We easily understand how beating a child may damage the developing brain, but what about the all-too-common psychological abuse of children? Because the abuse was not physical, these children may be told, as adults, that they should just “get over it.”
But as developmental neuropsychiatrist Martin Teicher reveals, scientists are discovering some startling connections between abuse of all kinds and both permanent debilitating changes in the brain and psychiatric problems ranging from panic attacks to posttraumatic stress disorder. Teicher sees not only a wake-up call for our society but hope for new treatments.
We know that the abuse or neglect of children is tragically common in America today. Nor are most of us surprised when studies point to a strong link between the physical, sexual, or psychological maltreatment of children and the development of psychiatric problems. Too often people minimize the impact of early abuse. They make it easy to reproach the victims to say, in so many words, “Get over it.”
Physical, sexual, and psychological trauma in childhood may lead to psychiatric difficulties that show up in childhood, adolescence, or adulthood. The victim’s anger, shame, and despair can be directed inward to spawn symptoms such as depression, anxiety, suicidal ideation, and posttraumatic stress disorder, or directed outward as aggression, impulsiveness, delinquency, hyperactivity, and substance abuse.
The trauma of abuse induces a cascade of effects, including changes in hormones and neurotransmitters that mediate development of vulnerable brain regions. Trauma causes brain damage, not the other way around.
There are four major components of brain abnormalities associated with childhood abuse.
- Limbic irritability is manifested by markedly increased prevalence of symptoms suggestive of temporal lobe epilepsy and by an increased incidence of clinically significant brain wave abnormalities. Abuse before the age of 18, when the brain is still rapidly developing, has a greater impact on limbic irritability than later abuse.
- Deficient development and differentiation of the left hemisphere is manifested throughout the cerebral cortex and the hippocampus, which is involved in memory retrieval.
- Deficient left-right hemisphere integration is indicated by marked shifts in hemispheric activity during memory recall and by underdevelopment of the middle portions of the corpus callosum, the primary pathway connecting the two hemispheres.
- Abnormal activity in the cerebellar vermis (the middle strip between the two hemispheres of the brain), which appears to play an important role in emotional and attentional balance and regulates electrical activity within the limbic system.
Many disorders are associated with childhood abuse. One is depression or heightened risk for developing it. Many scientists believe that depression may be a consequence of reduced activity of the left frontal lobes. If so, the stunted development of the left hemisphere related to abuse could easily enhance the risk of developing depression. Similarly, excess electrical irritability in the limbic system and alteration in development of receptors that modulate anxiety, set the stage for the emergence of panic disorder and increase the risk of posttraumatic stress disorder. Alterations in the neurochemistry of these areas of the brain also heighten the hormonal response to stress, producing a state of hyper vigilance and right-hemisphere activation that colors our view with negativity and suspicion. Alterations in the size of the hippocampus, along with limbic abnormalities shown on an EEG, further enhance the risk for developing dissociative symptoms and memory impairments.
 Wounds That Time Won’t Heal, The Neurobiology of Child Abuse, Martin H. Telcher M.D. Ph.D, The Dana Foundation, October 1, 2000