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- Title
Disrupted Reinforcement Learning and Maladaptive Behavior in Women With a History of Childhood Sexual Abuse.
- Authors
Pechtel, Pia; Pizzagalli, Diego A.
- Abstract
Importance: Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major de-pressive disorder (MDD), and high-risk behaviors. De-spite the epidemiological data available, the mecha-nisms underlying these maladaptive outcomes remain poorly understood. Objective: We examined whether a history of CSA, par-ticularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in re-inforcement learning, and whether such dysfunction is linked to maladaptive behavior. Design: Participants completed a clinical evaluation and a probabilistic reinforcement task while 128-channel event-related potentials were recorded. Setting: Academic setting; participants recruited from the community. Participants: Fifteen women with a history of CSA and remitted MDD (CSA + rMDD), 16 women with remit-ted MDD with no history of CSA (rMDD), and 18 healthy women (controls). Exposure: Three or more episodes of coerced sexual con-tact (mean [SD] duration, 3.00 [2.20] years) between the ages of 7 and 12 years by at least 1 male perpetrator. Main Outcomes and Measures: Participants' pref-erence for choosing the most rewarded stimulus and avoiding the most punished stimulus was evaluated. The feedback-related negativity and error-related negativity--hypothesized to reflect activation in the anterior cingu-late cortex--were used as electrophysiological indices of reinforcement learning. Results: No group differences emerged in the acquisi-tion of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previ-ously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological dif-ferentiation between correct and incorrect responses (rela-tive to controls), and (3) increased activation in the sub-genual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with im-pairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer per-formance of previously rewarded, but not previously punished, trials. Conclusions and Relevance: Irrespective of past MDD episodes, women with a history of CSA showed neural and behavioral deficits in utilizing previous reinforce-ment to optimize decision making in the absence of feed-back (blunted "Go learning"). Although our study pro-vides initial evidence for reward-specific deficits associated with CSA, future research is warranted to determine if disrupted positive reinforcement learning predicts high-risk behavior following CSA.
- Subjects
CHILD sexual abuse; REINFORCEMENT learning; SEX crimes; MENTAL depression; PATHOLOGICAL psychology; EPIDEMIOLOGICAL research
- Publication
JAMA Psychiatry, 2013, Vol 70, Issue 5, p499
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2013.728