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Part II: Vulnerabilities
and Risk Factors for
Psychopathology
Child Maltreatment
and Risk for
Psychopathology
Chapter 5
Sara R. Jaffee and Andrea Kohn Maikovich-Fong
TERMINOLOGICAL AND
CONCEPTUAL ISSUES
 Prevalence Rates of Maltreatment Among Subgroups
 Children under the age of 4 years represent approximately
one third of victims (U.S. Department of Health and Human
Services, 2011).
 Maltreatment rates are highest among African American,
Native American/Alaska Native, and multiethnic youth, and
lowest among Asian youth.
 Minority children are disproportionately represented in the
child welfare system because minority families experience
high rates of poverty and other social stressors rather than
pervasive bias in the child welfare system (Drake et al., 2011).
MALTREATMENT AND CHILDREN’S
RISK FOR PSYCHOPATHOLOGY
 Maltreatment and Risk for Externalizing Psychopathology
 Maltreated children and adolescents are at higher risk of
attention deficit/hyperactivity disorder, conduct disorder,
oppositional defiant disorder, delinquency and antisocial
behavior.
 Risk for externalizing problems extends into adulthood and may
include elevated rates of antisocial personality disorder, selfreported crime, and criminal arrests.
 Findings with respect to drug and alcohol use have been mixed.
 The relationship between externalizing problems and child
maltreatment varies as a function of age and sex.
MALTREATMENT AND CHILDREN’S
RISK FOR PSYCHOPATHOLOGY
 Maltreatment and Risk for Internalizing Psychopathology
 Maltreated children and adolescents are at higher risk of major
depressive disorder, anxiety disorders, posttraumatic stress
disorder (PTSD), and trauma symptoms.
 Risk for internalizing problems extends into adulthood and may
include elevated rates of major depressive disorder, depressive
symptoms, anxiety disorders, borderline personality disorder.
 Victims of child maltreatment are at elevated risk for suicide in
adolescence and adulthood and engage in elevated rates of selfinjury.
MALTREATMENT AND CHILDREN’S
RISK FOR PSYCHOPATHOLOGY
 Does the Association Between Maltreatment and
Psychopathology Reflect Reverse Causation?
 Evidence consistent with the hypothesis that
maltreatment was a cause of children’s antisocial
behavior (Jaffee et al., 2004).
 Abuse was associated with changes over time in children’s
antisocial behavior.
 A dose-response relationship between the severity of the
abuse and the severity of children’s antisocial behavior.
 Genetic factors accounted for a small and statistically
nonsignificant portion of the variation.
 Abuse remained a significant predictor of children’s antisocial
behavior controlling for parental antisocial behavior.
ETIOLOGICAL FORMULATIONS
 Biological Mechanisms
 Epigenetic effects of maltreatment
 Maltreatment may lead to psychopathology by triggering epigenetic
mechanisms that regulate gene expression in the central nervous
system.
 Maltreatment and limbic-hypothalamic pituitary
adrenal (LHPA) axis function
 Maltreatment may dysregulate the LHPA axis due to
chronic activation from stressors.
 LHPA axis dysregulation has been implicated in a range
of mental disorders including depression, anxiety
disorders, and conduct disorder (Arborelius, Owens, Plotsky, &
Nemeroff, 1999).
ETIOLOGICAL FORMULATIONS
 Structural and functional changes in the brain
 Maltreatment increases risk for depression by altering
dopaminergic circuitry projecting to the basal ganglia.
 Maltreated versus nonmaltreated children are selectively
attentive to cues for anger, as evidenced, for example, by
greater activation of the right amygdala and anterior
insular bilaterally to angry faces.
 Hyperattention to threat mediates the association
between a history of maltreatment and current symptoms
of anxiety (Shackman et al., 2007).
ETIOLOGICAL FORMULATIONS
 Cognitive, Behavioral, and Socioemotional Processes
 Externalizing problems
• Attribute hostile intent to others’ behavior and respond in an
aggressive manner.
• Maltreated youth have difficulty regulating their own emotions
leading to peer rejection.
• Maltreated preschoolers also have difficulty with emotion
understanding.
• More positive beliefs about violence, which leads to antisocial
peer groups and increases their risk for violent behavior.
ETIOLOGICAL FORMULATIONS
 Internalizing problems
• Sexual abuse in particular has been linked with a range of
problems in self-functioning, defined in terms of selfcoherence, self-continuity, self-affectivity, and self-agency
(Stern, 1985).
• Some studies show that abused and neglected youth report
elevated symptoms of dissociation compared with
nonmaltreated youth (Macfie, Cicchetti, & Toth, 2001).
• Others have found that sexually abused and neglected
children are more likely to develop an external locus of
control, with perceived external control accounting
substantially for their elevated symptoms of internalizing
problems (Bolger et al., 2001).
MODERATORS OF MALTREATMENT ON
RISK FOR PSYCHOPATHOLOGY
 Characteristics of the Maltreatment
 Maltreatment subtype
 Maltreatment chronicity
 Developmental timing
 Characteristics of the Individual
 Sex
 Race
 Personality characteristics
 Genotype
 Characteristics of the Environment
 Neighborhood
 Social support
 Family environment
CLINICAL TREATMENT OF
MALTREATED CHILDREN
 The strongest empirical support is for trauma




focused cognitive behavioral therapy
Dynamic play therapy for children with sexual
behavior problems and their caregivers (group
therapies)
Cognitive processing therapy
Eye movement desensitization and reprocessing
therapy
Multisystemic therapy
Parent-child interaction therapy
CONCLUSION
 Basic research: Would benefit from more longitudinal research is needed to
better understand the course of resilience and dysfunction over time.
 Biology research: Would benefit from larger and more representative
samples.
 Research on psychological sequelae of maltreatment: Would benefit from
research designs that allow for stronger causal inferences about potential
mediators of maltreatment.
 Multilevel perspective research: Is needed to trace the effects of
maltreatment on pathways from genes to brain to behavior.
 Clinical research: More research is needed to better evaluate treatment
efficacy for maltreated children, to improve access to services and the quality
of services for maltreated children, and to understand why some maltreated
children respond better to treatment than others.