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The preparation of this article was supported by the UK Economic and Social Research Council (Grant ES/K005723).
There is now an overwhelming body of evidence that childhood maltreatment significantly increases the risk of psychiatric disorder in adolescence and throughout adulthood (Gilbert et al., 2009). It is important to note that such an association is probabilistic: maltreatment experience serves to significantly increase the likelihood of poor outcome (e.g., Koenen & Widom, 2009; Widom, DuMont, & Czaja, 2007). What is remarkable is the sheer diversity of disorders that are potentiated by exposure to this form of early adversity. These range from depression (Anda et al., 2002), anxiety (Scott, Smith, & Ellis, 2010), and borderline personality disorder (Widom, Czaja, & Paris, 2009) to schizophrenia (Read, Os, Morrison, & Ross, 2005). This impact on psychological health is in turn embedded within a broader spectrum of maladaptive outcomes associated with maltreatment, which includes poorer physical health (Widom, Czaja, Bentley, & Johnson, 2012), economic productivity (Currie & Widom, 2010), educational attainment, and social functioning (Nikulina, Widom, & Czaja, 2011). This spectrum of difficulties suggests that maltreatment (i.e., experiences of neglect and/or physical, sexual, and emotional abuse) leaves its mark by altering core aspects of functioning that are likely to play a general role in the ability to successfully negotiate normative stresses and developmental challenges across the life span.
If this picture were not sufficiently sobering, an emerging body of research suggests that when a psychiatric condition does present in an individual who has experienced childhood maltreatment, the nature of the individual's disorder is more problematic or intractable in a number of respects. First, psychiatric disorders in individuals who have experienced maltreatment are likely to develop earlier, and with more severe symptomatology (Hovens et al., 2010). Second, such disorders are more likely to present alongside other co-occurring conditions (Harkness & Wildes, 2002). This increased likelihood of co-morbidity is consistent with the general supposition that the experience of maltreatment has a broad rather than focal impact on functioning. Third, a disorder in an individual who has experienced childhood maltreatment is more likely to be persistent and recurrent and less likely to respond to standard treatment approaches (Hovens et al., 2012; Nanni, Uher, & Danese, 2012)....