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The Resilient Emotional Brain: A Scoping Review of the Medial Prefrontal Cortex and Limbic Structure and Function in Resilient Adults With a History of Childhood Maltreatment

  • Author Footnotes
    1 LM-L and KI contributed equally to this work.
    Laura Moreno-López
    Correspondence
    Address correspondence to Anne-Laura van Harmelen, Ph.D., M.Sc., or Laura Moreno-López, Ph.D., Department of Psychiatry, University of Cambridge, Douglas House, Trumpington Rd, Cambridge CB2 8AH, UK.
    Footnotes
    1 LM-L and KI contributed equally to this work.
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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  • Author Footnotes
    1 LM-L and KI contributed equally to this work.
    Konstantinos Ioannidis
    Footnotes
    1 LM-L and KI contributed equally to this work.
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

    Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, United Kingdom
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  • Adrian Dahl Askelund
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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  • Alicia J. Smith
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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  • Katja Schueler
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

    Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
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  • Anne-Laura van Harmelen
    Correspondence
    Address correspondence to Anne-Laura van Harmelen, Ph.D., M.Sc., or Laura Moreno-López, Ph.D., Department of Psychiatry, University of Cambridge, Douglas House, Trumpington Rd, Cambridge CB2 8AH, UK.
    Affiliations
    Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
    Search for articles by this author
  • Author Footnotes
    1 LM-L and KI contributed equally to this work.
Published:December 19, 2019DOI:https://doi.org/10.1016/j.bpsc.2019.12.008

      Abstract

      Childhood maltreatment (CM) is one of the strongest predictors of adult mental illness, although not all adults with CM develop psychopathology. Here, we describe the structure and function of the emotional brain regions that may contribute to resilient functioning after CM. We review studies that report medial prefrontal cortex, amygdala, and hippocampus (limbic regions) structure, function, and/or connections in resilient adults (i.e., those reporting CM without psychopathology) versus vulnerable adults (i.e., those reporting CM with psychopathology) or healthy adults (those without CM and with no psychopathology). We find that resilient adults have larger hippocampal gray and white matter volume and greater connectivity between the central executive network and the limbic regions. In addition, resilient adults have improved ability to regulate emotions through medial prefrontal cortex–limbic downregulation, lower hippocampal activation to emotional faces, and increased amygdala habituation to stress. We highlight the need for longitudinal designs that examine resilient functioning across domains and consider gender, type, timing, and nature of CM assessments and further stressors to further improve our understanding of the role of the emotional brain in resilient functioning after CM.

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