This review by Teicher and Samson examines the neurobiological effects of childhood maltreatment, including neglect, physical, sexual, and emotional abuse. The authors synthesize neuroimaging findings from studies involving children, adolescents, and adults who experienced various forms of maltreatment. Key findings include morphological alterations in brain regions such as the anterior cingulate, dorsal lateral prefrontal, and orbitofrontal cortex, as well as changes in the corpus callosum and adult hippocampus. Emotional abuse, witnessing domestic violence, and sexual abuse are associated with specific brain regions and pathways processing aversive experiences. Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be more directly linked to abuse. The review discusses the importance of type and timing of exposure, gender differences, reversibility, and the relationship between brain changes and psychopathology. It also explores whether these changes represent adaptive modifications or stress-induced damage. The authors conclude that childhood maltreatment significantly influences brain development and has been an unrecognized confound in psychiatric neuroimaging studies. They suggest that these brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity, and that mechanisms fostering resilience will be a primary focus of future research.This review by Teicher and Samson examines the neurobiological effects of childhood maltreatment, including neglect, physical, sexual, and emotional abuse. The authors synthesize neuroimaging findings from studies involving children, adolescents, and adults who experienced various forms of maltreatment. Key findings include morphological alterations in brain regions such as the anterior cingulate, dorsal lateral prefrontal, and orbitofrontal cortex, as well as changes in the corpus callosum and adult hippocampus. Emotional abuse, witnessing domestic violence, and sexual abuse are associated with specific brain regions and pathways processing aversive experiences. Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be more directly linked to abuse. The review discusses the importance of type and timing of exposure, gender differences, reversibility, and the relationship between brain changes and psychopathology. It also explores whether these changes represent adaptive modifications or stress-induced damage. The authors conclude that childhood maltreatment significantly influences brain development and has been an unrecognized confound in psychiatric neuroimaging studies. They suggest that these brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity, and that mechanisms fostering resilience will be a primary focus of future research.