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The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder

  • Eamon J. McCrory (a1) and Essi Viding (a1)

Maltreatment in childhood is associated with a significantly increased likelihood of psychiatric disorder that endures across the life span. If disorders emerge they tend to be more severe and less responsive to treatment. We introduce the concept of latent vulnerability as a way of conceptualizing the nature of this psychiatric risk. We argue that vulnerability to mental health problems can be understood as changes in a suite of neurocognitive systems that reflect adaptation or altered calibration to early neglectful or maltreating environments. Altered threat processing is presented as one exemplar candidate system. Heightened neurocognitive vigilance to threat is argued to reflect a calibration to an early at-risk environment that becomes maladaptive (and instantiates vulnerability) in the longer term. Other neurocognitive domains, including reward and memory processing, represent equally promising candidates for indexing latent vulnerability and warrant future enquiry. We suggest that the operationalization of latent vulnerability has the potential to guide a preventative psychiatry approach. Intervention currently occurs at two stages when maltreatment is confirmed: first, by addressing issues of risk; and second, by providing clinical intervention if a child meets criteria for psychiatric disorder. We argue that indexing latent vulnerability represents a third intervention opportunity, with the potential to target an indicated prevention approach for the most vulnerable children, offsetting risk trajectories before psychiatric disorders emerge.

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Corresponding author
Address correspondence and reprint requests to: Eamon McCrory, Developmental Risk and Resilience Unit, 26 Bedford Way, University College London WC1H 0AP, UK; E-mail:
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Admon, R., Lubin, G., Rosenblatt, J. D., Stern, O., Kahn, I., Assaf, M., et al. (2013). Imbalanced neural responsivity to risk and reward indicates stress vulnerability in humans. Cerebral Cortex, 23, 2835.
Admon, R., Lubin, G., Stern, O., Rosenberg, K., Sela, L., Ben-Ami, H., et al. (2009). Human vulnerability to stress depends on amygdala's predisposition and hippocampal plasticity. Proceedings of the National Academy of Sciences, 106, 1412014125.
Admon, R., Milad, M. R., & Hendler, T. (2013). A causal model of post-traumatic stress disorder: Disentangling predisposed from acquired neural abnormalities. Trends in Cognitive Sciences, 17, 337347.
Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R, et al. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53, 10011009.
Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35, 4958.
Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindhiem, O., & Carlson, E. (2012). Enhancing attachment organization among maltreated children: Results of a randomized clinical trial. Child Development, 83, 623636.
Britton, J. C., Bar-Haim, Y., Clementi, M. A., Sankin, L. S., Chen, G., Shechner, T., et al. (2013). Training-associated changes and stability of attention bias in youth: Implications for attention bias modification treatment for pediatric anxiety. Developmental Cognitive Neuroscience, 4, 5264.
Caplan, G. (1964). Principles of preventive psychiatry. Oxford: Basic Books.
Cicchetti, D. (2013). Annual Research Review: Resilient functioning in maltreated children—Past, present, and future perspectives. Journal of Child Psychology and Psychiatry, 54, 402422.
Cicchetti, D., & Blender, J. A. (2006). A multiple-levels-of-analysis perspective on resilience: Implications for the developing brain, neural plasticity, and preventive interventions. Annals of the New York Academy of Sciences, 1094, 248258.
Cicchetti, D., & Curtis, W. (2005). An event-related potential study of the processing of affective facial expressions in young children who experienced maltreatment during the first year of life. Development and Psychopathology, 17, 641677.
Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623649.
Cicchetti, D., Rogosch, F. A., Toth, S. L., & Sturge-Apple, M. L. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Development and Psychopathology, 23, 789800.
Cicchetti, D., & Toth, S. L. (2009). The past achievements and future promises of developmental psychopathology: The coming of age of a discipline. Journal of Child Psychology and Psychiatry, 50, 1625.
Correll, C. M., Rosenkranz, J. A., & Grace, A. A. (2005). Chronic cold stress alters prefrontal cortical modulation of amygdala neuronal activity in rats. Biological Psychiatry, 58, 382391.
Creamer, M., McFarlane, A. C., & Burgess, P. (2005). Psychopathology following trauma: The role of subjective experience. Journal of Affective Disorders, 86, 175182.
Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreatment, 15, 111120.
Curtis, W. J., & Cicchetti, D. (2011). Affective facial expression processing in young children who have experienced maltreatment during the first year of life: An event-related potential study. Development and Psychopathology, 23, 373.
Curtis, W. J., & Cicchetti, D. (2013). Affective facial expression processing in 15-month-old infants who have experienced maltreatment an event-related potential study. Child Maltreatment, 18, 140154.
Dannlowski, U., Kugel, H., Huber, F., Stuhrmann, A., Redlich, R., Grotegerd, D., et al. (2013). Childhood maltreatment is associated with an automatic negative emotion processing bias in the amygdala. Human Brain Mapping, 34, 28992909.
Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P., Lenzen, T., Grotegerd, D., et al. (2012). Limbic scars: Long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biological Psychiatry, 71, 286293.
Dillon, D. G., Holmes, A. J., Birk, J. L., Brooks, N., Lyons-Ruth, K., & Pizzagalli, D. A. (2009). Childhood adversity is associated with left basal ganglia dysfunction during reward anticipation in adulthood. Biological Psychiatry, 66, 206213.
Dozier, M., Peloso, E., Lewis, E., Laurenceau, J. P., & Levine, S. (2008). Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care. Development and Psychopathology, 20, 845859.
Etkin, A., & Wager, T. (2007). Functional neuroimaging of anxiety: A meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164, 14761488.
Fales, C. L., Barch, D. M., Rundle, M. M., Mintun, M. A., Snyder, A. Z., Cohen, J. D., et al. (2008). Altered emotional interference processing in affective and cognitive-control brain circuitry in major depression. Biological Psychiatry, 63, 377384.
Figee, M., Vink, M., de Geus, F., Vulink, N., Veltman, D. J., Westenberg, H., et al. (2011). Dysfunctional reward circuitry in obsessive–compulsive disorder. Biological Psychiatry, 69, 867874.
Fisher, P. A., & Kim, H. K. (2007). Intervention effects on foster preschoolers' attachment-related behaviors from a randomized trial. Prevention Science, 8, 161170.
Gibbs, B. R., & Rude, S. S. (2004). Overgeneral autobiographical memory as depression vulnerability. Cognitive Therapy and Research, 28, 511526.
Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373, 6881.
Gordon, R. S. Jr. (1983). An operational classification of disease prevention. Public Health Reports, 98, 107.
Grant, M. M., Cannistraci, C., Hollon, S. D., Gore, J., & Shelton, R. (2011). Childhood trauma history differentiates amygdala response to sad faces within MDD. Journal of Psychiatric Research, 45, 886895.
Guyer, A. E., Kaufman, J., Hodgdon, H. B., Masten, C. L., Jazbec, S., Pine, D. S., et al. (2006). Behavioral alterations in reward system function: The role of childhood maltreatment and psychopathology. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 10591067.
Harkness, K. L., Bagby, R. M., & Kennedy, S. H. (2012). Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder. Journal of Consulting and Clinical Psychology, 80, 342.
Harkness, K. L., & Wildes, J. E. (2002). Childhood adversity and anxiety versus dysthymia co-morbidity in major depression. Psychological Medicine, 32, 12391249.
Heuer, K., Rinck, M., & Becker, E. S. (2007). Avoidance of emotional facial expressions in social anxiety: The Approach–Avoidance Task. Behaviour Research and Therapy, 45, 29903001.
Hommer, D. W., Bjork, J. M., & Gilman, J. M. (2011). Imaging brain response to reward in addictive disorders. Annals of the New York Academy of Sciences, 1216, 5061.
Hovens, J. G. F. M., Giltay, E. J., Wiersma, J. E., Spinhoven, P., Penninx, B. W. J. H., & Zitman, F. G. (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 126, 198207.
Hovens, J. G. F. M., Wiersma, J. E., Giltay, E. J., Van Oppen, P., Spinhoven, P., Penninx, B. W. J. H., et al. (2010). Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Acta Psychiatrica Scandinavica, 122, 6674.
Insel, T. R. (2009). Translating scientific opportunity into public health impact: A strategic plan for research on mental illness. Archives of General Psychiatry, 66, 128133.
Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: Precision medicine for psychiatry. American Journal of Psychiatry, 171, 395397.
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., et al. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167, 748751.
Kerestes, R., Davey, C. G., Stephanou, K., Whittle, S., & Harrison, B. J. (2013). Functional brain imaging studies of youth depression: A systematic review. NeuroImage: Clinical, 4, 209231.
Koenen, K. C., & Widom, C. S. (2009). A prospective study of sex differences in the lifetime risk of posttraumatic stress disorder among abused and neglected children grown up. Journal of Traumatic Stress, 22, 566574.
LaBar, K. S., LeDoux, J. E., Spencer, D. D., & Phelps, E. A. (1995). Impaired fear conditioning following unilateral temporal lobectomy in humans. Journal of Neuroscience, 15, 68466855.
LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23, 155184
Liberzon, I., & Sripada, C. S. (2007). The functional neuroanatomy of PTSD: A critical review. Progress in Brain Research, 167, 151169.
Liberzon, I., Taylor, S. F., Amdur, R., Jung, T. D., Chamberlain, K. R., Minoshima, S., et al. (1999). Brain activation in PTSD in response to trauma-related stimuli. Biological Psychiatry, 45, 817826.
Lind, T., Bernard, K., Ross, E., & Dozier, M. (2014). Intervention effects on negative affect of CPS-referred children: Results of a randomized clinical trial. Child Abuse and Neglect. Advance online publication. doi:10.1016/j.chiabu.2014.04.004
Mackinger, H. F., Pachinger, M. M., Leibetseder, M. M., & Fartacek, R. R. (2000). Autobiographical memories in women remitted from major depression. Journal of Abnormal Psychology, 109, 331.
MacLeod, C., & Mathews, A. (1988). Anxiety and the allocation of attention to threat. Quarterly Journal of Experimental Psychology, 40, 653670.
Maheu, F. S., Dozier, M., Guyer, A. E., Mandell, D., Peloso, E., Poeth, K., et al. (2010). A preliminary study of medial temporal lobe function in youths with a history of caregiver deprivation and emotional neglect. Cognitive, Affective, & Behavioral Neuroscience, 10, 3449.
McCrory, E. J., De Brito, S. A., Kelly, P. A., Bird, G., Sebastian, C. L., Mechelli, A., et al. (2013). Amygdala activation in maltreated children during pre-attentive emotional processing. British Journal of Psychiatry, 202, 269276.
McCrory, E. J., De Brito, S. A., Sebastian, C. L., Mechelli, A., Bird, G., Kelly, P. A., et al. (2011). Heightened neural reactivity to threat in child victims of family violence. Current Biology, 21, R947R948.
McGlashan, T. H., & Johannessen, J. O. (1996). Early detection and intervention with schizophrenia. Schizophrenia Bulletin, 22, 201222.
McGorry, P. (2013). Prevention, innovation and implementation science in mental health: The next wave of reform. British Journal of Psychiatry, 202, s3s4.
McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229252.
Mehta, M. A., Golembo, N. I., Nosarti, C., Colvert, E., Mota, A., Williams, S. C., et al. (2009). Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: The English and Romanian Adoptees study pilot. Journal of Child Psychology and Psychiatry, 50, 943951.
Milad, M. R., & Quirk, G. J. (2002). Neurons in medial prefrontal cortex signal memory for fear extinction. Nature, 420, 7074.
Mogg, K., & Bradley, B. P. (1998). A cognitive–motivational analysis of anxiety. Behaviour Research and Therapy, 36, 809848.
Monk, C. S., Telzer, E. H., Mogg, K., Bradley, B. P., Mai, X., Louro, H. M., et al. (2008). Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of General Psychiatry, 65, 568576.
Mrazek, P. B., & Haggerty, R. J. (Eds.). (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academies Press.
Mueller, S. C., Hardin, M. G., Korelitz, K., Daniele, T., Bemis, J., Dozier, M., et al. (2012). Incentive effect on inhibitory control in adolescents with early-life stress: An antisaccade study. Child Abuse and Neglect, 36, 217225.
Nanni, V., Uher, R., & Danese, A. (2012). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: A meta-analysis. American Journal of Psychiatry, 169, 141151.
Nikulina, V., Widom, C. S., & Czaja, S. (2011). The role of childhood neglect and childhood poverty in predicting mental health, academic achievement and crime in adulthood. American Journal of Community Psychology, 48, 309321.
Öhman, A. (2009). Of snakes and faces: An evolutionary perspective on the psychology of fear. Scandinavian Journal of Psychology, 50, 543552.
Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278, 637643.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2008, August). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 5273.
Pape, H. C., & Pare, D. (2010). Plastic synaptic networks of the amygdala for the acquisition, expression, and extinction of conditioned fear. Physiological Reviews, 90, 419.
Pine, D. S., Mogg, K., Bradley, B. P., Montgomery, L., Monk, C. S., McClure, E., et al. (2005). Attention bias to threat in maltreated children: Implications for vulnerability to stress-related psychopathology. American Journal of Psychiatry, 162, 291296.
Pollak, S. D., Cicchetti, D., Klorman, R., & Brumaghim, J. T. (1997). Cognitive brain event-related potentials and emotion processing in maltreated children. Child Development, 68, 773787.
Pollak, S. D., & Kistler, D. J. (2002). Early experience is associated with the development of categorical representations for facial expressions of emotion. Proceedings of the National Academy of Sciences, 99, 90729076.
Pollak, S. D., Klorman, R., Thatcher, J. E., & Cicchetti, D. (2001). P3b reflects maltreated children's reactions to facial displays of emotion. Psychophysiology, 38, 267274.
Pollak, S. D., Messner, M., Kistler, D. J., & Cohn, J. F. (2009). Development of perceptual expertise in emotion recognition. Cognition, 110, 242247.
Pollak, S. D., & Sinha, P. (2002). Effects of early experience on children's recognition of facial displays of emotion. Developmental Psychology, 38, 784791.
Rawal, A., & Rice, F. (2012). Examining overgeneral autobiographical memory as a risk factor for adolescent depression. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 518527.
Read, J., Os, J. V., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330350.
Rieder, C., & Cicchetti, D. (1989). An organizational perspective on cognitive control functioning and cognitive–affective balance in maltreated children. Developmental Psychology, 25, 382393.
Rosenkranz, J. A., Venheim, E. R., & Padival, M. (2010). Chronic stress causes amygdala hyperexcitability in rodents. Biological Psychiatry, 67, 11281136.
Roy, A. K., Vasa, R. A., Bruck, M., Mogg, K., Bradley, B. P., Sweeney, M., et al. (2008). Attention bias toward threat in pediatric anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 11891196.
Rubia, K., Smith, A., Halari, R., Matsukura, F., Mohammad, M., Taylor, E., et al. (2009). Disorder-specific dissociation of orbitofrontal dysfunction in boys with pure conduct disorder during reward and ventrolateral prefrontal dysfunction in boys with pure ADHD during sustained attention. American Journal of Psychiatry, 166, 8394.
Scott, K. M., Smith, D. R., & Ellis, P. M. (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry, 67, 712719.
Shackman, J. E., Shackman, A. J., & Pollak, S. D. (2007). Physical abuse amplifies attention to threat and increases anxiety in children. Emotion, 7, 838852.
Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35, 169191.
Springer, J. F., & Phillips, J. L. (2007). The Institute of Medicine framework and its implication for the advancement of prevention policy, programs and practice (Prevention Policy Paper Series). Folsom, CA: EMT Associates.
Stein, M., Simmons, A., Feinstein, J., & Paulus, M. (2007). Increased amygdala and insula activation during emotion processing in anxiety-prone subjects. American Journal of Psychiatry, 164, 318327.
Stoy, M., Schlagenhauf, F., Sterzer, P., Bermpohl, F., Hägele, C., Suchotzki, K., et al. (2012). Hyporeactivity of ventral striatum towards incentive stimuli in unmedicated depressed patients normalizes after treatment with escitalopram. Journal of Psychopharmacology, 26, 677688.
Stronach, E. P., Toth, S. L., Rogosch, F., & Cicchetti, D. (2013). Preventive interventions and sustained attachment security in maltreated children. Development and Psychopathology, 25, 919930.
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67, 614623.
Tottenham, N., Hare, T. A., Millner, A., Gilhooly, T., Zevin, J. D., & Casey, B. J. (2011). Elevated amygdala response to faces following early deprivation. Developmental Science, 14, 190204.
US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2013). Child maltreatment, 2012. Washington, DC: Author.
Valentino, K., Toth, S. L., & Cicchetti, D. (2009). Autobiographical memory functioning among abused, neglected, and nonmaltreated children: The overgeneral memory effect. Journal of Child Psychology and Psychiatry, 50, 10291038.
van Wingen, G. A., Geuze, E., Vermetten, E., & Fernández, G. (2011). Perceived threat predicts the neural sequelae of combat stress. Molecular Psychiatry, 16, 664671.
Viding, E., Sebastian, C. L., Dadds, M. R., Lockwood, P. L., Cecil, C. A., De Brito, S. A., et al. (2012). Amygdala response to preattentive masked fear in children with conduct problems: The role of callous–unemotional traits. American Journal of Psychiatry, 169, 11091116.
Wald, I., Lubin, G., Holoshitz, Y., Muller, D., Fruchter, E., Pine, D. S., et al. (2011). Battlefield-like stress following simulated combat and suppression of attention bias to threat. Psychological Medicine, 41, 699.
White, M. G., Bogdan, R., Fisher, P. M., Muñoz, K. E., Williamson, D. E., & Hariri, A. R. (2012). FKBP5 and emotional neglect interact to predict individual differences in amygdala reactivity. Genes, Brain and Behavior, 11, 869878.
Widom, C. S., Czaja, S. J., Bentley, T., & Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102, 11351144.
Widom, C. S., Czaja, S. J., & Paris, J. (2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of Personality Disorders, 23, 433446.
Widom, C. S., DuMont, K., & Czaja, S. J. (2007). A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Archives of General Psychiatry, 64, 4956.
Wiech, K., Lin, C. S., Brodersen, K. H., Bingel, U., Ploner, M., & Tracey, I. (2010). Anterior insula integrates information about salience into perceptual decisions about pain. Journal of Neuroscience, 30, 1632416331.
Wolfensberger, S., Veltman, D. J., Hoogendijk, W. J., Boomsma, D. I., & de Geus, E. J. (2008). Amygdala responses to emotional faces in twins discordant or concordant for the risk for anxiety and depression. NeuroImage, 41, 544552.
Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22, 353370.
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