Social Psychiatry and Psychiatric Epidemiology

, Volume 43, Issue 8, pp 602–611 | Cite as

Psychotic experiences in people who have been sexually assaulted

  • Aoiffe M. Kilcommons
  • Anthony P. Morrison
  • Alice Knight
  • Fiona Lobban
ORIGINAL PAPER

Abstract

Objective

In recent years, there has been a call for greater awareness of the relationship between trauma and psychosis, and several studies involving patients with psychotic disorders have found a link between traumatic life experience and the development of psychosis. However, little research has examined psychotic experiences in a traumatised population.

Method

This study investigated psychotic experiences in a sample of 40 survivors of sexual assault (SA) compared to a control group without a history of sexual assault (measured using a self-report questionnaire) and examined the psychological factors that may contribute to the development of psychotic experiences in sexually traumatised individuals. In particular, the role of dissociation and cognitive factors such as post-traumatic cognitions were explored.

Results

Of the 26 sexually assaulted participants that were interviewed, 46% reported auditory hallucinations and 46% reported visual hallucinations. A significantly higher rate of psychotic phenomena (delusional ideation and predisposition to hallucinations) was found in the sexually assaulted group compared to the control group. Severity of SA trauma was significantly associated with severity of PTSD and psychotic symptomatology. Dissociation was strongly associated with all measures of psychotic phenomena and negative cognitions about the self and the world were associated with predisposition to hallucinations and delusional ideation. Regression analyses revealed that after controlling for the severity of SA trauma, dissociation and negative beliefs about the self significantly predicted delusional distress, and dissociation significantly predicted predisposition to visual hallucinations.

Conclusions

These exploratory findings support the idea that psychotic phenomena may be caused by traumatic life experiences and highlight the need for further research. The implications of these results for research and clinical practice are discussed.

Key words

psychosis sexual assault trauma 

References

  1. 1.
    Agar K, Read J (2002) What happens when people disclose sexual or physical abuse to staff at a community mental health centre? Int J Ment Health Nurs 11(2):70–79PubMedCrossRefGoogle Scholar
  2. 2.
    Allen JG, Coyne L (1995) Dissociation and vulnerability to psychotic experiences. J Nerv Ment Dis 183(10):615–622PubMedCrossRefGoogle Scholar
  3. 3.
    Allen JG, Coyne L, Console DA (1996) Dissociation contributes to anxiety and psychoticism on the brief symptom inventory. J Nerv Ment Dis 184(10):639–641PubMedCrossRefGoogle Scholar
  4. 4.
    Allen JG, Coyne L, Console DA (1997) Dissociative detachment relates to psychotic symptoms and personality decompensation. Compr Psychiatry 38(6):327–334PubMedCrossRefGoogle Scholar
  5. 5.
    Bebbington PE et al (2004) Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry 185:220–226PubMedCrossRefGoogle Scholar
  6. 6.
    Bernstein EM, Putnam FW (1986) Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 174(12):727–735PubMedCrossRefGoogle Scholar
  7. 7.
    Bowe SB, Morrison AP, Morley S (2008) Relationship between childhood trauma and auditory hallucinations in individuals with psychosis. Br J Clin Psychol (Submitted)Google Scholar
  8. 8.
    Calam R, Slade P (1989) Sexual experiences and eating problems in female undergraduates. Int J Eat Disord 8(4):391–397CrossRefGoogle Scholar
  9. 9.
    Carlin A, Ward N (1992) Subtypes of psychiatric inpatient women who have been sexually assaulted. J Nerv Ment Dis 180:392–397PubMedCrossRefGoogle Scholar
  10. 10.
    Darvez-Bamez JM et al (1995) Sexual victimisation in women with schizophrenia and bipolar disorder. Soc Psychiatry Psychiatr Epidemiol 32:78–84CrossRefGoogle Scholar
  11. 11.
    Davidson J (1996) Davidson trauma scale (DTS). Multi-Health Systems Inc., New YorkGoogle Scholar
  12. 12.
    Davidson J et al (1997) Assessment of a new rating scale for post-traumatic stress disorder. Psychol Med 27(1):153–160PubMedCrossRefGoogle Scholar
  13. 13.
    Dill DL et al (1991) The reliability of abuse history reports: a comparison of two inquiry formats. Compr Psychiatry 32(2):166–169PubMedCrossRefGoogle Scholar
  14. 14.
    Ehlers A, Clark DM (2000) A cognitive model of posttraumatic stress disorder. Behav Res Ther 38(4):319–345PubMedCrossRefGoogle Scholar
  15. 15.
    Ellason JW, Ross CA (1995) Positive and negative symptoms in dissociative identity disorder and schizophrenia: a comparative analysis. J Nerv Ment Dis 183(4):236–241PubMedGoogle Scholar
  16. 16.
    Ellason JW, Ross CA (1997) Childhood trauma and psychiatric symptoms. Psychol Rep 80:447–450PubMedGoogle Scholar
  17. 17.
    Famularo R, Kinscherff R, Fenton T (1992) Psychiatric diagnoses of abusive mothers. A preliminary report. J Nerv Ment Dis 180(10):658–661PubMedCrossRefGoogle Scholar
  18. 18.
    Foa EB et al (1999) The posttraumatic cognitions inventory (PTCI): development and validation. Psychol Assess 11(3):303–314. http://www.apa.org/journals/pas.html Google Scholar
  19. 19.
    Friedman S et al (2002) The incidence and influence of early traumatic life events in patients with panic disorder: a comparison with other psychiatric outpatients. J Anxiety Disord 16(3):259–272PubMedCrossRefGoogle Scholar
  20. 20.
    Friedman S, Harrison G (1984) Sexual histories, attitudes and behaviour of schizophrenic women and normal women. Arch Sex Behav 13:555–567PubMedCrossRefGoogle Scholar
  21. 21.
    Goff D et al (1991) Self-reports of child abuse in chronically psychotic patients. Psychiatry Res 37:73–80PubMedCrossRefGoogle Scholar
  22. 22.
    Gracie A et al (2007) The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatr Scand 116(4):280–289PubMedCrossRefGoogle Scholar
  23. 23.
    Greenfield SF et al (1994) Childhood abuse in first-episode psychosis. Br J Psychiatry 164(6):831–834PubMedGoogle Scholar
  24. 24.
    Haddock G et al (1999) Scales to measure dimensions of hallucinations and delusions: the psychotic symptoms rating scales (PSYRATS). Psychol Med 29:879–889PubMedCrossRefGoogle Scholar
  25. 25.
    Hammersley P et al (2003) Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. Br J Psychiatry 182:543–547PubMedCrossRefGoogle Scholar
  26. 26.
    Hardy A et al (2005) Trauma and hallucinatory experience in psychosis. J Nerv Ment Dis 193(8):501–507PubMedCrossRefGoogle Scholar
  27. 27.
    Haugen MC, Castillo RJ (1999) Unrecognised dissociation in psychotic outpatients and implications of ethnicity. J Nerv Ment Diss 187(12):751–754CrossRefGoogle Scholar
  28. 28.
    Holowka DW et al (2003) Childhood abuse and dissociative symptoms in adult schizophrenia. Schizophr Res 60(1):87–90PubMedCrossRefGoogle Scholar
  29. 29.
    Hunter J (1991) A comparison of psychosocial maladjustment of adult males and females sexually molested as children. J Interpers Violence 6:205–217CrossRefGoogle Scholar
  30. 30.
    Janoff-Bulman R (1985) The aftermath of victimisation: rebuilding shattered assumptions. In: Figley CR (eds) Trauma and its wake. Brunner-Mazel, New YorkGoogle Scholar
  31. 31.
    Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R, van Os (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand 109:38–45PubMedCrossRefGoogle Scholar
  32. 32.
    Janssen I et al (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand, pp 38–45Google Scholar
  33. 33.
    Kennerley H (1996) Cognitive therapy for dissociative symptoms associated with trauma. Br J Clin Psychol 35:325–340PubMedGoogle Scholar
  34. 34.
    Kilcommons A, Morrison AP (2005) Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand 112(5):351–359PubMedCrossRefGoogle Scholar
  35. 35.
    Larkin W, Morrison AP (2006) Trauma and psychosis: new directions for theory and therapy. Routledge, East SussexGoogle Scholar
  36. 36.
    Launay G, Slade PD (1981) The measurement of hallucinatory predisposition in male and female prisoners. Pers Individ Dif 2:221–234CrossRefGoogle Scholar
  37. 37.
    Lundberg-Love P et al (1992) The long-term consequences of childhood incestuous victimization upon women’s psychological symptomatology. J Child Sex Abuse 1:81–102CrossRefGoogle Scholar
  38. 38.
    Merckelbach H (2000) More questions about recovered memories. Am J Psychiatry 157(8):1346–1347PubMedCrossRefGoogle Scholar
  39. 39.
    Miller L, Finnerty M (1996) Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders. Psychiatr Serv 47(5):502–506PubMedGoogle Scholar
  40. 40.
    Morrison AP (2001) The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother 29:257–276Google Scholar
  41. 41.
    Morrison AP (2004) Cognitive therapy for people with psychosis. In: Read J, Mosher LR, Bentall RP (eds) Models of madness. Brunner-Routledge, HoveGoogle Scholar
  42. 42.
    Morrison AP, Frame L, Larkin W (2003) Relationships between trauma and psychosis: a review and integration. Br J Clin Psychol 42:331–353PubMedCrossRefGoogle Scholar
  43. 43.
    Morrison AP, Wells A, Nothard S (2000) Cognitive factors in predisposition to auditory and visual hallucinations. Br J Clin Psychol 39:67–78PubMedCrossRefGoogle Scholar
  44. 44.
    Morrison AP, Wells A, Nothard S (2002) Cognitive and emotional predictors of predisposition to hallucinations in non-patients. Br J Clin Psychol 41(3):259–270PubMedCrossRefGoogle Scholar
  45. 45.
    Mueser KT, et al. (1998) Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 66:493–499PubMedCrossRefGoogle Scholar
  46. 46.
    Offen L, Waller G, Thomas G (2003) Is reported childhood sexual abuse associated with the psychopathological characteristics of patients who experience auditory hallucinations? Child Abuse Negl 27(8):919–927PubMedCrossRefGoogle Scholar
  47. 47.
    Peters E et al (2008) Measuring delusional ideation: the 21-item Peters et al. delusions inventory (PDI). Schizophr Bull (in press)Google Scholar
  48. 48.
    Peters ER, Joseph SA, Garety PA (1999) Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. delusions inventory). Schizophr Bull 25(3):553–576PubMedGoogle Scholar
  49. 49.
    Read J (1997) Child abuse and psychosis: a literature review and implications for professional practice. Prof Psychol Res Pr 28:448–456CrossRefGoogle Scholar
  50. 50.
    Read J et al (2001) The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry 64(4):319–345PubMedGoogle Scholar
  51. 51.
    Read J et al (2003) Sexual and physical assault during childhood and adulthood as predictors of hallucinations, delusions, and thought disorder. Psychol Psychother Theory Res Pract 76:1–22CrossRefGoogle Scholar
  52. 52.
    Read J, Argyle N (1999) Hallucinations, delusions, and thought disorder among adult psychiatric inpatients with a history of child abuse. Psychiatr Serv 50:1467–1472PubMedGoogle Scholar
  53. 53.
    Read J, Fraser A (1998) Abuse histories of psychiatric inpatients: to ask or not to ask? Psychiatr Serv 49(3):355–359PubMedGoogle Scholar
  54. 54.
    Read J, Fraser A (1998) Staff response to abuse histories of psychiatric inpatients. Aust N Z J Psychiatry 32(2):206–213PubMedCrossRefGoogle Scholar
  55. 55.
    Read J, Hammersley P (2005) Child sexual abuse and schizophrenia. Br J Psychiatry 186:76 (author reply 76)PubMedCrossRefGoogle Scholar
  56. 56.
    Read J, Ross CA (2003) Psychological trauma and psychosis: another reason why people diagnosed schizophrenic must be offered psychological therapies. J Am Acad Psychoanal 2003(31):1Google Scholar
  57. 57.
    Read J et al (2004) Childhood trauma, loss and stress. In: Read J, Mosher LRR, Bentall RP (eds) Models of madness. Bruner-Routledge, HoveGoogle Scholar
  58. 58.
    Resnick SG, Bond GR, Mueser KT (2003) Trauma and posttraumatic stress disorder in people with schizophrenia. J Abnorm Psychol 112(3):415–423PubMedCrossRefGoogle Scholar
  59. 59.
    Ross CA, Anderson G, Clark P (1994) Childhood abuse and the positive symptoms of schizophrenia. Hosp Community Psychiatry 42:489–491Google Scholar
  60. 60.
    Ross CA, Joshi S (1992) Paranormal experiences in the general population. J Nerv Ment Dis 180(6):357–361 (discussion 362–8)PubMedCrossRefGoogle Scholar
  61. 61.
    Ross CA, Joshi S (1992) Schneiderian symptoms and childhood trauma in the general population. Compr Psychiatry 33(4):269–273PubMedCrossRefGoogle Scholar
  62. 62.
    Ross CA, Keyes B (2004) Dissociation and schizophrenia. J Trauma Dissociation, p. 69–83Google Scholar
  63. 63.
    Ross CA, Norton GR, Wozney K (1989) Multiple personality disorder: an analysis of 236 cases. Can J Psychiatry 34(5):413–418PubMedGoogle Scholar
  64. 64.
    Russell D (1983) Incidence and prevalence of intrafamilial sexual abuse of female children. Child Abuse Negl 7:133–146PubMedCrossRefGoogle Scholar
  65. 65.
    Sansonnet-Hayden H et al (1987) Sexual abuse and psychopathology in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 26(5):753–757PubMedCrossRefGoogle Scholar
  66. 66.
    Scott R, Stone D (1986) MMPI profile constellations in incest families. J Consult Clin Psychol 54(3):364–368PubMedCrossRefGoogle Scholar
  67. 67.
    Spataro J et al (2004) Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry 184:416–421PubMedCrossRefGoogle Scholar
  68. 68.
    Startup M (1999) Schizotypy, dissociative experiences and childhood abuse: relationships among self-report measures. Br J Clin Psychol 38(Pt 4):333–344PubMedCrossRefGoogle Scholar
  69. 69.
    Tsai M (1979) Child molestation. J Abnorm Psychol 88:407–17PubMedCrossRefGoogle Scholar
  70. 70.
    Van der Hart O, Witztum E, Friedman B (1993) From hysterical psychosis to reactive dissociative psychosis. J Trauma Stress 6(1):43–64CrossRefGoogle Scholar
  71. 71.
    Whitfield CL, et al. (2005) Adverse childhood experiences and hallucinations. Child Abuse Negl 29:797–810PubMedGoogle Scholar
  72. 72.
    Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms, vol 9. Cambridge University Press, CambridgeGoogle Scholar
  73. 73.
    Wurr CJ, Partridge IM (1996) The prevalence of a history of childhood sexual abuse in an acute adult inpatient population. Child Abuse Negl 20(9):867–872PubMedCrossRefGoogle Scholar
  74. 74.
    Young M et al (2001) Evaluating and overcoming barriers to taking abuse histories. Prof Psychol Res Pract 32:407–414CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Aoiffe M. Kilcommons
    • 1
    • 3
  • Anthony P. Morrison
    • 2
    • 3
  • Alice Knight
    • 3
  • Fiona Lobban
    • 1
  1. 1.Dept. of Clinical PsychologyUniversity of LiverpoolLiverpoolUK
  2. 2.School of Psychological SciencesUniversity of ManchesterManchesterUK
  3. 3.Psychological Services, Bolton, Salford & Trafford Mental Health TrustPrestwichUK

Personalised recommendations