The link between psychosis and trauma is complex and multifactorial with different Of interest are the questions of why some people develop PTSD and whether it is associations between PTSD severity and personality disorder features. but has been less widely explored in relation to trauma and psychosis (16). Items 15 - 27 dren are resilient after traumatic exposure, some develop significant and type that includes secondary or comorbid psychotic features. 3. . complex relationship within the adult population may provide insight into the diag-. Traumatic Life Events as a Risk Factor for Psychosis: The Underlying .. the stimulating, positive aspects that an otherwise normally developing brain . Few studies have examined TLEs in relation to negative symptoms of psychosis. . Despite the complex interrelation between posttraumatic symptoms.
- Childhood trauma and psychosis - what is the evidence?
This time course from shortly after the trauma to years later indicates the need to conceptualize PTSD as longitudinal, and offer ongoing assessment and targeted treatments at different stages. The voices of persons with lived experience has been essential in our understanding of psychosis at multiple levels, but has been less widely explored in relation to trauma and psychosis Britz writes eloquently, and with disarming honesty, about her experience of trauma and psychosis, and developing an understanding of the interface between the two while also drawing upon current discourse to highlight the importance of meaningful collaboration with people with lived experience.
Adding to this lived experience perspective is Lu et al.
As previously mentioned, although a clear link between trauma and psychosis has been established, the specific mechanisms involved are still unknown. Two papers in this research topic examine potential explanatory models.
This paper is the first to propose a theoretical link between early childhood attachment and dissociative processing as mechanisms to explain the origin, and maintenance of distressing voice hearing. Hardy proposes a comprehensive, theoretically informed model of posttraumatic stress in psychosis that encompasses emotion regulation and autobiographical memory to understand the pathway between victimization and psychosis and provides case vignettes to illustrate how this model informs case formulation and treatment.
This approach examines the impact of an intervention on a proposed causal mechanism compared with a control intervention while observing the impact on the symptom of interest.
The authors propose several potential mechanisms, including memory processing, negative posttraumatic beliefs, dissociation, and posttraumatic avoidance with connected interventions. This interventionist-causal paradigm has already been applied in psychosis research 17 and offers a model to better understand proposed mechanisms in trauma and psychosis.
Recognizing the debate regarding schizophrenia as a unitary diagnostic category, Stevens et al. The concept of psychosis on a continuum, rather than as a discrete entity, is also of importance to the paper presented by Mayo et al. This population is important to this topic in that they are a group of individuals who have not yet developed full psychosis, and may indeed not do so, but who are typically experiencing attenuated psychotic symptoms and are distressed and help seeking.
Alarmingly, this population reports high levels of childhood trauma and the paper reviews these data while providing clinical recommendations on the assessment, treatment, and future research directions. As previously discussed, there are concerns in the field about the under-detection of trauma in persons with psychosis or other severe mental illnesses. Under-detection due to professionals failing to screen for trauma and PTSD can be overcome by routine screening of individuals receiving services In line with this theme of the importance of accurate assessment, Rosen et al.
In particular their use of qualitative analysis in the study highlights the importance of careful and sensitive assessment to understanding the time course and impact of trauma on individuals and their mental health.
The recovery literature has changed how recovery from mental illness is understood, with a shift from traditional medical definitions that emphasize symptom remission to conceptualizing recovery as a personally meaningful process that involves the development of meaning and a sense of purpose despite symptoms or other challenges 19 In this Research Topic, Mazor et al.
Clinical Interventions Interventions specifically for PTSD in individuals with a psychotic disorder are not as well established as for psychosis e. Further work continues in this area with growing awareness of the link between trauma and psychosis and the need to provide targeted interventions that address the PTSD. In this Research Topic, Swan et al. A range of interventions have been studied for trauma and psychosis and in this Research Topic Prolonged Exposure Grubaugh et al. Trappier and Newville, 52 for instance, treated 24 patients with chronic schizophrenia and complex PTSD using the first phase of skills training in affect, and interpersonal regulation STAIR.
A control group of patients received supportive psychotherapy sessions. After 12 weeks of treatment, the patients in the STAIR group showed significant reductions in Impact, of Events Scale scores and positive psychotic symptoms, while no improvement in these was observed in the control group.
Furthermore, several case studies and open trials have reported that exposure-based interventions can also be used safely and effectively in patients with psychosis.
Frueh et al 54 treated 20 patients with PTSD and either schizophrenia or schizoaffective disorder via an week CBT intervention that, consisted of 14 sessions of psychoeducation, anxiety management, and social skills training, as well as 8 sessions of exposure therapy, provided at community mental health centers. Treatment completers showed significant. PTSD symptom improvement, maintained at 3-month followup.
Moreover, significant improvements existed with regard to other targeted domains eg, anger, general mental health. At 6-month follow-up, CBT clients had improved significantly more in PTSD symptoms, perceived health, negative trauma-related beliefs, and case manager working alliance. Conclusions The evidence for an association between childhood trauma and psychosis is steadily accumulating, and exploration of potential mechanistic pathways has begun.
Emerging findings from longitudinal studies and demonstration of a dose-response relationship in others suggest a role of childhood trauma in the development of psychosis.
Childhood trauma and psychosis - what is the evidence?
The relative influence of other variables in this relationship, however, warrants further investigation. Independent from the question of causality, childhood trauma and PTSD are frequent in patients with psychosis and severely affect, course and outcome. More research is therefore needed to further develop and evaluate appropriate treatments for psychotic patients suffering from the consequences of childhood trauma. Nevertheless, the existing trials suggest that patients with psychotic disorders can benefit from both presentfocused and trauma-focused treatments, despite severe symptoms, suicidal thinking, and vulnerability to hospitalizations.
Sticks, stones, and hurtful words: The long-term sequelae of child and adolescent abuse: Impact of child sexual abuse: Early sexual abuse and clinical depression in adult life. Parental separation, loss and psychosis in different ethnic groups: Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Childhood sexual abuse and mental health in adult life. Childhood sexual abuse and psychiatric disorder in young adulthood: Psychiatric outcomes of childhood sexual abuse.
Childhood sexual abuse and adult psychiatric and substance use disorders in women: Childhood abuse and lifetime psychopathology in a community sample. Association between selfreported childhood sexual abuse and adverse psychosocial outcomes: Child abuse and psychosis: Prof Psychol Res Pr. Reliability and comparability of psychosis patients' retrospective reports of childhood abuse.
Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: Soc Psychiatry Psychiatr Epidemiol.
Impact of psychological trauma on the development of psychotic symptoms: Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample.What is the Difference Between Borderline Personality Disorder and Complex PTSD (C-PTSD)?
Childhood trauma and children's emerging psychotic symptoms: Childhood abuse as a risk factor for psychotic experiences. Childhood adversity and hallucinations: Psychopathology in a large cohort of sexually abused children followed up to 43 years.
Psychosis, victimisation and childhood disadvantage: Childhood sexual abuse and psychosis: