Mentalizing impairment as a mediator between reported childhood abuse and outcome in nonaffective psychotic disorder

Abstract

Reported childhood abuse has been linked to the severity of clinical symptoms and social dysfunction in non-affective psychotic disorder. Impaired mentalizing ability may be one of the mechanisms accounting for this effect. This study examined whether impaired mentalizing mediates the effect of reported childhood abuse on positive symptoms, negative symptoms, and social dysfunction. Eighty-seven patients with non-affective psychotic disorder were examined. Reported childhood abuse was measured using the Childhood Experience of Care and Abuse interview. Additionally, the Social Functioning Scale and the Positive and Negative Syndrome Scale were used. The Hinting Task was used to measure mentalizing impairment. Reported childhood abuse was significantly related to the severity of positive and negative symptoms, not to social dysfunction. Reported childhood abuse was also related to mentalizing impairment. Mentalizing impairment was related to negative symptoms, but not to positive symptoms or social dysfunction. Mentalizing impairment accounted for 40% of the association between reported childhood abuse and negative symptoms, indicating partial mediation. A sensitivity analysis revealed that the mediating effect was only observed in those who reported fairly severe childhood abuse.

Does childhood trauma predict poorer metacognitive abilities in people with first-episode psychosis?

“…One way to interpret these findings is that childhood trauma is related to better metacognitive abilities. However, no other study have found any such positive associations (Aydin et al, 2016;Garcia et al, 2016;Kilian et al, 2017;Palmier-Claus et al, 2016;Weijers et al, 2018), except for one that must be regarded with caution as it only assessed one type of childhood traumasexual abuseand found it associated with higher Self-reflectivity scores (Lysaker et al, 2011). We will however consider the possibility of a positive association by testing the idea that insight into a trauma-psychosis association could have increased metacognitive abilities.…”

“…In relation to these findings it seems there might not be an association between childhood trauma and metacognition. On the other hand, (Garcia et al, 2016) found that total CTQ was related to poorer social cognition and (Kilian et al, 2017) and (Weijers et al, 2018) found it to be associated with mentalizing impairments. Thus, their results are not uniform with respectively neglect and abuse being associated, and they are not as easily compared to our findings as we apply the original trauma categories.…”

Treatment outcomes and associations in an adolescent‐specific early intervention for psychosis service

“…Mentalization and metacognition difficulties have also been associated with negative symptoms Weijers et al, 2018). It is possible that individuals with pre-existing difficulties in understanding their social world are vulnerable to a process of social withdrawal already present at the point of first contact with services.…”

Mentalization and Psychosis: A Rationale for the Use of Mentalization Theory to Understand and Treat Non-affective Psychotic Disorder

“…Indeed, mentalizing deficits seem related to both positive (e.g. Hasson-Ohayon et al 2018;Mcleod et al 2014) and negative symptoms (Mcleod et al 2014;Weijers et al 2018). Debbané et al (2016) further expanded upon Frith's hypothesis by suggesting that patients with NAPD suffer specifically from problems with 'embodied' mentalizing.…”

“…Kelleher et al 2013). Childhood abuse has also been widely shown to hinder the development of mentalizing ability (see Fonagy et al 2017 for an overview) and impaired mentalizing has been shown to account for some of the relation between childhood abuse and negative symptoms in NAPD (Weijers et al 2018).…”