INTRODUCTION

The US Federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as the recent act or failure of parents and caretakers resulting in physical or emotional injury, sexual exploitation, and/or death. According to national statistics on the prevalence of childhood abuse and neglect in the United States, 905,000 people under 18 years of age were victimized during 2006. Of these, 64.1% were neglected; 16.0% were physically abused; and 15.1% suffered abandonment, threats of harm, congenital drug addiction, or other forms of maltreatment. Furthermore, 8.8% were sexually abused; 6.6% were either emotionally or psychologically maltreated; and 2.2% were medically neglected.

Childhood maltreatment is a major risk factor for the development of depression, drug and alcohol abuse, posttraumatic stress disorder (PTSD), bipolar disorder (BPD), personality disorders, and aggression. Depending on an individual's sex, genetic makeup, and age at insult, chronic childhood traumatic stress (CTS) alters the endocrine profile and gene-expression pattern, as well as the functional activity, hemispheric integration, and morphology of the brain. In this chapter, we offer a holistic portrayal of the pathways between maltreatment and adverse psychiatric outcomes, arguing that the impact of abuse and neglect is best understood in the context of normal ontogenetic processes relating to trajectories of brain development.

NEUROPSYCHIATRIC EFFECTS OF TRAUMA

Several studies have documented the consequences of exposure to CTS. One of the most compelling is the Adverse Childhood Experience (ACE) Study, led by Vincent Felitti and Robert Anda (Felitti et al., 1998).