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Articles   |    
Decreased Cortical Representation of Genital Somatosensory Field After Childhood Sexual Abuse
Christine M. Heim, Ph.D.; Helen S. Mayberg, M.D.; Tanja Mletzko, M.S.; Charles B. Nemeroff, M.D., Ph.D.; Jens C. Pruessner, Ph.D.
Am J Psychiatry 2013;170:616-623. doi:10.1176/appi.ajp.2013.12070950
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Presented at the 50th annual meeting of the American College of Neuropsychopharmacology, Waikoloa, Hawaii, December 4–8, 2011.

Dr. Mayberg has received consulting fees from St. Jude Medical Neuromodulation. Dr. Nemeroff has received consulting fees from Takeda and Xhale; holds stock or other financial interests in CeNeRx BioPharma, NovaDel Pharma, PharmaNeuroBoost, Revaax Pharma, and Xhale; has patents for methods and devices for transdermal delivery of lithium and for a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay; has served on scientific advisory boards for the American Foundation for Suicide Prevention, the Anxiety Disorders Association of America, CeNeRx BioPharma, NARSAD, NovaDel Pharma, and PharmaNeuroBoost; has served on the board of directors for the American Foundation for Suicide Prevention and NovaDel Pharma; and has received research grants from the Agency for Healthcare Research and Quality and NIH. Dr. Heim, Ms. Mletzko, and Dr. Pruessner report no financial relationships with commercial interests.

Supported by NIH (MH 073698 and MH 58922), NARSAD, and Charité Research Funds.

From the Institute of Medical Psychology, Charité University Medicine Berlin, Germany; the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; and the McGill Center for Studies in Aging and the Departments of Psychology and of Psychiatry, Neurology, and Neurosurgery, McGill University, Montreal.

Address correspondence to Dr. Heim (christine.heim@charite.de) and Dr. Pruessner (jens.pruessner@mcgill.ca).

Copyright © 2013 by the American Psychiatric Association

Received July 20, 2012; Revised December 10, 2012; Accepted January 28, 2013.

Abstract

Objective  Sexual dysfunction is a common clinical symptom in women who were victims of childhood sexual abuse. The precise mechanism that mediates this association remains poorly understood. The authors evaluated the relationship between the experience of childhood abuse and neuroplastic thinning of cortical fields, depending on the nature of the abusive experience.

Method  The authors used MRI-based cortical thickness analysis in 51 medically healthy adult women to test whether different forms of childhood abuse were associated with cortical thinning in areas critical to the perception and processing of specific behavior implicated in the type of abuse.

Results  Exposure to childhood sexual abuse was specifically associated with pronounced cortical thinning in the genital representation field of the primary somatosensory cortex. In contrast, emotional abuse was associated with cortical thinning in regions relevant to self-awareness and self-evaluation.

Conclusions  Neural plasticity during development appears to result in cortical adaptation that may shield a child from the sensory processing of the specific abusive experience by altering cortical representation fields in a regionally highly specific manner. Such plastic reorganization may be protective for the child living under abusive conditions, but it may underlie the development of behavioral problems, such as sexual dysfunction, later in life.

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FIGURE 1. Regression of Childhood Trauma Questionnaire (CTQ) Total Score Against Cortical Thickness in Women With and Without Childhood Sexual Abusea

a Cortical thickness analysis results after regressing CTQ total score against thickness across the entire cortex. Control variables included age and depression scores. Main effects are seen in the somatosensory cortex in the female genital and mouth area on the left, the parahippocampal gyrus (PHG) bilaterally, the left anterior cingulate cortex (ACC), and the precuneus (PRC) bilaterally. For the precise location of the genital sensory field as identified using functional MRI of neural response to stimulation, see references 22 and 23. BA3=Brodmann’s area 3; PCC=posterior cingulate cortex; A=anterior; P=posterior. The color scale refers to the F values of the linear regression (significance threshold: F>4.33).

FIGURE 2. Regression of Childhood Trauma Questionnaire (CTQ) Sexual Abuse Score Against Cortical Thickness in Women With and Without Childhood Sexual Abusea

a Cortical thickness analysis results after regressing CTQ sexual abuse score against thickness across the entire cortex. Control variables included age, depression, and all other CTQ subscales. Main effects are seen in the somatosensory cortex in the female genital area on the left and the parahippocampal gyrus (PHG) bilaterally. For the precise location of the genital sensory field as identified using functional MRI of neural response to stimulation, see references 22 and 23. BA3=Brodmann’s area 3; A=anterior; P=posterior. The color scale refers to the F values of the linear regression (significance threshold: F>4.33).

FIGURE 3. Regression of Childhood Trauma Questionnaire (CTQ) Emotional Abuse Score Against Cortical Thickness in Women With and Without Childhood Sexual Abusea

a Cortical thickness analysis results after regressing CTQ emotional abuse score against thickness across the entire cortex. Control variables included age, depression, and all other CTQ subscales. Main effects are seen in the left and right precuneus (PRC), left anterior cingulate cortex (ACC), right parahippocampal gyrus (PHG), and left somatosensory cortex in the area of the face. BA3=Brodmann’s area 3; PCC=posterior cingulate cortex; A=anterior; P=posterior. The color scale refers to the F values of the linear regression (significance threshold: F>4.33).

FIGURE 4. Regression of Onset Age of Maltreatment Against Cortical Thickness in Women With and Without Childhood Sexual Abusea

a Cortical thickness analysis results after regressing age at onset of abuse against thickness across the entire cortex in the group of women with moderate to severe exposure according to Childhood Trauma Questionnaire cutoff scores. Control variables included age and depression. Main effects are seen in the left frontal pole (LFP), right frontal pole (RFP), left temporal pole (LTP), left parietal lobe (LPL), and left anterior cingulate cortex (ACC). A=anterior; P=posterior. The color scale refers to the F values of the linear regression (significance threshold: F>4.33).

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