SCARS THAT WON'T HEAL: THE NEUROBIOLOGY OF CHILD ABUSE
Maltreatment at an early age can have enduring negative effects on a
child's brain development and function.
In 1994 Boston Police were shocked to discover a malnourished four-year-old locked away in a filthy Roxbury apartment, where he lived in dreadfully squalid conditions.
Worse, the boy's tiny hands were found to have been horrendously burned.
It emerged that his drug-abusing mother had held the child's hands under a steaming hot faucet to punish him for eating her boyfriend'd food, despite her instructions not to do so.
The ailing youngster had been given no medical care at all. The disturbing story made national headlines. Later placed in foster care, the boy received skin grafts to help his scarred hands to regain function. But even though the victim's physical wounds were treated, recent research finding s indicate that any injuries inflicted to his developing mind may never truly heal.
Though an extreme example, the notorious case is unfortunately not all that uncommon. Every year child welfare agencies in the US receive more then three million allegations of childhood abuse and neglect and collect sufficient evidence to substantiate more than a million instances.
It is hardly surprising to us that research reveals a strong link between physical, sexual and emotional mistreatment of children and the development of psychiatric problems. But in the early 1990s mental health professionals believed that emotional and social difficulties occurred mainly through psychological means. Childhood maltreatment was understood either to foster the development of intrapsychic defense mechanisms that proved to be self-defeating in adulthood or to arrest psychosocial development, leaving a "wounded child" within. Researchers thought of the damage as basically a software problem amenable to reprogramming via therapy or simply erasable through the exhortation "Get over it".
New investigations into the consequences opt early maltreatment, including work my colleagues and I have done at McLean Hospital in Belmont, Mass., and at Harvard Medical School, appear to tell a different story.. Because childhood abuse occurs during the critical formative time when the brain is being physically sculpted by experience, the impact of severe stress can leave an indelible imprint on its structure and function. Such and abuse, it seems, induces a cascade of molecular neurobiological effects that irreversibly alter neural development.
Extreme Personalities
The aftermath of childhood abuse can manifest itself at any age in a variety of ways. Internally it can appear as depression, anxiety, suicidal thoughts or post traumatic stress; it can also be expressed outward as aggression, impulsiveness, delinquency, hyperactivity or substance abuse. One of the more perplexing psychiatric conditions that is strongly associated with ill-treatment is borderline personality disorder. Someone with this disfunction characteristically sees others in black and white terms, often first putting a person on a pedestal, then vilifying the same person after some perceived slight or betrayal. Those afflicted are also prone to volcanic outbursts of anger and transient episodes of paranoia or psychosis. They typically have a history of intense, unstable relationships, feel empty or unsure of their identity, commonly try to escape through substance abuse, and experience self-destructive or suicidal impulses.
While treating three patines with borderline personality disorder 1984, begin to suspect that their early exposure to various forms of maltreatment had altered the development of their limbic systems. The limbic system is a collection of interconnected brain nuclei(neural centers) that play a pivotal role in the regulation of emotion and memory. Two critically important limbic regions are the hippocampus and the amygdala, which lie below the cortex in the temporal lobe. The hippocampus is thought to be important in the formation and retrieval of both verbal and emotional memories, whereas the amygdala is concerned with creating the emotional content of memory- for example, feelings relating to fear conditioning and aggressive responses.
My McLean colleagues Yutaka Ito and Carol A. Glod and I Wondered whether childhood abuse might disrupt the healthy maturation of the brain regions. Could early maltreatment stimulate the amygdala into a state of heightened electrical irritability or damage the developing hippocampus through excessive exposure to stress hormones? We reasoned further that hippocampal harm or amygdaloid over excitation could produce symptoms similar to those experienced by patients with temporal lobe epilepsy (TLE), which sporadically disrupts the function of these brain nuclei. During TLE seizures, patines remain conscious while experiencing a range of psychomotor symptoms brought on by electrical storms within these regions. Associated effects include the abrupt onset of tingling, numbness or vertigo; motor-related manifestations such as uncontrollable staring or twitching; and automatic symptoms such as flushing, nausea or the "pit in your stomach" feeling one gets in a fast-rising elevator. TLE can also cause hallucinations or illusions in any of the five senses. It is not unusual, for instance, for one afflicted with this condition to experience Alice-in-Wonderland -like distortions of the sizes or shapes of objects.
