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Experiences of abuse and neglect during childhood are linked to distinct differences in brain structure among young adults, depending on their age, biological sex, and the specific type of adversity they faced. A new neuroimaging study published in European Neuropsychopharmacology indicates that physical abuse and the tendency to downplay childhood hardship are associated with a thinner outer layer of the brain, whereas a pattern combining emotional abuse and female sex is tied to a smaller left amygdala, a region involved in processing emotions.
Childhood maltreatment encompasses physical, emotional, and sexual abuse, as well as physical and emotional neglect during a person’s formative years. Individuals who experience early maltreatment are more likely to develop mood and anxiety conditions at a younger age and often experience more severe symptoms than peers with the same psychiatric diagnosis who were not mistreated.
To understand why, scientists examine how early stress relates to the physical structure of the cerebral cortex, the folded outer layer of neural tissue that covers the brain and handles complex thought and sensory processing, and the amygdala, an almond-shaped cluster of neurons deep inside the brain’s temporal lobes that detects threats and regulates emotions.
Pinpointing consistent brain changes linked to early adversity has proven difficult when studies treat trauma as a single summary score or look at individual brain regions in isolation. For instance, a 2025 analysis of over 3,200 adults, which included several authors of the new study, found that links between childhood maltreatment and brain gray matter volume did not replicate from one group of participants to the next.
Some researchers argue that more consistent patterns emerge when studies account for biological sex and zoom in on smaller anatomical compartments. Along these lines, a 2020 study of youth at risk for mental illness indicated that dividing the amygdala into its individual subregions helped link childhood physical and sexual abuse to smaller volumes in specific compartments tied to anxiety and depressive symptoms.
How people answer trauma questionnaires also complicates neuroimaging research, as some individuals minimize or deny painful childhood memories, possibly as a way of coping with past distress. Earlier work, including a 2016 study of nearly 20,000 people, showed that this tendency to idealize one’s upbringing on surveys is common and can blur the distinction between psychiatric patients and healthy volunteers.
Building on these insights, Fabian Huth of the Carl Gustav Carus University Hospital at Technische Universität Dresden, David Popovic of the Max Planck Institute for Psychiatry and Ludwig-Maximilian-University in Munich, and their colleagues used machine learning to test how specific abuse items, trauma denial, age, and sex together relate to brain structure in young adults at the earliest stages of mental health difficulties.
The researchers analyzed data from 251 help-seeking adolescents and young adults aged 17 to 35, with an average age of about 25 and a nearly even split between 130 males and 121 females. Participants were recruited across six university hospitals and early detection centers in Germany as part of a larger project tracking individuals with early mood or anxiety symptoms, ADHD, or other risk factors for bipolar disorder. The authors focused on young people early in the course of their mental health challenges to reduce the influence of chronic illness and long-term treatment, although a majority of participants with medication data were already taking antidepressants.
Each participant completed the Childhood Trauma Questionnaire, a 28-item survey that measures emotional, physical, and sexual abuse alongside emotional and physical neglect. The questionnaire also includes three items designed to detect minimization or denial of hardship, such as strongly agreeing with the statement, “I had the best family in the world.” Participants underwent structural MRI scans to measure the thickness and surface area of the cerebral cortex across dozens of regions, as well as the volumes of nine subregions within the amygdala and multiple subregions of the hippocampus, a neighboring seahorse-shaped structure involved in memory and stress regulation.
Clinicians rated each participant’s depressive symptoms and overall psychological, social, and occupational functioning on a 1 to 100 scale, and participants completed a questionnaire about subclinical psychotic experiences. Functioning was rated again one year and two years later. Rather than averaging the trauma items together or statistically removing the effects of age and biological sex, the authors fed all 28 questionnaire items, age, sex, and 182 brain measurements into a pattern-finding algorithm known as sparse partial least squares. This mathematical technique identifies clusters of life experiences and demographic traits that vary together with distributed networks of brain structure, while controlling for overall head size and scanning site.
To check that the patterns would generalize, the team repeatedly tested them on portions of the data held out from model building. The analysis uncovered two distinct brain-behavior profiles across the sample. The first profile linked older age, severe physical abuse, and extreme trauma denial to a thinner cerebral cortex across both halves of the brain (a difference between participants, not a measured loss of tissue over time), which the researchers refer to as cortical thinning. This pattern accounted for 18 percent of the shared variance between the participants’ questionnaire profiles and their brain measurements, with cortical thickness making up over 86 percent of the brain pattern while cortical surface area and deep brain volumes contributed very little.
Follow-up statistical checks showed that the physical abuse item, which asked whether the person had been hit so badly that a teacher, neighbor, or doctor noticed, and the denial item, which claimed having the “best family in the world,” each independently predicted this cortical thinning pattern. None of the 22 participants who strongly endorsed the denial statement reported more than minimal physical abuse, yet denial was linked to the same pattern of thinner cortex. However, this cortical thinning profile was not statistically significant as a predictor of how well participants functioned in their daily lives one or two years later.
The second profile identified a female-specific pattern that accounted for 32 percent of the shared variance between the behavioral and brain data. The pattern linked female sex, which carried the most weight, and higher levels of emotional abuse, with smaller contributions from physical abuse, emotional neglect, and sexual abuse, to smaller volumes in the left amygdala. Specifically, this reduction was concentrated in the total left amygdala and three of its internal compartments: the basal, paralaminar, and accessory basal nuclei, while hippocampal subregions did not contribute to the pattern.
Unlike the cortical thinning pattern, the female-specific emotional trauma profile was linked to later daily functioning. Across all female participants with follow-up data, average daily functioning scores improved from 62.6 at the start of the study to 69.6 after one year and 72.0 after two years, but women who scored higher on the emotional abuse profile had worse functioning at both the one-year and two-year marks, an association that held at two years even after accounting for baseline functioning. Paradoxically, having smaller left amygdala subregions alongside emotional trauma initially predicted better functioning at the two-year mark, though this brain-outcome link was no longer statistically significant after accounting for baseline functioning.
To better understand this amygdala pattern, the researchers divided participants with high emotional trauma scores into subgroups with smaller versus larger left amygdala volumes and trained a classification algorithm on 17 clinical and diagnostic measures. Among the most extreme third of the female group, comprising 26 women per subgroup, the algorithm distinguished those with larger versus smaller amygdala volumes with 69.2 percent balanced accuracy, whereas models for male participants performed no better than a coin toss.
Descriptively, women in this extreme subgroup who reported high emotional trauma and had larger left amygdala volumes showed somewhat poorer daily functioning than those with smaller volumes, although direct statistical comparisons between the groups were not significant. The classification result was also modest: it did not hold when the groups were split at the median, and its accuracy was not statistically better than the male model’s.
“What interests me most is the attempt to understand how different experiences of maltreatment relate to brain structure across the early stages of mental health difficulties,” Zai-Fu Yao, an associate professor in the College of Education and director of the Research Center for Education and Mind Sciences at National Tsing Hua University in Taiwan, who was not involved in the research, told PsyPost. “Understanding someone’s developmental history may tell us something that their current diagnosis alone cannot capture. One finding deserves particular attention: the cortical-thickness pattern was not associated with functioning at follow-up. Identifying a brain difference and explaining a person’s everyday difficulties are separate scientific tasks.”
“The clinical meaning of an imaging finding still has to be demonstrated,” Yao added. “For me, this makes the study valuable as a starting point for asking more precise questions about individual differences. We need to understand what these patterns mean in people’s lives before assigning them a label such as vulnerability or resilience.”
These observations align with research covered by PsyPost earlier in 2026, which examined a broader international cohort spanning healthy individuals and patients across the lifespan rather than young adults with early affective or anxiety syndromes, and similarly found that childhood trauma is linked to age- and sex-specific differences in brain structure.
At the same time, the cortical thinning results stand in tension with a study, which evaluated brain structural changes linked to childhood trauma using the Childhood Trauma Questionnaire in healthy adults rather than young adults with early affective and anxiety disorders, and found that moderate to severe childhood trauma was associated with larger gray matter volume in parts of the parietal, temporal, and occipital lobes.
Beyond structural brain scans that measure physical volume, other studies have used functional brain imaging to observe how strongly the amygdala reacts during emotional tasks. “Broadly, it extends evidence linking childhood maltreatment with differences in brain systems involved in emotional processing,” Yao said. “In our 2025 meta-analysis, which included 30 studies involving 2,474 participants, we identified convergent evidence of increased right-amygdala activation during emotional tasks among people with maltreatment histories.”
“The present study examines a different aspect of the picture: structural variation, particularly in the left amygdala, and how it relates to maltreatment profiles, age, and sex,” Yao explained. “These findings address different measurements and different sides of the amygdala. A smaller volume does not, by itself, tell us whether a region responds more strongly or weakly.”
There are a few things to keep in mind when interpreting these results. Because brain scans were only collected once at the start of the study, the findings cannot establish whether smaller amygdala subregions or a thinner cortex were caused by childhood maltreatment, existed prior to the trauma, or emerged as temporary adjustments during the early stages of a mood disorder.
“The word ‘thinning’ can sound as though the researchers watched people’s brains lose tissue over time,” Yao noted. “They did not: the imaging analysis used a single assessment. Similarly, ‘smaller’ and ‘thinner’ have no universal psychological meaning. These measurements alone cannot tell us someone’s intelligence, capacity to learn, or potential for recovery.”
Additionally, when the researchers tested emotional abuse and left amygdala size directly, the link was not statistically significant. Biological sex was by far the strongest predictor of amygdala size, and the authors acknowledge that the multivariate pattern needs to be confirmed in larger, independent samples.
“I would describe this as promising exploratory evidence,” Yao said. “The multisite sample of 251 participants, follow-up assessments of functioning, and analytical safeguards against overfitting are meaningful strengths. However, internal cross-validation cannot replace replication in an independent sample. I am more confident in the broader association between maltreatment and variation in emotional-processing systems than in the precise age- and sex-specific interpretation proposed here.”
“The direct trauma-by-sex interaction for left-amygdala volume was not statistically significant, so I would treat the female-specific interpretation as provisional,” he added. “These qualifications leave the findings worth investigating, while limiting how confidently we can describe them as sex-specific mechanisms or predictors of recovery.”
The study also relied on young adults recalling their childhood experiences on a questionnaire, a method that is vulnerable to memory inaccuracies and the influence of current emotional distress. In the case of the “best family” denial item, which only 22 participants strongly endorsed, the authors note that it remains uncertain whether those who claimed to have a perfect family were actively suppressing memories of unacknowledged abuse or simply displaying a defensive response tendency. Future studies that track young people’s brain development over several years and combine self-reports with objective records of childhood adversity and cognitive testing could help determine how these brain patterns evolve and whether they can guide personalized mental health care.
“I would be especially careful with the questionnaire findings described as denial or minimization,” Yao cautioned. “Those responses cannot establish that someone experienced undisclosed abuse, and the imaging findings cannot resolve the truth of an individual’s childhood history. There is also a human point that matters to me: people should never have to produce an abnormal brain scan for their suffering to be taken seriously.”
“The question I find particularly compelling is: what helps a person update their expectations of danger when their circumstances become safer?” Yao continued. “That would require measuring learning directly, alongside actual changes in safety, social support, and treatment. The brain keeps learning from experience. An important next step is to discover which experiences help that learning become less constrained by past danger.”
The study, “Childhood maltreatment is linked to transdiagnostic age- and sex-specific cortical thinning and reduced amygdalar volume in young adults,” was authored by Fabian Huth, Clara Vetter, Clara Weyer, Kyra Bröckel-Bundt, Christina Berndt, Julia Martini, Birgit Maicher, Falk Gerrik Verhees, Paula M. Henneberg, Leonardo Tozzi, Andreas Jansen, Tilo Kircher, Irina Falkenberg, Florian Thomas-Odenthal, Martin Lambert, Vivien Kraft, Gregor Leicht, Christoph Mulert, Andreas J. Fallgatter, Thomas Ethofer, Anne Rau, Karolina Leopold, Andreas Bechdolf, Andreas Reif, Silke Matura, Felix Bermpohl, Jana Fiebig, Stefanie Schreiter, Thomas Stamm, Christoph U. Correll, Georg Juckel, Vera Flasbeck, Udo Dannlowski, Eva Mennigen, Philipp Ritter, Paris Alexandros Lalousis, Peter Falkai, Nikolaos Koutsouleris, Michael Bauer, Andrea Pfennig, David Popovic, and Pavol Mikolas.