Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Sunday, April 27, 2014

New POLL Article: Childhood Emotional Maltreatment

I'm posting a new POLL article on LinkedIn, entitled:

Childhood Emotional Maltreatment Severity Is Associated with Dorsal Medial Prefrontal Cortex Responsivity to Social Exclusion in Young Adults


Children who have experienced chronic parental rejection and exclusion during childhood, as is the case in childhood emotional maltreatment, may become especially sensitive to social exclusion. This study investigated the neural and emotional responses to social exclusion (with the Cyberball task) in young adults reporting childhood emotional maltreatment. Using functional magnetic resonance imaging, we investigated brain responses and self-reported distress to social exclusion in 46 young adult patients and healthy controls (mean age = 19.2±2.16) reporting low to extreme childhood emotional maltreatment. Consistent with prior studies, social exclusion was associated with activity in the ventral medial prefrontal cortex and posterior cingulate cortex. In addition, severity of childhood emotional maltreatment was positively associated with increased dorsal medial prefrontal cortex responsivity to social exclusion. The dorsal medial prefrontal cortex plays a crucial role in self-and other-referential processing, suggesting that the more individuals have been rejected and maltreated in childhood, the more self- and other- processing is elicited by social exclusion in adulthood. Negative self-referential thinking, in itself, enhances cognitive vulnerability for the development of psychiatric disorders. Therefore, our findings may underlie the emotional and behavioural difficulties that have been reported in adults reporting childhood emotional maltreatment.

The study looks at reactions to the Cyberball game, in which the participant plays a game of cyber-catch with the computer and two other players, one male and one female. In the first, inclusion, part of the game, the computer throws the ball to each player an equal number of times. In the second, exclusion, part, the computer throws the ball to the subject once or twice a the beginning of the game, and then never again. The game is supposed to be a model for social exclusion.

The study examined severity of childhood emotional maltreatment using the Dutch version of something called the Childhood Trauma Questionnaire.

They looked at Mood and something called, "Need Threat", after the inclusion section, then after the exclusion, and then after the whole thing was done:

The Cyberball game didn't seem to have much differential effect between groups, and what you see is mostly a difference in baseline, unrelated to the game. The main difference seemed to be in fMRI, with greater childhood emotional maltreatment corresponding to greater dorsal medial prefrontal cortex activity:

It's hard to know how much this matters, in the grand scheme of things-whether people who suffered childhood emotional maltreatment are really more vulnerable to social exclusion, and if the difference in brain activity amounts to a difference in perceived experience, and greater vulnerability to other pathology.

But please take a look at the article and let me know what you think, either here, or on POLL.

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