Child Trauma Exposure and Psychopathology: Mechanisms of Risk and Resilience

Abstract

Exposure to trauma in childhood is associated with elevated risk for multiple forms of psychopathology. Here we present a biopsychosocial model outlining the mechanisms that link child trauma with psychopathology and protective factors that can mitigate these risk pathways. We focus on four mechanisms of enhanced threat processing: information processing biases that facilitate rapid identification of environmental threats, disruptions in learning mechanisms underlying the acquisition of fear, heightened emotional responses to potential threats, and difficulty disengaging from negative emotional content. Supportive relationships with caregivers, heightened sensitivity to rewarding and positive stimuli, and mature amygdala-prefrontal circuitry each serve as potential buffers of these risk pathways, highlighting novel directions for interventions aimed at preventing the onset of psychopathology following child trauma.

Figure 1

A biopsychosocial model of risk and resilience to psychopathology following child trauma. This figure depicts a biopsychosocial model of mechanisms linking child trauma with psychopathology and protective factors that mitigate risk pathways. Solid lines reflect direct associations between child trauma and threat processing and between threat processing and psychopathology. Enhanced threat processing is a transdiagnostic factor associated with multiple forms of child psychopathology. Each domain of threat processing is associated with internalizing and externalizing psychopathology, as well as post-traumatic stress disorder (PTSD); although greater research is needed to clarify whether the specific disruptions in emotional learning associated with child trauma are associated with mental health problems other than externalizing psychopathology. PTSD is depicted separately from internalizing and externalizing problems given its current classification as a trauma and stressor-related disorder in DSM-5. Dashed lines represent the buffering effect of each of the protective factors on specific risk pathways.