People-pleasing and panic are signs of childhood neglect? Sir H N Reliance Foundation Hospital psychiatrist explainsPublished on: Aug 18, 2026, 15:23:00 IST

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Dr Ashutosh Shah, psychiatrist with 25 years of experience, explains how childhood neglect rewires the brain — and why small things can feel so big as an adult.

It happens on an ordinary Tuesday. You are answering an email. A colleague writes back with a curt line. A partner forgets to buy milk. Most people register it, shrug, and move on. For some adults, the body responds as if a threat has entered the room. Also read | Neurosurgeon with 26 years of experience explains panic attacks are terrifying: 'You literally feel you're going to die'

The heart pounds. The palms go damp. A surge of dread or anger rises before thought can catch it. To anyone watching, it looks like an overreaction. Inside the brain, it is something older: a survival program running on time.

Dr Ashutosh Shah, a consultant psychiatrist at Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, often sees this pattern. The flare is rarely about the email. It is about the architecture built years earlier.

“Development of the human brain and central nervous system begins at three weeks following conception,” Dr Shah shared in an interview with Lifestyle, adding, “Full development is accomplished by early adulthood. Within the first few years of life, the brain is particularly vulnerable to the interplay of genetic and environmental factors.”

When those early years are marked by emotional unpredictability, chronic criticism, or quiet neglect, the brain adapts. It learns to scan for danger, to react fast, to stay ready, he highlighted – the cost of that adaptation can be a lifetime of heightened anxiety and depression. Also read | Here's what to do when you are having an anxiety attack

How early life builds the brain

The brain is not finished at birth. It is built in public. In infancy and early childhood, it forms billions of connections at a speed it will never match again – Dr Shah explained that construction depends on the environment. Warmth, consistency, and responsiveness help wire circuits for regulation and trust.

Their absence does something else, he highlighted. The brain treats instability as data about the world. If caregivers are erratic or absent, the lesson is that safety cannot be assumed. The damage is not only psychological. It is biological.

“Biological injuries to the developing brain may occur due to intrauterine factors, including maternal depression, psychosis, infections, diabetes, and other chronic medical illnesses, leading to inflammation,” Dr Shah said. “In the initial period of life, injury may also be caused by nutritional deficiency, lack of environmental enrichment, and neglect related to maternal psychiatric illness," he added.

The result is a nervous system calibrated to a harsher setting. According to Dr Shah, three regions bear much of the imprint:

⦿ The amygdala: this almond-shaped cluster flags threat. In children who grew up without steady nurturance, it becomes hyper-armed. “The amygdala triggers an instant emotional and physiological response to stress even under non-threatening conditions,” Dr Shah said. In adulthood, that can look like a racing pulse during a minor disagreement or sudden panic in an objectively safe room.

⦿ The prefrontal cortex: this is the brain’s manager. It weighs options, inhibits impulses, and tells the amygdala to stand down. After early trauma, its connections to the amygdala are weaker, and its volume can be smaller. “The prefrontal cortex’s ability to signal the amygdala to stop the stress response is diminished,” Dr Shah explained.

⦿ The hippocampus: this structure files memories and gives them context: then vs now, there vs here. Under sustained stress, it struggles to make new neurons and can shrink. “It results in structural atrophy of the hippocampus,” Dr Shah said, 'which leads to difficulty differentiating current, safe situations from past traumatic memories'.

While those circuits are being shaped, the body’s stress system is also being tuned. The hypothalamic-pituitary-adrenal axis, or HPA axis, governs the release of cortisol and other stress hormones. “Being brought up in a dangerous or unpredictable environment results in the permanent activation of the brain’s stress process called the HPA axis,” Dr Shah shared, adding, “This ensures that the nervous system is continually kept in a physical state of fighting, fleeing, or freezing, even in adulthood.”

Neurochemistry follows. Key signalling systems — GABA, serotonin, dopamine — that normally help the brain downshift become dysregulated. “The disturbance reduces the brain’s capability to naturally inhibit anxiety or achieve a relaxed state,” Dr Shah said. Emotion from below overwhelms regulation from above.

Why some bend and others break

Two children can grow up in the same difficult home and take very different paths. One develops recurrent depression. The other seems resilient. Psychiatry has spent decades trying to explain the split. Dr Shah pointed to several biological variables that shape the response to early adversity:

⦿ Variations in genes that govern serotonin and other neurotransmitters can make some brains more stress-sensitive.

⦿ Severe early stress can switch genes on or off without changing DNA. The effect can be years of elevated stress hormones.

⦿ Stronger links between reasoning and fear centres support recovery. Weaker links make pleasure and relief harder to access.

⦿ Because brain regions mature on different schedules, trauma during a rapid growth window causes deeper disruption.

⦿ Toxic stress can shift immune signalling. Higher circulating inflammatory markers are linked to depression risk.

None of this is destiny. “It is imperative to note that psychiatrists cannot tell the exact outcome an individual will have based on their genetics alone,” Dr Shah cautioned. Also read | AIIMS-trained neurologist shares 3 steps to follow during a panic attack: ‘Sit down somewhere and pay attention to…’

The adult vocabulary of old wounds

Because trauma lives in wiring, it rarely announces itself as simple sadness. It speaks in habits, reflexes, and interpretations that once kept a child safe, Dr Shah highlighted. Emotionally, adults with early neglect often swing between intensity and numbness.

There is rage or panic over small slights, or a blankness where feeling should be. There is a persistent fear of abandonment and a tendency to read neutral faces as rejection. There is self-blame without cause, and alexithymia — the inability to name what is being felt in the moment.

Behaviourally, according to Dr Shah, the adaptations are just as clear:

⦿ People-pleasing: saying 'yes' when the answer should be 'no'. Avoiding conflict at the cost of self.

⦿ Hypervigilance: monitoring tone, posture, and timing for signs of anger or withdrawal.

⦿ Avoidance: pulling back from intimacy or difficult conversations to prevent overwhelm.

⦿ Impulsive soothing: food, alcohol, scrolling, shopping — anything that ends the feeling fast.

⦿ Perfectionism: controlling schedules, spaces, and performance to contain inner chaos.

These patterns are common, but not diagnostic. “It is essential to remember that having the above-mentioned behavioural patterns does not necessarily mean that someone has a history of childhood trauma,” Dr Shah said. Similar presentations appear in ADHD, autism spectrum disorder, and anxiety disorders.

Can the brain unlearn this?

If experience can wire the brain toward threat, experience can also rewire it toward safety. That is the premise of neuroplasticity, and it is where treatment begins, Dr Shah shared. “Treatment and healthy coping can actually rearrange the structure of emotions of the brain, making it less prone to depression, as found through neuroimaging and stress studies,” he said.

The work targets four mechanisms, he explained:

⦿ Strengthen top-down control: therapies that train attention to irrational appraisals, and practices like paced breathing, stimulate the prefrontal cortex. With repetition, the pathway to the amygdala gets stronger. “Over time, the prefrontal cortex will be capable of transmitting inhibitory messages to the fear centre and thus stop emotional distress and physical terror before the emergence of depressive disorders,” Dr Shah said.

⦿ Lower amygdala reactivity: exposure to stress with new coping tools teaches the fear centre that not every signal is danger. Baseline anxiety drops. Emotional exhaustion becomes less likely.

⦿ Regulate stress hormones: consistent coping brings the HPA axis back toward normal. As cortisol levels fall, systemic inflammation tends to decline as well.

⦿ Support hippocampal growth: exercise and effective stress management increase BDNF (Brain-derived neurotrophic factor). “BDNF is an important factor in achieving neurogenesis in the hippocampus,” Dr Shah said. A larger, healthier hippocampus is better at placing memories in time, so the present does not feel like the past.

In severe cases, talk therapy alone is not enough at the start. When depression is profound, psychomotor retardation or cognitive impairment can prevent a patient from engaging, Dr Shah highlighted. “Before employing psychotherapy in such situations, medications must be administered to help regulate the patient’s neurochemistry and improve his/her cognitive function,” he said.

Recovery is not quick. “Neuroplasticity needs consistent practice of skills learned in psychotherapy,” Dr Shah noted. Genetics, trauma severity, and frequency of practice all influence speed. There is also a practical barrier. He added, “Ultimately, it is hard to find therapists who specialise in trauma-based therapy.” Also read | AIIMS-trained neurologist explains how using a ‘simple paper bag’ can calm anxiety and help manage panic attacks

A different ending to the same story

The insight that has changed psychiatry in the last few decades is simple and stubborn: the brain that learned to survive a hostile environment can learn that the environment has changed. That does not mean the old alarms disappear overnight. It means new circuits can be built alongside them, Dr Shah highlighted.

With practice, the prefrontal cortex gets better at quieting the amygdala. With repetition, the body learns that a curt email is not a predator. With time, the hippocampus gets better at filing memory correctly: that was then, this is now.

For the adult in the quiet room, the moment still arrives. The message pings. The milk is forgotten. The body may still surge. But now there is a pause. A breath. A choice. And in that small space, the brain begins to do what it was built to do all along: update itself.

About the expert

Dr Ashutosh Shah is a consultant psychiatrist at Sir H N Reliance Foundation Hospital, Mumbai, with over 25 years of experience. Holding an MBBS, DPM, and DNB, he specialises in mood and anxiety disorders, schizophrenia, and dementia.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

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