Type and timing of adverse childhood experiences differentially affect severity of PTSD, dissociative and depressive symptoms in adult inpatients

Abstract

BackgroundA dose-dependent effect of Adverse Childhood Experiences (ACE) on the course and severity of psychiatric disorders has been frequently reported. Recent evidence indicates additional impact of type and timing of distinct ACE on symptom severity experienced in adulthood, in support of stress-sensitive periods in (brain) development. The present study seeks to clarify the impact of ACE on symptoms that are often comorbid across various diagnostic groups: symptoms of posttraumatic stress disorder (PTSD), shutdown dissociation and depression. A key aim was to determine and compare the importance of dose-dependent versus type and timing specific prediction of ACE on symptom levels.MethodsExposure to ten types of maltreatment up to age 18 were retrospectively assessed in N = 129 psychiatric inpatients using the Maltreatment and Abuse Chronology of Exposure (MACE). Symptoms of PTSD, shutdown dissociation, and depression were related to type and timing of ACE. The predictive power of peak types and timings was compared to that of global MACE measures of duration, multiplicity and overall severity.ResultsA dose-dependent effect (MACE duration, multiplicity and overall severity) on severity of all symptoms confirmed earlier findings. Conditioned random forest regression verified that PTSD symptoms were best predicted by overall ACE severity, whereas type and timing specific effects showed stronger prediction for symptoms of dissociation and depression. In particular, physical neglect at age 5 and emotional neglect at ages 4–5 were related to increased symptoms of dissociation, whereas the emotional neglect at age 8–9 enhanced symptoms of depression.ConclusionIn support of the sensitive period of exposure model, present results indicate augmented vulnerability by type x timing of ACE, in particular emphasizing pre-school (age 4–5) and pre-adolescent (8–9) periods as sensitive for the impact of physical and emotional neglect. PTSD, the most severe stress-related disorder, varies with the amount of adverse experiences irrespective of age of experience. Considering type and timing of ACE improves understanding of vulnerability, and should inform diagnostics of psychopathology like PTSD, dissociation and depression in adult psychiatric patients.

Trajectories of childhood adversity and the risk of depression in young adulthood: Results from the Avon Longitudinal Study of Parents and Children

“…Future studies should aim to investigate the differential impact of specific types of adversities (Dunn et al, 2017(Dunn et al, , 2018 occurring during specific developmental periods (Schalinski et al, 2016(Schalinski et al, , 2017 and to assess the effects of adversity trajectories on other mental health and behavioral outcomes (English et al, 2005;Kaplow & Widom, 2007) and on depression at later ages. Future studies should aim to investigate the differential impact of specific types of adversities (Dunn et al, 2017(Dunn et al, , 2018 occurring during specific developmental periods (Schalinski et al, 2016(Schalinski et al, , 2017 and to assess the effects of adversity trajectories on other mental health and behavioral outcomes (English et al, 2005;Kaplow & Widom, 2007) and on depression at later ages.…”

“…The timing and persistence of childhood adversity may be particularly important for the development of mental health problems (Dunn et al, 2018;Dunn, Nishimi, Powers, & Bradley, 2017;Schalinski et al, 2016Schalinski et al, , 2017. Some prospective studies have found adverse experiences in early childhood (e.g., before age five) to have long-term effects on depression (Kaplow & Widom, 2007;Manly, Kim, Rogosch, & Cicchetti, 2001;Thornberry, Henry, Ireland, & Smith, 2010), whereas others have found stronger effects of adverse events occurring at later times (e.g., middle childhood or adolescence; Harpur, Polek, & van Harmelen, 2015;Najman et al, 2010;Thornberry, Ireland, & Smith, 2001).…”

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

“…To this end, studies examining the effects of adverse childhood events on the severity of PTSD indicate that certain types of experiences at specific sensitive periods have stronger impact on and more predictive strength for symptom development than others. While Schalinski et al (2016) found sexual abuse at age 12 to be the best predictor of the development of PTSD in adulthood, Schoedl et al (2010) found that individuals who reported CSA before the age of 12 years were more likely to develop depressive symptoms, whereas those abused after 12 years of age were more likely to develop PTSD. It remains unclear, however, whether the age or developmental period at which a child is abused influences the outcome of treatment for PTSD.…”

Does sleep disruption mediate the effects of childhood maltreatment on brain structure?

“…This modern computationally demanding technique is well suited to the analysis of highly collinear data sets and can handle models with a very large number of predictor variables and does not assume a linear relationship between predictor variables and outcome (Breiman, 2001; Liaw & Wiener, 2002; Svetnik et al, 2003). We found using Monte-Carlo simulations with actual exposure data ( N  = 530) and simulated sensitive period outcomes that random forest regression with conditional trees (Strobl, Boulesteix, Zeileis, & Hothorn, 2007) most accurately identified the type and timing of exposure used to generate the outcomes (compared to conventional random forest, gradient boosted machines, support vector machines, neural networks or generalized linear models), and have used this approach in recent reports (Khan et al, 2015; Schalinski & Teicher, 2015; Schalinski et al, 2016). …”