Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

Teicher, Martin H.; Gordon, Jeoffry B.; Nemeroff, Charles B.

doi:10.1038/s41380-021-01367-9

Cited by 325Child Abuse and TraumaPosttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology Research

Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

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Teicher, Martin H., Gordon, Jeoffry B., Nemeroff, Charles B.·2022·Molecular Psychiatry

DOI 10.1038/s41380-021-01367-9PMC PMC8567985

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Abstract

Childhood maltreatment is the most important preventable risk factor for psychiatric disorders. Maltreated individuals typically develop psychiatric disorders at an earlier age, have a more pernicious course, more comorbidities, greater symptom severity, and respond less favorably to treatments than non-maltreated individuals with the same primary DSM-5 diagnosis. Furthermore, maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response, and inflammatory marker levels not discernible in their non-maltreated counterparts. Hence, maltreated and non-maltreated individuals with the same primary DSM-5 diagnoses appear to be clinically and neurobiologically distinct. The failure to embody this distinction in DSM-5 has interfered with our ability to discover novel treatments, to recommend currently available treatments most likely to be efficacious, and has been a largely unrecognized confound that has thwarted our ability to identify the biological basis for major psychiatric disorders. Incorporating this distinction into DSM will help transform this sign and symptom-based classification system to a more etiologically informed nosology. We discuss several diagnostic alternatives and recommend the inclusion of a Developmental Trauma Disorder diagnosis for severely dysregulated individuals, of all ages, with numerous comorbidities, who experienced interpersonal victimization and disruptions in attachment, such as emotional maltreatment or neglect. For less severely affected maltreated individuals, we suggest using conventional diagnostic categories, such as major depression, but with an essential modifier indicating a history of childhood maltreatment, or early life stress, to delineate the ecophenotypic variant. Implementing this strategy should improve our ability to effectively diagnose and treat individuals with psychiatric disorders and to accelerate discovery.

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60.0 Integrating Child Maltreatment Exposure and Impact in Comprehensive Assessment, Diagnosis, and Treatment in Child Psychiatry
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Authors: Teicher, M. H., Gordon, J. B., & Nemeroff, C. B.
Affiliations: Harvard University (US)
California Department of Social Services (US)
The University of Texas at Austin (US)
Corresponding author: Nemeroff, Charles B.
ORCID: Teicher, Martin H.
Gordon, Jeoffry B.
Nemeroff, Charles B.
Venue: Molecular Psychiatry
Publisher: Springer Science and Business Media LLC
Published: 2021-11-04
Volume: 27
Issue: 3
Pages: 1331-1338
ISSN: 1359-4184 (ISSN-L)
1476-5578
DOI: 10.1038/s41380-021-01367-9
PMC: PMC8567985
OpenAlex: W3211215709
Cited by: 325
References: 104
Citations by year: 2026: 59 · 2025: 84 · 2024: 89 · 2023: 57 · 2022: 35 · 2021: 1
FWCI: 6.04
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: public-domain
www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Molecular Psychiatry (publishedVersion, public-domain)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Health & Human Services | National Institutes of Health (MH-117293, AA-024933, HD-079484, DA-017846)
ANS Foundation
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: child abuse, developmental trauma disorder, DSM-5, psychiatric classification, early life stress, psychological maltreatment, attachment disruption, hypothalamic-pituitary-adrenal axis, neuroinflammation, comorbidities, treatment response, major depressive disorder, ecophenotypes
MeSH terms: Mental Disorders, Brain, Child, Child Abuse, Major Depressive Disorder, Depressive Disorder, Major, Humans, Diagnostic and Statistical Manual of Mental Disorders

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Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

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