2020: Childhood Maltreatment, Brain Development and a New Understanding of what Recovery Entails (Keynote)

Presented by Marty Teicher, MD: Exposure to childhood adversity markedly increases the risk of developing mood, anxiety, personality, substance abuse and psychotic disorders. Recent studies suggest that clinical sequelae may stem, at least in part, from enduring adverse effects on brain development. Generally, early onset and longer duration of abuse have been associated with greater brain changes, but this is an oversimplification. It appears that stress-susceptible brain regions have their own unique sensitive periods (or windows of vulnerability) to the effects of early stress. Further, evidence also suggests that maltreated and non-maltreated individuals with the same DSM diagnoses are clinically, neurobiogically and genetically distinct. We refer to the disorder in the maltreated cohort as an ‘ecophenotype’ and show that it is associated with earlier age of onset, more severe course, more comorbid diagnoses and poorer response to first-line treatments. A key challenge has been to understand why some individuals appear to be resilient to the psychiatric sequelae of abuse, particularly as they show the same basic array of alterations in stress-susceptible brain regions as comparably maltreated individuals with severe psychopathology. Our recent studies of brain network architecture have identified additional alterations in the brains of maltreated individuals that enable them to effectively compensate and to obtain high levels of mental health. This leads to a new understanding of how recovery occurs and how effective treatments may work – which is not to reverse the effects of maltreatment, but to foster compensatory resilience by altering the connectivity of specific brain regions.

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Presented by Marty Teicher, MD: Exposure to childhood adversity markedly increases the risk of developing mood, anxiety, personality, substance abuse and psychotic disorders. Recent studies suggest that clinical sequelae may stem, at least in part, from enduring adverse effects on brain development. Generally, early onset and longer duration of abuse have been associated with greater brain changes, but this is an oversimplification. It appears that stress-susceptible brain regions have their own unique sensitive periods (or windows of vulnerability) to the effects of early stress. Further, evidence also suggests that maltreated and non-maltreated individuals with the same DSM diagnoses are clinically, neurobiogically and genetically distinct. We refer to the disorder in the maltreated cohort as an ‘ecophenotype’ and show that it is associated with earlier age of onset, more severe course, more comorbid diagnoses and poorer response to first-line treatments. A key challenge has been to understand why some individuals appear to be resilient to the psychiatric sequelae of abuse, particularly as they show the same basic array of alterations in stress-susceptible brain regions as comparably maltreated individuals with severe psychopathology. Our recent studies of brain network architecture have identified additional alterations in the brains of maltreated individuals that enable them to effectively compensate and to obtain high levels of mental health. This leads to a new understanding of how recovery occurs and how effective treatments may work – which is not to reverse the effects of maltreatment, but to foster compensatory resilience by altering the connectivity of specific brain regions.

2020: Childhood Maltreatment, Brain Development and a New Understanding of what Recovery Entails (Keynote)
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