Psychological Mechanisms Mediating Effects Between Trauma and Psychotic Symptoms: The Role of Affect Regulation, Intrusive Trauma Memory, Beliefs, and Depression

Abstract

Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, intrusive trauma memory, beliefs, and depression. The majority of participants (74.1%) reported victimization trauma, and a fifth (21.5%) met symptomatic criteria for Posttraumatic Stress Disorder. We found a specific link between childhood sexual abuse and auditory hallucinations (adjusted OR = 2.21, SE = 0.74, P = .018). This relationship was mediated by posttraumatic avoidance and numbing (OR = 1.48, SE = 0.19, P = .038) and hyperarousal (OR = 1.44, SE = 0.18, P = .045), but not intrusive trauma memory, negative beliefs or depression. In contrast, childhood emotional abuse was specifically associated with delusions, both persecutory (adjusted OR = 2.21, SE = 0.68, P = .009) and referential (adjusted OR = 2.43, SE = 0.74, P = .004). The link with persecutory delusions was mediated by negative-other beliefs (OR = 1.36, SE = 0.14, P = .024), but not posttraumatic stress symptoms, negative-self beliefs, or depression. There was no evidence of mediation for referential delusions. No relationships were identified between childhood physical abuse and psychosis. The findings underline the role of cognitive-affective processes in the relationship between trauma and symptoms, and the importance of assessing and treating victimization and its psychological consequences in people with psychosis.

Testing models of post‐traumatic intrusions, trauma‐related beliefs, hallucinations, and delusions in a first episode psychosis sample

“…Fifty‐three per cent of the sample had experienced childhood victimization trauma, and 27% met diagnostic criteria for PTSD. These rates are both notably higher than those in the general population (Kessler et al ., ) and are comparable to those from previous studies assessing childhood victimization trauma and PTSD in psychosis (Bonoldi et al ., ; Hardy et al ., ).…”

“…Four of five studies (three clinical and one non‐clinical) found relationships (Alsawy, Wood, Taylor, & Morrison, ; Bendall, Alvarez‐Jimenez, Nelson, & McGorry, ; Bendall, Hulbert, et al ., ; Gracie et al ., ; Lysaker & LaRocco, ) including a dose–response relationship (Alsawy et al ., ). However, the most comprehensive study to date ( n = 228) did not find intrusive trauma memory to be a mediator between childhood sexual abuse and auditory hallucinations (Hardy et al ., ).…”

“…Consistent findings also have been found in studies of negative beliefs and delusions using measures of a broad range of negative beliefs (Fisher, Appiah‐Kusi, & Grant, ; Gracie et al ., ; Hardy et al ., ) and in the context of attachment style (Sitko, Bentall, Shevlin, O'Sullivan, & Sellwood, ; van Dam, Korver‐Nieverg, Velthorst, Meijer, & de Haan, ). However, negative beliefs and delusions may be overlapping constructs, which may partially account for some of these relationships.…”

Cognitive Attachment Model of Voices: Evidence Base and Future Implications

“…(19)] and that several peri- and posttraumatic processes may contribute the formation of hallucinatory experiences, including peritraumatic dissociation and several symptoms of posttraumatic stress [e.g., Ref. (20, 21)].…”

Depresión y trauma temprano: hacia una caracterización clínica de perfiles de consulta en un servicio de salud secundario

“…Esta relación ha sido descrita en la literatura 67,68 . De hecho, se sabe que las experiencias discrepantes no integradas, como el abuso sexual, pueden manifestarse bajo la forma de alucinaciones 67 .…”