Personality functioning as a mediator of adult mental health following child maltreatment

Krakau, Lina; Tibubos, Ana Nanette; Beutel, Manfred E.; Ehrenthal, Johannes C.; Gieler, Uwe; Brähler, Elmar

doi:10.1016/j.jad.2021.05.006

Cited by 29 publications

(23 citation statements)

References 63 publications

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“…Albeit our results have to be interpreted carefully due to lacking stability of the edge weights, we found emotional abuse and neglect to be connected to the depression components of the network, especially emotional-cognitive aspects (relating e.g., to self-perception andevaluation). The present findings expand previous evidence of stronger overall associations between depression and emotional abuse (Krakau et al, 2021;Negele et al, 2015). They are also in line with previous network investigations underscoring the centrality of emotional abuse experiences within other contexts, such as suicidal crises (Schönfelder et al, 2021).…”

Section: Discussionsupporting

confidence: 92%

Seeing the past in a new light: Change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms (Postprint)

Ernst¹,

Beutel²,

Zwerenz³

et al. 2022

Preprint

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Objective: As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.Method: Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment.Results: After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge.Conclusion: The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

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Section: Discussionsupporting

confidence: 92%

Seeing the past in a new light: Change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms (Postprint)

Ernst¹,

Beutel²,

Zwerenz³

et al. 2022

Preprint

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“…Scarce research already including personality functioning focused on different psychopathologies in adulthood. For example, a similar pathway was found for depression and anxiety where personality functioning (partially) mediated the association between child maltreatment and depression and anxiety symptoms, respectively (12,25). Personality functioning appears to be a relevant underlying mechanism in adults with different psychopathologies including PTSD and especially cPTSD and a history of ACEs.…”

Section: Discussionmentioning

confidence: 66%

“…ACEs are defined as "childhood events, varying in severity and often chronic, occurring in a child's family or social environment that cause harm or distress, thereby disrupting the child's physical or psychological health and development" (4). There is a large body of evidence suggesting a close association between adverse experiences as a child and the development of physical health problems (5)(6)(7)(8) and mental disorders (including psychological distress) (8)(9)(10)(11)(12) in adulthood.…”

Section: Introductionmentioning

confidence: 99%

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

et al. 2022

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BackgroundAdverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust—the capacity for social learning—on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD.MethodsWe conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models’ fit.ResultsN = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041–0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043–0.081). ACEs were significantly associated with cPTSD (β = 0.44, p < 0.001) and PTSD (β = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (β = 0.21/β = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%).ConclusionWe add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.

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“…Finally, although the psychodynamic concept of personality functioning makes theoretical assumptions about the early childhood development of these traits ( Dagnino et al, 2020 ; Krakau et al, 2021 ), due to the cross-sectional design of the study we cannot make a clear statement about the causality of the associations between personality functioning and non-adherence. However, we collected data from a large and well-characterized clinical sample which serves as an important and appropriate first step in investigating associations between these variables.…”

Section: Discussionmentioning

confidence: 98%

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

et al. 2022

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ObjectiveAlthough treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.Methods194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.ResultsNon-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.ConclusionIn cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

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Personality functioning as a mediator of adult mental health following child maltreatment

Cited by 29 publications

References 63 publications

Seeing the past in a new light: Change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms (Postprint)

Seeing the past in a new light: Change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms (Postprint)

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

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