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Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

Molecular Psychiatry volume 27, pages 1331–1338 (2022)Cite this article

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Abstract

Childhood maltreatment is the most important preventable risk factor for psychiatric disorders. Maltreated individuals typically develop psychiatric disorders at an earlier age, have a more pernicious course, more comorbidities, greater symptom severity, and respond less favorably to treatments than non-maltreated individuals with the same primary DSM-5 diagnosis. Furthermore, maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response, and inflammatory marker levels not discernible in their non-maltreated counterparts. Hence, maltreated and non-maltreated individuals with the same primary DSM-5 diagnoses appear to be clinically and neurobiologically distinct. The failure to embody this distinction in DSM-5 has interfered with our ability to discover novel treatments, to recommend currently available treatments most likely to be efficacious, and has been a largely unrecognized confound that has thwarted our ability to identify the biological basis for major psychiatric disorders. Incorporating this distinction into DSM will help transform this sign and symptom-based classification system to a more etiologically informed nosology. We discuss several diagnostic alternatives and recommend the inclusion of a Developmental Trauma Disorder diagnosis for severely dysregulated individuals, of all ages, with numerous comorbidities, who experienced interpersonal victimization and disruptions in attachment, such as emotional maltreatment or neglect. For less severely affected maltreated individuals, we suggest using conventional diagnostic categories, such as major depression, but with an essential modifier indicating a history of childhood maltreatment, or early life stress, to delineate the ecophenotypic variant. Implementing this strategy should improve our ability to effectively diagnose and treat individuals with psychiatric disorders and to accelerate discovery.

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Acknowledgements

We thank Kelly Puzdrak for technical assistance. Sources of support include NIH RO1 awards HD-079484 (MHT), DA-017846 (MHT), MH-117293 (CBN), AA-024933 (CBN), and funding from the ANS Foundation (MHT).

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Authors and Affiliations

  1. Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, 02478, USA

    Martin H. Teicher

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA

    Martin H. Teicher

  3. Citizens Review Panel-Critical Incidents, Office of Child Abuse Prevention, California Department of Social Services, Sacramento, CA, USA

    Jeoffry B. Gordon

  4. Institute of Early Life Adversity Research, The University of Texas at Austin, Austin, TX, 78712-1873, USA

    Charles B. Nemeroff

  5. Mulva Clinic for the Neurosciences, The University of Texas at Austin, Austin, TX, 78712-1873, USA

    Charles B. Nemeroff

  6. Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, Austin, TX, 78712-1873, USA

    Charles B. Nemeroff

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Contributions

JBG and CBN conceived the idea and wrote the initial drafts. MHT wrote the final drafts and supplementary materials with input from the other co-authors.

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Correspondence to Charles B. Nemeroff.

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Competing interests

MHT has created rating scales to retrospectively assess type and timing of exposure to CM [16] but there is no financial conflict as he has placed these scales into the public domain. MHT has also received research or consulting fees (last 12 months) from the NIH, Interactive Metronomeâ„¢, Brain Balance Centersâ„¢, the ANS Foundation, and MindLightâ„¢. MHT is on the Scientific Advisory Board for the Juvenile Bipolar Research Foundation and member of the Board of Children, Youth and Families at the National Academies of Sciences, Engineering and Medicine and a member of the Board of Directors of the Trauma Research Foundation and the Kahn Family Foundation. MHT has been awarded 19 US Patents, none of which are relevant to this article. CBN has received grant support from the NIH. During the last 12 months, he has consulted to ANeuroTech (division of Anima BV), Signant Health, Sunovion Pharmaceuticals, Inc., Janssen Research & Development LLC, Magstim, Inc., Navitor Pharmaceuticals, Inc., Intra-Cellular Therapies, Inc., EMA Wellness, Acadia Pharmaceuticals, Axsome, Sage, BioXcel Therapeutics, Silo Pharma, XW Pharma, Neuritek, Engrail Therapeutics, and Corcept Therapeutics Pharmaceuticals Company. CBN is a stockholder in Xhale, Seattle Genetics, Antares, BI Gen Holdings, Inc., Corcept Therapeutics Pharmaceuticals Company, and EMA Wellness; he is on the Scientific Advisory Board for ANeuroTech (division of Anima BV), Brain and Behavior Research Foundation (BBRF), Anxiety and Depression Association of America (ADAA), Skyland Trail, Signant Health, Laureate Institute for Brain Research (LIBR), Inc., Magnolia CNS; and he is on the Board of Directors for Gratitude America, ADAA, and Xhale Smart, Inc. CBN holds two patents: Method and devices for transdermal delivery of lithium (US 6,375,990B1) and Method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2). He is not a part of any Speakers Bureau. JBG has no potential conflicts of interest to disclose.

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Teicher, M.H., Gordon, J.B. & Nemeroff, C.B. Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education. Mol Psychiatry 27, 1331–1338 (2022). https://doi.org/10.1038/s41380-021-01367-9

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