title: Disrupted reinforcement learning and maladaptive behavior in women with a history of childhood sexual abuse: a high-density event-related potential study.
abstract: OBJECTIVE
  Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major depressive disorder (MDD), and high-risk behaviors. Despite the epidemiological data available, the mechanisms underlying these maladaptive outcomes remain poorly understood.
  
  
  OBJECTIVE
  We examined whether a history of CSA, particularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in reinforcement learning, and whether such dysfunction is linked to maladaptive behavior.
  
  
  METHODS
  Participants completed a clinical evaluation and a probabilistic reinforcement task while 128-channel event-related potentials were recorded.
  
  
  METHODS
  Academic setting; participants recruited from the community.
  
  
  METHODS
  Fifteen women with a history of CSA and remitted MDD (CSA + rMDD), 16 women with remitted MDD with no history of CSA (rMDD), and 18 healthy women (controls).
  
  
  METHODS
  Three or more episodes of coerced sexual contact (mean [SD] duration, 3.00 [2.20] years) between the ages of 7 and 12 years by at least 1 male perpetrator.
  
  
  METHODS
  Participants' preference for choosing the most rewarded stimulus and avoiding the most punished stimulus was evaluated. The feedback-related negativity and error-related negativity-hypothesized to reflect activation in the anterior cingulate cortex-were used as electrophysiological indices of reinforcement learning.
  
  
  RESULTS
  No group differences emerged in the acquisition of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological differentiation between correct and incorrect responses (relative to controls), and (3) increased activation in the subgenual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with impairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer performance of previously rewarded, but not previously punished, trials.
  
  
  CONCLUSIONS
  Irrespective of past MDD episodes, women with a history of CSA showed neural and behavioral deficits in utilizing previous reinforcement to optimize decision making in the absence of feedback (blunted "Go learning"). Although our study provides initial evidence for reward-specific deficits associated with CSA, future research is warranted to determine if disrupted positive reinforcement learning predicts high-risk behavior following CSA.
authors.affiliation: Center for Depression, Anxiety and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA. ppechtel@mclean.harvard.edu
authors.forename: Pia
authors.initials: P
authors.lastname: Pechtel
authors.forename: Diego A
authors.initials: DA
authors.lastname: Pizzagalli
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D003865:Major Depressive Disorder / Q000209:etiology / Q000503:physiopathology*; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012054:Reinforcement, Psychology; D055815:Young Adult