Structural and Functional Brain Abnormalities Associated With Exposure to Different Childhood Trauma Subtypes: A Systematic Review of Neuroimaging Findings

Abstract

Background: Childhood trauma subtypes sexual abuse, physical abuse, emotional maltreatment, and neglect may have differential effects on the brain that persist into adulthood. A systematic review of neuroimaging findings supporting these differential effects is as yet lacking. Objectives: The present systematic review aims to summarize the findings of controlled neuroimaging trials regarding long-term differential effects of trauma subtypes on the human brain. Methods: A systematic literature search was performed using the PubMed and PsycINFO databases from January 2017 up to and including January 2018. Additional papers were identified by a manual search in the reference lists of selected papers and of relevant review articles retrieved by the initial database search. Studies were then assessed for eligibility by the first author. Only original human studies directly comparing neuroimaging findings of exposed and unexposed individuals to well-defined emotional, physical or sexual childhood maltreatment while controlling for the effects of other subtypes were included. A visual summary of extracted data was made for neuroimaging modalities for which comparison between trauma subtypes was feasible, taking the studies' numbers and sample sizes into account. Results: The systematic literature search yielded 25 publications. Sexual abuse was associated with structural deficits in the reward circuit and genitosensory cortex and amygdalar hyperreactivity during sad autobiographic memory recall. Emotional maltreatment correlated with abnormalities in fronto-limbic socioemotional networks. In neglected individuals, white matter integrity and connectivity were disturbed in several brain networks involved in a variety of functions. Other abnormalities, such as reduced frontal cortical volume, were common to all maltreatment types. Conclusions: There is some evidence for long-term differential effects of trauma subtypes on the human brain. The observed alterations may result from both protective adaptation of and damage to the brain following exposure to threatening life events. Though promising, the current evidence is incomplete, with few brain regions and neuroimaging modalities having been investigated in all subtypes. The comparability of the available evidence is further limited by the heterogeneity of study populations regarding gender, age and comorbid psychopathology. Future neuroimaging studies should take this potentially differential role of childhood trauma subtypes into account.

Keywords: child abuse [MeSH]; childhood trauma; emotional maltreatment; neglect; neuroimaging[MeSH]; physical abuse; sexual abuse; trauma subtypes.

Figure 1

Biological pathways underlying the association between early-life stress and psychopathology. CNS, central nervous system.

Figure 2

Selection of papers.

Figure 3

Neuroimaging findings associated with SA. SoSens, genital somatosensory cortex; CN, caudate nucleus; A, amygdala. Adapted from: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. https://creativecommons.org/licenses/by/2.5/

Figure 4

Neuroimaging findings associated with EM. PFC, prefrontal cortex; ACC, anterior cingulate cortex; A, amygdala; amTG, anterior middle temporal gyrus. Adapted from: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. https://creativecommons.org/licenses/by/2.5/

Figure 5

Neuroimaging findings associated with neglect. PFC, prefrontal cortex. Adapted from: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. https://creativecommons.org/licenses/by/2.5/