Relationship Between Childhood Emotional Neglect, Brain–Body Stress Response, and Adult Emotional Regulation Difficulties

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Background: Childhood emotional neglect has been related to persistent challenges in emotional functioning and changes in physiological stress regulation, however the overlap of these psychological and physiological correlates has been less explored in adults. Objective: To analyze the associations between childhood emotional neglect, emotion regulation challenges, resting heart rate variability (HRV-RMSSD), and baseline salivary cortisol in adults residing in Lahore. Methods: A cross-sectional correlational study included 88 adults aged between 18-45 years recruited from healthcare settings and academic institutions of Lahore between December 2024 to August 2025. Childhood emotional neglect and emotion regulation were measured by administering childhood trauma questionnaire SF (CTQ-SF)emotional-neglect subscaleand difficulties in emotion regulation scale-16 (DERS-16) respectively. Resting heart rate variability, specifically HRV-RMSSD (an index of parasympathetic nervous activity), and resting baseline salivary cortisol levels were measured as physiological indices. Pearson's correlations were run to identify bivariate relations of childhood emotional neglect, DERS-16, HRV-RMSSD and cortisol. Multiple linear regression was used to analyze predictors and mediators/confounders. Results: Childhood emotional-neglect had a strong positive correlation with DERS-16 scores (r = 0.58, p<0.001) and resting baseline cortisol levels (r=0.36, p<0.001), and an inverse correlation with resting heart rate variability-RMSSD (r = -0.49, p<0.001). Emotional neglect score (=0.39;p<0.001) and resting heart rate variability-RMSSD score(=0.32;p<0.001) predicted DERS-16, independent of age and gender. Salivary cortisol, however did not predict emotion regulation difficulties (=0.14, p=0.119). The variables included accounted for 53.2% of variance (R=0.532) in predicting DERS-16 scores. Conclusion: Childhood emotional neglect appears to relate to increased emotional regulation difficulties and lower resting heart rate variability in adulthood. Our cross-sectional finding demonstrates the linkage between early life adversity and physiological as well as psychological functioning in adulthood but without inferring causality

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