Mechanisms of childhood trauma: an integrative review of a multimodal, transdiagnostic pathway

Abstract

Childhood trauma (CT), conceptualized as emotional, physical or sexual abuse or emotional or physical neglect before the age of 18, is a risk factor for the emergence and poorer course of many mental and somatic disorders. The mechanisms underlying the impact of CT range from (neuro)biological changes (e.g., epigenetics, hypothalamic-pituitary-adrenal axis, and brain structure/function) to psychosocial mechanisms (e.g., personality, attachment, emotion regulation, and coping), and behavioral factors (e.g., smoking and exercise). Given the interrelatedness of mechanisms, there is a need for research that integrates the effects of CT across modalities. We aim to integrate (neuro)biological, psychosocial and behavioral mechanisms of CT in health and across mental and somatic disorders. The multimodal impact of CT requires more recognition in research and clinical practice and should be considered independent of current health status and diagnostic categories. Additionally, research should incorporate the impact of (daily life) stress to provide a more comprehensive understanding of the impact of CT. These recommendations may improve understanding, treatment and eventually prevention of CT-related health problems.

Keywords: Childhood trauma; Mechanisms; Mental health; Multimodal; Somatic health; Transdiagnostic.

Fig. 1

Broad impact of CT on mental and somatic health. This figure depicts odds-ratios (ORs) from literature discussed in the review for illustrative purposes. Blue represents somatic disorders; pink represents mental disorders or complaints. The dots represent ORs, while the error bars represent confidence intervals. ORs are averaged where multiple studies are listed. In those cases, the minimum and maximum confidence intervals are applied. Note, caution is warranted when comparing these ORs, due to differences in (meta-analytical) methods and CT subtypes. In addition, ORs depicted here are not exhaustive. PTSD = post-traumatic stress disorder; CI = confidence interval.

Fig. 2

Transdiagnostic mechanisms linking childhood trauma exposure to mental and somatic health. Childhood trauma exerts profound, long-term impact across biological, psychological, and behavioral domains, including brain structure and function, the HPA-axis, the immune system, epigenetics, biological aging, lifestyle, and psychosocial mechanisms. GR = glucocorticoid receptor, HPA = hypothalamus-pituitary-adrenal, CT = childhood trauma, TNF-α = tumor necrosis factor alpha, IL-6 = interleukin 6, CRP = c-reactive protein, GMV = grey matter volume, CTh = cortical thickness, WMI = white matter integrity, PFC = prefrontal cortex, dlPFC = dorsal lateral prefrontal cortex, DNA = deoxyribonucleic acid. Figure created using BioRender.