Cumulative Effects of Stressful Childhood Experiences on Delusions and Hallucinations

Abstract

The association between stressful childhood experiences (SCE) and psychotic symptoms is still not clearly understood, and different causal pathways have been proposed. Generalized estimating equation modeling was used to test the dose-response relationship between SCE and delusions and hallucinations at baseline and follow-up periods and the possible confounding effects of dissociation on this relationship. The prevalence of SCE in individuals with psychotic disorders was high, with more co-occurring SCE categories being positively associated with more types of delusions and hallucinations. Each additional SCE was associated with a 1.20 increase in the incidence rate ratio (95% confidence interval [CI; 1.09, 1.32]) for hallucinations and a 1.19 increase (CI [1.09, 1.29]) for delusions, supporting a dose-response association. After we controlled for the mediating effects of dissociative symptoms at follow-up, SCE remained independently associated with delusions. We propose that cumulative SCE can result in complex trauma reactions that present with a broad range of symptomatology, including dissociative, posttraumatic stress disorder, and psychotic symptoms.

Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis

“…National comorbidity studies and meta-analysis have reported a potentially causal relationship between cumulative TLEs exposure and psychosis (26, 53, 54). Our data are consistent with other studies that show that the overall lifetime TLE exposure is significantly higher in the African-American population (47, 55, 56).…”

“…Childhood adversity, as well as broader lifetime trauma, tends to be correlated with additional environmental factors, including prenatal insults [such as alcohol exposure during gestation (24), poverty/structural adversity 1 , and personal substance use (25)]. Muenzenmaier et al (26), have described “complex trauma reactions” triggered by cumulative social adversities and TLEs leading to a broad range of presenting psychotic or psychotic-like symptoms, including dissociation, flashbacks, hallucinations, and paranoid ideation. Recent debates have centered on the differences and overlap between dissociative phenomena, including hallucinations, and psychotic symptoms as they manifest across traditional diagnostic boundaries [e.g., Ref.…”

The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review

“…Exposure to SLEs are associated with increased risk for depressed mood, anxiety, eating disorders, suicidality, substance use, and psychosis symptoms in later adolescence (29, 81–85). Current findings on the SLE–psychosis risk relationship are inconclusive; some cited a positive relationship (39, 51, 86, 87) while others did not (43, 47, 48, 57). Kraan and colleagues (5) indicated that recent SLEs were less commonly endorsed by CHR youth than HC, which may be due to increasing negative symptoms of psychosis (e.g., increased avolition, social withdrawal) that limit activities.…”

“…Compared to adult participants with no history of CT, those with exposure to four or more traumas were at substantial risk (4- to 12-fold) for developing substance use, depression, and suicidality (38). Thus, several studies on stress and trauma posit that the experience of CT and prolonged early stressors may contribute to the increased risk of future SMI (24–34, 39–41). …”

The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries

“…Thus, we need more complex models that account for both the type and number of CAs are needed to determine whether the associations of CAs with PEs are specific to certain types of experiences but not others, and how increasing levels of exposure influence the risk for PEs. Indeed, several prior studies have documented a dose-response relationship between number of CAs and lifetime prevalence of PEs (Janssen et al , 2004, Shevlin et al , 2007, Wigman et al , 2011a, Wigman et al , 2011b, Bentall et al , 2012, Murphy et al , 2013, Muenzenmaier et al , 2015). …”