0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Disrupted Reinforcement Learning and Maladaptive Behavior in Women With a History of Childhood Sexual Abuse:  A High-Density Event-Related Potential Study

Pia Pechtel, PhD; Diego A. Pizzagalli, PhD
JAMA Psychiatry. 2013;70(5):499-507. doi:10.1001/jamapsychiatry.2013.728.
Text Size: A A A
Published online

Importance Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major depressive disorder (MDD), and high-risk behaviors. Despite the epidemiological data available, the mechanisms underlying these maladaptive outcomes remain poorly understood.

Objective We examined whether a history of CSA, particularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in reinforcement 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 remitted MDD with no history of CSA (rMDD), and 18 healthy women (controls).

Exposure Three or more episodes of coerced sexual contact (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' preference 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 cingulate cortex—were used as electrophysiological indices of reinforcement learning.

Results No group differences emerged in the acquisition of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological differentiation between correct and incorrect responses (relative to controls), and (3) increased activation in the subgenual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with impairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer performance 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 reinforcement to optimize decision making in the absence of feedback (blunted “Go learning”). Although our study provides 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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Mean percentage accuracy (A) and reaction time (B) for healthy women (controls), women with a history of childhood sexual abuse and remitted major depressive disorder (CSA + MDD), and women with remitted MDD with no history of abuse (rMDD) in reward (A novel), punishment (B novel), and familiar (A-B) trials. Error bars indicate standard error.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Response-locked waveforms (testing phase) for healthy women (A), women with a history of childhood sexual abuse and remitted major depressive disorder (B), and women with remitted major depressive disorder with no history of abuse (C) averaged for all A-B familiar trials following correct responses (grey curve) and incorrect responses (black curve) at electrode position Cz. Negative values are plotted upward. ERN indicates error-related negativity.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Subgenual (Brodmann area [BA] 25) activation in A novel trials for healthy women (controls), women with a history of childhood sexual abuse and remitted major depressive disorder (CSA + rMDD), and women with remitted major depressive disorder with no history of abuse (rMDD). Less negative values denote a higher current density (ie, activation). Error bars indicate standard error.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();