Skip to main content Accessibility help

Childhood adversity and psychosis: generalised or specific effects?

  • E. Longden (a1), M. Sampson (a2) and J. Read (a3)



This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions.


Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect.


Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose–response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted.


The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Childhood adversity and psychosis: generalised or specific effects?
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Childhood adversity and psychosis: generalised or specific effects?
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Childhood adversity and psychosis: generalised or specific effects?
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

* Address for correspondence: Dr E. Longden, Institute of Psychology, Health and Society, Block B 2nd Floor, Waterhouse Building, University of Liverpool, Liverpool L69 3GL, UK. (Email:


Hide All
Agar, K, Read, J (2002). What happens when people disclose sexual or physical abuse to staff at a community mental health centre? International Journal of Mental Health Nursing 11, 7079.
Bacon, T, Kennedy, A (2014). Clinical perspectives on the relationship between psychosis and dissociation: utility of structural dissociation and implications for practice. Psychosis: Psychological, Social and Integrative Approaches 7, 8191.
Bentall, RP (2006). Madness explained: why we must reject the Kraepelinian paradigm and replace it with a ‘complaint-orientated’ approach to understanding mental illness. Medical Hypotheses 66, 220233.
Bentall, RP, Fernyhough, C (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin 34, 10091011.
Bentall, RP, Wickham, S, Shevlin, M, Varese, F (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 the Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734740.
Bentall, RP, de Sousa, P, Varese, F, Wickham, S, Sitko, K, Haarmans, M, Read, J (2014). From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology 49, 10111022.
Bernstein, DP, Fink, L (1998). Childhood Trauma Questionnaire: A Retrospective Self-report: Manual. Psychological Corporation: New York.
Boyda, D, McFeeters, D, Shevlin, M (2014). Intimate partner violence, sexual abuse, and the mediating role of loneliness on psychosis. Psychosis: Psychological, Social and Integrative Approaches 7, 113.
Braehler, C, Gumley, AI, Harper, J, Wallace, S, Norrie, J, Gilbert, P (2013). Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. British Journal of Clinical Psychology 52, 199214.
British Psychological Society Division of Clinical Psychology (2011). Good Practice Guidelines on the use of Psychological Formulation. A Report by the British Psychological Society Division of Clinical Psychology. British Psychological Society: Leicester.
Buehler, C, Orme, JG, Post, J, Patterson, DA (2000). The long-term correlates of family foster care. Children and Youth Services Review 22, 595625.
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences. Lawrence Erlbaum Associates: Hillsdale, New Jersey.
Corstens, D, Longden, E (2013). The origins of voices: links between voice hearing and life history in a survey of 100 cases. Psychosis: Psychological, Social and Integrative Approaches 5, 270285.
Darves-Bornoz, J-M, Lemperiere, T, Degiovanni, A, Gaillard, P (1995). Sexual victimization in women with schizophrenia and bipolar disorder. Social Psychiatry and Psychiatric Epidemiology 30, 7884.
De Sousa, P, Varese, F, Sellwood, W, Bentall, RP (2014). Parental communication deviance and psychosis: a meta-analysis. Schizophrenia Bulletin 40, 756768.
Dill, DL, Chu, JA, Grob, MC, Eisen, SV (1991). The reliability of abuse history report: a comparison of two inquiry formats. Comprehensive Psychiatry 32, 166169.
Drake, B, Pandey, S (1996). Understanding the relationship between neighborhood poverty and specific types of child maltreatment. Child Abuse and Neglect 20, 10031018.
Evans, GW, Kim, P (2007). Childhood poverty and health cumulative risk exposure and stress dysregulation. Psychological Science 18, 953957.
Falukozi, E, Addington, J (2012). Impact of trauma on attenuated psychotic symptoms. Psychosis: Psychological, Social and Integrative Approaches 4, 203212.
Fibiger, HC (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia Bulletin 38, 649650.
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J, Hutchinson, G, Doody, GA, Jones, PB, McGuffin, P, Murray, RM, Leff, J, Morgan, C (2011). Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546553.
Fisher, HL, Schreier, A, Zammit, S, Maughan, B, Munafò, MR, Lewis, G, Wolke, D (2013). Pathways between childhood victimisation and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin 39, 10451055.
Freyd, J (1994). Betrayal trauma: traumatic amnesia as an adaptive response to childhood abuse. Ethics and Behavior 4, 307330.
Gaudiano, BA, Herbert, JD (2006). Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behaviour Research and Therapy 44, 415437.
Gillham, B, Tanner, G, Cheyne, B, Freeman, I, Rooney, M, Lambie, A (1998). Unemployment rates, single parent density, and indices of child poverty: their relationship to different categories of child abuse and neglect. Child Abuse and Neglect 22, 7990.
Goodman, L, Thompson, K, Weinfurt, K, Corl, S, Acker, P, Mueser, KT, Rosenberg, SD (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress 12, 587599.
Gracie, A, Freeman, D, Green, S, Garety, PA, Kuipers, E, Hardy, A, Ray, K, Dunn, G, Bebbington, P, Fowler, D (2007). The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatrica Scandinavica 116, 280289.
Grubaugh, AL, Zinzow, HM, Paul, L, Egede, LE, Frueh, BC (2011). Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clinical Psychology Review 31, 883899.
Hainsworth, C, Starling, J, Brand, F, Groen, K, Munro, K (2011). Trauma and psychotic symptoms: data from a pediatric mental health inpatient unit. Journal of Traumatic Stress 24, 491494.
Harder, S (2014). Attachment in schizophrenia – implications for research, prevention, and treatment. Schizophrenia Bulletin 40, 11891193.
Hardy, A, Fowler, D, Freeman, D, Smith, B, Steel, C, Evans, J, Garety, P, Kuipers, E, Bebbington, P, Dunn, G (2005). Trauma and hallucinatory experience in psychosis. Journal of Nervous and Mental Disease 193, 501507.
Hepworth, L, McGowan, L (2013). Do mental health professionals enquire about childhood sexual abuse during routine mental health assessment in acute mental health settings? A substantive literature review. Journal of Psychiatric and Mental Health Nursing 20, 473483.
Herman, JL (1992). Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. Basic Books: New York.
Herman, J, Schatzow, E (1987). Recovery and verication of memories of childhood sexual trauma. Psychoanalytic Psychology 4, 114.
Horwath, J (2007). The missing assessment domain: personal, professional and organizational factors influencing professional judgements when identifying and referring child neglect. British Journal of Social Work 37, 12851303.
IBM Corp. (2011). IBM SPSS Statistics for Windows, version 20.0. IBM Corp: Armonk, NY.
Johnstone, L, Dallos, R (2006). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems. Routledge: London.
Lee, BJ, Goerge, RM (1999). Poverty, early childbearing, and child maltreatment: a multinomial analysis. Children and Youth Services Review 21, 755780.
Lewinsohn, PM, Rosenbaum, M (1987). Recall of parental behaviour by acute depressives, remitted depressives, and nondepressives. Journal of Personality and Social Psychology 52, 611619.
Lommen, MJJ, Restifo, K (2009). Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder. Community Mental Health Journal 45, 485496.
Longden, E, Corstens, D, Escher, S, Romme, M (2012). Voice hearing in biographical context: a model for formulating the relationship between voices and life history. Psychosis: Psychological, Social and Integrative Approaches 4, 224234.
Matheson, SL, Shepherd, AM, Pinchbeck, RM, Laurens, KR, Carr, VJ (2013). Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225238.
Mauritz, MW, Goossens, PJ, Draijer, N, van Achterberg, T (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European Journal of Psychotraumatology 4, 10.3402/ejpt.v4i0.19985. doi: 10.3402/ejpt.v4i0.19985
McGorry, PD, Killackey, E, Yung, A (2008). Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 7, 148156.
Meyer, I, Muenzenmaier, K, Cancienne, J, Struening, E (1996). Reliability and validity of a measure of sexual and physical abuse histories among women with serious mental illness. Child Abuse and Neglect 20, 213219.
Morgan, C, Reininghaus, U, Reichenberg, A, Frissa, S, Hotopf, M, Hatch, SL (2014). Adversity, cannabis use and psychotic experiences: evidence of cumulative and synergistic effects. British Journal of Psychiatry 204, 346353.
Morrison, AP, Turkington, D, Pyle, M, Spencer, H, Brabban, A, Dunn, G, Christodoulides, T, Dudley, R, Chapman, N, Callcott, P, Grace, T, Lumley, V, Drage, L, Tully, S, Irving, K, Cummings, A, Byrne, R, Davies, LM, Hutton, P (2014). Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet 383, 13951403.
National Health Service Confederation (NHS) (2008). Briefing 162: Implementing National Policy on Violence and Abuse. NHS: London.
Neil, E (2000). The reasons why young children are placed for adoption: findings from a recently placed sample and a discussion of implications for subsequent identity development. Child and Family Social Work 5, 303316.
Raune, D, Bebbington, P, Dunn, G, Kuipers, E (2006). Event attributes and the content of psychotic experiences in first-episode psychosis. Psychological Medicine 36, 221230.
Read, J (1998). Child abuse and severity of disturbance among adult psychiatric inpatients. Child Abuse and Neglect 22, 359368.
Read, J (2010). Can poverty drive you mad? “Schizophrenia,” socio-economic status and the case for primary prevention. New Zealand Journal of Psychology 39, 719.
Read, J (2013 a). Does ‘schizophrenia’ exist? Reliability and validity. In Models of Madness: Psychological, Social and Biological Approaches to Psychosis (ed. Read, J and Dillon, J), pp. 4761. Routledge: Hove.
Read, J (2013 b). Childhood adversity and psychosis: from heresy to certainty. In Models of Madness: Psychological, Social and Biological Approaches to Psychosis (ed. Read, J and Dillon, J), pp. 249275. Routledge: Hove.
Read, J, Argyle, N (1999). Hallucinations, delusions and thought disorders among Adult psychiatric inpatients with a history of child abuse. Psychiatric Services 50, 14671472.
Read, J, Fraser, A (1998). Staff response to abuse histories of psychiatric inpatients. Australian and New Zealand Journal of Psychiatry 32, 206213.
Read, J, Gumley, A (2008). Can attachment theory help explain the relationship between childhood adversity and psychosis? Attachment 2, 135.
Read, J, Agar, K, Argyle, N, Aderhold, V (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy 76, 122.
Read, J, Hammersley, P, Rudegeair, T (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment 13, 101110.
Read, J, Johnstone, M, Taitimu, M (2013). Psychosis, poverty and ethnicity. In Models of Madness: Psychological, Social and Biological Approaches to Psychosis (ed. Read, J and Dillon, J), pp. 191209. Routledge: Hove.
Read, J, Fosse, R, Moskowitz, A, Perry, B (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry 4, 6579.
Ross, CA, Halpern, N (2009). Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and Complex Comorbidity. Manitou Communications Inc: Texas.
Rossiter, A, Byrne, F, Wota, A, Nisar, Z, Ofuafor, T, Murray, I, Byrne, C, Hallahan, B (2015). Childhood trauma levels in individuals attending adult mental health services: an evaluation of clinical records and structured measurement of childhood trauma. Child Abuse and Neglect 110.
Salyers, MP, Evans, LJ, Bond, GR, Meyer, PS (2004). Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives. Community Mental Health Journal 40, 1731.
Seikkula, J, Alakare, B, Aaltonen, J (2011). The comprehensive Open-Dialogue approach in western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis: Psychological, Social and Integrative Approaches 3, 191204.
Sheffield, JM, Williams, LE, Blackford, JU, Heckers, S (2013). Childhood sexual abuse increases risk of auditory hallucinations in psychotic disorders. Comprehensive Psychiatry 54, 10981104.
Shevlin, M, Houston, JE, Dorahy, MJ, Adamson, G (2008). Cumulative traumas and psychosis: an analysis of the national comorbidity survey and the British Psychiatric Morbidity Survey. Schizophrenia Bulletin 34, 193199.
Shevlin, M, McAnee, G, Bentall, RP, Murphy, J (2014). Specificity of association between adversities and the occurrence and co-occurrence of paranoia and hallucinations: evaluating the stability of childhood risk in an adverse adult environment. Psychosis: Psychological, Social and Integrative Approaches 113.
Sitko, K, Bentall, RP, Shevlin, M, Sellwood, W (2014). Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatric Research 217, 202209.
Thompson, A, Nelson, B, McNab, C, Simmons, M, Leicester, S, McGorry, PD, Bechdolf, A, Yung, AR (2010) Psychotic symptoms with sexual content in the “ultra high risk” for psychosis population: frequency and association with sexual trauma. Psychiatry Research 177, 8491.
Van Dam, DS, van der Ven, E, Velthorst, E, Selten, JP, Morgan, C, De Haan, L (2012). Childhood bullying and the association with psychosis in non-clinical and clinical samples: a review and meta-analysis. Psychological Medicine 42, 24632474.
Van Nierop, M, Lataster, T, Smeets, F, Gunther, N, van Zelst, C, ten Have, M, van Dorsselaer, S, Bak, M, Myin-Germeys, I, Viechtbauer, W, van Os, J, van Winkel, R (2014). Psychopathological mechanisms linking childhood traumatic experiences to risk of psychotic symptoms: analysis of a large, representative population-based sample. Schizophrenia Bulletin 40, S123S130.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood trauma increases the risk of psychosis: a meta-analysis of patient-control, prospective- and cross sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Vassos, E, Pedersen, CB, Murray, RM, Collier, DA, Lewis, CM (2012). Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 38, 11181123.
Wickham, S, Taylor, P, Shevlin, M, Bentall, RP (2014). The impact of social deprivation on paranoia, hallucinations, mania and depression: the role of discrimination social support, stress and trust. PLoS ONE 9, e105140.
Wigman, JT, van Os, J, Thiery, E, Derom, C, Collip, D, Jacobs, N, Wichers, M (2013). Psychiatric diagnosis revisited: towards a system of staging and profiling combining nomothetic and idiographic parameters of momentary mental states. PLoS ONE 8, e59559.
Wurr, JC, Partridge, IM (1996). The prevalence of a history of childhood sexual abuse in an acute adult inpatient population. Child Abuse and Neglect 20, 867872.
Young, M, Read, J, Barker-Collo, S, Harrison, R (2001). Evaluating and overcoming barriers to taking abuse histories. Professional Psychology: Research and Practice 32, 407414.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed