[Childhood maltreatment and adult psychopathology: pathways to hypothalamic-pituitary-adrenal axis dysfunction].
OBJECTIVE
The aim of this paper was to examine the relationship between childhood maltreatment and adult psychopathology, as reflected in hypothalamic-pituitary-adrenal axis dysfunction.


METHODS
A selective review of the relevant literature was undertaken in order to identify key and illustrative research findings.


RESULTS
There is now a substantial body of preclinical and clinical evidence derived from a variety of experimental paradigms showing how early-life stress is related to hypothalamic-pituitary-adrenal axis function and psychological state in adulthood, and how that relationship can be modulated by other factors.


CONCLUSIONS
The risk for adult psychopathology and hypothalamic-pituitary-adrenal axis dysfunction is related to a complex interaction among multiple experiential factors, as well as to susceptibility genes that interact with those factors. Although acute hypothalamic-pituitary-adrenal axis responses to stress are generally adaptive, excessive responses can lead to deleterious effects. Early-life stress alters hypothalamic-pituitary-adrenal axis function and behavior, but the pattern of hypothalamic-pituitary-adrenal dysfunction and psychological outcome in adulthood reflect both the characteristics of the stressor and other modifying factors.


CONCLUSIONS
Research to date has identified multiple determinants of the hypothalamic-pituitary-adrenal axis dysfunction seen in adults with a history of childhood maltreatment or other early-life stress. Further work is needed to establish whether hypothalamic-pituitary-adrenal axis abnormalities in this context can be used to develop risk endophenotypes for psychiatric and physical illnesses.
Mello
Marcelo F
MF
Instituto PROVE, Universidade Federal de São Paulo, São Paulo, SP, Brazil. mf-mello@uol.com.br
Faria
Alvaro A
AA
Mello
Andrea F
AF
Carpenter
Linda L
LL
Tyrka
Audrey R
AR
Price
Lawrence H
LH
D000328:Adult; D001007:Anxiety / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D003863:Depression / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000209:etiology* / Q000503:physiopathology