About Adoptee Rage

Statistics Identify large populations of Adoptees in prisons, mental hospitals and committed suicide.
Fifty years of scientific studies on child adoption resulting in psychological harm to the child and
poor outcomes for a child's future.
Medical and psychological attempts to heal the broken bonds of adoption, promote reunions of biological parents and adult children. The other half of attempting to repair a severed Identity is counselling therapy to rebuild the self.

Sunday, May 31, 2015

Adopted Child's Lack of Past or Future Perspective

ADOPTEE RAGE!

Adopted Child's Lack of Perspective
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The adopted child's only possessions are his conception, birth, psychological beginning and past, Identity, parent & family and history are erased and kept as legal secrets from the adopted child.

The only psychological possessions that belong to the human individual constitute his dignity, history and belonging.

Adopted children are robbed of their only psychological possessions and legally kept from knowing these dignifying self- esteem based knowledge are the personal possessions that constitute the foundations of all human beings.

The beginning of life, genetic and ancestral history and the biological family make up the welcoming committee for human birth. When these possessions are taken away from an individual and replaced with temporary substitute identity, family and a blank history we have no beginning of which we started.
Without a beginning we can not conceive of the future, so adoptee's are compromised to living in the present without future or past.

Adoptee's can not calculate or plan future events, as the concept of future doesn't compute.
The adopted child can't plan, can't save money, cant see beyond today. Although life goes on, day after day, for the adopted child life is only about the now.
As the concept of the future is not achievable without the cognitive knowledge of the whole time frame of an individual's life.

Adult adoptee's attempting to make sense of search and reunion dialog takes an enormous amount of time to recreate the past through third party of what took place in the past, exaggeration and omission of serious details plague the truth and vague the facts of informational versions that are biased to the person retelling their history.

Adoptees must sift through other peoples truths to find shreds of personal truth that apply to the adoptee's omitted history.

When we think we have found some truth in facts they are discounted by yet another relatives version of what went on in childhood's past.

We find ourselves piecing together a puzzle of which we can't obviously identify the pieces, and only know the general outline of the end result.

The life of an adoptee must be put together with great patients as the people we are forced to rely on for answers have personal stakes in keeping the past a secret or a humiliation for them in uncovering the truth of one's origins. There are no simple questions in adoption and the answers are dialogues that the truth must be sifted out of the thousands of sentences that make up novels of third party lives.
  

Adoption's Bitter Truths

ADOPTEE RAGE!

Adoption's Bitter Truths
Part 1 Series Link Below
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LINK:www.dailykos.com/story/2013/09/30/1242457/-Adoption-Series-Part-1-Bitter-Truths

By Ladijules

There has been so many stories about adoption and its issues in the news lately that I thought it was time to discuss the issues surrounding it. Depending on who you talk to, Adoption is either a tale of rainbows and unicorns, or a tale of abuse and atrocity. The reality is... its both, depending on who you talk to.
For some birth parents, adoption means that they no longer need to be responsible for a life they brought into this world. Hopefully, that child will go on to a better life, a better one than they could provide. In some cases, it means that the birth parent can go on and build a better life for themselves without the baggage of a child. In other cases, its a way to earn money. In yet other cases, its a way to deny custody to the other parent out of spite. Then there are the cases where giving up this child is a way to to recover from a terrible tragedy, such as a child born of rape. In the cases of a parent that is abusive or incarcerated.... its either a relief, a way to get rid of an annoyance or a great sadness. The stories are as varied as the people involved.
For adoptive parents, adoption is a way to fill the need to have a child when the universe has chosen to deprive them of the ability to have children of their own. It can be a way to make their family larger, or even a case of charity. It can also be a way to give a child a good home... or to get a child as a fashion accessory or in the worst case... to get a child to abuse. Again, the stories are as varied as the people involved.
The stories for adoptees are also different. What bothers me the most is how rare it is to hear the stories from adoptees. Whether we came out of foster care, were given up by scared mothers at birth, were taken away by shady adoption agencies.... our stories are all different, but rarely heard. No one hears OUR stories, no one cares about how adoption affects those of us who bear the title of "adoptee". So many people have no idea of the discrimination we face, the questions we can not get answers to, the hollow feelings we feel, the displacement and anger that can come with those things.
So I decided to tell not only my story, but let the world know about the problems facing adoptees as well as the horrors of the "adoption industry". I will be doing this as a series of articles, since doing it as one article would be REALLY long. But its time the world finally acknowledged the reality: Adoption is not the warm and fuzzy THING so many people want you to believe. Its time to face the truth.
FROM AN ADOPTEES POINT OF VIEW
I will start this with my own story. Those of you who have not been adopted often don't "get" where adoptees are coming from or the problems we face or why we are the way we are. From this you will at least know ONE story... I hope you will go out an ask your friends who have been adopted for THEIR stories. Perspective is an important thing.
I was adopted from foster care when I was 3 years old. My birth mother, who I was lucky enough to find before her death, was seventeen when she gave birth to me. Being a teenage, single parent tends to be a common story... until you start digging into my particular case. My birth mothers story wasn't ordinary, in fact, it was pretty horrible.  My mothers name was Bernadine and I was not her first child. Her first child was my sister Francis... born when my birth mother was all of 14. She was married... or rather, married OFF, at thirteen to a man much older than her, because her mothers new husband was a little TOO interested in her and her mom felt there would be "less competition" for the mans affection if Bernadine wasn't there.
She managed to keep Francis, for awhile anyway. My older sister ended up in foster care after Bernadine's husband left her. At 14, with no support, my birth mother had no way to take care of Francis or herself nor was she mentally stable enough to do so. (Rather understandable, really). She lost custody of Francis to foster care and later, while in a mental hospital, she hooked up with another man and ended up conceiving ME at 17. ( I should note for the record, that she told me she named me after a friend of hers. Its almost poetic that the "friend" i was named after later went to Johnstown with her children and some insane idiot name Jim Jones and "drank the kool-aid".)
The reality here is simple and I fully admit it. Bernadine didn't have a snowballs chance in hell of raising her kids or being a decent parent. She had no support, had come out of an abusive and uneducated home, had no job prospects and had mental health issues as well as being negligent and abusive. The fact she would lose custody of my sister and I was a forgone conclusion.
FOSTER CARE - IT SUCKS
So my sister and I were placed in foster care. From the few records I have been able to find, we were bounced from foster home to foster home over a period of 2 years. For awhile, we were placed in the same home. We finally found our way to a foster home that wanted to adopt us both. They were an older couple who had had us awhile and loved us both. Eventually, they filed for adoption. This should have been the happy end to a rough story. The couple gets to keep the kids they love, the kids stay together and live happily ever after. Too bad it didn't end that way.
Our foster care caseworker, in all her infinite wisdom, decided to pull us out of that home and to place us separately. I have no idea why she did this. All I can say is that decision was certainly NOT in our best interest. My sister was instead adopted out to another family and to this day, I have never seen her again. ( I HAVE spoken to her... I found her on Facebook two years ago.) I was adopted out to what everyone would think was a perfect placement: An upper middle class family with 5 kids of their own, living in a perfect little neighborhood with perfect little credentials. Their reason for adopting me was because they only had 1 girl and 4 boys, and they wanted another girl. Besides, the church had handed out flyers about kids needing an adoptive home and I was cute. For all that I was 3 years old, I remember the day they took me away from my foster home. I can even tell you I was watching the show "Family Affair" on TV. I can describe the house I was taken from, how many stairs from the front door to the ground, that I got to take my yellow electric car named George with me when I left. Don't let them tell you that a kid that young won't remember their past. Trust me.. we do.
This should have been another happy ending to a bad story. Sorry, it doesn't work out that way. Don't get me wrong. I loved my adoptive parents. They weren't bad people. They just had NO IDEA what they were getting into or how to deal with it. The adoption agency never bothered to give them a reality check. The adoption agency was more interested in getting money from the state to place a "hard to adopt" child than anyone's best interest.
My adoptive parents were given this sweet, cute 3 year old girl with honey blonde curls. They had no idea that the sweet little child would later be diagnosed with Reactive Attachment Disorder and ADHD, wouldn't be able to bond with parents after all the trauma she went through and that her issues would require intensive treatment. They had no idea that the sweet little child, so needing of LOVE would become the perfect victim of a sexual predator in the family, who preyed on children desperately in need of someone to ACCEPT them as they were. They had no idea that this child was at least smart enough to know that telling someone about this abuse would become a "blood is thicker than water" issue and everyone would believe the predator over a child that wasn't really a blood relative. They had no idea that they had pulled this cute child out of a place the child felt safe to a place proven unsafe and had torn that child away from her sister.. the only family she had left. They had no idea of the living hell this child would go through because the child did not have answers to "where did I come from" and "why am I here". They had no idea how horrible it would be for this child going through school, being told "You were so hated by your birth parents that someone else was forced to take you". They had no idea that their other children weren't exactly thrilled with the "new arrival". They had no idea of the hell this pretty little child would go through on the path to adulthood and beyond.
It wasn't my adoptive parents fault. They did the best they could. Most of the damage had been done before I ever walked into their house, courtesy of the very system that was meant to protect me. At the time, there were no studies about adopted children or the problems they would face in life. There certainly were no "best practice" therapies to deal with the problems adoptees face by being separated from their comfortable environments or the people in their young lives they had bonded with. Matter in fact, the therapies even now for Reactive Attachment disorder are more like a hope and a prayer... sometimes effective but often dangerous.
I survived. I made it to adulthood... more by luck than design. My path has lead me through some pretty dark places. I've been a runaway on the streets of Los Angeles. I have used and abused drugs. I've been to juvenile hall in my day. I am fortunate that now I'm a middle aged lady who has been married for almost 25 years and has two children. I have a house and a job. That alone is something of a triumph.
So why am I telling you all this? Because I NEVER forget I am "adopted". I never forget that my story starts with "you were not wanted". Being adopted is so much a part of my own story and how I view the world that it is never far from my mind. My own journey through adoption has showed me its reality. Its the reason why when I see all those stories about "Adoption... its a loving choice!"  I wince. For me and for many like me, adoption wasn't a loving choice. It wasn't rainbows and unicorns. It was and still is a dirty reality. It speaks of a terrible disruption of the "natural order of things". It means a separation of what "should have been". It means that in the beginning... we were not wanted.
ADOPTEES - WE ARE DIFFERENT
I find it funny that so many slogans about adoption give this idea that an adoptive child is "just like having your own kid". I don't know what dipshit came up with THAT load of horse crap. Adoptive parents might think thats true. Most adoptees don't think that way at all.
I remember as a teenager I used to be able to spot fellow adoptees a mile away. Of the kids I went to school with, I could have picked the adoptees out of a crowd with no prior knowledge. It had nothing to do with the fact that we looked DIFFERENT than our adoptive parents. For all that I'm sort of white and so were my adoptive parents, that wasn't it. So often, its because we were TREATED different.  Not just by our adoptive parents, but by society as a whole. We seemed to have a whole different "vibe" to us. I'm not saying it was either good or bad... it was just different and because of that, we were treated "different". We seemed to be the kids that stuck out. The kids that seemed to be treated as outsiders in our own families.
One of the kids I knew, whose name was Russ, was a perfect and very conspicuous example of "treated different" and being a stranger in his own family . EVERYONE knew he was adopted. There was no way to avoid it. He was adopted because his parents wanted another child. They already had one biological child and adopted Russ because they "wanted one more". He didn't look that much different really. One more white kid in a family of white kids. Unfortunately for Russ, after he was adopted his parents conceived again and had a baby girl. They made it quite clear in the way they treated him as well as the screaming from the house that they should never have adopted him and treated him differently because he was not biologically theirs. They frequently told him how much they regretted adopting him when it became obvious they could have another child of their own, and usually did this at the top of their voice for the entire neighborhood to hear. They definitely treated him different.... his siblings were spoiled rotten.... Russ was verbally abused any time his parents had the opportunity. When I last saw the poor guy, he was depressed to the point of contemplating suicide. I recently checked his sister's facebook page and I noticed he wasn't on it and I can find no record of whatever happened to him. I have a bad feeling he was yet another victim of a bad adoption..... a causality of the "adoption wars". Another child treated "differently"... another child who fell victim to the idea of "adoption.. its a loving option" mentality. Another child who had to deal with the reality of adoption. What is sadder is stories like Russ's aren't even uncommon. I often wonder..... what fairy tale did they tell his birth mother? Did they tell her he would go to a nice, upper middle class home where he would be well cared for? Would she even care about the reality of what her son had to face?
I admit, not looking like everyone else in the family is difficult. Its not just the color of the skin. Adoptees go through life NOT KNOWING. Of not CONNECTING. For people who are raised with their biological parents, this doesn't sound like a big deal. They grow up knowing whose big feet they have, where they got that weird nose, why they are musically talented. Biological families take this simple information for granted. For Adoptees, living without that knowledge, it IS a big deal. As I'm writing this, my daughter came out to show me how she can move her big toe in this really odd way and how she can twist her tongue. Weird and stupid information as it is, she knows she can twist her tongue that way because she inherited that from her mom and can move her toes like that from her dad. To adoptees, we don't take this for granted. We grow up not knowing where we got the abilities we have, why our hair is curly, who we got our brown eyes from. It doesn't sound important, but when you don't know the answers to those simple questions, it bothers you. Those of us from closed adoptions deal with that lack of knowledge every day. From the simple questions of "who do we look like" to the more complicated "what is our medical history", we deal with a lack of knowledge that biological kids don't even think about. We grow up without the connections to our past and out biological families that everyone else just KNOWS. Not only does it drive US nuts, our doctors hate it too.
For those of us that are adopted, lack of knowledge and connection to our biological families means we get treated different. By doctors, by peers, by society, by parents. Doctors are annoyed by us, because we can't give them accurate information about family histories. Society treats us as second class citizens. We are often denied security clearance for jobs because we don't have accurate birth records. We have been denied citizenship and passports because the records we do have access to have been falsified by the state. We are treated as permanent children by the state, not to be trusted with our own birth records. Our adoptive parents often expect us to be oh so grateful that they "rescued" us. Our peers are sometimes cruel, as the kids I went to school with were. Every day, we live with the knowledge that we started life as "someone else's child".
I know this sounds all negative and that I hate adoption. That couldn't be further from the truth. I think providing a child who does not have a loving, stable home with a safe place to grow up is a wonderful thing. But I see the reality of adoption. Its not warm and fuzzy with rainbows and unicorns. Its not what all those posters of "Adoption.. its a loving option" try to make it out to be. Instead, it is a reality that those of us who have been adopted have to deal with every day... and often, that reality is harsh.
So as I see these stories of adoption pop up in the press, I wince. Every time. So often, the people reporting these stories have no idea the effect these stories are having on those of us that for so long had no voice. In the future, I will be discussing the issues surrounding adoption not with an unbiased eye, but as someone who has walked that path. From the issues with the "adoption" of Veronica Brown to the problems with re-homing covered so nicely by Reuters News service.... I see them through the eyes of an adoptee. Its time OUR story was told, Its time OUR voices on this subject were heard.
And yes... all these years later... I still wonder about Russ.

The hypocrisy In Adopttee's behavior and the lack of our own Child's Rights

ADOPTEE RAGE!

The Hypocrisy in Adoption and a Child's Rights
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I write about my own pain from being forced into  adoption, but I am a hypocrite to the suffering of my offspring child.
 I write about the selfish behavior of  adoptive parents and at the same time allowed the same secrecy that was forced on me to be forced on my own choice to bear a child alone. my own childish inexperience that has plagued my life without insight
has caused me to be guilty of omission, of not acting to ensure her life free of birth related secrets and the truths that continued year after year unknown to her.
I have much experience with people telling me that they don't want to hear it, so I shut my mouth. But there are things that we should be told regardless if we want to hear the possibility ow awful or secrets that are not so well absorbed or not.  One thing that I do know is that children change their minds, they are young and want emotional control of their own lives. My failure to bash, failure to mention, and deep down seeded fears of rejection are what propel  parents to ignore the complicated details when we are not asked.  I was afraid that the ugly might get mixed up with the good in my own recollection. I am forever ashamed of my soul of my very existence and all of the bad decisions that I perpetrated throughout my life. Those bridges that I always seem to set on fire after I cross them. Because I have no past, I can only exist in the now, unable to see any future beyond today. I have never possessed a past history so I don't know how to contemplate tomorrow, and unfortunately my tomorrow turns into ten years down the road. An adopted at birth infant's past is non existent and unknown as we do not even know who we are most of our lives. Adoptees are raised to believe in the temporary now and nothing beyond that pain or fear can educate us to the concept of time or the future where we do not exist. Omission is as guilty as commission as we are guilty of both. The secrets that our children do not want to hear is not the option we should listen to as they are children living by the direction of our distorted attempt at living.

Saturday, May 30, 2015

ADOPTEE'S Searching For The Meaning Of Life

ADOPTEE RAGE!

ADOPTEE'S Searching The Meaning Of Life
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The newborn infant that is intentionally subjected to separation trauma, Adoptee's prolonged suffering of isolation and the resulting in The Primal Wound, Constitute the lives of the adopted child's emotional tolerance of suffering. 

The plight of the adopted child is living the temporary life as someone other than who we truly are. We pretend to be a member of someone else's family.
The adoptive family is a temporary family that does not belong to us. Although the adopted child is emotionally blackmailed, triangulated and psychologically manipulated to believe we are beholden, indebted and emotionally obligated to the adoptive parent's. 

The adoption related "Saviors" is a culturally created position of prestige for those who take on charity to the extreme in securing unwanted,legally parent-less and legally sanctioned orphans as human cargo for sale to financially eligible  applicants in the adoption industry. The adoptive parent saviors, who "saved" as Jesus has saved us from our own true nature. The saviors "save us" adopted children from ourselves, our lives and the adoption industry created "plight" of being legally available, legally orphaned and forever marooned to the forbidden Island of the adoption industry's "No Return".

Yet the truths about the adoption industry's coercion, illegal and deceptive nature of this corrupt institution that takes a perfect newborn child and destroys all links to his humanity, destroys all assumptions of innocence and turns the newly born into the epitome of sinister corruption in the eyes of god. That labels a child bastard, the worthlessness of being born Illegitimate and the discards of society that label a mother's coveted offspring an unwanted undesirable and the philosophy of a somehow flawed newborn child. Even though the mother did not choose to have this child legally severed from her tightly held arms, the coercion, detestable psychological manipulations and the commonplace legal wrangling that the ignorant and temporary problematic have no choice but the forced submission to the institutions of domination. The adoption industry promotes the psychological raping of the innocent to benefit the highest bidder in the game of financial domination in the U.S. where the poor will always loose out to the dominant class's financial warfare, where morality benefit's the wealthy and empathy for a mother and her child is nonexistent.

As the truth of the adoption industry's corruption and it's bedfellows the Christian right's allocation of religion to support adoption laws for the chosen marketing of human cargo constitutes the immoral practices of the adoption industry's black market morality.     

When the adopted child gains the cognitive knowledge of the adult adoptee who exit's the adoption fog of deception we begin to see the truth of the coercion that made us victims to an immoral industry in human childhood sales.
Adoptees coming out of the adoption fog begin to see the truth for themselves of being used, pretending and perpetuating the lies and secrets of our adoptive parents. Truths that vilify the innocence of our biological parents that are broken and beyond repair from the adoption's intentional damage to the young, poor and vulnerable pregnant mother's who sustained emotional rape at the hands of those they trusted. The lives torn away leaving us as emotional islands with no connections to the past, present and future. We adoptees are set adrift without the courage to sustain us as we share in our real parent's constant and un relentless suffering that can never be healed, even with a miracle we are condemned to exist as the puppets for which we were purchased, that now hold no meaning except to serve as an example for how to destroy two people for the benefit of one.

The adoptee's search for meaning begins at the search and reunion place, but from there the search for life meaning can never end, as the search can not yield the answer to meaning in life for those victims stolen from their own destiny.      

Tuesday, May 26, 2015

Munchausen Syndrome By Proxy

ADOPTEE RAGE!

Adopted Child Abuse

Munchausen Syndrome In Adopted Children
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Münchausen syndrome by proxy (MSBP orMBP) is a behaviour pattern in which a caregiver fabricates, exaggerates, or induces mental or physical health problems in those who are in their care.  
With deception at its core, this behavior is an elusive, potentially lethal, and frequently misunderstood form of child abuse and/or medical neglect that has been difficult to define, detect, and confirm.
MSbP has also spawned much heated controversy within the legal and social services communities. In a handful of high-profile cases, mothers who have had multiple children die from SIDS ( sudden infant death syndrome) have been declared to have MSbP. Based on MSbP testimony of an expert witness, they were tried for murder, convicted, and imprisoned for several years. In some cases, that testimony was later impeached, resulting in exoneration of those defendants.

Signs and symptoms

In Münchausen syndrome by proxy, an adult caregiver makes a child appear mentally or physically ill or impaired by either fabricating symptoms or actually causing harm to the child, in order to gain the attention of medical providers and others. In order to perpetuate the medical relationship, the caregiver systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the child (e.g. by poisoning, suffocation, infection, physical injury). Studies have shown a mortality rate of between 6% and 10% of MSbP victims, making it perhaps the most lethal form of abuse.
A review found the average age of the person affected at diagnosis was 4 years; slightly over half of were aged 24 months or younger, and 75% were under six years old. The average duration from onset of symptoms to diagnosis was 22 months. Six percent were dead, mostly from apnea (a common result of smothering) or starvation and 7% suffered long-term or permanent injury. About half of them had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the victim or that were otherwise suspicious. The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.
In the above study, most presented with about three medical problems in some combination out of 103 different reported symptoms. The most frequently reported problems are apnea (26.8% of cases), anorexia / feeding problems (24.6% of cases), diarrhea (20%), seizures (17.5%), cyanosis (blue skin) (11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%), and fevers (8.6%). Other symptoms include failure to thrive, vomiting, bleeding, rash and infections. Many of these symptoms are easy to fake because they are subjective. For example, reports that "my baby had a fever last night" are impossible to prove or disprove. The number and variety of presented symptoms contributes to the difficulty in reaching a proper MSbP diagnosis.
The primary distinguishing feature that differentiates MSbP from "typical" physical child abuse is the degree of premeditation involved. Whereas most physical abuse entails lashing out at a child in response to some behavior (e.g. crying, bedwetting, spilling food), assaults on the MSbP victim tend to be unprovoked and planned.
Also unique to this form of abuse is the role that health care providers play by actively, albeit unintentionally, enabling the abuse. By reacting to the concerns and demands of perpetrators, medical professionals are manipulated into a partnership of child maltreatment. Challenging cases that defy simple medical explanations may prompt health care providers to pursue unusual or rare diagnoses, thus allocating even more time to the child and the abuser. Even without prompting, medical professionals may be easily seduced into prescribing diagnostic tests and therapies that are at best uncomfortable and costly, and at worst potentially injurious to the child. If the health practitioner instead resists ordering further tests, drugs, procedures, surgeries, or specialists, the MSbP abuser makes the medical system appear negligent for refusing to help a poor sick child and their selfless parent. Like those with Münchausen Syndrome, MSbP perpetrators are known to switch medical providers frequently, until they find one that is willing to meet their level of need; this practice is known as "doctor shopping" or "hospital hopping".
The perpetrator will continue the abuse because maintaining the child in the role of the patient satisfies the abuser's needs. The cure for the victim is to separate the child completely from the abuser. When parental visits are allowed, sometimes there is a disastrous outcome for the child. Even when the child is removed, the perpetrator may turn their attention to another child: a sibling or other child in the family.
More recently a psychiatric form of MSbP has been postulated - Psychiatric Munchausens Syndrome By Proxy - which involves the presentation of a psychiatric disorder in the child.
Münchausen by Proxy can also have many long-term emotional effects on a child. Depending on their experience of medical interventions, a percentage of child victims may learn that they are most likely to receive the positive maternal attention they crave when they are playing the sick role in front of health care providers. Several case reports describe Münchausen syndrome patients suspected of themselves having been MSbP victims. Seeking personal gratification through illness can thus become a lifelong and multi-generational disorder in some cases. In stark contrast, other reports suggest survivors of MSbP develop avoidance of medical treatment with post traumatic responses to it.  This variation possibly reflects that broad statistics on survivors of child abuse in general where around 30% go on to also become abusers even though a significant percentage do not.
The adult care provider who is abusing the child often seems comfortable and not upset over the child's hospitalization. While the child is hospitalized, medical professionals need to monitor the caregiver's visits in order to prevent any attempt to worsen the condition of the child. In addition, in many jurisdictions, medical professionals have a duty to report such abuse to legal authorities. Warning signs of the disorder include:.
  • A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling, and unexplained. Caused and/or portrayed/brought on by caretaker; particularly mother.
  • Physical or laboratory findings that are highly unusual, discrepant with patient's presentation or history, or physically or clinically impossible.
  • A parent who appears to be medically knowledgeable, fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients' problems.
  • A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention.
  • A parent who appears to be unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities.
  • The suspected parent may work in the health care field themselves or profess interest in a health-related job.
  • The signs and symptoms of a child's illness do not occur in the parent's absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
  • A family history of similar or unexplained illness or death in a sibling.
  • A parent with symptoms similar to their child's own medical problems or an illness history that itself is puzzling and unusual.
  • A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with a serious illness.
  • A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment.
  • A parent who seems to have an insatiable need for adulation or who makes self-serving efforts for public acknowledgment of their abilities.
  • A patient who inexplicably deteriorates whenever discharge is planned.
Caution is required in the diagnosis of MSbP/FII/FDP. Many of the items above are also indications of a child with organic, but undiagnosed illness. An ethical diagnosis of MSbP must include an evaluation of the child, an evaluation of the parents, and an evaluation of the family dynamics. Diagnoses based only on a review of the child's medical chart can be rejected in court.

Factual Differences Between Adopted Child and the Biologically Raised Child, Denied By Many Adoptive Parents

ADOPTEE RAGE!

The Factual Differences Between Biological Raised Child and the Adopted Child
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The many adoptive parents that claim they are offended by the obvious FACT that raising adopted children
is far different than bearing and raising biological offspring. The adoptive parent's that deny the obvious, also deny the facts of adoption that the adopted child has another set of parents, siblings, grandparents and extended family of which the temporary lost adopted child still exist in the minds, hearts and the biological ancestral family tree where the adopted child will one day claim his position within this genetic family tree.
  
The adoptive parent's that engage in pretending that there are no differences negatively impact the adopted child's psychological health and well being, as the adopted child must go along with the adoptive parent's charade of adoption pretense.

They don’t always feel the difference, ignore the obvious differences and more importantly, they don’t want to see the differences. This denial of the differences that the public can see but the adoptive parent's deny that these differences exist, makes the adopted child question the sanity of their adoptive parents, question the adoptive parent's motivation for living these lies and the adopted child feels ambiguity toward the factual truth which has become a questionable stand by the adoptive parent's denials of facts and truths.

The adopted child is not of the adoptive parent's genetic makeup, biological, Nor is the adopted child a blood relative.  
The adopted child usually possess abilities, personality traits, psychological gifts and physical talents that don’t run in the adoptive family.  The common mistake and psychological injury in adoptive families is to try to “make” the adopted child into a biological child by telling them what they will like and what they will do that is not natural to the disposition of the adopted child, but is forced on the adopted child in the adoptive parent's attempt to mold the adopted child into what they want will always fail miserably. 

  Perhaps the child doesn’t want to be a football player or a musician.  The true joy of being an adoptive parent is to love each of your children for their uniqueness.  They don’t know who they are, yet, having no family history to inherit, they live life with blinders on.

Not all adoption situations are the same, but following are some differences that generally apply to most adoptions –
            1) An adopted child has four parents.  He lives with two and he thinks about the other two even though he may never meet them. A) A biological child has two parents.
            2) An adopted child usually does not live with anyone he is related to, he has no biological tie.          A) The biological child is related to all members of his family.
            3) An adopted child has no ‘hand me down’ physical traits or common talents that run in the family. A) A biological child often has the binding element of being similar in physique, temperament, and talents to his parents and siblings.
            4) An adopted child knows he was placed into his family by other people’s decisions.   
A) A biological child was placed by nature’s decision. One is artificial and one is natural.
            5) An adopted child does not share naturally in the family heritage Forced By Legal adoption. 
A)  A biological child feels a sense of belonging and a natural affinity to his heritage.
            6) An adopted child was relinquished by his birth parents.  This issue can have a great impact on a large population of adoptees. A)  A biological child was born into a family and that is where he belongs.
A) the adopted child will one day return to his biological origins as an adult seeking truth and Identity.


Monday, May 25, 2015

The Adopted Child's Psychological Slavery

ADOPTEE RAGE!

The Adopted Child's Psychological Slavery
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According to relevant literature, slavery has been a legal institution in which one person the slave (adopted child) is the property of another the master (adoptive Parent). Slavery dates back to ancient times, but contemporary international treaties (Slavery Convention of 1926) consider slavery a crime against humanity.
However, slavery and human exploitation still exist. Along with them, we are left with a legacy of psychological slavery that we see in many adoptive homes where highly abusive relationships prevail between adoptive parents and their adopted child.
Many studies in the field of psychology and sociology explain psychological slavery based on an incident which occurred in 1973, where two robbers entered a bank in Stockholm, Sweden with guns and dynamite, took four hostages- three women and a man- and held them hostage for 131 hours. After their rescue, the hostages showed a peculiar behavior. These people who had been threatened, abused, and intimidated felt gratitude towards their captors and tried to protect them when expert investigations were made. One of the women became emotionally attached to one of the assailants and another began a campaign to raise funds for the legal defense of the criminals.  The phrase "Stockholm Syndrome" was coined as we see the behavior of abused and neglected children in defense of their parent perpetrators.  
As strange as it sounds, similar situations occur in daily life with abused children, battered women in relationships, prisoners of war, victims of incest, and generally in families where there is verbal, physical, emotional and sexual abuse perpetrated on the adopted child by the trusted adoptive parents.
The explanation lies in our survival instinct, described here as Stockholm Syndrome. When the lives of adopted child victims depend on the action of their assailant adoptive parents, the emotional reactions of some victims turn into gratitude once they survive, just as slaves may have also expressed gratitude when they were given their freedom. Similarly, in many contemporary families the victims, feeling hopeless, develop positive feelings toward the abuser or controller, rationalize to accept such behavior, react negatively to family or friends who try to rescue them, and have difficulty freeing themselves from the adoptive parent's emotional entrapment.
For psychological slavery to occur, research studies have found four typical situations:
◦ Perception of a threat, physical or psychological, and the conviction that misfortune can really occur;
◦ Appreciation of small acts of kindness by the abuser towards the victim;
◦ Isolation from others;
◦ Conviction that one is unable to escape the situation.
Just as in the case of the bank hostages in Sweden, interpersonal relationships where there is an abuse of power also establish a similar pattern which is hard to escape, resulting in psychological slavery. The adoptive parent repeatedly recounts their "savior" status to the unwanted adopted child. Repeatedly reminding the adopted child that they were saved by the adoptive parent bringing out the expectation of the adopted child's gratefulness, servitude and allegiance to the adoptive parent.  
The adoptive parent's demanding and maintaining control over the adopted child by the use of ridicule, personal and self-esteem attacks, and the daily use of threats to remind the adopted child of their poor social status may be direct or indirect. These threat may be directed toward other family members in keeping the adopted child dominated and under the control of the adopted parent. 
When a person feels threatened, the reaction is to find hope in anything that will strengthen the adopted child's will to survive. When the abuser or controller offers small acts of kindness such as a glass of water, the victim adopted child may think that behind the adoptive parent's maliciousness, the perpetrator has positive feelings and good intentions.                                   As a consequence, a "spiritual connection" and gratitude for still being alive is established by the unwanted adopted child.
The adopted child victim may rationalize and justify the adoptive parent's cruel,  antisocial or criminal behavior. Moreover, the adopted child may genuinely try to help the abusive adoptive parent emotionally, feeling the pain of the other instead of the adopted child's own emotional pain.
When an adopted child lives in a world of abuse, domination and control, that adopted child quickly learns to be careful of what to say or do for fear of provoking the adoptive parent, their unrest that might result in violence against the adopted child. As a result, the adopted child victim tries to please their adoptive parent abuser and controller by worrying about everything that could disturb them and by trying to satisfy the wants, needs and desires of the adoptive parent abuser and controller to keep the peace at any cost. Unfortunately, this attitude helps perpetuate the abuse. The adoptive parent abuser learns to demand more from the adopted child, to practice control and power over the child. In turn, the adopted child victim must remain isolated so that the abuser can continue manipulating the adopted child victim with criticism, ridicule and accusations. The victim agrees to be isolated to avoid conflict, humiliation, embarrassment and detaches from other friends or family members. Overwhelmed by abuse and already depressed, the adopted child victim comes to accept the situation and considers it part of their miserable adopted life and servitude.
Freeing oneself from this kind of relationship can be very difficult, even impossible. The victims of adoption often feel bound not only emotionally, but also because of financial obligations, legal issues, the adopted child´s future, threats of death or suicide.
Understanding the complexity of adopted child's psychological slavery preserves the possibility of helping those who need it, keeping a connection, contributing to their self-esteem and opening the door when the time comes to cherish their freedom when the adult adoptee finds the courage to escape the bondage of child adoption and adoption fog that denies his plight.

Adoption Slavery Living the Immoral Forced Adopted Child's Lie

ADOPTEE RAGE!

The Adoption Industry Promoted Adopted Child Slavery.....

"Living the Immoral Forced Adopted Child's Lie"
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The bondage child of slavery that thrives in the United States under the disguise of "The Child Adoption Industry" is child servitude at it's best.

The adopters, adopting parents are those seeking human cargo to be bought, sold, traded and discarded.

The adopted child is treated like the purchased goods that are bought through high dollar financial transactions. The adopted child's identity is erased to keep all records and paper trails to that individual from being identified by biological grieving families, out of the range for any administrative tracking and are lost under the privacy laws of The Adoption Industry that keep that child from ever being found by the families that the genetic child was stolen from.

The brainwashing begins as the perpetrating adoptive parents legally change the identity into a false birth certificate that states that the adopting parents are the birth parents, legally stating that the adoptive parents gave birth to the adopted child- a complete Hippocratic statement, legal lie and obscene offense to the facts of the adopted child's birth record truth.

The brainwashed child believes in young childhood that they are the false name that they were given by the adopting parents. The adopted child lives the lie of adoption until the time in adolescence where the adopted child begins to put the lies under his own cognitive understanding, only to realize that they have been living a lie and a false, made up identity by the adoptive parents.

When child adoption is for the sole benefit of the adopted child, they are not given a false identity and their identity and biological families are not erased.

The mental state of such adoptive parents comes into question of why they pretending that the adopted child is someone other than who the child at birth, really is and belongs to biologically.

Identity destruction is done for the purpose of the adopting parent's fears that the child might and predictably will seek out his own biological family in adulthood.

The birthright of the adopted child is a moral issue that belongs to the adopted child alone. The birthright of the adopted child is the only thing that belongs to the child living under the assumption of the adopted identity, living the adopted child lie.

Adopted Child Slavery

ADOPTEE RAGE!

Category: Adopted Child Slavery

Slavery Alive and Thriving Under the Disguise of
The Child Adoption Industry
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LINK:www.fightslaverynow.org/illegal_adoption/


Adoption today has become a business that sells children as commodities with a disregard for children’s human rights and with the moral indignity of selling children to meet the need of some adults to parent and others merely to make money. ~ Kenneth J. Herrmann, Jr.,  Associate Professor, Department of Social Work, SUNY

With the adoption industry often suffering from a shortage of healthy newborns and a surplus of parents eager to adopt, the industry is rife with opportunities for illegal activity. The global community is becoming aware of and concerned with ways to end illicit practices in intercountry adoption. Although adoption often benefits birth families, adoptive families, and children, increasing cases of illegal practices in intercountry adoptions have significantly harmed families and children. Countries that have undergone violent conflict, like Cambodia, Vietnam, Sierra Leone, and Guatemala, have become breeding grounds for improper adoption practices including child buying, coercion of birth parents, and adoption related kidnapping.

Norma Cruz is a Guatemalan grassroots activist and recipient of the U.S. Department of State’s designation “2009 International Woman of Courage.” Ms. Cruz has become a world renowned human rights defender through her tireless campaign to document cases of violence against women in Guatemala, promote justice for women, and call for an end to illicit adoption. Ms. Cruz tells the stories of Guatemalan parents who have lost their children to illicit intercountry adoption. She describes the advocacy efforts of her organization, Fundación Sobrevivientes (Survivors Foundation), on behalf of the mothers whose children have been taken in an illegal lucrative supply chain for international adoptions. In Spain, a long history of scandalous adoption procedures is rooted in its political history. Newborn babies were stolen from their mothers who were told that their babies were stillborn. The victims were invariably opponents of the fascist Franco regime, while political supporters were allowed to buy or “adopt” the healthy infants.

The abduction of children is a continuing problem in China, where a lingering preference for boys coupled with strict controls on the number of births have helped create a lucrative black market in children. Reports that family planning officials stole children, beat parents, forcibly sterilized mothers and destroyed families’ homes sowed a quiet terror through parts of Longhui County in the first half of the past decade.(Excerpt, NY Times 8/5/11): Yang Libing discovered the loss of his daughter during his monthly telephone call home from a pay phone on a Shenzhen street. “Is she behaving?” he asked cheerily. The answer, he said, made him physically sick. After racing home, he said, he begged family planning officials to let him pay the fine. They said it was too late. When he protested, he said, a group of more than 10 men beat him. Afterward, the office director offered a compromise: although their daughter was gone forever, the Yangs would be allowed to conceive two more children.
“I can’t even describe my hatred of those family planning officials,” Mr. Yang said. “I hate them to my bones. I wonder if they are parents, too. Why don’t they treat us as humans?” Asked whether he was still searching for his daughter, he replied: “Of course! This is not a chicken. This is not a dog. This is my child.”
Related:
The Child Exchange: Inside America’s Underground Market for Adopted Children, by Megan Twohey for Reuters Investigates, September 9, 2013. Highly recommended series of in depth reporting.
Inside Nigeria’s Baby Factories, Expressen, December 28, 2013
Finding Fernanda: Two Mothers, One Child, and a Cross-Border Search for Truth, by Erin Siegal.  The dramatic story of how an American housewife discovered that the Guatemalan child she was about to adopt had been stolen from her birth mother.
Adoption as Human Trafficking, The Daily Iowan, 3/25/08
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Resources for further information
A How to for International Adoptions provides the following links and others:
To join us in action and discussion, please visitMeetup.com/Fight-Slavery-Now
TO REPORT AN INSTANCE OF HUMAN TRAFFICKING, DIAL1-888-3737-888 OR CALL YOUR LOCAL POLICE DEPARTMENT/DISTRICT ATTORNEY’S OFFICE!









Sunday, May 24, 2015

The Controlling Adoptive Mother's Spying Tactics

ADOPTEE RAGE!

The Controlling Adoptive Mother's Spying Tactics
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The changes from adopted child innocence in young childhood into the cognitive aware adolescent causes controlling adoptive mother's to suspect their young adult adopted child to be engaging in age appropriate behavior, which is not tolerated by the dominating adoptive mother, as she will not allow you to grow up. The deceptive adoptive mother will begin rummaging through your drawers, papers and reading your diary, listening to your tapes and voice recordings, looking through your dirty clothing and inspecting your dirty under-pants. Listening to your phone calls and spying on your every move.
The adoptive mother knows that your up to no good and she is determined to seek it out. In today's electronics, she will read your emails, scan your pages and snoop through and read what your friends
say and do as well.
The adoptive mother can't stand the fact that she might lose control over you and will make up shit if she can't find anything wrong to punish you and make you feel as though you are being watched.
These narcissistic adoptive mother's can't stand the fact that at some point you will run away because you can no-longer tolerate her intrusive snooping and twisted behavior. The most disturbing is when the adoptive mother makes up people who tell her things about what you are doing to blackmail you into believing that people are watching you that will report back to her. The intrusive adoptive mother has no life and her only driving force is to make the adopted child's life miserable and intolerable until you run away to freedom. Where there is no dominating adoptive mother to look through your laundry or spy on you ever again.

Intrusive Adoptive Mothers

ADOPTEE RAGE!

The Intrusive Adoptive Mother
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Not only can an intrusive mom be a pain, but also she breeds ill will and harmful qualities in her daughters. Intrusive adoptive mothers:
  • Habitually give unsolicited advice.
  • Have no respect for their adopted child's privacy and barge into her room or go through cabinets in her home.
  • Show unwanted concern in their adopted child's weight and appearance.
  • Ask too many personal questions that are used for gossip about the adopted child.
  • Forcefully influence the adopted child's personal decisions.

A Bird's-Eye-View of the Cycle of Intrusion

So what's so bad about these moms you may ask? Nothing if you are strong enough not to pay attention or be affected by their intrusiveness. However, that is not always easily accomplished. Rose R. Oliver, Ph.D., professor of psychology and women and gender studies at Amherst College, describes a cycle that is put into motion by the intrusive mom. This diagram shows how it goes.

The Effects of Intrusive Adoptive Mothering

One only need look at the general traits associated with adopted children who have been raised by intrusive adoptive mothers to understand the damage.  Adopted children who have lived with intrusive adoptive mothers often tend to…
  • Regularly defer their own interests to those of others.
  • Experience feelings of vulnerability.
  • Rely on the judgments of others rather than their own.
  • Be uneasy with disagreement.
  • Require the opinions of others to formulate their own ideas.
  • Need approval to feel secure.
  • Feel as if they are always being judged.
It is clear from this list of traits how intrusive adoptive mothers rob their adopted children of their autonomy. Without autonomy, the mother-child relationship is based in fear, fight or flight stress response.   

The Psychologically Controlling Invasive Narcissistic Adoptive Mother

ADOPTEE RAGE!

The Psychologically Controlling Invasive Narcissistic Adoptive Mother
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This article simply explains many aspects of an adopted childhood. Not being allowed to express feelings or emotions that are not acceptable to the adoptive mother's fantasy of how things will be done without deviation from her master plan and expectation for how the adopted child should act, behave and conduct themselves when the adoptive mother is not watching. The adoptive mother does anticipate the adopted child will act out and will punish the adopted child before the bad behavior is committed to remind the adopted child that their place and class is below the social standing of the adoptive mother's status in society. The adoptive mother's constant verbal aggression, physical strikes and severe punishments are intended for the adopted child's own good, to keep them in line, submissive and afraid of the time when the adoptive mother will catch the adopted child doing wrong and the horrible punishments that the adopted child should expect to receive for such bad behavior. Yet in the adoptive mother's mind the genetically flawed adopted child is expected to fail to live up to the standards of strict behavior that the adoptive family expects their pet adopted child to perform.

There is a specific kind of narcissistic mother who appears to be devoted to her daughter. She pays attention to her when others are watching. She makes sure that her daughter is dressed beautifully and has a perfect room. 
The narcissistic mother puts her daughter on display for everyone to see. She talks endlessly about how special her little darling is to her friends and relatives. There are many photographs of mother and daughter displayed.  
Anyone who didn’t know the secrets of this mother/daughter relationship would never guess what is going on.  These narcissistic mothers use their daughters to burnish their own images of themselves. Playing the role of loving mother means that they can be professionally successful and an extraordinary mother at the same time. 
From the beginning mother decides what her daughter wants and needs. She is incapable of attuning to the nonverbal and verbal messages that her daughter is communicating.This daughter is like her perfect experiment. She is in complete charge despite the many signs that indicate that this little one is in distress, feels uncomfortable, frightened, etc.
These narcissistic mothers are highly controlling and invasive. As the daughter grows, mother doesn’t allow her to have any privacy. She is always intruding on her child’s private times to be alone, think her own thoughts and express her feelings. This is not allowed, especially since narcissistic mothers don’t have access to their own interior world. They are incapable of empathy–the capacity of understanding how the other person is feeling from her point of view not yours. The mother decides how her daughter should react and is highly critical when she doesn’t behave or respond  according to mother’s expectations.
Narcissistic mothers are invasive to the point of reading their child’s dairies and journals, listening in on their private conversations and trying to control their thinking. If the daughter of the narcissist tends is an an independent, creative thinker, she is ridiculed and sharply criticized. She is often called stupid and naive when she makes attempts to share her original ideas.  Mother mocks her, even laughs at her child.
The core issue is that daughters of narcissistic mothers are not allowed to be their authentic selves. These mothers are often envious of their daughters who in many cases are more intellectually curious, creative and  lively than their tightly wound mothers.
As the daughter grows, the narcissistic mother does not change. Some daughters live in the home only as long as they must and then find ways to leave this psychological  prison created by their narcissistic non-mothers. Other daughters wear themselves out trying to please their narcissistic mothers, wanting the love that this mother is incapable of giving.
Those who recognize that their mothers are narcissists and cannot change, often make the leap forward to separate from the cruel unbending yoke to which they have been attached for so long. They step out on their own, find ways to support themselves and finish their schooling. If they are fortunate, they find female mentors who act as surrogate mothers to them. This is part of their healing process. Having separated psychologically and physically from the controlling and invasive narcissistic mother is an enormous achievement. This is a process of many steps forward and at times, movements backwards but the goal seen ahead is one of ever-deepening belief in one’s original self, an independence of mind, the full use of one’s creative gifts and the knowing that you are a loving human being,: unique and wonderful.
Linda Martinez-Lewi, Ph.D.

Saturday, May 23, 2015

The Impact of Childhood Maltreatment

ADOPTEE RAGE!

The Impact of Childhood Maltrreatment
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The Impact of Childhood Maltreatment: A Review of Neurobiological and Genetic Factors

Abstract

Childhood maltreatment represents a significant risk factor for psychopathology. Recent research has begun to examine both the functional and structural neurobiological correlates of adverse care-giving experiences, including maltreatment, and how these might impact on a child’s psychological and emotional development. The relationship between such experiences and risk for psychopathology has been shown to vary as a function of genetic factors. In this review we begin by providing a brief overview of neuroendocrine findings, which indicate an association between maltreatment and atypical development of the hypothalamic–pituitary–adrenal axis stress response, which may predispose to psychiatric vulnerability in adulthood. We then selectively review the magnetic resonance imaging (MRI) studies that have investigated possible structural and functional brain differences in children and adults who have experienced childhood maltreatment. Differences in the corpus callosum identified by structural MRI have now been reliably reported in children who have experienced abuse, while differences in the hippocampus have been reported in adults with childhood histories of maltreatment. In addition, there is preliminary evidence from functional MRI studies of adults who have experienced childhood maltreatment of amygdala hyperactivity and atypical activation of frontal regions. These functional differences can be partly understood in the context of the information biases observed in event-related potential and behavioral studies of physically abused children. Finally we consider research that has indicated that the effect of environmental adversity may be moderated by genotype, reviewing pertinent studies pointing to gene by environment interactions. We conclude by exploring the extent to which the growing evidence base in relation to neurobiological and genetic research may be relevant to clinical practice and intervention.

Introduction

Early adversity, and in particular childhood maltreatment, has been reliably associated with an increased risk of poor outcome across a range of domains, including, physical and mental health, social and academic functioning, and economic productivity (e.g., Lansford et al., ; Shirtcliff et al., ; Currie and Widom, ). Over the last decade, new techniques have allowed researchers to investigate the possible impact of such adversity on both brain structure and function (e.g., Teicher et al., ; Caspi and Moffitt, ; Lupien et al., ). The aim of this review is to present a concise overview of those studies that have investigated the neurobiological impact of childhood maltreatment. Neuroendocrine, neuroimaging, and genetic factors are considered in turn. Space constraints mean that it is not possible to widen the focus to include many related studies of institutionalization or neglect (see instead Gunnar et al., ; Neigh et al., ). Rather, the primary focus of this review relates to the experience of childhood maltreatment, defined as an experience of physical, sexual, or emotional abuse. However, we occasionally highlight investigations of institutionalization in contexts where there remains a paucity maltreatment-related research (notably in the field of functional resonance imaging).
We first provide a short overview of the hypothalamic–pituitary–adrenal (HPA) axis stress response before considering evidence that maltreatment may alter the functioning of this system in children and adults. The second and third sections review the evidence for changes at the level of regional brain structure and function, respectively. We then consider the evidence from genetic studies, including investigations of gene by environment (GxE) interactions and epigenetic effects in humans and animals, relating these to possible mechanisms associated with vulnerability and resilience. The final sections of the review seek to consider the limitations of current research and consider the degree to which neurobiological research can help advance our clinical understanding of the impact of maltreatment.

Stress Systems and Early Adversity

Maltreatment and the HPA system

The HPA axis represents one of the body’s core stress response systems. Exposure to stress triggers release of corticotrophin releasing hormone (CRH) and arginine vasopressin (AVP) release from the paraventricular nucleus of the hypothalamus, which in turn stimulate secretion of adrenocortico-trophic hormone (ACTH) that acts on the adrenal cortex to synthesize cortisol. Feedback loops at several levels ensure that the system is returned to homeostasis since chronically elevated cortisol levels can have deleterious effects on health (Lupien et al., ).

Children who have experienced maltreatment

Findings from studies investigating HPA axis activity in children and adolescents with a history of maltreatment are mixed (Tarullo and Gunnar, ). For example, in one study of HPA axis response to CRH stimulus (Kaufman et al., ) reported ACTH hyper-responsiveness, but only among a subsample of maltreated children who were depressed and still exposed to a stressful home environment; no differences were found in cortisol measures. By contrast, Hart et al. () in a study of preschoolers who had experienced maltreatment reported a pattern of cortisol suppression in situations of stress that was associated with social competence.
Most studies have collected basal cortisol level data given the ethical and practical implications of pharmacological challenge tests with children. Several studies have reported elevated basal cortisol levels (De Bellis et al., ; Cicchetti and Rogosch, ; Carrion et al., ) while others have reported cortical suppression (Hart et al.,). One explanation for these apparently contradictory findings is that elevation is associated with the presence of a concurrent affective disorder (Tarullo and Gunnar, ). For example, two studies have reported a rise in cortisol levels across the day for maltreated children with depression, but no effects in maltreated children without depression (Kaufman, ; Hart et al., ). This pattern is also consistent with the elevated ACTH response to CRH in the maltreated-depressed group noted above (Kaufman et al., ). Other studies have reported similar elevations in relation to maltreated children with post-traumatic stress disorder (PTSD; Carrion et al., ) and dysthymic girls who had been sexually abused (De Bellis et al., ). While this pattern of elevated cortisol also characterizes non-maltreated children with affective disorders (e.g., Goodyer et al., ) it is not clear if maltreatment contributes an additional effect (Cicchetti and Rogosch, ; Cicchetti et al., ). It should also be noted that several studies of children with antisocial behavior have reported reduced basal cortisol concentrations and lower cortisol levels when exposed to stress (see van Goozen and Fairchild, , for a comprehensive review). It is possible that that exposure to early adversity in these children leads to a pattern of stress habituation over time, a pattern that increases the risk of difficulties in emotional and behavioral regulation; equally, reduced stress responsivity may emerge as a result of genetic factors, or GxE interactions (van Goozen and Fairchild, ).

Adults who have experienced maltreatment as children

Heim and colleagues propose that childhood maltreatment increases the risk of developing depression due to a sensitization of the neurobiological systems implicated in stress adaptation and response (Heim et al., ). In an early study using the standardized Treir Social Stress Test (requiring public speaking and mental arithmetic) they reported that women with a history of maltreatment with and without depression exhibited an increased ACTH response compared with controls (Heim et al., ). A history of childhood abuse was found to be the strongest predictor of ACTH responsiveness; this was amplified by the experience of further trauma in adulthood (Heim et al., ). More recently, Heim et al. () used the combined pharmacological test of HPA functioning (the dexamethasone/CRF challenge) with a sample of men with and without childhood maltreatment and current depression. A pattern of increased cortisol response was reported in the context of a failure of the glucocorticoid-mediated negative feedback loop to adequately control HPA activation (Heim et al., ). These studies suggest that major depression subsequent to childhood maltreatment is associated with inadequate inhibitory feedback regulation of the HPA axis. We know from animal models that low levels of maternal care are associated with reduced concentration of glucocorticoid receptors in the hippocampus (Liu et al., ); it is thus possible that a similar mechanism may account, at least in part, for the observed changes in HPA regulation in humans following maltreatment.
A parallel set of research studies has investigated PTSD in a wide range of populations including those with a prior history of maltreatment. Findings from this literature have been mixed at best (Shea et al., ); however a recent systematic review and meta-analysis supports the view that PTSD is associated with a general pattern of hypocortisolism, with reduced cortisol levels, at least in the afternoon (Meewisse et al., ). Furthermore, Meewisse et al. () highlight the relationship between lower cortisol levels and PTSD in the context of physical and sexual forms of abuse. These findings therefore indicate a possible distinct patterns of adaptation across the two disorders, with HPA hypoactivity characterizing those with maltreatment-related PTSD (Meewisse et al.,) and hyperactivity of the HPA system characterizing maltreated individuals presenting with depression (e.g., Heim et al., ). These differing patterns may in part reflect adaptations of the HPA axis to different forms of maltreatment, different periods of onset and chronicity, and differential genetic susceptibility. Equally, methodological confounds may account for some of the reported differences, including the frequently observed comorbidity of depression and PTSD (Newport et al., ).

Summary: Stress systems and early adversity

Early trauma, including physical, sexual, and emotional abuse is associated with increased risk of psychopathology in childhood and adulthood, as well as social and health problems (Gilbert et al., ). There is persuasive evidence from human (and animal) studies of a link between early stress and atypical HPA functioning. Specifically, it appears that childhood maltreatment may lead to atypical responsiveness of the HPA axis to stress, which in turn predisposes to psychiatric vulnerability in later life (van Goozen and Fairchild, ). While there is general agreement around this broad principle, the putative mechanisms of how dysregulation of the HPA axis might mediate the link between stress and psychopathology and the precise nature of any interaction remain less clear (see Miller et al., ). It is possible that diminished cortisol responsiveness (for example) may emerge if early chronic stress leads to an initial hyper-activation of the HPA system which then progresses over time to a state of hyporeactivity, as a form of adaptation following sustained exposure to ACTH (e.g., Fries et al., ).

Structural Brain Differences Associated with Maltreatment

A growing body of research has investigated how stress, and specifically different forms of childhood maltreatment, can influence neural structure and function. These studies have employed both children who have experienced maltreatment and adults reporting childhood histories of early adversity. In the following section we first consider those studies that have investigated differences in brain structure, before considering the evidence from the smaller number of studies that have investigated the impact on brain function.

Hippocampus

Children who have experienced maltreatment

A substantial body of animal research has shown that the hippocampus plays a central role in learning and various aspects of memory (Mizomuri et al., ) and that memory function is impaired in animals that have been exposed to chronic stress (McEwen, ). De Bellis et al. () were the first to report that maltreated children with PTSD presented with smaller intracranial and cerebral volumes, smaller corpus callosum (CC) and larger lateral ventricular volume compared to healthy, non-maltreated children. It was notable that the expected decrease in hippocampal volume, based on previous studies of adults with PTSD was not observed. Since that time, over 10 structural MRI (sMRI) studies of children and adolescents with PTSD following maltreatment have consistently failed to detect the adult pattern of lower hippocampal volume (e.g., Carrion et al., ; Woon and Hedges, ; Jackowski et al., ; Mehta et al.,).

Adults who have experienced maltreatment as children

By contrast, with the exception of one study (Pederson et al., ), reduced volume of the hippocampus has generally been reported for adults who have experienced maltreatment as children (Vythilingam et al., ; Vermetten et al., ; Woon and Hedges, ). Two explanations have been proposed to account for the discrepancy of child and adult findings (see Lupien et al.,). The neurotoxicity hypothesis, based on data from both animal and human studies, postulates that stress-induced prolonged exposure to glucocorticoids can lead to a reduction in hippocampal cell complexity and even lead to cell death (e.g., Sapolsky et al., ). Thus, it is possible that in humans, hippocampal volume reduction may result from years or decades of PTSD or chronic stress. In support of this hypothesis, (Carrion et al., ) in a longitudinal study reported that cortisol levels and PTSD symptoms at baseline predicted the degree of hippocampal volume reduction over an ensuing 12- to 18-month interval in 15 maltreated children with PTSD. Alternatively, the vulnerability hypothesis posits that a smaller hippocampal volume in individuals with PTSD is not a consequence of stress, but rather a predisposing risk factor for the disorder present in some individuals prior to any traumatic experience (e.g., Gilbertson et al., ). Further longitudinal studies and studies taking advantage of identical twins discordant for maltreatment exposure are required to distinguish between these competing accounts.

Amygdala

Children who have experienced maltreatment

The amygdala plays a key role in evaluating potentially threatening information, fear conditioning, emotional processing, and memory for emotional events (Phelps and LeDoux, ). In animal studies chronic stress has been shown to increase dendritic arborization in the amygdala (e.g., Vyas et al., ). It would therefore seem reasonable to predict that differences in amygdala structure would be associated with childhood maltreatment (Lupien et al., ). Until recently there was a consensus that children with maltreatment-related PTSD did not differ in terms of amygdala volume compared to non-maltreated children (Woon and Hedges, ). However, two recent studies have reported increased amygdala volumes in children and adolescents who had experienced early institutionalization and subsequent adoption. Mehta et al. () reported greater amygdala volume in 14 adoptee adolescents who had experienced severe early institutional deprivation in Romania compared to a group of non-deprived, non-adopted UK controls. Similarly (Tottenham et al., ) reported greater amygdala volume in 17 mainly preadolescent children who had been adopted out of an orphanage when older that 15 months compared to non-adopted controls or early adopted children. A significant correlation is also reported between amygdala volume and age of adoption, suggesting that early and extended exposure to institutionalized care may lead to atypical development of limbic circuitry. It is noteworthy that the effects of early adversity on the amygdala in these two studies were observed even many years after the adversity had ceased, which is in line with evidence from animal research (Lupien et al., ).

Adults who have experienced maltreatment as children

To date only three studies have examined amygdala volume in adults with a history of childhood maltreatment; one found reduced volume in female patients with dissociative identity disorder as compared to healthy females (Vermetten et al., ) while the other two reported no measurable differences (Bremner et al., ; Andersen et al., ). While it is too early to draw definitive conclusions regarding impact of maltreatment on amygdala development, these preliminary findings suggest that the amygdala is vulnerable to early and severe stress in the context of parental loss and institutionalization. However, it appears that less severe, time-limited, and developmentally later exposure has a weaker impact on amygdala volume.

Corpus callosum and other white matter tracts

Children who have experienced maltreatment

The CC is the largest white matter structure in the brain and controls inter-hemispheric communication of a host of processes, including, but not limited to, arousal, emotion, and higher cognitive abilities (Kitterle, ; Giedd et al., ). Crucially, in terms of development, nerve fiber connections passing though this region are fully formed before birth with myelination continuing throughout childhood and adulthood (Giedd et al., ; Teicher et al., ). Teicher et al. () have speculated that different regions of the CC might have different windows of vulnerability to early experience. With the exception of one study (Mehta et al., ), decreases in CC volume (particularly middle and posterior regions) have consistently been reported in maltreated children and adolescents compared to non-maltreated peers (De Bellis et al., ; De Bellis and Keshavan, ; Teicher et al., ; Jackowski et al., ). Furthermore, preliminary evidence suggests that these effects are characterized by sex-dependent differences (De Bellis and Keshavan, ; Teicher et al., ). It may be speculated that these structural abnormalities within the CC may be associated with some of the emotional and cognitive impairments that have been reported in maltreated individuals (e.g., Pears et al., ).
A recent study that employed diffusion tensor imaging (DTI) found decreased fractional anisotropy values (indicative of decreased white matter fiber tracts coherence or lower density of white matter fiber tracts) in maltreated children in frontal and temporal white matter regions, as compared to non-maltreated children (Govindan et al., ). Similar to an earlier DTI study in maltreated children (Eluvathingal et al., ), group differences were also observed in the uncinate fasciculus, which connects the orbitofrontal cortex (OFC) to the anterior temporal lobe, including the amygdala (Govindan et al., ). Interestingly, the reduction in fractional anisotropy observed by Govindan and colleagues was associated with longer periods within an orphanage and may partly underpin some of the cognitive and socioemotional impairments associated with early severe deprivation.

Adults who have experienced maltreatment as children

A study of adult females with maltreatment-related PTSD has also reported smaller area of the posterior midbody of the CC as compared to healthy controls (Kitayama et al., ). More recently, a recent DTI study in a non-clinical sample examined the effects of severe parental verbal abuse (e.g., ridicule, humiliation, and disdain) on brain connectivity; three white matter tracts were reported to show reduced fractional anisotropy (Choi et al., ). Again, the researchers hypothesized that these abnormalities may underlie some of the language and emotional regulation difficulties seen in victims of childhood maltreatment.

Prefrontal cortex

Children who have experienced maltreatment

The prefrontal cortex (PFC) is extensively interconnected with other cortical and subcortical regions consistent with its major role in the control of many aspects of behavior, cognition, and emotion regulation (Fuster, ; Davidson et al., ; Miller and Cohen, ). There are mixed findings from studies comparing PFC volume of children with maltreatment-related PTSD and non-maltreated children. One study reported no group difference (De Bellis et al., ), but another found smaller prefrontal volume and prefrontal white matter (De Bellis et al., ) in the maltreated group, while the two most recent studies – one using voxel-based morphometry (VBM; provides a measure of regional volume differences by analyzing spatially normalized brain segments on a voxel-wise basis) investigating PTSD – observed larger gray matter volume of the middle-inferior and ventral regions of the PFC in the clinical groups (Richert et al., ; Carrion et al., ).
Tensor-based morphometry (TBM) provides a measure of regional volume by examining regional shape differences via analyses of the deformation fields. A recent study used TBM to compare 31 children with documented histories of physical abuse without PTSD to 41 non-abused children matched for age, pubertal stage, and gender (Hanson et al., ). One of the largest reported differences was observed in the right OFC. The abused group were found to have significantly smaller brain volumes in this region, differences which in turn correlated with poorer social functioning. Given that the OFC is known to play a key role in emotion and social regulation, the authors suggest that these alterations in OFC structure may partly represent the biological mechanism linking early social learning to later behavioral outcomes. However, we know that cortical thickness of the OFC is susceptible to thinning following prenatal exposure to maternal cigaret smoking and to drug taking, risk factors likely to characterize a proportion of those in a maltreated sample (Lotfipour et al., ). Further research will be necessary to tease apart possible risk factors that may influence structural development of this region.
A lack of consistency regarding observed structural differences in the PFC may relate to methodological differences, sample differences in age range of participants, variation in maltreatment type and chronicity, and a focus on different regions within the PFC. In addition, while it is likely that there are specific windows of vulnerability in brain development, we know little about how maltreatment at different points in development impacts different brain regions. In a unique cross-sectional study, Andersen et al. () found that gray matter volume of the frontal cortex was maximally affected by abuse at ages 14–16 years, while the hippocampus and CC were maximally affected at ages 3–5 and 9–10 years respectively, indicating that the frontal cortex in this sample was particularly susceptible to structural change following abuse during the adolescent period. Further work exploring how regional brain differences may emerge depending on the timing of maltreatment is essential if we are to formulate a developmentally informed picture of the impact of such adversity on neurobiological development.

Adults who have experienced maltreatment as children

In contrast to the studies on maltreated children, decreased PFC volume in adults with a history of childhood maltreatment has been a consistent finding. For example, in a non-clinical sample, Tomoda et al. () found that harsh childhood corporal punishment was associated with reduced gray matter volume in the left dorsolateral PFC and the right medial PFC, two brain regions central to higher cognitive processing, such as working memory and to aspects of social cognition, respectively (Miller and Cohen, ; Amodio and Frith, ). In another study, in comparison to healthy individuals, patients with major depressive disorder who reported a history of childhood maltreatment exhibited reduced volume of the rostral anterior cingulate cortex (ACC), which was negatively correlated with both cortisol levels and maltreatment severity (Treadway et al., ). Despite important limitations (such as the lack of information on the age of onset and duration of maltreatment) this study suggests that the rostral ACC, like the hippocampus, might be vulnerable to prolonged glucocorticoid exposure resulting from chronic stress, which in turn may decrease its ability to exert negative feedback control over HPA regulation (Treadway et al., ). Finally, a recent study compared healthy controls and patients with depression and/or anxiety disorders reporting childhood emotional maltreatment before age 16 to a group composed of healthy controls and patients who reported no childhood abuse (van Harmelen et al., ). The authors reported that emotional abuse was associated with a reduction in left dorsal medial PFC, even in the absence of physical or sexual abuse in childhood. Crucially, this group difference was independent of gender and could not be attributed to current psychopathology, which support the idea that the observed brain differences might be associated with the experience of maltreatment.

Summary: Structural brain differences associated with maltreatment

The findings from the structural studies reviewed above are summarized in Table Table1.1. It is clear that there is relatively consistent evidence for reduced CC volume in children and adults who have experienced adversity, some evidence of greater amygdala volume in late-adopted previously institutionalized children, and a relatively clear pattern of normal hippocampal volume during childhood, which contrasts with the consistent finding of reduced hippocampal volume seen in adults with histories of abuse. It has recently been suggested that variations in developmental timing and age of measurement may partly account for the observed variability in the findings for structural differences in the amygdala and hippocampus (Tottenham and Sheridan, ). The structural findings are more mixed for the PFC in maltreated children, but there is a consistent pattern of decreased PFC volume among adults with childhood histories of maltreatment. However, a recent finding highlights that structural differences in the OFC may be linked to degree of social difficulty in physically abused children even in the absence of PTSD (Hanson et al.,).
Table 1
Structural magnetic resonance brain imaging studies comparing maltreated to non-maltreated individuals.

Functional Brain Differences Associated with Maltreatment

Children who have experienced maltreatment

In contrast to the research examining structural brain differences associated with maltreatment, there are as yet relatively few that have used functional MRI (fMRI). To date, only five fMRI studies have investigated children exposed to early adversity, and only two from the same research group have recruited children who have experienced maltreatment. These studies by Carrion and colleagues investigated cognitively oriented processes. The first, which compared youths with post-traumatic stress symptoms (PTSS) secondary to maltreatment (i.e., trauma related to physical and sexual abuse and exposure to violence) with healthy controls, investigated response inhibition (Carrion et al., ). Increased activation in the ACC was reported in maltreated participants as compared to controls. This result is consistent with a model in which impaired cognitive control arises in the context of heightened subcortical reactivity to negative affect, potentially conferring an increased risk for psychopathology (Mueller et al., ). The second study used a verbal declarative memory task and compared youths with PTSS secondary to maltreatment with healthy controls (Carrion et al., ). During the retrieval component of the task, the youths with PTSS exhibited reduced right hippocampal activity, which was associated with greater severity of avoidance and numbing symptoms.
Three other fMRI studies have investigated the impact of early institutionalization. Using an emotional face processing paradigm, children exposed to such adversity were found to exhibit increased amygdala response to threatening facial cues (Maheu et al., ; Tottenham et al., ). It is not yet clear if these findings of atypical emotional processing generalize to children who have experienced maltreatment, such as physical, sexual, and emotional abuse. Another study assessed response inhibition and observed increased activation in the ACC in previously institutionalized children as compared to controls (Mueller et al., ).
While the main strength of fMRI is its good spatial resolution in relation to brain activity, event-related potentials (ERP) record the brain’s electrical activity and yield detailed information about the temporal sequence (resolution in milliseconds) of cognitive operations throughout the brain (i.e., mental chronometry). Much of the existing ERP research has compared the pattern of brain response of maltreated children and healthy children when processing facial expressions, an ability that is usually mastered by the preschool years (Izard and Harris, ). When compared with never institutionalized children, institutionalized children who have experienced severe social deprivation show a pattern of cortical hypoactivation when viewing emotional facial expressions (Parker and Nelson, ), and familiar and unfamiliar faces (Parker et al., ). A second set of important studies by Pollak and colleagues has demonstrated that school-aged children who had been exposed to physical abuse allocate more attention to angry faces (Pollak et al., ) and require more attentional resources to disengage from such stimuli (Pollak and Tolley-Schell, ) leading to problems with emotional regulation that may predispose to anxiety (Shackman et al., ). Findings consistent with this pattern have also been obtained with toddlers who experienced maltreatment in their first year of life (Cicchetti and Curtis, ). It appears therefore that some maltreated children allocate more resources and remain hyper-vigilant to social threat cues in their environment, potentially at the cost of other developmental processes.

Adults who have experienced maltreatment as children

Three fMRI studies using a range of paradigms have compared adults with a history of childhood maltreatment to adults without such a history. Using a flanker task with face stimuli, Grant et al. () observed a robust positive correlation between physical abuse and right amygdala response to sad faces in sample including 20 patients with depression and 16 healthy controls. Importantly, group differences indicated that heightened amygdala response to sad faces was not a characteristic of individuals with depression, but rather of those with a significant history of maltreatment. This pattern of amygdala response to negative faces is consistent with that observed in maltreated children in the studies reviewed above. Dillon et al. () recently investigated reward processing using a monetary incentive delay task and found that adults with a history of childhood maltreatment, relative to peers with no history of adversity, reported higher depressive symptoms, rated reward-predicting cues as less positive, and exhibited a blunted brain response to reward cues in the left pallidus. According to the authors, this result suggests a possible link between childhood adversity and later depressive psychopathology. Given the overlap between the brain regions previously identified in sMRI studies in maltreated populations and the projection area of the olfactory system, such as the amygdala, OFC, and hippocampus, Croy et al. () compared neural response to neutral and pleasant olfactory stimulation between female patients from a psychosomatic clinic with (n = 12) and without (n = 10) a history of childhood abuse. Results indicated that, despite similar group ratings for hedonic and intensity values of the stimuli and normal neural activation in olfactory projection areas, patients with a history of childhood maltreatment displayed increased activation in the posterior cingulate cortex and decreased activation in the subgenual ACC, possibly indicative of altered processing of non-traumatic stimuli.

Summary: Functional brain differences associated with maltreatment

Studies of adults using fMRI suggest that the experience of maltreatment may be associated with hyperactivity of the amygdala in response to negative facial affect; such an effect has also been reported in children who have experienced early institutionalization. Studies of maltreated children that have examined response inhibition have observed increased activity in the ACC. The findings from these fMRI studies of children and adults are summarized in Table Table2.2. ERP studies have found increased responses to angry faces in prefrontal regions consistent with increased attentional monitoring for social threat.
Table 2
Functional magnetic resonance brain imaging studies comparing maltreated to non-maltreated individuals.

The Genetics of Resilience and Vulnerability

Do genetic differences account for individual differences in resilience and vulnerability?

Many recent studies have measured the biological impact of environmental adversity by taking into account genetic differences that may constrain the stress response and increase the likelihood of resilience vs. vulnerability following maltreatment (Moffitt et al., ). Twin and adoption studies have demonstrated that many of the psychiatric outcomes that are associated with maltreatment, such as PTSD, depression, and antisocial behavior, are partly heritable (e.g., Sullivan et al., ; Rhee and Waldman, ; Koenen et al., ). In other words, individual differences in susceptibility to these disorders are partly driven by genetic influences. Despite demonstrable heritable influences, it is not the case that there are genes for PTSD, depression, or antisocial behavior. Rather, there are genetic variants each adding a small increment to the probability that someone may develop or be protected from developing a psychiatric disorder (Plomin et al., ). It is believed that these genetic variants act across the lifespan by biasing the functioning of several brain and hormonal circuits, which mediate the body’s response to stress (Viding et al., ).
For example, linkage and association studies have implicated variants within several genes, such as monoamine oxidase-A (MAOA), Brain-Derived Neurotrophic Factor (BDNF), serotonin transporter (5-HTT), and catechol-O-methyl transferase (COMT) in the etiology of PTSD, depression, and antisocial behavior (e.g., Craig, ; Feder et al., ). Several issues should be borne in mind when considering these genetic findings. Firstly, for every study reporting a positive association between a gene and a disorder there seem to be an equal or larger number of negative findings. This is not surprising. Given the assumed small main effect of any single gene on behavioral outcome, the reliable detection of a main effect will require a degree of statistical power that is beyond most existing studies. Secondly, although the genes influencing stress reactivity are likely to act in an additive manner, gene–gene interactions have also been reported to drive individual differences in stress reactivity; for example, carrying two risk-associated gene variants may confer a greater level of vulnerability to stress reactivity compared to the combined risk conferred by each separately (e.g., Kaufman et al., ). Thirdly, several GxE interaction studies have demonstrated that in addition to conferring vulnerability to environmental adversity, genetic make-up can also denote resilience. Finally, the vulnerability effects exerted by the genes do not appear to be disorder specific. In other words, the same risk genes are often implicated in the etiology of several disorders associated with maltreatment/adversity. For example, 5-HTT has been associated with PTSD, depression, and antisocial behavior (e.g., Cicchetti et al., ; Feder et al., ).

The interaction of genes and environment in conferring risk or resilience

There is intuitive appeal of a biologically driven predisposition (genes) interacting with environmental factors to produce an individual’s phenotype (i.e., the classic notion put forward by the stress-diathesis model). GxE research has taken off in recent years following the first seminal reports of gene–environment interaction by Caspi et al. (). Much of this work has focused on outcomes of early stress and maltreatment as a function of genotype. Caspi et al. () were the first to report on an interaction of a measured genotype (MAOA) and environment (maltreatment) for a psychiatric outcome and demonstrated that individuals who are carriers of the low activity allele (MAOA-l), but not of the high activity allele (MAOA-H), are at an increased risk for antisocial behavior disorders following maltreatment.
This finding has since been replicated by several other research groups (see Taylor and Kim-Cohen, ; Weder et al., ) and imaging genetic studies have found that the risk, MAOA-l, genotype is related to hyper-responsivity of the brain’s threat detection system and reduced activation in emotion regulation circuits, as well as to structural differences (in males) in key regulatory regions, such as OFC (Meyer-Lindenberg et al., ). This work suggests that a mechanism by which MAOA genotype engenders vulnerability to (reactive) aggression following maltreatment may include increased and poorly regulated neural reactivity to threat cues in the environment (Viding and Frith, ).
These studies suggest that genotypes potentially serve as predictors of both risk and resilience for adult psychiatric outcomes for people who have survived childhood maltreatment and abuse. GxE research has also suggested that positive environmental influences, such as social support, can buffer genetic and environmental risk for psychopathology and promote resiliency. Kaufman et al. () demonstrated that children with genetic vulnerability (BDNF met allele and two 5-HTT short alleles) and environmental risk (maltreatment) were less likely to develop depression if they had social support. This finding illustrates the importance of considering positive environmental influences (such as contact with a supportive attachment figure) and how these may be protective even in the context of genetic vulnerability.

Epigenetics and the impact of early rearing environment

The risk effects of a gene may never manifest if that gene is not actually expressed. The regulation of gene expression has been proposed as a potential molecular mechanism that can mediate maladaptations (vulnerability) as well as adaptations (resilience) in the brain (Tsankova et al., ). These “epigenetic” mechanisms refer to complex processes by which environmental influences can serve to regulate gene activity without altering the underlying DNA sequence. We now know that epigenetic regulation is a candidate mechanism through which care-giving behaviors, at least in animals, may produce long-lasting effects on HPA activity and neuronal function (e.g., Weaver et al., ). In other words, epigenetic modification of gene expression may help explain the link between a set of maternal behaviors (high licking and grooming of rat pups early in life) and more modest HPA responses to stress (Weaver et al., ). One striking finding from this work is that cross-fostering can reverse the epigenetic methylation changes associated with less attentive maternal care highlighting the ongoing importance of environmental influences (both positive and negative) in shaping the stress response at the biological level. Such reversibility has important implications for intervention.
A recent animal study investigating epigenetic effects of maltreatment employed a rodent model in which infant rats were exposed to stressed caretakers that showed abusive behaviors (Roth et al., ). It was reported that early maltreatment produced persisting changes in methylation of BDNF DNA. Critically, the methylation changes altered BDNF gene expression in the adult PFC and hippocampus. This finding is of particular interest as it documents “epigenetic” effects of maltreatment in brain areas that are known to be both structurally and functionally altered in adults following maltreatment. Roth et al. () also observed altered BDNF DNA methylation in the offspring of these females that had previously been exposed to maltreatment as pups. This suggests the possibility of a trans-generational transmission of changes in gene expression and behavior associated with early maltreatment, even in a new generation of animals who had not been exposed to such environmental stressors.
We know of only few human epigenetic studies that have assessed the effects of maltreatment on gene expression. McGowan et al. () observed differences in epigenetic regulation of hippocampal glucocorticoid receptor expression (including increased cytosine methylation of an NR3C1 promoter) in suicide victims with a history of childhood abuse, as compared with either suicide victims with no childhood abuse or controls. Interestingly, the epigenetic effects observed in the childhood abuse victims of this human study were comparable to the effects observed for the rats with low licking and grooming and reduced arched back nursing mothers (Weaver et al.,). Another recent study suggested that long-lasting changes in methylation of the 5-HTT promoter region could explain some of the association between childhood sexual abuse and symptoms of antisocial personality disorder in women (Beach et al., ). To our knowledge, no studies have looked at how baseline genotype differences may limit the extent and nature of epigenetic changes following maltreatment to provide a more mechanistic understanding of maltreatment GxE interactions. Finally, it should be noted that epigenetic processes, such as DNA methylation, regulate tissue specific gene expression. One consequence for human research is that this limits our ability to directly characterize epigenetic modification of neural structures or central tissues implicated in stress regulation. This is in contrast to rodent models where it is possible to assay tissue from cortical structures (e.g., Roth et al., ). While researchers have attempted to circumvent this limitation by using post-mortem tissue, this severely constrains the potential of further research in humans. It should be possible, however, to establish the association between patterns of epigenetic modification of accessible tissues, such as T cells in the blood or cells from buccal cheek swabs and specific developmental experiences, such as maltreatment. There is increasing evidence that measuring epigenetic changes longitudinally using such cells can provide meaningful information with regard to pathophysiology (e.g., Mill, ).

Summary: Genetics of resilience and vulnerability

There are genetic influences on individual differences in the psychiatric outcomes associated with maltreatment. Recent GxE interaction studies suggest that certain polymorphisms may confer vulnerability or resilience to maltreatment, for example in terms of later levels of PTSD, depression, or antisocial behavior. Epigenetics is providing an exciting new avenue of research that aims to understand the mechanisms by which gene expression is influenced by exposure to environmental stressors and protective factors.

Limitations of Current Research

It is important to highlight several limitations that characterize many of the research studies investigating maltreatment. Firstly, all, but one (Carrion et al., ) of the brain imaging studies included in this review are cross-sectional, therefore no conclusions can be made on the causal effect of maltreatment on the brain; indeed it is possible (albeit unlikely) that the reported brain differences might represent a risk factor for exposure to maltreatment that in turn increases the risk of developing psychopathology. Secondly, the studies on adult samples have all relied on subjective retrospective reporting of maltreatment, which is liable to errors in recall that may reduce the reliability and validity of the data collected. Thirdly, researchers in the field have struggled to recruit and assess samples of children and adults that are readily comparable. Samples labeled “maltreated” have often been highly heterogeneous, drawn from different contexts (e.g., residential settings vs. home environments) and have been characterized by very different maltreatment histories. There is an increasing recognition of the need to improve the construct validity of measures that assess maltreatment type (Herrenkohl and Herrenkohl, ) as well as improve our accuracy in gaging maltreatment severity (Litrownik et al., ). If findings across studies are to be meaningfully compared, future studies need to meet the challenge of becoming more systematic in delineating maltreatment type, chronicity, frequency, and even perpetrator identity in their samples. There are some notable exceptions where researchers are already working to address these challenges (e.g., Andersen et al., ; Cicchetti and Rogosch, ). Fourthly, as noted earlier, many studies of adults and children have tended to recruit individuals with PTSD, particularly studies assessing structural brain differences. This approach makes it difficult to tease apart effects unique to maltreatment experience and current psychopathology. However, there now are a number of new studies that have recruited children who have experienced maltreatment but who do not present with PTSD (e.g., Hanson et al., ). Finally, it is worth noting the relatively small sample sizes that have characterized some of the studies reviewed here, particularly in several neuroimaging studies. There are undoubtedly real practical barriers that make recruiting such samples of children difficult, but larger samples would certainly improve statistical power, and allow us to better understand individual differences. These limitations should act to caution any strong conclusions regarding the neurobiological developmental trajectories of children experiencing maltreatment.

Clinical Implications

There is good evidence that early adversity in the form of childhood maltreatment is associated with poor outcome across a range of domains; in our view the evidence reviewed here suggests that this association is likely to be reflected, at least in part, at the neurobiological level. Specifically it appears that an early hostile environment contributes to stress-induced changes in the child’s neurobiological systems that may be adaptive in the short-term but which reap long-term costs. These costs can be conceptualized at both the biological and psychological level. At the biological level we know from animal and human studies that chronic exposure to early stress is associated with atypical levels of stress hormones that may have an effect on the structure and function of the neurobiological systems that underpin social and psychological functioning (e.g., Arborelius et al., ; McEwen and Gianaros,). At the psychological level it is possible that attentional and emotional systems adapt, such that they may become more effective in detecting and processing social threat but less able to successfully negotiate other aspects of social interaction (Pollak, ). One might speculate that these psychological changes ultimately become manifest as clinical symptoms in some children, for example as attentional difficulties or in the form of reactive aggression.
While neurobiological and genetic research has genuine long-term potential to inform clinical practice (Cicchetti and Gunnar, ; McCrory et al., ), it has already contributed to a broadening of our developmental narrative when thinking about how disruption to early caregiving can impact on a child’s psychological and emotional development. Research at the neuroendocrine level – that has documented changes in the functioning of the HPA axis in children and adults who have experienced maltreatment – is probably the most advanced in this regard. Maternal behavior, for example, has been shown to be predictive of how well very young infants respond to everyday stressors: infants with mothers demonstrating higher quality maternal behavior, including greater sensitivity, show lower cortisol responses (Albers et al., ). Similarly, attachment security has been found to be associated with a child’s pattern of stress reactivity to novel and stressful environments, such as entering child care for the first time (Ahnert et al., ). In securely attached infants the presence of their mother serves a stress protective function, indicated by lower levels of cortisol production when adapting to a novel environment; this contrasts with higher levels of cortisol production in insecurely attached infants (Ahnert et al., ). Such variation in normative samples illustrates how sensitively the neurobiological system is calibrated by the behavior of the caregiver who is tasked both with creating a safe micro-environment for the child and with helping the child regulate their own emotional states. In other words, patterns of sensitive, responsive, and attentive caregiving provides an external mechanism that can help regulate glucocorticoid and other stress responses (Nachmias et al.,; Gunnar and Donzella, ). This review has highlighted the consequences of maltreatment where such scaffolding is markedly absent and a child is forced to regulate their own levels of stress and/or manage heightened levels of negative affect in the environment. Sadly, in some cases it is the caregiver themselves who may be the source of stress for the child. As we have seen, this may lead to developmental adaptation of the HPA axis with psychological and biological consequences that increase long-term vulnerability for psychopathology (Gunnar and Cheatham, ).
A greater understanding of how the quality of caregiving can alter a child’s stress reactivity has prompted several studies where the effectiveness of an intervention has been partly evaluated by assessing a child’s cortisol reactivity under mild stress. Dozier et al. (,), for example, have investigated patterns of cortisol reactivity in children following an attachment-based intervention for foster parents. Children whose foster parents received this intervention essentially showed a normalization of cortisol responses to a social stressor (Dozier et al., ), demonstrating that clinical interventions may have the capacity to help recalibrate a child’s stress reactivity.
While these studies investigating the relationship between indices of a child’s HPA axis functioning and parenting have clear clinical relevance, the field of brain imaging lags somewhat behind in this regard. As yet, there is limited scope for explicit implications to be drawn from existing brain imaging research. Arguably there are several reasons what this is the case. Firstly, structural brain imaging studies have generally not aimed to explore the functional significance of observed brain differences in maltreated and non-maltreated children. Rather the interpretation of an observed difference is generally made in the context of our existing neurocognitive framework regarding the function of a given region. For many brain regions such a framework remains sparsely delineated, particularly within child samples. There have been a number of notable exceptions to this rule. In a recent study, Hanson et al., ( investigated not only structural differences in a region implicated in social functioning (the OFC) but investigated whether such differences were associated with impairments in actual social functioning of the children who participated in the study. Establishing brain–behavior correlations in this way is an important advance in building a more clinically relevant framework within which structural brain imaging findings can be meaningfully interpreted. Ultimately these correlational studies need to be complemented by longitudinal as well as by intervention studies that will allow changes in the child’s environment and behavior to be measured alongside changes in brain structure and function. Such an approach is necessary if we are to begin to make even tentative inferences regarding causality.
Secondly our ability to draw clinical implications is constrained by our limited understanding of how neurobiological sensitivity to stress varies across development. This issue is not straightforward for the simple fact that brain areas are characterized by regional variation in rates of maturation; in other words, different brain regions develop at different rates (Gogtay et al., ). Therefore a given brain region may be more or less susceptible to the impact of maltreatment at a given stage in development. The consequence of this for researchers is that the same experience may lead to different patterns of brain abnormality depending on when a child is exposed to a given traumatogenic event. Andersen et al. ), who employed an innovative cross-sectional design, have reported preliminary evidence for this phenomenon. They aimed to investigate whether the experience of sexual abuse at different ages had specific effects in terms of regional brain volume. Twenty-six young women aged between 18 and 24 who had experienced repeated episodes of childhood sexual abuse were compared with non-abused controls. The authors reported that hippocampal volume was reduced in association with childhood sexual abuse at ages 3–5 years and ages 11–13 years; CC volume was reduced with childhood sexual abuse at ages 9–10 years, and frontal cortex volume was reduced in subjects with childhood sexual abuse at ages 14–16 years. The authors concluded that different brain regions are likely to have unique windows of vulnerability to the effects of traumatic stress. This study highlights the possibility that the same maltreatment experience (in this case, sexual abuse) may have very different effects on brain structure depending on the age at which the abuse was experienced. It might be conjectured that these windows of vulnerability would be differentially susceptible to different forms of traumatic stress or maltreatment; however, further research is required to support such a hypothesis.
For most clinicians, a third limitation of the existing brain imaging literature pertains to the populations of children investigated. As noted earlier, many of the structural studies have focused on children presenting with clinically diagnosed PTSD, making it difficult to identify the specific correlates that are uniquely associated with maltreatment as opposed to those that might reflect predisposition to PTSD. To date the two fMRI studies of emotional processing have recruited children who have experienced early institutionalization and subsequent adoption. These children, who have experienced a diverse range of early stressors – most of which are undocumented – are very unlikely to be representative of the community samples typically referred to social services. Community based familial maltreatment, including physical, sexual, and emotional abuse as well as neglect and domestic violence characterize the majority who present to mental health clinics. These are not rare experiences, with 896,000 cases of substantiated maltreatment in the USA alone during 2005 (U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, ). Despite this, we know almost nothing about the functional neural correlates of such experiences in these children, which limits our ability to make clinically informed inferences.
Recent years have increased our understanding of gene–environment interactions that may increase the likelihood of psychopathology in children exposed to maltreatment. From a clinical perspective this helps provide a rationale as to the potential for individual variability in outcome for children exposed to similar traumatic experiences. In the field of GxE research it is recognized that advances will be contingent on improvements in how environmental influences are quantified, and precision in identifying the timing of their occurrence (Lenroot and Giedd, ). However, there is preliminary evidence that genetic polymorphisms may also help account for the potential variability in clinical outcome. In a study of 1- to 3-year-old children with externalizing problems Bakermans-Kranenburg et al.  found a moderating role for the dopamine D4 receptor (DRD4) in a video-feedback intervention study designed to improve maternal sensitivity and discipline. The intervention was effective primarily in those children with the DRD4 7-repeat polymorphism. This is the first study to provide preliminary evidence that gene by environment interactions may play an important role in explaining the differential effectiveness of a given intervention. We remain a long way, however, from being able to tailor interventions to specific groups of children on the basis of genetic information. Nonetheless, improving our conceptual understanding of the factors underpinning outcome variability will represent an important advance in our efforts to treat more effectively the wide range of problems that are known to be associated with maltreatment.

Conclusion

While there is now accumulating evidence indicating an association between neurobiological change and childhood maltreatment there remains a need for caution in how such evidence is interpreted. Much of the research to date has been based on very mixed samples of children or adults with diverse experiences of early adversity. This partly derives from the complexities inherent in the defining and assessing maltreatment type, given that abusive experiences seldom occur in isolation. Nonetheless greater precision and homogeneity in how groups are characterized in relation to maltreatment experience, age range, socio-economic status, and intellectual ability are required, as too is the need for longitudinal and intervention studies. This will assist in making more meaningful inferences about the significance of any observed neurobiological differences.
Nonetheless, the studies reviewed here support a growing consensus that maltreatment contributes to stress-induced changes in a child’s neurobiological systems. While these changes may be adaptive in the short-term it is hypothesized that they contribute to heightened risk for psychopathology over the longer term. There is a need to specify with more precision the psychological factors that may mediate the association with poor behavioral outcome, both in terms of adaptations to psychological processes (e.g., attentional hypervigilance to threat) and in terms of internal representations of self and others (e.g., schemas or internal working models). The longer-term goal is to establish a clearer picture of the links between environmental stress, neurobiological, and neuroendocrine change and the ways in which these may potentiate and shape social, affective, and cognitive development.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

Eamon McCrory and Stephane A. De Brito are supported by RES-061-25-0189 from the ESRC, and Eamon McCrory and Essi Viding are also supported by RES-062-23-2202 from ESRC and BARDA-53229 from the British Academy.

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