Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms

Abstract

Traumatic life events have been robustly associated with various psychosis outcomes, including increased risk of psychotic disorders, the prodrome of psychosis, and dimensional measures of psychotic symptoms, such as attenuated positive psychotic symptoms. However, trauma exposure has been linked to various mental disorders; therefore, the specificity of trauma exposure to psychosis remains unclear. This review focuses on two understudied areas of the trauma and psychosis literature: 1) the specificity between trauma and psychosis in relation to other disorders that often result post-trauma, and 2) proposed mechanisms that uniquely link trauma to psychosis. We begin by discussing the underlying connection between trauma exposure and the entire psychosis spectrum with a focus on the influence of trauma type and specific psychotic symptoms. We then consider how the principles of multifinality and equifinality can be useful in elucidating the trauma-psychosis relationship versus the trauma-other disorder relationship. Next, we discuss several cognitive and neurobiological mechanisms that might uniquely account for the association between trauma and psychosis, as well as the role of gender. Lastly, we review important methodological issues that complicate the research on trauma and psychosis, ending with clinical implications for the field.

The role of a family history of psychosis for youth at clinical high risk of psychosis

“…Current literature and reviews (Fusar‐Poli et al, ; Gibson, Alloy, & Ellman, ) have shown trauma to be an important risk factor among those at high risk of psychosis. Interestingly, although our sample all met criteria for being at CHR, we found a further distinction between those with and without a family history.…”

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

“…Childhood adversity is also a risk factor for bipolar I disorder 167 . Childhood adversity is clearly linked to reality distortion symptoms, while its association with negative symptoms is less consistent and understudied, and data on disorganization are lacking 168 . With regard to traits, childhood adversity is consistently associated with psychoticism, and preliminary evidence supports a link to detachment 169,170 .…”

A utilização do Método de Rorschach no diagnóstico diferencial da Esquizofrenia e Transtorno Dissociativo de Identidade

“…Além disso, ambos têm no ambiente um elemento comum: na esquizofrenia, fatores do ambiente (interno e externo) provocam um efeito patogênico sobre o sistema nervoso do paciente afetado; nas desordens dissociativas, uma das características essenciais é a interrupção das funções que integram a percepção do ambiente. O trauma, ocorrido na primeira infância, é um dos fatores ambientais de risco para esquizofrenia e condição para início de experiências dissociativas, como o TDI (Gibson, Alloy, & Ellman, 2016;Negro Júnior, Negro, & Louzã, 1999;Van der Hart, 2012). Esses fatores integram o foco deste trabalho.…”

“…Na primeira, citam-se como fatores traumáticos a negligência emocional, o abandono, o desamparo e a rejeição na infância, associados ao surgimento de sintomas psicóticos ou repercussões nocivas na fase adulta. A extensão dos danos decorrentes desses fatores varia de acordo com a vulnerabilidade de cada paciente, uma vez que os traumas podem se referir a um único acontecimento externo, como abuso sexual ou estupro ou a um acúmulo deles (Gibson, Alloy, & Ellman, 2016;Kumar, Castellani, Maiti, O'reilly, & Singh, 2013).…”

“…Eventos traumáticos ocorridos no passado podem estar vinculados ao desenvolvimento da esquizofrenia, e a gravidade, a duração e a proximidade da exposição de um indivíduo a um evento traumático são fatores determinantes para a probabilidade de surgimento da dissociação patológica (Dell, 2002;Gibson, Alloy, & Ellman, 2016). Em termos de violência externa, o abuso infantil, físico ou psíquico pode ser fator etiológico determinante do desencadeamento do TDI, relacionado com a dissociação patológica da consciência, que também pode estar associada à base etiológica da esquizofrenia (Haddock, 2001;Putnam, 1989;Rich, 2005).…”