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

• Published in: Schizophrenia bulletin Vol. 42 Suppl 1; no. suppl 1; pp. S34 - S43
• Main Authors: Hardy, Amy, Emsley, Richard, Freeman, Daniel, Bebbington, Paul, Garety, Philippa A, Kuipers, Elizabeth E, Dunn, Graham, Fowler, David
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.07.2016
• Subjects: Adult; Adult Survivors of Child Abuse - psychology; Adult Survivors of Child Abuse - statistics & numerical data; Affect - physiology; Comorbidity; Delusions - epidemiology; Delusions - etiology; Delusions - physiopathology; Depression - epidemiology; Depression - etiology; Depression - physiopathology; Female; Hallucinations - epidemiology; Hallucinations - etiology; Hallucinations - physiopathology; Humans; Male; Memory, Episodic; Middle Aged; Psychological Trauma - complications; Psychological Trauma - epidemiology; Psychological Trauma - physiopathology; Psychotic Disorders - epidemiology; Psychotic Disorders - etiology; Psychotic Disorders - physiopathology; Recurrence; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - physiopathology; Supplement; United Kingdom - epidemiology; schema; reexperiencing; hyperarousal; victimization; avoidance; psychosis
• ISSN: 0586-7614; 1745-1701
• DOI: 10.1093/schbul/sbv175

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.