Anxious arousal predicts within-person changes in hippocampal volume in adults with a history of childhood maltreatment: A CAN-BIND4 report.

Abstract

Childhood maltreatment (CM) is a strong transdiagnostic risk factor for future psychopathology. This risk is theorized to emerge partly because of glucocorticoid-mediated atrophy in the hippocampus, which leaves this area sensitive to further volume loss even through adulthood in the face of future stress and the emergence of psychopathology. This proof-of-principle study examines which specific dimensions of internalizing psychopathology in the context of a CM history are associated with decreases in hippocampal volume over a 6-month period. This study included 80 community-recruited adults (ages 18–66 years, 61.3% women) oversampled for a lifetime history of internalizing psychopathology. At baseline and a naturalistic 6-month follow-up, the symptom dimensions of the tripartite model (anxious arousal, anhedonic depression, and general distress) were assessed by self-report. Hippocampal volume was derived through T1-weighted magnetic resonance imaging scanning segmented via the volBrain HIPS pipeline. CM severity was determined via a semistructured, contextual interview with independent ratings. We found that higher levels of anxious arousal predicted decreases in hippocampal volume over time in those with greater severity of CM but were associated at a trend with increases in hippocampal volume over time in those with lower severity of maltreatment. Findings were specific to anxious arousal and the CA1 subregion of the hippocampus. These novel results suggest that for individuals with a history of CM, transdiagnostic interventions that target and reduce psychological and physiological arousal may result in the preservation of hippocampal structure and, thus, improvements in cognitive and emotional regulation in the face of stress.

Studying fine-grained elements of psychopathology to advance mental health science.

“…In response to the first question, several author teams suggested symptoms as the starting point for fine-grained investigations—either those that are explicitly included in the DSM , or those that are a part of models such as the tripartite model of anxiety and depression (e.g., Rowe et al, 2023). This approach is interesting to consider in light of the limitations of the extant diagnostic systems described above.…”

To fully leverage fine-grained clinical phenomena, we have to think beyond DSM-based concepts and the presumption of diagnostic kinds.

“…However, this implies that mechanisms are nested within—and, therefore, relevant only to—the most fine-grained symptoms, such that higher-order dimensions are just convenient summaries for data reduction rather than potentially substantive constructs in and of themselves. Articles in this special section (e.g., Pasion et al, 2023; Rowe et al, 2023) demonstrate that psychopathological processes and mechanisms are themselves hierarchical. Complex systems theory (Olthof et al, 2023) takes this premise a step further in looking at dynamics theorized to represent general principles of clinical change, which suggests further avenues for hierarchical integration.…”

“…This section is a remarkable effort led by three researchers who approach psychopathology in different, but complementary ways. Fittingly, the articles comprising this section provide distinct perspectives on the target topic, including genetics (Waldman & Poore, 2023), neuroanatomy (Rowe et al, 2023), psychophysiology (Pasion et al, 2023; Stange et al, 2023), epidemiology (Karlovich et al, 2023), and intervention (Olthof et al, 2023). I carry this stance of pluralistic collegiality into my commentary as well.…”