Abstract
Abstract There is strong evidence that childhood maltreatment has significant long-term mental health consequences, and these adverse childhood experiences have resulted in a serious public health crisis. Though they are highly prevalent, these early life stress (ELS) events contribute substantially to the risk of a variety of psychiatric and medical disorders including mood disorders, substance use, anxiety, suicidality, and common medical comorbidities such as obesity, diabetes, and cardiovascular disease. The consensus of most studies show that childhood maltreatment is associated with a higher incidence, worsened course, and poorer treatment response to both psychotherapy and psychopharmacology. Multiple genetic polymorphisms interact to increase risk for these disorders, increasing the likelihood of long-term consequence when children are exposed to the stressful events. Numerous animal studies report long lasting neurobiological consequences of ELS to include alterations in endocrine regulation and neural development. Substantial research supports that childhood maltreatment leads to elevated inflammatory markers in later life, and that these elevated biomarkers contribute toward the risk of inflammatory-linked disorders including autoimmune diseases, heart disease, diabetes, cancer, GI disorders, as well as other medical conditions. Imaging studies demonstrate persistent structural brain changes after individuals suffered physical, sexual, and emotional abuse. Many studies point toward epigenetic mechanisms causing heritable changes in gene expression as a causative mechanism by which ELS may influence gene expression. Other studies document advanced cellular aging in the form of shortened telomere length as another mechanism by which psychological stress and trauma contribute to both medical and psychiatric disorders. In this review, we examine the expanding body of research on the long-term biological and clinical consequences of child maltreatment, and the need for public health efforts to work toward reducing the incidence of this abuse, and the consequent lifelong morbidity it creates.