Characteristics of Child Maltreatment and Their Relation to Dissociation, Posttraumatic Stress Symptoms, and Depression in Adult Psychiatric Patients

Abstract

Abstract:Little is known about the influence of particular characteristics of childhood maltreatment, such as developmental stage, relationship to the perpetrator and nature of the trauma, on adult psychopathology. The effects of childhood maltreatment were assessed in adult psychiatric patients (N=287) using self-rating scales and diagnostic checklists. Maltreatment was strongly associated with dissociation. This relationship was observed for all childhood developmental stages and was strongest when the perpetrator was outside the family. Dissociation was more strongly correlated with childhood emotional abuse and sexual harassment, than with sexual or physical abuse. Childhood sexual abuse was found to be associated with symptoms of posttraumatic stress. Findings suggest that dissociation is a relatively specific consequence of childhood maltreatment that is largely independent of the familial relationship to the perpetrator or the child's developmental stage. Keywords: Dissociation, Child Abuse, Posttraumatic Stress Disorder 3The World Health Organization defines child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power" (World Health Organization, 1999). Dissociation, mood disorders, anxiety and posttraumatic stress symptoms are believed to constitute potential sequelae of childhood trauma (Fairbank et al, 2007;Heim et al, 2001;Spertus et al, 2003;Van der Hart et al, 2006). However, it is not clear what aspects of childhood maltreatment influence the development and nature of trauma-related symptoms.Dissociation related to trauma may involve disruptions or breakdowns of memory, awareness, identity and/or perception ("psychoform dissociation") as well as losses or distortion of sensory, perceptual, affective or motor functions ("somatoform dissociation") ( Van der Hart et al, 2004). Current theories about the development of severe dissociation emphasize the role of early onset chronic abuse and neglect from primary caregivers in childhood (Liotti, 2006;Van der Hart et al, 2006). There is ample evidence supporting the strong association between childhood maltreatment and dissociative psychopathology (Chu et al, 1999;Draijer et al, 1999;Nijenhuis et al, 1998;Ogawa et al, 1997;. Not all traumatized children develop dissociative symptoms and other factors, such as severity of abuse, numbers of perpetrators, the victim's coping style and affect modulation capacities, may moderate its relationship with maltreatment (Briere, 2006;Lange et al, 1999). This also holds true for the relationship between posttraumatic stress symptoms, depression and childhood maltreatment; victims of child abuse are at increased risk for developing posttraumatic stress disorder and depressive disorder, but childhood victimization alone is not sufficient to cause these disorders (Ch...

Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood?

“…Evidence regarding the effects of age at onset to natural disasters appears more consistent, with both retrospective 34 and prospective studies 35,36 observing higher levels of PTSD symptoms or PTSD diagnoses among older children (around age 7 and above) compared to younger children (those younger than about age 7). However, results for other traumas is less conclusive, with retrospective studies suggesting there are no differences 37,38 in risk for PTSD based on age at onset of trauma, that early-life trauma is more harmful 39,40 , or that middle childhood (ages 6–11) is more strongly associated with PTSD 41 .…”

Predicting a dissociative disorder from type of childhood maltreatment and abuser–abused relational tie

“…Along with sexual and physical abuse, emotional abuse has been receiving increased attention in the literature. Emotional abuse has been associated with or may predict dissociative symptoms in various populations, including adult psychiatric patients with various diagnoses (Mueller-Pfeiffer et al, 2013), adolescent psychiatric out-patients (Sar et al, 2014), female psychiatric in-patients with posttraumatic stress disorder linked to childhood maltreatment (Haferkamp et al, 2015), patients with borderline personality disorder (Watson et al, 2006), and patients with schizophrenia spectrum disorders (Schäfer et al, 2006).…”

Predicting a dissociative disorder from type of childhood maltreatment and abuser–abused relational tie

“…The relationships between types of childhood maltreatment and specific abuserabused relational ties and their influence on DD have never been addressed simultaneously. Mueller-Pfeiffer et al (2013) came close when they studied three variables simultaneously (abuse type, familial relationship and developmental stage) in relation to dissociative symptoms as measured by the DES Taxon score. We investigate the specific types of childhood maltreatment, and the associated specific abuser-abused relational ties that are the best predictors of a dissociative disorder (DD).…”

“…Along with sexual and physical abuse, emotional abuse has been receiving increased attention in the literature. Emotional abuse has been associated with or may predict dissociative symptoms in various populations, including adult psychiatric patients with various diagnoses (Mueller-Pfeiffer et al, 2013), adolescent psychiatric out-patients , female psychiatric in-patients with posttraumatic stress disorder linked to childhood maltreatment (Haferkamp et al, 2015), patients with borderline personality disorder (Watson et al, 2006), and patients with schizophrenia spectrum disorders (Schäfer et al, 2006). Emotional abuse has also been associated with or may predict pathological dissociative disorder (DD).…”

“…Pfeiffer et al (2013) followed a different approach by devising a new scoring system in their German adaptation of the TEC(Schumacher et al, 2011). Mueller-Pfeiffer et al(2013) also parsed out early life stress and adult life stress separately in an attempt to circumvent the TEC"s conflation of various life stages in the original design of the scale.…”