Abstract
There is now substantial evidence that childhood adverse events are a significant risk factor for symptoms of psychosis in both clinical and community samples. Both childhood trauma and positive symptoms of psychosis are associated with an increased risk of self-harming behaviours. Therefore the current study aimed to consider the relationship between retrospective reports of childhood adversity, sub-clinical positive symptoms of psychosis and self-harm in a non-clinical community sample. The study employed a cross-sectional survey design, distributed online. Participants were asked to complete psychometric assessments relating to: demographic characteristics including past-year substance misuse; childhood adversity; sub-clinical symptoms of psychosis (delusions and hallucinations) and self-harming behaviours. The results found that, after controlling for substance misuse, childhood adversity predicted significant variance in sub-clinical delusions and hallucinations in the general population. Both symptoms of psychosis and childhood adversity increased the risk of self-harming behaviours. Positive symptoms partially mediated the relationship between early adversity and self-harming behaviours. For some people, the sequelae of early adversity including sub-clinical delusions and hallucinations may increase the risk of self-harming behaviours. Future research would benefit from considering the role of dissociation in these relationships and the affective impact of pseudo-psychotic experiences. Practitioners should consider the impact of childhood adversity, unusual perceptual experiences and distorted beliefs when working with people who self-harm. The current research was limited by the cross-sectional survey design and non-random sampling methodology.
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References
Arseneault, L., Cannon, M., Fisher, H. L., Polanczyk, G., Moffitt, T. E., & Caspi, A. (2011). Childhood trauma and children’s emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American journal of Psychiatry, 168(1), 65–72.
Bailey, T., Alvarez-Jimenez, M., Garcia-Sanchez, A. M., Hulbert, C., Barlow, E., & Bendall, S. (2018). Childhood trauma is associated with severity of hallucinations and delusions in psychotic disorders: a systematic review and meta-analysis. Schizophrenia Bulletin, 44(5), 1111–1122.
Batey, H., May, J., & Andrade, J. (2010). Negative intrusive thoughts and dissociation as risk factors for self-harm. Suicide and Life-Threatening Behavior, 40(1), 35–49.
Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature death after self-harm: a multicentre cohort study. The Lancet, 380(9853), 1568–1574.
Bhugra, D. (2005). The global prevalence of schizophrenia. PLoS Med, 2(5), e151.
Brown, S. M., & Shillington, A. M. (2017). Childhood adversity and the risk of substance use and delinquency: The role of protective adult relationships. Child Abuse & Neglect, 63, 211–221.
Farber, S. K. (2008). Dissociation, traumatic attachments, and self-harm: Eating disorders and self-mutilation. Clinical Social Work Journal, 36(1), 63–72.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.
Fliege, H., Lee, J. R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behavior: A systematic review. Journal of psychosomatic research, 66(6), 477–493.
Freeman, D., & Garety, P. A. (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy, 41(8), 923–947.
Gratz, K. L. (2001). Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. https://doi.org/10.1023/A:1012779403943
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: an empirical and conceptual review. Clinical Psychology: Science and Practice, 10(2), 192–205.
Hanlon, F. M., Yeo, R. A., Shaff, N. A., Wertz, C. J., Dodd, A. B., Bustillo, J. R., & Mayer, A. R. (2019). A symptom-based continuum of psychosis explains cognitive and real-world functional deficits better than traditional diagnoses. Schizophrenia Research, 208, 344–352.
Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. The British Journal of Psychiatry, 182(6), 537–542.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R. O. N., Demyttenaere, K., Gasquet, I., & Uestuen, T. B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6(3), 168–176.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
Konings, M., Bak, M., Hanssen, M., Van Os, J., & Krabbendam, L. (2006). Validity and reliability of the CAPE: A self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica, 114(1), 55–61.
Konings, M., Henquet, C., Maharajh, H. D., Hutchinson, G., & Van Os, J. (2008). Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica, 118(3), 209–213.
Mark, W., & Toulopoulou, T. (2016). Psychometric properties of “community assessment of psychic experiences”: review and meta-analyses. Schizophrenia Bulletin, 42(1), 34–44.
Mulder, R. T., Beautrais, A. L., Joyce, P. R., & Fergusson, D. M. (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. American Journal of Psychiatry, 155(6), 806–811.
Müller, A., Claes, L., Smits, D., Brähler, E., & de Zwaan, M. (2016). Prevalence and correlates of self-harm in the German general population. PLoS One, 11(6), e0157928.
Myin-Germeys, I., Lataster, T., & van Os, J. (2007). Childhood victimization and developmental expression of sub-clinical psychosis. European Psychiatry, 22(S1), S19–S19.
Nishida, A., Sasaki, T., Nishimura, Y., Tanii, H., Hara, N., Inoue, K., & Asukai, N. (2010). Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12–15 years. Acta Psychiatrica Scandinavica, 121(4), 301–307.
Paulhus, D. L., & Reid, D. B. (1991). Enhancement and denial in socially desirable responding. Journal of Personality and Social Psychology, 60(2), 307–317.
Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4(1), 65–79.
Read, J., Perry, B. D., Moskowitz, A., & Connolly, J. (2001). The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry: Interpersonal and Biological Processes, 64(4), 319–345.
Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5), 330–350.
Resnick, P. J., & Knoll, J. (2005). How to detect malingered psychosis. Current Psychiatry, 4(11), 13–25.
Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A systematic review of the prevalence of schizophrenia. PLoS Med, 2(5), e141.
Sheffield, J. M., Williams, L. E., Blackford, J. U., & Heckers, S. (2013). Childhood sexual abuse increases risk of auditory hallucinations in psychotic disorders. Comprehensive psychiatry, 54(7), 1098–1104.
Shevlin, M., Murphy, J., Read, J., Mallett, J., Adamson, G., & Houston, J. E. (2011). Childhood adversity and hallucinations: a community-based study using the National Comorbidity Survey Replication. Social Psychiatry and Psychiatric Epidemiology, 46(12), 1203–1210.
Taylor, P. J., Hutton, P., & Wood, L. (2015). Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis. Psychological Medicine, 45(5), 911–926.
Tucker, P. (2009). Substance misuse and early psychosis. Australasian Psychiatry, 17(4), 291–294.
van Heugten-Van der Kloet, D., Giesbrecht, T., van Wel, J., Bosker, W. M., Kuypers, K. P., Theunissen, E. L., & Ramaekers, J. G. (2015). MDMA, cannabis, and cocaine produce acute dissociative symptoms. Psychiatry Research, 228(3), 907–912.
Varese, F., Barkus, E., & Bentall, R. P. (2012). Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychological Medicine, 42(5), 1025–1036.
Verdoux, H., & van Os, J. (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia research, 54(1–2), 59–65.
World Health Organization. (2018). Adverse Childhood Experiences International Questionnaire. In Adverse Childhood Experiences International Questionnaire (ACE-IQ). https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq): Geneva: WHO
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Green, K., Webster, A. The Relationships Between Childhood Abuse and Neglect, Sub-clinical Symptoms of Psychosis and Self-harm in a Non-clinical Community Sample. Journ Child Adol Trauma 15, 605–614 (2022). https://doi.org/10.1007/s40653-021-00422-5
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DOI: https://doi.org/10.1007/s40653-021-00422-5
Keywords
- Child abuse
- Neglect
- Delusions
- Hallucinations
- Self-harm
- Psychosis
- Trauma
- Adverse childhood experience