The complex neurobiology of resilient functioning after childhood maltreatment

Abstract

Background: Childhood maltreatment has been associated with significant impairment in social, emotional and behavioural functioning later in life. Nevertheless, some individuals who have experienced childhood maltreatment function better than expected given their circumstances. Main body: Here, we provide an integrated understanding of the complex, interrelated mechanisms that facilitate such individual resilient functioning after childhood maltreatment. We aim to show that resilient functioning is not facilitated by any single 'resilience biomarker'. Rather, resilient functioning after childhood maltreatment is a product of complex processes and influences across multiple levels, ranging from 'bottom-up' polygenetic influences, to 'top-down' supportive social influences. We highlight the complex nature of resilient functioning and suggest how future studies could embrace a complexity theory approach and investigate multiple levels of biological organisation and their temporal dynamics in a longitudinal or prospective manner. This would involve using methods and tools that allow the characterisation of resilient functioning trajectories, attractor states and multidimensional/multilevel assessments of functioning. Such an approach necessitates large, longitudinal studies on the neurobiological mechanisms of resilient functioning after childhood maltreatment that cut across and integrate multiple levels of explanation (i.e. genetics, endocrine and immune systems, brain structure and function, cognition and environmental factors) and their temporal interconnections. Conclusion: We conclude that a turn towards complexity is likely to foster collaboration and integration across fields. It is a promising avenue which may guide future studies aimed to promote resilience in those who have experienced childhood maltreatment.

Systems all the way down: embracing complexity in mental health research

“…Ioannidis et al [9] further explore the effects of childhood maltreatment in an integrated overview of the neurobiological mechanisms underlying resilience. The authors embrace a systems perspective, conceptualizing resilience to adverse events in childhood as a product of a complex biopsychosocial system that includes both bottom-up (genetic and endocrinological) and top-down (social and psychological) influences.…”

Embracing the positive: An examination of how well resilience factors at age 14 can predict distress at age 17

“…To this end one could for example focus on resilience predictors reviewed by Kalisch and colleagues (2015; including hair cortisol concentration, trait self-enhancement, expression of specific gene networks, and cortisol stress reactivity), 60 or on factors that predict resilient growth trajectories and resilient functioning outcomes as reviewed by Bonanno and colleagues (2011; including perceived control, high positive affectivity, low negative affectivity, trait resilience, low brooding, coping self-efficacy, emotional support, social support, instrumental support, favorable worldviews, and positive emotions), 61 or on factors that relate to resilient functioning specifically following childhood maltreatment, as reviewed in Ioannidis and colleagues (2020; including the social environment as well as biological factors related to the hypothalamic-pituitary-adrenal axis and polygenetics). 62 Overall, our results showed that the RFs were able to correctly predict the categorical ('low'/'moderate'/'high') distress class of 2 in 3 adolescents three years later. This finding was highly similar when predicting age-17 from age-14 distress.…”

Embracing the positive: an examination of how well resilience factors at age 14 can predict distress at age 17

“…Moreover, while this manuscript specifically focusses on using RFs that predict mental health problems (in individuals with and without CA exposure), it would be interesting to see future research taking the same modelling approach but focussing on those factors that predict a resilient functioning outcome. To this end one could for example focus on resilience predictors reviewed by Kalisch et al (including hair cortisol concentration, trait self-enhancement, expression of specific gene networks, and cortisol stress reactivity) 58 , on factors that predict resilient growth trajectories and resilient functioning outcomes as reviewed by Bonanno et al (including perceived control, high positive affectivity, low negative affectivity, trait resilience, low brooding, coping self-efficacy, emotional support, social support, instrumental support, favourable worldviews, and positive emotions) 59 , or on factors that relate to resilient functioning specifically following childhood maltreatment, as reviewed in Ioannidis et al (including the social environment as well as biological factors related to the hypothalamic-pituitary-adrenal axis and polygenetics) 60 .…”