The case for a preventative approach to mental health: Childhood maltreatment, neuroimaging, and the theory of latent vulnerability

Abstract

This chapter addresses the well-established association between childhood maltreatment and increased risk for psychopathology. Recent functional magnetic resonance imaging research has demonstrated that childhood maltreatment is associated with altered functioning in a range of neurocognitive systems, including threat and reward processing. Such changes are observable even in the absence of psychiatric disorder and in some cases, predict future symptomatology. According to the theory of latent vulnerability they are thought, in part, to reflect adaptations to early adverse environments. The evidence from clinical studies suggests that these changes are strikingly consistent with those observed in individuals presenting with psychiatric disorder, suggesting such neurocognitive ‘adaptations’ embed latent vulnerability to future psychiatric disorder. Ultimately, this growing body of work is establishing a compelling case to develop a more precise, mechanistic understanding of the pathogenesis of psychiatric disorder following maltreatment, and the need to invigorate efforts to build a preventative clinical approach.