CONTROVERSIES IN PSYCHIATRY IN 2013 

Minerva Psichiatrica 2013 June;54(2):137-48

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Is there a link between child abuse and neglect and anxiety disorders?

Perna G. ^{1, 2, 3}, Alciati A. ², Prestia D. ², Torti T. ², Nemeroff C. B. ¹

¹ Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA; ² Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese San Cassano, Como, Italy; ³ Department of Psychiatry and Neuropsychology, Faculty of Health Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands

A link between childhood maltreatment and mental disorders is firmly established. Although the link between depression and childhood maltreatment is well established, the same cannot be said for the anxiety disorders. The plausibility of this latter relationship relies, in part, on the evidence of a crucial involvement of hypothalamic-pituitary-axis (HPA) in the mammalian organism’s responses to threats, that is likely to contribute to the brain mechanisms underlying anxiety disorders. Studies on adverse childhood experiences (ACE) suggest that persistent changes occur in the function, structure and epigenetics of the HPA axis after early life stress. To date few studies have assessed this relationship, most focusing on post-traumatic stress disorder, but most of them reported a positive association between childhood maltreatment and anxiety disorders in adulthood. The effects of childhood maltreatment on the development of anxiety disorders is not likely specific but depends on genetic vulnerability and resilience, timing and type of the maltreatment and other environmental and biological factors. Imaging genomic studies will help elucidate the relationship between genetic vulnerability and the observed alterations in activity of cortical brain circuits. Most importantly this will likely lead to development of predictors of treatment response that will allow for matching each anxiety disorder patient with optimal pharmacotherapeutic and psychotherapeutic treatments, a major goal in the new personalized medicine era.