Child abuse and neglect: psychiatric and neuro-biological consequences

Child abuse and neglect is a common problem that is potentially damaging to long-term physical and psychological health of children. Over the past, researchers have documented this relationship and have identified two possible mechanisms that can explain the increased incidence of childhood stress and consequent adult somatic disease: the increased incidence of health harming behaviors and causes epigenetic and other changes that predispose individuals to disease through a raised non-specific inflammatory profile [1]. Abuse survivors, as well as persons who have experienced other types of childhood adversities, are more likely to participate in high-risk behaviors [2]. Possible etiologic factors in survivors' health problems include abuse-related alterations in brain functioning that can increase vulnerability to stress and decrease immune function. Adult survivors are also more likely to participate in risky behaviors that undermine health or to have cognitions and beliefs that amplify health problems [2].

Childhood abuse and early life stress may become hard-coded into the genome, creating an epigenetic memory of events that leads to impaired health at a later date [3].

Chronic early life stress results in long-term changes in HPA (hypothalamic-pituitary-adrenal) axis function and regulation typified by hypersecretion of CRH and ACTH. The initial hypersecretion of cortisol may over time lead to blunting of the cortisol response to CRH and ACTH and relative glucocorticoid resistance. A decrease in glucocorticoid levels or impaired glucocorticoid receptor function might then lead to increased stress responsiveness [2].

Childhood abuse and neglect is also associated with reduced adult hippocampal volume, particularly on the left side, and these findings support the hypothesis that exposure to early stress in humans, as in other animals, affects hippocampal subfield development [4].

Another recent study demonstrate that children who experienced two or more types of violence exposure showed significantly accelerated telomere erosion from age-5 baseline to age-10 follow-up measurement compared with children who had one type of violence exposure or who were not exposed to violence [5].

People experience and interpret physical and emotional insults in diverse ways and many contextual factors affect the phenomenology of abuse and neglect, and in Italy there are many children victims of various types of maltreatment particularly within their own families. But we must not forget the most vulnerable children who may have even more serious consequences: those who live in foster care [6] or abandoned babies [7] that are actually little-known but that equally needs of social interventions, health and human rights.