Sexual abuse and physical neglect in childhood are associated with affective theory of mind in adults with schizophrenia

Abstract

Whereas childhood trauma is associated with reduced nonsocial cognition in schizophrenia, research on the relationship between childhood trauma and social cognition is limited and mixed. The aim of this study was to examine the association between childhood trauma and theory of mind (ToM) in persons with schizophrenia (n = 68) compared to healthy control participants (n = 70). Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ), providing information on physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect. ToM was indexed by the Movie for the Assessment of Social Cognition (MASC), which yields scores for total, cognitive and affective ToM, and for three error types (overmentalizing, undermentalizing, no mentalizing). Persons with schizophrenia had elevated rates of childhood trauma and lower ToM scores than healthy controls. In the schizophrenia group, associations between sexual abuse and affective ToM was statistically significant. In regression analyses, physical neglect was found to be the strongest predictor of affective ToM. In healthy controls, childhood trauma was not associated with ToM. Follow-up analyses comparing individuals with/without clinically significant childhood trauma, confirmed the findings for the schizophrenia group. No causal inferences can be made in this cross-sectional study, but the results suggest an illness-specific association between both sexual abuse and physical neglect in childhood, and adult affective ToM in individuals with schizophrenia.

Affective and cognitive theory of mind in posttraumatic stress, major depressive, and somatic symptom disorders: Association with childhood trauma

“…Given that ToM impairments have so far been found solely in hospitalized patients with somatoform disorders (Sch€ onenberg et al, 2014;Subic-Wrana et al, 2010;Zunhammer et al, 2015), however, it could be assumed that only individuals with severe SSD demonstrate marked ToM deficits Analyzing the association between childhood trauma and ToM performance in the whole sample, higher levels of childhood trauma turned out to be significantly associated with lower scores in overall ToM performance. Our findings replicate prior research, demonstrating associations between childhood trauma and ToM impairments in clinical and general population samples (e.g., Br€ une, Walden, Edel, & Dimaggio, 2016;Duque-Alarc on et al, 2019;Germine et al, 2015;Huang et al, 2020;Kvarstein et al, 2020;Li et al, 2020;Vaskinn et al, 2020;but see Hillmann et al, 2020, for inconsistent results). So far, however, studies have been limited by relying on self-report measures or static cartoonbased tasks to assess ToM capacities and/or by examining only one clinical group, particularly BPD patients, compared to one healthy control group.…”

“…Of note, in the whole sample, no significant correlation between childhood trauma and ToM error types emerged. Previous studies using the MASC and targeting the association between childhood trauma and ToM error types have been mixed, indicating fewer ToM errors (i.e., ‘hypomentalizing’) with higher childhood trauma levels in individuals with BPD and HVs (Duque‐Alarcón et al, 2019), or no significant association in individuals with schizophrenia and HVs (Vaskinn et al, 2020). More transdiagnostic studies investigating individuals with and without different mental disorders are needed to disentangle inconclusive findings.…”

“…In line with previous studies using different ToM tasks, studies administering the MASC indicate ToM impairments in adults with MDD (Wolkenstein et al, 2011;Zwick & Wolkenstein, 2017; but see Wilbertz, Brakemeier, Zobel, H€ arter, & Schramm, 2010, for divergent results), SSD (Sch€ onenberg et al, 2014), and comorbid PTSD (Preißler, Dziobek, Ritter, Heekeren, & Roepke, 2010) compared to HVs. Furthermore, higher levels of self-reported childhood trauma have been associated with more errors in the MASC in clinical and healthy samples (Duque-Alarc on, Alcal a-Lozano, Gonz alez-Olvera, Garza-Villarreal, & Pellicer, 2019;Kvarstein et al, 2020;Vaskinn et al, 2020). Nevertheless, since previous studies have largely focused on one clinical condition, differences in the association between childhood trauma and ToM performance among multiple mental disorders have gone unexplored.…”

“…Intact ToM is deemed critical for adapting to complex social environments (Byom & Mutlu, 2013). Deficits in ToM have been found in several mental disorders (Cotter et al, 2018) which are characterized by high prevalence rates of childhood trauma, including PTSD (Plana, Lavoie, Battaglia, & Achim, 2014; Stevens & Jovanovic, 2019), MDD (Bora & Berk, 2016; van Neerven, Bos, & van Haren, 2021), bipolar disorder (Bora, Bartholomeusz, & Pantelis, 2016), schizophrenia (Quidé et al, 2017; Vaskinn, Melle, Aas, & Berg, 2020), and SSD (Subic‐Wrana, Beutel, Knebel, & Lane, 2010; Zunhammer, Halski, Eichhammer, & Busch, 2015). Additionally, ToM impairments have been shown to be associated with childhood trauma (Germine, Dunn, McLaughlin, & Smoller, 2015; Quidé et al, 2018; Rokita, Dauvermann, & Donohoe, 2018), and to mediate the effect of childhood trauma on adult psychopathology, including, but not restricted to, symptoms of PTSD (Huang, Fonagy, Feigenbaum, Montague, & Nolte, 2020) and MDD (Li, Carracher, & Bird, 2020).…”

Preliminary Evidence for Anhedonia as a Marker of Sexual Trauma in Female Adolescents

“…Sexual abuse has been associated with various psychopathology. 26 , 27 Our study was the first in the literature to report a differential effect of sex on the association between sexual abuse and anhedonia in adolescents. In this sample, the association between sexual abuse and anhedonia was stronger in female participants compared to male participants.…”