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Childhood abuse and psychotic experiences in adulthood: findings from a 35-year longitudinal study

  • Caroline J. Bell (a1), James A. Foulds (a2), L. John Horwood (a3), Roger T. Mulder (a4) and Joseph M. Boden (a5)...

Abstract

Background

The extent to which exposure to childhood sexual and physical abuse increases the risk of psychotic experiences in adulthood is currently unclear.

Aims

To examine the relationship between childhood sexual and physical abuse and psychotic experiences in adulthood taking into account potential confounding and time-dynamic covariate factors.

Method

Data were from a cohort of 1265 participants studied from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood sexual and physical abuse. At ages 30 and 35, they were questioned about psychotic experiences (symptoms of abnormal thought and perception). Generalised estimating equation models investigated covariation of the association between abuse exposure and psychotic experiences including potential confounding factors in childhood (socioeconomic disadvantage, adverse family functioning) and time-dynamic covariate factors (mental health, substance use and life stress).

Results

Data were available for 962 participants; 6.3% had been exposed to severe sexual abuse and 6.4% to severe physical abuse in childhood. After adjustment for confounding and time-dynamic covariate factors, those exposed to severe sexual abuse had rates of abnormal thought and abnormal perception symptoms that were 2.25 and 4.08 times higher, respectively than the ‘no exposure’ group. There were no significant associations between exposure to severe physical abuse and psychotic experiences.

Conclusions

Findings indicate that exposure to severe childhood sexual (but not physical) abuse is independently associated with an increased risk of psychotic experiences in adulthood (particularly symptoms of abnormal perception) and this association could not be fully accounted for by confounding or time-dynamic covariate factors.

Declaration of interest

None.

Copyright

Corresponding author

Correspondence: Caroline Bell, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. Email: caroline.bell@otago.ac.nz

References

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Childhood abuse and psychotic experiences in adulthood: findings from a 35-year longitudinal study

  • Caroline J. Bell (a1), James A. Foulds (a2), L. John Horwood (a3), Roger T. Mulder (a4) and Joseph M. Boden (a5)...
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eLetters

Borderline personality disorder and schizophrenia- the missing link.

Nandini Chakraborty, Consultant Psychiatrist, RCPsych
16 April 2019

The article from Bell et al, was of great interest to me as a Consultant psychiatrist in early intervention in psychosis. However the findings do not demonstrate anything radically new from what is already available in literature. There have been numerous studies with conflicting findings (Sideli et al, 2012). Whilst the presence of psychotic symptoms being present in higher proportions in case of childhood sexual abuse is not in doubt, the literature varies in opinion about the links with schizophrenia and psychotic illnesses.

What is further confusing is the lack of robust research around the links between borderline personality disorder and schizophrenia. Again the links between the high proportion of reported child sexual abuse in borderline personality disorder (Cattane et al, 2017) and the report of hallucinatory experiences in borderline personality disorder (D'Agostino, 2019), seems consistent. Authors report difficulty in distinguishing the phenomenology of hallucinations in borderline personality disorder and schizophrenia.

The missing link seems to be research looking at the relationship between childhood sexual abuse, borderline personality disorder and schizophrenia. The lack of screening for borderline personality disorder in studies looking at childhood sexual abuse and psychotic symptoms, introduces the likelihood of a major confounding factor.
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Conflict of interest: None declared

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to Borderline personality disorder and schizophrenia- the missing link.


Childhood abuse and psychotic experiences or dissociative experiences?

Berker Duman, M.D., psychiatrist, Ankara University School of Medicine Department of Psychiatry
Burçin Çolak, M.D., psychiatrist, Ankara University School of Medicine Department of Psychiatry
16 April 2019

An important paper published by Bell et al. (2018) in order to investigate association between childhood sexual and physical abuse and psychotic experiences recently. This is a well-designed cohort study from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood abuse. At ages 30 and 35 they were evaluated by DIS-IV for assessing two classes of psychotic experiences (symptoms of abnormal thought and abnormal perception). A total score was calculated and analysed. Findings conclude that subjects those exposed to severe sexual abuse had increased odds ratios of 2.25 and 4.08 (abnormal thought and abnormal perception respectively) than the no exposure group.

To our opinion, this key finding of the study is not properly adressed in the discussion. The main reason for this association could be the effect of dissociative experiences. Dissociative experiences such as perception abnormalities are strongly related to the childhood adversity especially to severe childhood sexual abuse which is a well-established clinical entity (1). To assess this confounder, dissociative symptoms scales such as Dissociative Experiences Scale (DES) could be used (2). Probably, DES scores would have been highly correlated with psychotic experiences scores in their study. Authors should at least indicate that the findings which they have shown could be due to the dissociative experiences which is a well-known phenomenological issue. Differences and similiarities between psychotic and dissociative experiences should be highlighted in the discussion. This well-defined phenomena ( association between childhood sexual abuse and adulthood dissociative experiences) should be added as a limitation of the study.

Reference

1.Rodriguez-Srednicki O. Childhood sexual abuse, dissociation, and adult self-destructive behavior. Journal of Child Sexual Abuse, 2002; 3: 75-89.

2.Van Ijzendoorn MH, Schuengel C. The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review, 1996; 5: 365-382.
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Conflict of interest: None declared

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