The Resilient Emotional Brain: A Scoping Review of the Medial Prefrontal Cortex and Limbic Structure and Function in Resilient Adults With a History of Childhood Maltreatment

Childhood Maltreatment (CM) is one of the strongest predictors of adult mental illness, though not all adults with CM develop psychopathology. Here, we describe the structure and function of emotional brain regions that may contribute to resilient functioning after CM. We review studies that report medial prefrontal cortex (mPFC), amygdala and hippocampus (‘limbic regions’) structure, function, and/or connections, in resilient (i.e., adults reporting CM without psychopathology) vs. vulnerable (i.e., adults reporting CM with psychopathology), or healthy adults (adults without CM with no psychopatology). We find that resilient adults have larger hippocampal grey and white matter volume, and increased connectivity between the central executive network and limbic regions. In addition, resilient adults have improved ability to regulate emotions through mPFC-limbic downregulation, lower hippocampal activation to emotional faces, and increased amygdala habituation to stress. We highlight the need for longitudinal designs that examine resilient functioning across domains and consider gender, type, timing, nature of CM assessments and further stressors, in order to further improve our understanding of the role of the emotional brain in resilient functioning after CM.
ALvH is funded by the UK’s Royal Society (DH15017, RGF\EA\180029 & 567RGF\RI\180064), MQ (MQBFC/2), and the MRC MRF Emerging Leaders award. Part of this research was carried out by K.I. during a Fellowship awarded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. ADA was funded by the Aker Scholarship.