings when patient's conditions are less acute, providing opportunities to address complex serious underlying etiologies of obesity. Obesity has not been alleviated by teaching about diet and exercise because obesity may be the result of dietary self-medication of pain from previous experiences. CSA is a very serious problem that could precipitate suicide attempts, obesity, and multifaceted poor health outcomes throughout the life span; subsequently placing individuals at greater risk of requiring rehabilitation services.

Childhood maltreatment and corpus callosum volume in recently diagnosed patients with bipolar I disorder: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)

Childhood trauma (CT) has been associated with abnormalities in the corpus callosum (CC). Decreased CC volumes have been reported in children and adolescents with trauma as well as adults with CT compared to healthy controls. CC morphology is potentially susceptible to the effects of Bipolar Disorder (BD) itself. Therefore, we evaluated the relationship between CT and CC morphology in BD. We using magnetic resonance imaging in 53 adults with BD recently recovered from their first manic episode, with (n = 23) and without (n = 30) CT, defined using the Childhood Trauma Questionnaire (CTQ) and 16 healthy controls without trauma. ANCOVA was performed with age, gender and intracranial volume as covariates in order to evaluate group differences in CC volume. The total CC volume was found to be smaller in BD patients with trauma compared to BD patients without trauma (p < .05). The differences were more pronounced in the anterior region of the CC. There was a significant negative correlation between CTQ scores and total CC volume in BD patients with trauma (p = .01). We did not find significant differences in the CC volume of patients with/without trauma compared to the healthy subjects. Our sample consists of patients recovered from a first episode of mania and are early in the course of illness and reductions in CC volume may occur late in the course of BD. It might mean there may be two sources of CC volume reduction in these patients: the reduction due to trauma, and the further reduction due to the illness.

Through the eyes of the wounded: a narrative analysis of children's sexual abuse experiences and recovery process

Numerous children receive counseling for sexual abuse, yet their personal perspectives related to the abuse, the impact of making the disclosure, and the recovery process are noticeably absent from the scholarly literature. This study addressed this gap by analyzing trauma narratives written by children as part of a counseling intervention. Qualitative analysis revealed three themes: memories of the abuse, the disclosure and subsequent events, and the healing journey. Children's descriptions of their thoughts, feelings, and beliefs about their experiences are delineated and recommendations are provided for counseling professionals to increase the efficacy of care provided.

Hypothalamic pituitary thyroid axis and exposure to interpersonal violence in childhood among women with borderline personality disorder

BACKGROUND

A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD). Women with borderline personality disorder (BPD) report a high estimate of childhood trauma.

OBJECTIVE

The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD.

METHOD

A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD) diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS). The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6-14 years) and during adult life (15 years or older). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed.

RESULTS

Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD.

CONCLUSION

Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD.

A neuropsychological profile of childhood maltreatment within an adolescent inpatient sample

Recent research has begun to identify the neurocognitive and psychological effects of childhood maltreatment, although information is limited on the neuropsychological presentation of maltreatment in psychiatrically hospitalized adolescents. This study examined the executive-functioning and language abilities as well as psychopathological presentation of childhood maltreatment victims in an adolescent psychiatric inpatient setting. The sample consisted of adolescent inpatients (ages 13-19 years old) who completed a neuropsychological/psychological assessment during hospitalization (n = 122). The sample was grouped based on childhood maltreatment history, with one group categorized by maltreatment history (n = 49) and the other group characterized by no maltreatment history (n = 73). Analyses revealed statistically significant differences (p < .01) between maltreatment groups on executive functioning, as well as on measures of self-reported depression and anxiety symptoms. No group differences remained after controlling for posttraumatic stress disorder. Further, distinct neuropsychological profiles were identified for specific types of maltreatment experienced. These findings suggest that while childhood maltreatment is associated with a range of neuropsychological impairments, the specific type of maltreatment experienced may have a significant influence on the type and severity of impairments. These findings contribute to the growing body of research on the significant consequences of childhood maltreatment.

How Much Child Sexual Abuse is "Below the Surface," and Can We Help Adults Identify it Early?

Child sexual abuse (CSA) occurs frequently in society to children aged between 2 and 17. It is significantly more common in girls than boys, with the peak age for CSA occurring when girls are aged 13-17. Many children experience multiple episodes of CSA, as well as having high rates of other victimizations (such as physical assaults). One of the problems for current research in CSA is different definitions of what this means, and no recent review has clearly differentiated more severe forms of CSA, and how commonly this is disclosed. In general we suggest there are four types of behavior that should be included as CSA, namely (1) non-contact, (2) genital touching, (3) attempted vaginal and anal penetrative acts, and (4) vaginal and anal penetrative acts. Evidence suggests that CSA involving types (2), (3), and (4) is more likely to have significant long-term outcomes, and thus can be considered has having higher-impact. From the research to date approximately 15% of girls aged 2-17 experience higher-impact CSA (with most studies suggesting that between 12 and 18% of girls experience higher-impact CSA). Approximately 6% of boys experience higher-impact CSA (with most studies suggesting that between 5 and 8% experience higher-impact CSA). The data also suggests that in over 95% of cases the CSA is never disclosed to authorities. Thus, CSA is frequent but often not identified, and occurs "below the surface" in the vast majority of higher-impact cases. Helping adults to understand "below the surface" CSA might help them to recognize it early, but there are very few indicators specific to CSA, making this a challenging goal to achieve. Nonetheless, given that CSA frequently occurs with other types of abuse, a training program that focuses on both CSA and other abuse may offer a method to allow both early recognition and prevention by adults in the general population.

Posttraumatic stress disorder

Children are exposed to a variety of traumatic experiences, and each child is unique in his or her response to that trauma. The most common psychiatric disorder that develops after exposure to trauma is posttraumatic stress disorder (PTSD). This article will help pediatric nurse practitioners understand PTSD in terms of diagnosis, epidemiology, risk factors, comorbidity, and treatment. DSM-IV diagnostic criteria will be discussed, along with modifications to consider when evaluating very young children for PTSD. Implications for practice will be discussed along with suggested questions to ask parents and children to assess for exposure to trauma.

A translational neuroscience perspective on the importance of reducing placement instability among foster children

Placement instability is a common occurrence among foster children and others involved with child welfare system services, and is associated with negative psychiatric and mental health outcomes. The purpose of this paper is to review and synthesize research in this area and to consider this information in terms of child welfare practice and policy. Evidence from 59 sources is reviewed, including research on (a) the connection between placement instability and poor outcomes; (b) sources of information that can be employed to reliably predict risk for placement instability; and (c) interventions designed to mitigate the effects of placement instability. The available empirical evidence suggests that placement instability and other family chaos is associated with disrupted development of the brain’s prefrontal cortex, which is involved in executive functioning. Poor executive functioning is implicated in elevated risk for ADHD, disruptive behavior disorders, substance abuse, and other forms of disinhibitory psychopathology. This might help to explain the high rates of psychiatric medication prescriptions for foster children. Notably, however, recent research findings have shown that placement instability is both predictable and preventable and that interventions to address placement instability have the potential to mitigate neurobiological and psychiatric effects of prior adversity.

The cognitive impact of sexual abuse and PTSD in children: a neuropsychological study

Sexual abuse is known to have an impact on both child and adult mental health, but the neuropsychological basis of this effect is still largely unknown. This study compared neuropsychological test results from a group of 76 children, 13 of them sexual abuse victims with symptoms of post-traumatic stress disorder, 26 victims of sexual abuse who showed no symptoms post-traumatic stress disorder, and 37 controls. The groups were matched by age, sex, socioeconomic status, and educational level. Child sexual abuse was associated with reduced ability to inhibit automatic responses measured by the Stroop test regardless of post-traumatic stress disorder status. These findings indicate possible attentional inhibition difficulties in child victims of sexual abuse, which may help explain psychopathology associated with the experience.

Differences in Abuse and Related Risk and Protective Factors by Runaway Status for Adolescents Seen at a U.S. Child Advocacy Centre

OBJECTIVES

This study examined the abuse prevalence and characteristics, and risk and protective factors, among both runaway and non-runaway adolescents evaluated at a Child Advocacy Center (CAC) in Minnesota, which had implemented a referral program to assess runaways for potential sexual assault or sexual exploitation.

METHODS

A cross-sectional analysis of self-report and chart data for the 489 adolescent girls who were evaluated between 2008 and 2010. Chi-square and t-tests by runaway status compared abuse experiences, trauma responses, health issues, and potential protective assets associated with resilience between runaways and non-runaways. Bivariate logistic regressions explored the relationship of these risk and protective factors to self-harm, suicide attempts, and problem substance use, separately for runaways and non-runaways who had experienced sexual abuse.

RESULTS

Runaways were significantly more likely than non-runaways to have experienced severe sexual abuse, to have used alcohol and drugs, and reported problem substance use behavior, higher levels of emotional distress, more sexual partners, and they were more likely to have a sexually transmitted infection (STI). Runaways had lower levels on average of social supports associated with resilience, such as connectedness to school, family or other adults. Yet higher levels of these assets were linked to lower odds of self-harm, suicide attempt and problem substance use for both groups.

CONCLUSIONS AND IMPLICATIONS

CACs should encourage referrals of runaway adolescents for routine assessment of sexual assault, and incorporate screening for protective factors in addition to trauma responses in their assessments of all adolescents evaluated for possible sexual abuse, to guide interventions.

An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan

Accumulation of life stressors predicts accelerated development and progression of diseases of aging. Telomere length, the DNA-based biomarker indicating cellular aging, is a mechanism of disease development, and is shortened in a dose response fashion by duration and severity of life stressor exposures. Telomere length captures the interplay between genetics, life experiences and psychosocial and behavioral factors. Over the past several years, psychological stress resilience, healthy lifestyle factors, and social connections have been associated with longer telomere length and it appears that these factors can protect individuals from stress-induced telomere shortening. In the current review, we highlight these findings, and illustrate that combining these `multisystem resiliency' factors may strengthen our understanding of aging, as these powerful factors are often neglected in studies of aging. In naturalistic studies, the effects of chronic stress exposure on biological pathways are rarely main effects, but rather a complex interplay between adversity and resiliency factors. We suggest that chronic stress effects can be best understood by directly testing if the deleterious effects of stress on biological aging processes, in this case the cell allostasis measure of telomere shortening, are mitigated in individuals with high levels of multisystem resiliency. Without attending to such interactions, stress effects are often masked and missed. Taking account of the cluster of positive buffering factors that operate across the lifespan will take us a step further in understanding healthy aging. While these ideas are applied to the telomere length literature for illustration, the concept of multisystem resiliency might apply to aging broadly, from cellular to systemic health.

Posttraumatic stress disorder in children and adolescents: neuroendocrine perspectives

Posttraumatic stress disorder (PTSD) is a syndrome of distress that develops after exposure to traumatic life experiences. Dysregulation of both the hypothalamic-pituitary-adrenal (HPA) axis and the locus caeruleus/norepinephrine-sympathetic nervous system (LC/NE-SNS) is associated with the pathophysiology of the disorder. Studies have demonstrated a neuroendocrine profile unique to adults with PTSD, with centrally elevated corticotropin-releasing hormone (CRH), low cortisol in the periphery, and elevated catecholamines. Traumatic stress experiences in early life are strong predisposing factors for later PTSD development. In addition, early life stress programs the developing brain to overreact to future stressors. In children and adolescents involved in motor vehicle accidents, we found that high evening salivary cortisol and morning serum interleukin 6 concentrations were predictive of PTSD development 6 months later. We demonstrated a progressive divergence of the HPA and LC/NE-SNS axes of the stress system, which may be part of the pathophysiologic mechanism responsible for PTSD maintenance. An initial elevation of cortisol in the aftermath of the trauma, followed by a gradual normalization and finally low cortisol secretion, together with a gradual elevation of catecholamines over time, may represent the natural history of neuroendocrine changes in pediatric PTSD. Thus, the low cortisol concentrations found in adults with PTSD may reflect prior trauma and might represent a biologic vulnerability factor for later PTSD development.

Introduction to the special section: medical advances in child sexual abuse, part 2

This volume is the second of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The four articles in this special section discuss topics such as estimating the sexual maturity of a child from computer or photographic images; how several cases of supposed Neisseria gonorrhoeae meningitis actually were a different, but related, organism, thereby removing sexual abuse as a consideration as to etiology; what current laboratory methods are available today to detect specific sexually transmitted infections and what should be used; and how all the evidence in child sexual abuse cases is organized to make clear and accurate statements.