Childhood adversity

What is childhood adversity?

Childhood adversities encompass a range of childhood experiences, including loss of a close relative, parental separation, bullying, physical abuse, sexual abuse, emotional abuse, and neglect. The nature, timing, severity, and duration of exposure are likely to influence mental health, however any evidence that childhood adversity directly causes psychosis or schizophrenia is controversial. Firstly, psychotic disorders may be secondary to comorbid affective, substance use, personality, or post-traumatic stress disorders, all of which have been linked to early adversities, and all are common in those with a psychotic mental illness. Another difficulty is accurately measuring childhood adversity, as it is dependent on assessment of the experiences via information collected retrospectively. This is particularly problematic if having a psychotic disorder impacts on memory recall.

What is the evidence for childhood adversity?

Moderate to high quality evidence finds the rate of childhood sexual abuse in people with psychosis is approximately 26.3%, childhood physical abuse is approximately 38.8%, and childhood emotional abuse is approximately 34%. Rates are highest in older studies, in studies with more females, in studies with older patients, and in studies of patients with comorbid substance abuse.

There was a medium-sized increase in the rate of any childhood adversity in people with schizophrenia, psychotic disorders, psychotic symptoms, or ultra-high risk mental states when compared to people without these disorders or symptoms. There were small, significant associations between exposure to childhood trauma and increased severity of positive symptoms, poor cognition, and poor treatment outcomes, and a small association between exposure to childhood neglect and increased severity of negative symptoms.

Compared to people with anxiety disorders, there was a medium-sized increased rate of childhood adversity in people with schizophrenia. Compared to people with dissociative disorders or post-traumatic stress disorder, there was a large decreased risk of childhood adversity in people with schizophrenia. There were no differences in rates of childhood adversity between people with schizophrenia and people with depression or affective psychoses (e.g. bipolar disorder).

December 2020

Last updated at: 12:53 am, 15th December 2020
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