The 36th Annual Boston International Trauma Conference — Day Two
8:30am - 12:45pm : The Lasting Impact of Early Adversity: Neurobiological and Psychological Insights into Trauma
Today was full of heavy hitters in the trauma field. I got to see Bessel in the flesh, the author of The Body Keeps the Score. He was entertaining, courageous, and knowledgeable. What I learned about Developmental Trauma today gave me a new appreciation for my self, and for those who have persevered through their chaotic upbringings. Without further ado—
Karen Lyons-Ruth, PhD — Is Neglect the First Form of Threat?
She went over a her findings from her study— Mother-Infant Neurobiological Development(MIND) that revolved around observing the physical brain changes (amygdala size) and neurochemical changes (changes in salivary cortisol) in the newborn baby, in response to either neglect or abuse that occurred during the pregnant mothers childhood. What she found was that there is a positive correlation with neglect, which led to increased cortisol levels in saliva and a larger amygdala. Interestingly, there was a negative correlation with abuse, leading to a blunted response to stress in those infants. She recommends a Developmental Salience Model of Threat in infancy, suggesting that neglect, not caregiver attack, is the first survival threat to infants.
Interesting bits of information—
While the changes in the brain due to neglect lead to increased Amygdala volume in young children, that changed after about 8 years— After the age of 8, healthy children’s amygdala’s surpassed the at risk children’s amygdala’s in volume, suggesting stunted growth after premature stress induced development. Perhaps these increased connections in later development for healthy individuals are why most healthy individuals can self regulate, while many in the at risk population struggle?
The largest correlation for neglect in an infant, after birth and during care, was disorientation in the mother. Essentially. a mother who isn’t tuned into what their baby needs or doesn’t match the cues of the infant.
I found myself wondering how this enlarged amygdala showed up functionally for this at risk population— I thought maybe the neglected population were possibly more prone to the fight/flight response, while the abuse population leaned towards the fawn/freeze response. Dr. Ruth-Lyons stated that there is something else altogether, something she called “Hyper-Vigilance”. which you see in infants that first learn to sooth themselves, then begin soothing the parent. A form of parentification.
Peter Fonagy — Trauma and Mentalization Based Psychotherapy
He went over what he calls “Mentalization”, which is essentially our ability to acknowledge ourselves and others empathetically. The other primary focus of his was “Epistemic Trust” an important capacity for learning from trustworthy others, and how developmental trauma can impact it. He claimed that our ability to mentalize relies on largely the same brain areas as the default mode network(DMN)— notably the right temporoparietal junction(rTPJ), Precuneus(PC), Medial prefrontal cortex(MPFC), and the dorsomedial prefrontal cortex (dMPFC). He also talked about interventions that can potentially restore lost epistemic trust, and in turn proper mentalizing capabilities. His paper is quite in depth, and deeper than I want to go here, but it is interesting and in the references if you want to learn more!
Interesting bits of information—
In healthy human development, mentalization should progress from the I-mode, to the Me-Mode, and eventually to the We-Mode— in which collaboration becomes the means of success.
The implications that childhood adversity have on epistemic trust are known as Epistemic Hypervigilance (Lack of Trust) and Epistemic Credulity (To much Trust)
Epistemic Petrification can result if left unresolved, essentially locking a traumatized individual in their insufficient early capacity of mentalization.
Martin Teicher, MD, PhD — Early Trauma and the Developing Brain: Links to ADHD, Attachment-Related Disorders, and Obesity
Marty is a kindred soul, in exploring the foundational changes in the brain, caused by early adversity and parental neglect. The key differences he found, were that the hippocampal areas were reduced (important for memory and emotion regulation) and that the amygdala areas were increased in volume (responsible for fight/flight response). This is understating just how many differences he found, as there were many areas in the cortex that suffered compared to controls.
Most interestingly, he claimed that male brains are nearly twice as susceptible to cerebral impairment due to early neglect. This is because all brains start out inherently female, until exposed to testosterone during development, meaning that male brains go through many changes that leave them vulnerable. The majority of these changes are on the cerebral level, as the limbic system changes are very similar acrossed the sexes.
Another major insight gleaned from Dr. Teicher came from the MACE scale that he developed. As opposed to the ACE scale, the Maltreatment and Abuse Chronology of Expose (MACE) scale is also focused on the timing of experienced adversity, because it matters—
For Example:
If a developing child is 3 or younger and experiences adversity —> over production of synaptic connections —> cortical thickening —> blunted stress response
If a developing child is older than 3 years and experiences adversity —> increased synaptic pruning —> cortical thinning —> more extreme stress response
This only grazes the surface of Dr. Teichers explorations— but even this is enough for us to question what we know about PTSD, ADHD, or other potential mental illnesses that begin during our development.
Summary: These summaries dont do these studies the justice they deserve. If any of them pique your interest, please don’t be afraid to explore them more deeply on your own! The common theme I’m sensing through these studies— is that we are still working to understand trauma, especially trauma that leads to PTSD, developmental differences, and maladaptive patterns that we can study.
References
Lyons-Ruth, K., Chasson, M., Khoury, J., & Ahtam, B. (2024). Reconsidering the nature of threat in infancy: Integrating animal and human studies on neurobiological effects of infant stress. Neuroscience and Biobehavioral Reviews, 163, 105746. https://doi.org/10.1016/j.neubiorev.2024.105746
Fonagy, P., & Allison, E. (2023). Beyond mentalizing: Epistemic trust and the transmission of culture. The Psychoanalytic Quarterly, 92(4), 599–640. https://doi.org/10.1080/00332828.2023.2290023
Fleming, L. L., Ohashi, K., Enlow, M. B., Khoury, J., Klengel, T., Lyons-Ruth, K., Teicher, M., & Ressler, K. J. (2025). Childhood maltreatment and brain aging during adulthood. bioRxiv. https://doi.org/10.1101/2025.01.16.633271
Teicher, M. H., & Parigger, A. (2015). The ‘maltreatment and abuse chronology of exposure’ (Mace) scale for the retrospective assessment of abuse and neglect during development. PLoS ONE, 10(2), e0117423. https://doi.org/10.1371/journal.pone.0117423
