Skip to main content Accessibility help

The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder

  • H. L. Fisher (a1), P. B. Jones (a2), P. Fearon (a1), T. K. Craig (a1), P. Dazzan (a1) (a3), K. Morgan (a4), G. Hutchinson (a5), G. A. Doody (a6), P. McGuffin (a1), J. Leff (a1), R. M. Murray (a1) (a3) and C. Morgan (a1) (a3)...



Childhood adversity has been associated with onset of psychosis in adulthood but these studies have used only general definitions of this environmental risk indicator. Therefore, we sought to explore the prevalence of more specific adverse childhood experiences amongst those with and without psychotic disorders using detailed assessments in a large epidemiological case-control sample (AESOP).


Data were collected on 182 first-presentation psychosis cases and 246 geographically matched controls in two UK centres. Information relating to the timing and frequency of exposure to different types of childhood adversity (neglect, antipathy, physical and sexual abuse, local authority care, disrupted living arrangements and lack of supportive figure) was obtained using the Childhood Experience of Care and Abuse Questionnaire.


Psychosis cases were three times more likely to report severe physical abuse from the mother that commenced prior to 12 years of age, even after adjustment for other significant forms of adversity and demographic confounders. A non-significant trend was also evident for greater prevalence of reported severe maternal antipathy amongst those with psychosis. Associations with maternal neglect and childhood sexual abuse disappeared after adjusting for maternal physical abuse and antipathy. Paternal maltreatment and other forms of adversity were not associated with psychosis nor was there evidence of a dose–response effect.


These findings suggest that only specific adverse childhood experiences are associated with psychotic disorders and only in a minority of cases. If replicated, this greater precision will ensure that research into the mechanisms underlying the pathway from childhood adversity to psychosis is more fruitful.


Corresponding author

*Address for correspondence: H. L. Fisher, Ph.D., PO 80 MRC SGDP Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email:


Hide All
Agid, O, Shapira, B, Zislin, J, Ritsner, M, Hanin, B, Murad, H, Troudart, T, Bloch, M, Heresco-Levy, U, Lerer, B (1999). Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia. Molecular Psychiatry 4, 163172.
Beattie, N, Shannon, C, Kavanagh, M, Mulholland, C (2009). Predictors of PTSD symptoms in response to psychosis and psychiatric admission. Journal of Nervous and Mental Disease 197, 5660.
Bebbington, P, Nayani, T (1995). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research 5, 1120.
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimization and childhood disadvantage. British Journal of Psychiatry 185, 220226.
Bendall, S, Jackson, HJ, Hulbert, CA, McGorry, PD (2008). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Bernstein, DP, Fink, L (1998). Childhood Trauma Questionnaire: A Retrospective Self-report Manual. The Psychological Corporation: New York, NY.
Bifulco, A, Bernazzani, O, Moran, PM, Jacobs, C (2005). The Childhood Experiences of Care and Abuse Questionnaire (CECA.Q) – validation in a community series. British Journal of Clinical Psychology 44, 563581.
Blaauw, E, Arensman, E, Kraaij, V, Winkel, FW, Bout, R (2002). Traumatic life events and suicide risk among jail inmates: the influence of types of events, time period and significant others. Journal of Traumatic Stress 15, 9–16.
Bowlby, J (1951). Maternal Care and Mental Health. Schocken: New York, NY.
Bowlby, J (1977). The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. British Journal of Psychiatry 130, 201210.
Briere, J, Woo, R, McRae, B, Foltz, J, Sitzman, R (1997). Lifetime victimization history, demographics and clinical status in female psychiatric emergency room patients. Journal of Nervous and Mental Disease 185, 95–101.
Brown, GW, Craig, TK, Harris, TO, Handley, RV, Harvey, AL (2007). Development of a retrospective interview measure of parental maltreatment using the Childhood Experience of Care and Abuse (CECA) instrument – a life-course study of adult chronic depression – 1. Journal of Affective Disorders 103, 205215.
Campbell, ML, Morrison, AP (2007). The relationship between bullying, psychotic-like experiences and appraisals in 14–16-year olds. Behaviour, Research and Therapy 45, 15791591.
Clausen, AH, Crittenden, PM (1991). Physical and psychological maltreatment: relations among types of treatment. Child Abuse and Neglect 15, 5–18.
Cohen, LJ, Campos, JJ (1974). Father, mother, and stranger as elicitors of attachment behaviors in infancy. Developmental Psychology 10, 146154.
Coid, J, Petruckevitch, A, Chung, W-S, Richardson, J, Moorey, S, Feder, G (2003). Abusive experiences and psychiatric morbidity in women primary care attenders. British Journal of Psychiatry 183, 332339.
Colins, O, Vermeiren, R, Vreugdenhil, C, Schuyten, G, Broekaert, E, Krabbendam, A (2009). Are psychotic experiences among detained juvenile offenders explained by trauma and substance use? Drug and Alcohol Dependence 100, 3946.
Croudace, TJ, Kayne, R, Jones, PB, Harrison, GL (2000). Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis. Psychological Medicine 30, 177185.
Fisher, H, Craig, T (2008). Childhood adversity and psychosis. In Society and Psychosis (ed. Morgan, C., McKenzie, K. and Fearon, P.), pp. 95–111. Cambridge University Press: Cambridge.
Fisher, H, Morgan, C, Dazzan, P, Craig, TK, Morgan, K, Hutchinson, G, Jones, PB, Doody, GA, Pariante, C, McGuffin, P, Murray, RM, Leff, J, Fearon, P (2009 a). Gender differences in the association between childhood abuse and psychosis. British Journal of Psychiatry 194, 319325.
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 (2009 b). Reliability and comparability of psychosis patients' retrospective reports of childhood abuse. Schizophrenia Bulletin. Published online: 7 October 2009. doi:10.1093/schbul/sbp103.
Garety, PA, Bebbington, P, Fowler, D, Freeman, D, Kuipers, E (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.
Gilbert, R, Widom, CS, Browne, K, Fergusson, D, Webb, E, Janson, S (2009). Burden and consequences of child maltreatment in high-income countries. Lancet 373, 6881.
Hammersley, P, Dias, A, Todd, G, Bowen-Jones, K, Reilly, B, Bentall, RP (2003). Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. British Journal of Psychiatry 182, 543547.
Hardt, J, Rutter, M (2004). Validity of adult retrospective reports of adverse childhood experiences: a review of the evidence. Journal of Child Psychology and Psychiatry 45, 260273.
Harris, T (1987). Recent developments in the study of life events in relation to psychiatric and physical disorders. In Psychiatric Epidemiology: Progress and Prospects (ed. Cooper, B.), pp. 81–102. Croom Helm: London.
Heads, TC, Taylor, PJ, Leese, M (1997). Childhood experiences of patients with schizophrenia and a history of violence: a special hospital sample. Criminal Behaviour and Mental Health 7, 117130.
Heins, T, Gray, A, Tennant, M (1990). Persisting hallucinations following childhood sexual abuse. Australian and New Zealand Journal of Psychiatry 24, 561565.
Hlastala, SA, McClellan, J (2005). Phenomenology and diagnostic stability of youths with atypical psychotic symptoms. Journal of Child and Adolescent Psychopharmacology 15, 497509.
Houston, JE, Murphy, J, Adamson, G, Stringer, M, Shevlin, M (2008). Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophrenia Bulletin 34, 580585.
Howard, LM (1993). Allegations of abuse in psychotic patients. American Journal of Psychiatry 150, 839840.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.
Jenkins, R, Meltzer, H (1995). The national survey of psychiatric morbidity in Great Britain. Social Psychiatry and Psychiatric Epidemiology 30, 14.
Jones, P, Rodgers, B, Murray, R, Marmot, M (1994). Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344, 13981402.
Keiley, MK, Howe, TR, Dodge, KA, Bates, JE, Petti, GS (2001). The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Development and Psychopathology 13, 891912.
Kelleher, I, Harley, M, Lynch, F, Arseneault, L, Fitzpatrick, C, Cannon, M (2008). Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. British Journal of Psychiatry 193, 378382.
Kilcommons, AM, Morrison, AP (2005). Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatrica Scandinavica 112, 351359.
Kim, D, Kaspar, V, Noh, S, Nam, JH (2006). Sexual and physical abuse among Korean female inpatients with schizophrenia. Journal of Traumatic Stress 19, 279289.
Kirkbride, J, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM, AESOP Study Group (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Archives of General Psychiatry 63, 250258.
Lataster, T, van Os, J, Drukker, M, Henquet, C, Feron, F, Gunther, N, Myin-Germeys, I (2006). Childhood victimisation and developmental expression of nonclinical delusional ideation and hallucinatory experiences: victimisation and nonclinical psychotic experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423428.
Mallett, R (1997). Sociodemographic Schedule. Section of Social Psychiatry, Institute of Psychiatry: London.
May-Chahal, C, Cawson, P (2005). Measuring child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. Child Abuse and Neglect 29, 969984.
McNeil, TF, Schubert, EW, Cantor-Graae, E, Brossner, M, Schubert, P, Henriksson, KM (2009). Unwanted pregnancy as a risk factor for offspring schizophrenia-spectrum and affective disorders in adulthood: a prospective high-risk study. Psychological Medicine 39, 957965.
Morgan, C, Dazzan, P, Morgan, K, Jones, P, Harrison, G, Leff, J, Murray, R, Fearon, P, AESOP Study Group (2006). First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry 5, 4046.
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.
Morgan, C, Kirkbride, J, Leff, J, Craig, T, Hutchinson, G, McKenzie, K, Morgan, K, Dazzan, P, Doody, GA, Jones, P, Murray, R, Fearon, P (2007). Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychological Medicine 37, 495503.
Mulder, RT, Beautrais, AL, Joyce, PR, Fergusson, DM (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. American Journal of Psychiatry 155, 806811.
Myhrman, A, Rantakallio, P, Isohanni, M, Jones, P, Partanen, U (1996). Unwantedness of a pregnancy and schizophrenia in the child. British Journal of Psychiatry 169, 637640.
Neria, Y, Bromet, EJ, Sievers, S, Lavelle, J, Fochtmann, LJ (2002). Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. Journal of Consulting and Clinical Psychology 70, 246251.
NHS Confederation (2008). Implementing National Policy on Violence and Abuse. The NHS Confederation: London.
Office of National Statistics (2002). The National Statistics Socio-economic Classification User Manual. Office for National Statistics: London.
Parker, G, Fairley, M, Greenwood, J, Jurd, S, Silove, D (1982). Parental representations of schizophrenics and their association with onset and course of schizophrenia. British Journal of Psychiatry 141, 573581.
Plomin, R, DeFries, JC, Loehlin, JC (1977). Genotype–environment interaction and correlation in the analysis of human behaviour. Psychological Bulletin 84, 309322.
Romero, S, Birmaher, B, Axelson, D, Goldstein, T, Goldstein, BI, Gill, MK, Iosif, AM, Strober, MA, Hunt, J, Esposito-Smythers, C, Ryan, ND, Leonard, H, Keller, M (2009). Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. Journal of Affective Disorders 112, 144150.
Rosenberg, SD, Lu, W, Mueser, KT, Jankowski, MK, Cournos, F (2007). Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services 58, 245253.
Rubino, IA, Nanni, RC, Pozzi, DM, Siracusano, A (2009). Early adverse experiences in schizophrenia and unipolar depression. Journal of Nervous and Mental Disease 197, 6568.
Schäfer, I, Harfst, T, Aderhold, V, Briken, P, Lehmann, M, Moritz, S, Read, J, Naber, D (2006). Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study. Journal of Nervous and Mental Disease 194, 135138.
Schenkel, L, Spaulding, W, DiLillo, D, Silverstein, S (2005). Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research 76, 273286.
Schilling, EA, Aseltine, RH Jr, Gore, S (2008). The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations. Social Science and Medicine 66, 11401151.
Schofield, W, Balian, L (1959). A comparative study of the personal histories of schizophrenic and nonpsychiatric patients. Journal of Abnormal Social Psychology 59, 216225.
Shevlin, M, Dorahy, MJ, Adamson, G (2007 a). Trauma and psychosis: an analysis of the National Comorbidity Survey. American Journal of Psychiatry 164, 166169.
Shevlin, M, Dorahy, MJ, Adamson, G (2007 b). Childhood traumas and hallucinations: an analysis of the National Comorbidity Survey. Journal of Psychiatric Research 41, 222228.
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.
Sidebotham, P, Heron, J, ALSPAC Study Team (2006). Child maltreatment in the ‘children of the nineties’: a cohort study of risk factors. Child Abuse and Neglect 30, 497522.
Smith, N, Lam, D, Bifulco, A, Checkley, S (2002). Childhood Experience of Care and Abuse Questionnaire (CECAQ): validation of a screening instrument for childhood adversity in clinical populations. Social Psychiatry and Psychiatric Epidemiology 37, 572579.
Sommer, IE, Daalman, K, Rietkerk, T, Diederen, KM, Bakker, S, Wijkstra, J, Boks, MP (2008). Healthy individuals with auditory verbal hallucinations; who are they? Psychiatric assessments of a selected sample of 103 subjects. Schizophrenia Bulletin. Published online: 9 October 2008. doi:10.1093/schbul/sbn130.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. British Journal of Psychiatry 188, 527533.
Steele, H, Steele, M, Fonagy, P (1996). Associations among attachment classifications of mothers, fathers, and their infants. Child Development 67, 541555.
Thornberry, TP, Ireland, TO, Smith, CA (2001). The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Development and Psychopathology 13, 957979.
van der Vegt, EJ, van der Ende, J, Ferdinand, RF, Verhulst, FC, Tiemeier, H (2009). Early childhood adversities and trajectories of psychiatric problems in adoptees: evidence for long lasting effects. Journal of Abnormal Child Psychology 37, 239249.
Weber, K, Rockstroh, B, Borgelt, J, Awiszus, B, Popov, T, Hoffmann, K, Schonauer, K, Watzl, H, Pröpster, K (2008). Stress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry 8, 63.
Wexler, BE, Lyons, L, Lyons, H, Mazure, CM (1997). Physical and sexual abuse during childhood and development of psychiatric illnesses during adulthood. Journal of Nervous and Mental Disease 185, 522524.
Whitfield, C, Dube, S, Felitti, V, Anda, R (2005). Adverse childhood experiences and hallucinations. Child Abuse and Neglect 29, 797810.
Widom, CS, Czaja, SJ, Dutton, MA (2008). Childhood victimization and lifetime revictimization. Child Abuse and Neglect 32, 785796.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
WHO (1994). Schedules for the Clinical Assessment of Neuropsychiatry. World Health Organization: Geneva.
WHO (2002). The World Health Report 2002: Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva.
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