Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology

Abstract

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.

Future Directions in Childhood Adversity and Youth Psychopathology

“…In addition to heightened neural responses in regions involved in salience processing, consistent associations between exposure to threatening environments and elevations in self-reported emotional reactivity to the environment have been observed in our lab and elsewhere (Glaser, Van Os, Portegijs, & Myin-Germeys, 2006; Heleniak, Jenness, Van Der Stoep, McCauley, & McLaughlin, in press; McLaughlin, Kubzansky et al, 2010). Atypical physiological responses to emotional cues have also been documented consistently among children who have experienced trauma, although the specific pattern of findings has varied across studies depending on the specific physiological measures and emotion eliciting paradigms employed.…”

“…For example, exposure to threatening environments early in development is associated with habitual engagement in rumination, a response style characterized by passive focus on feelings of distress along with their causes and consequences without attempts to actively resolve the causes of distress (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). High reliance on rumination as a strategy for responding to distress has been observed in adolescents and adults who were abused as children (Conway, Mendelson, Giannopoulos, Csank, & Holm, 2005; Heleniak et al, in press; Sarin & Nolen-Hoeksema, 2010), adolescents who experienced victimization by peers (McLaughlin, Hatzenbuehler, & Hilt, 2009), and both adolescents and adults exposed to a wide range of negative life events (McLaughlin & Hatzenbuehler, 2009; Michl, McLaughlin, Shepherd, & Nolen-Hoeksema, 2013), although the latter findings are not specific to threat per se.…”

Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys

“…One potential mechanism involves heightened salience of threat cues and magnified emotional reactions to potential threats. Child maltreatment is associated with elevated emotional reactivity to negative stimuli, as measured using self-report, 41,42 ecological momentary assessments of daily responses to stressful life events, 43 and amygdala response to negative stimuli. 44-47 Similar patterns have been observed in children of parents with psychopathology.…”

Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis

“…As a literature these studies suggest an increased emotional and physiologic reactivity to stressors following childhood maltreatment (McLaughlin et al . 2010b; Heleniak et al . 2016), but this is not often measured.…”