Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes
Open accessAbstract
OBJECTIVE: Childhood maltreatment increases risk for psychopathology. For some highly prevalent disorders (major depression, substance abuse, anxiety disorders, and posttraumatic stress disorder) a substantial subset of individuals have a history of maltreatment and a substantial subset do not. The authors examined the evidence to assess whether those with a history of maltreatment represent a clinically and biologically distinct subtype. METHOD: The authors reviewed the literature on maltreatment as a risk factor for these disorders and on the clinical differences between individuals with and without a history of maltreatment who share the same diagnoses. Neurobiological findings in maltreated individuals were reviewed and compared with findings reported for these disorders. RESULTS: Maltreated individuals with depressive, anxiety, and substance use disorders have an earlier age at onset, greater symptom severity, more comorbidity, a greater risk for suicide, and poorer treatment response than nonmaltreated individuals with the same diagnoses. Imaging findings associated with these disorders, such as reduced hippocampal volume and amygdala hyperreactivity, are more consistently observed in maltreated individuals and may represent a maltreatment-related risk factor. Maltreated individuals also differ from others as a result of epigenetic modifications and genetic polymorphisms that interact with experience to increase risk for psychopathology. CONCLUSIONS: Phenotypic expression of psychopathology may be strongly influenced by exposure to maltreatment, leading to a constellation of ecophenotypes. While these ecophenotypes fit within conventional diagnostic boundaries, they likely represent distinct subtypes. Recognition of this distinction may be essential in determining the biological bases of these disorders. Treatment guidelines and algorithms may be enhanced if maltreated and nonmaltreated individuals with the same diagnostic labels are differentiated.
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Environmental factors such as childhood adversity or prolonged exposure to psychosocial stressors contribute to mental disorder risk.
“a number of environmental factors such as childhood adversity or prolonged exposure to psychosocial stressors (Peedicayil, 2004;Rutten et al., 2013;Teicher & Samson, 2013) contribute to mental disorder risk”
From The applied implications of epigenetics in anxiety, affective and stress-related disorders - A review and synthesis on psychosocial stress, psychotherapy and prevention (2020) · cites this paper as Teicher & Samson, 2013
The Conclusions and Major Depressive Disorder and Maltreatment sections identify childhood maltreatment and adversity as risk factors for psychiatric disorders. The Post-traumatic Stress Disorder section also discusses repeated exposure to stressful maltreatment, but the paper does not establish the broader claim that prolonged exposure to psychosocial stressors generally increases mental disorder risk. Page numbers are unavailable in our copy. (LLM, conf=0.81)
Experimental — accuracy not yet measuredTeicher & Samson's (2013) meta-analysis reported aggregate adjusted odds ratios of 2.2 for depressive disorders, 4.4 for PTSD, 2.4 for anxiety disorders, 2.0 for alcohol use disorders, and 2.3 for drug use disorders.
“Results indicated aggregate AORs of 2.2 for depressive disorders, 4.4 for PTSD, 2.4 for anxiety disorders, 2.0 for alcohol use disorders, and 2.3 for drug use disorders.”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Teicher & Samson 2013
The Major Depressive Disorder and Maltreatment section reports about a twofold increased risk, and the Anxiety Disorders, Post-traumatic Stress Disorder, and Substance Use Disorders sections describe elevated risks after childhood maltreatment (pages not supplied). The paper does not report the five stated aggregate adjusted odds ratios or present them as results of its own meta-analysis; its PTSD section instead cites an adjusted odds ratio of 4.86 from a prospective study. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA history of childhood maltreatment exerts enduring and broad effects on mental health, including social functioning.
“Childhood maltreatment has long-lasting and pervasive impact on individuals’ psychological health (Teicher and Samson 2013), including social functioning (Simon et al. 2009).”
From Nonattachment Predicts Empathy, Rejection Sensitivity, and Symptom Reduction After a Mindfulness-Based Intervention Among Young Adults with a History of Childhood Maltreatment (2020) · cites this paper as Teicher and Samson 2013
Teicher & Samson (2013) hypothesized that because of its distinct clinical and neurobiological features-namely, physiological and neurohumoral changes that alter brain development trajectories-CM leads to a constellation of "ecophenotypes" that heighten the risk for the phenotypic expression of psychopathology.
“Taking this concept further, Teicher & Samson (2013) hypothesized that because of its distinct clinical and neurobiological features—namely, physiological and neurohumoral changes that alter brain development trajectories—CM leads to a constellation of “ecophenotypes” that heighten the risk for the phenotypic expression of psychopathology.”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Teicher & Samson 2013
Childhood adversity has been associated with 30-70% of the population attributable risk for depression, suicide attempts, anxiety disorders, and substance abuse.
“Childhood adversity has been associated with 30–70% of the population attributable risk for depression, suicide attempts, anxiety disorders and substance abuse (1).”
From Disorganized attachment in infancy predicts greater amygdala volume in adulthood (2016) · cites this paper as [1]
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Self-citationDepression With Atypical Features in the National Comorbidity Survey
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Role of the ventral subiculum in stress integration
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Cerebellar Volumes in Pediatric Maltreatment-Related Posttraumatic Stress Disorder
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Self-citationStructural and functional brain changes in posttraumatic stress disorder.
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Childhood Sexual Abuse Is Associated with Reduced Gray Matter Volume in Visual Cortex of Young Women
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Self-citationPredicting personality pathology among adult patients with substance use disorders
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Self-citationA Registry-Based Twin Study of Depression in Men
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Segmented Hippocampal Volume in Children and Adolescents with Posttraumatic Stress Disorder
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Self-citationAbnormal T2 relaxation time in the cerebellar vermis of adults sexually abused in childhood:
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Self-citationAn Update on Multiple Personality Disorder
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Self-citationAltered neural response of the appetitive emotional system in cocaine addiction: an fMRI Study
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The effects of childhood maltreatment on brain structure, function and connectivity
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Sensitive periods of amygdala development: the role of maltreatment in preadolescence
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Self-citationThe impact of environmental factors in severe psychiatric disorders
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Self-citationEpigenetic aging in major depressive disorder
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Hippocampal atrophy in major depression: a function of childhood maltreatment rather than diagnosis?
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“In line with our proposed framework, different types of stressors differentially impact neuroplasticity (Teicher & Samson, 2013), specifically in the limbic system (Cohen et al., 2013; Wilson et al., 2015), and specifically with regard to processing of threat and rewards (McLaughlin et al., 2014b).”
Effect of polygenic risk scores on depression in childhood trauma
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Childhood maltreatment: altered network centrality of cingulate, precuneus, temporal pole and insula
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Life adversities and suicidal behavior in young individuals: a systematic review
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Is emotional abuse as harmful as physical and/or sexual abuse?
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Genetic Determinants of Depression: Recent Findings and Future Directions
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Stress and functional neurological disorders: mechanistic insights
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Blunted HPA Axis Activity in Suicide Attempters Compared to those at High Risk for Suicidal Behavior
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Disorganized attachment in infancy predicts greater amygdala volume in adulthood
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Silveira, S., Boney, S., Tapert, S. F., & Mishra, J. (2021) · doi:10.1101/2021.01.29.21250544
- Authors
- Teicher, M. H., & Samson, J. A.
- Affiliations
- Harvard University (US)
- ORCID
- Teicher, Martin H.
- Venue
- American Journal of Psychiatry
- Published
- 2013-10
- Volume
- 170
- Issue
- 10
- Pages
- 1114-1133
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3928064
- OpenAlex
- W2029267876
- Cited by
- 1,050
- References
- 146
- Citations by year
- 2026: 66 · 2025: 92 · 2024: 74 · 2023: 96 · 2022: 98 · 2021: 74 · 2020: 95 · 2019: 117 · 2018: 95 · 2017: 76 · 2016: 64 · 2015: 64 · 2014: 35 · 2013: 2
- FWCI
- 8.12
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- John W. Alden Trust
- National Institutes of Health (1r01mh091391-01, 5r01da017846-14)
- National Institute of Mental Health (R01 MH-091391, R01 MH-66222, MH091391, DA-017846, MH-66222, R01MH066222)
- National Institute on Drug Abuse (R01DA-017846, R01DA016934)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- child abuse, ecophenotypes, major depressive disorder, substance use disorders, anxiety disorders, post-traumatic stress disorder, hippocampal volume, epigenetic modifications, gene-environment interaction, age of onset, comorbidities, suicide risk, treatment response, neuroimaging
- MeSH terms
- Adult, Anxiety Disorders, Mental Disorders, Brain, Child Abuse, Child, Preschool, Depressive Disorder, Major, Major Depressive Disorder, Humans, Phenotype, Psychopathology, Risk Factors, Stress Disorders, Post-Traumatic, Suicide, Attempted, Causality, Substance-Related Disorders, Gene-Environment Interaction
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