1. Prof. dr. Bernet M. Elzinga Section Clinical Psychology Leiden University Neurobiological Consequences of Childhood Abuse and Neglect

2. Long term psychological effects of childhood abuse and neglect Spinhoven et al., 2010; Norman et al., 2012; Nanni et al., 2012 3x increased risk to develop depression, with early onset, chronic and severe trajectory, suicidality & poor treatment response

3. Childhood < 18 jaar Adulthood ? How does childhood abuse gets under the skin, to affect risk for later psychopathology? How does childhood stress incubates in the body, manifesting in psychopathology several decades later? Child Abuse → Psychopathology epigeneticsbrain functioning

4. Impact of childhood abuse and neglect on brain development Early childhood: Fear and Safety learning, -Limbic system Puberty: Emotion Regulation, -Prefrontal brain regions Two key developmental stages of neural plasticity:

5. Van Harmelen et al., 2013, SCAN * * * I. Fear Learning

6. Amygdala response ↑ to faces in adults with reported history of emotional abuse and neglect Van Harmelen et al., 2013, SCAN ► Pattern consistently observed in (male and female) with depression, anxiety, and healthy controls ► Not explained by psychopathology, gender, nor neuroticism or recent life events * * *

7. Abused children earlier recognition angry faces Pollak & Kistler, 2002

8. Amydala activation to faces associated with avoidance of eye contact in neglected children Tottenham et al., 2011

9. Van Harmelen et al., 2013, SCAN * * * in response to social exclusion II. Emotion Regulation

10. Impact of Social Exclusion in individuals with history of childhood emotional abuse and neglect Gunther Moor et al, 2011 Van Harmelen et al., 2014, PLoS ONE II. Emotion Regulation Self-referential processing (e.g., rumination)

11. Heredity Negative self-inferences and rumination Negative self-inferences and rumination depression & anxiety Model long-term Consequences of Maltreatment Increased stress reactivity during social interactions Increased stress reactivity during social interactions COGNITIVE / NEUROBIOLOGICAL VULNERABILITY COGNITIVE / NEUROBIOLOGICAL VULNERABILITY Childhood maltreatment stressor Nature – Nurture?

12. Heredity Negative self-inferences and rumination Negative self-inferences and rumination depression & anxiety Model long-term Consequences of Maltreatment Increased stress reactivity during social interactions Increased stress reactivity during social interactions COGNITIVE / NEUROBIOLOGICAL VULNERABILITY COGNITIVE / NEUROBIOLOGICAL VULNERABILITY Childhood maltreatment Intergenerational transmission of abuse Nature – Nurture? crying child

13. Summary / Implications Childhood abuse, particular emotional abuse and neglect are most salient risk factors for emotional distress on long-term. Effects are transmitted not only on conscious level (‘you are a bad child!’), but also on implicit level by means of changes in neural reactivity In 30%, childhood abuse is transmitted to next generation: family studies and longitudinal studies needed to disentangle nature & nurture Family interventions (e.g., during early childhood, but also adolescents with depression) crucial to break vicious cycle

14. Thank you for your Attention University of Leiden  Prof. dr. Ph. Spinhoven  Drs. A. van Harmelen (PhD)  Prof. dr. E. Crone  Prof. dr. N. van der Wee  Free University Prof. Dr. B.W.J.H. Penninx Prof. dr. D. Veltman University of Groningen  Prof. dr. A. Aleman