Trauma and psychosis symptoms in a sample of help-seeking youth

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Abstract

Although childhood trauma is generally considered to be a risk factor for later development of psychosis, the influence of trauma on the specific presentation of psychosis symptoms in high-risk and first-episode samples remains unclear. The current study aims to investigate the association of trauma with psychosis and psychosis-risk symptoms among patients with early indications of psychosis as well as in a comparison group receiving mental health services for non-psychosis concerns. Participants (N = 125) were assessed for history of exposure to trauma using the KSADS-PL and psychosis-risk symptoms using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Individuals were categorized as “clinical high risk/early psychosis” or “low-risk for psychosis” on the basis of SIPS criteria. The association of traumatic events with specific symptoms was explored within each group. Exposure to one or more traumatic events was more common within the early psychosis group (85%) relative to the low-risk group (65%). Within both groups, trauma significantly correlated with the severity of clinician-rated positive – but not negative, disorganized, or general – symptoms. Within the low-risk group, there was a significant association between violent traumas and heightened suspiciousness. Within the early psychosis group, both violent and non-violent traumas predicted elevated grandiosity. The prevalence of traumatic events within this adolescent and young adult clinical sample was high. Trauma history significantly predicted greater positive symptoms. The apparent influence of trauma exposure on specific symptoms was unique in each group.

Introduction

Childhood exposure to traumatic events is generally considered to be a risk factor for later development of psychosis (Read et al., 2005). A recent meta-analysis concluded that adverse events including sexual, physical, and emotional abuse, neglect, parental death, and bullying by peers strongly contribute to the risk of psychosis in adulthood, with a cumulative dose-response relationship between the number of trauma exposures and the likelihood of psychotic symptoms (Varese et al., 2012). These effects were found even when controlling for likely confounds such as genetic liability, comorbid psychopathology, substance use, and urban vs. rural environment (Varese et al., 2012). Further, repeated exposure to adversity and/or traumatic events during childhood appears to have profound, lifelong effects on mental and physical wellbeing within the general population (Anda et al., 2006) that may be additive for those with additional familial or neurodevelopmental vulnerability towards serious mental illness (Dvir et al., 2013).

Recent efforts have aimed to improve services for young people at risk for or in early stages of a psychotic illness (Fusar-Poli et al., 2013). Given the young age and still-emerging symptoms within at-risk and early psychosis samples, these individuals may constitute a uniquely informative group in which to study associations between trauma and symptom expression. Seventy to 100% of people at “clinical high risk” (CHR) across multiple samples report a history of traumatic experiences including physical abuse and neglect; sexual traumas; witnessing or being victimized by serious violence; and involvement in uncontrollable events such as accidents, war, and natural disasters (Bechdolf et al., 2010, Thompson et al., 2009, Tikka et al., 2013). Certain traumas (in particular, sexual abuse) have been found to exacerbate the likelihood of progression to psychosis over time (Bechdolf et al., 2010, Cutajar et al., 2010, Thompson et al., 2014). This observation is consistent with the notion that interpersonal traumas, that is traumas experienced as violations of relationships or social contracts, may be especially effective at provoking a physiological stress response, activating neural structures important for negative emotional processing (e.g., the amygdala), and disrupting overall mental health and social functioning (Amstadter and Vernon, 2008, Arseneault et al., 2011, Jones and Fernyhough, 2007, Meyer-Lindenberg and Tost, 2012, Resnick et al., 1997, Santiago et al., 2013). These processes may lead to a variety of psychiatric symptoms among otherwise typically developing youth; however, for those with preexisting vulnerability to psychosis, they may trigger or exacerbate the development of psychotic symptoms (Van Os et al., 2008).

Despite these established associations, the influence of trauma on the specific presentation of psychosis symptoms remains unclear. Trauma and stress reaction disorders share clinical features with the emerging psychosis construct, such as dysregulations in affect, cognition, and sleep. Further, posttraumatic thought intrusions relating to past experiences may be difficult to distinguish clinically from psychosis-related thought insertions and “loss of control” over internal experiences. Determining whether psychosis-like symptoms are better accounted for by traumatic experiences may be particularly difficult among adolescents, for whom illusions, hallucinations, and suspicions are common features of Post-Traumatic Stress Disorder (PTSD; Schlosser et al., 2012). Further complicating the issue, despite the high rates of traumatic events reported in CHR cohorts, the prevalence of diagnosable PTSD within this population (3–15%; Bechdolf et al., 2010, Lim et al., 2015, Meyer et al., 2005, Rosen et al., 2006, Woods et al., 2009) appears to be relatively typical for populations exposed to traumatic stress (Santiago et al., 2013). Understanding the relation between trauma and specific symptoms may help to inform best practices for differential diagnosis and trauma-informed treatment for this vulnerable population.

The current study aims to investigate the association of potentially traumatic events with early psychosis and psychosis-risk symptoms among youth receiving mental health services. Because the literature to date on this topic is scant, our investigations were exploratory rather than hypothesis-driven with the goals of exploring the prevalence of violent and non-violent traumas within a CHR/early psychosis group relative to a naturalistic clinical control group and investigating the relation between trauma exposure and specific symptom domains within the early psychosis construct.

Section snippets

Procedures

This study took place within the context of a longitudinal investigation conducted at the Strive for Wellness (SFW) clinic at the University of Maryland, Baltimore County (UMBC) and the University of Maryland Medical Center (UMMC). SFW is a specialty team of clinicians, researchers, and trainees focused on identification and treatment of individuals at CHR for psychosis. The clinic is embedded within the Maryland Early Intervention Program, a multi-institutional research/clinical/training

Results

Current analyses include data from 125 individuals. Participants' mean age was 15.88 years (SD = 2.93). The sample was 61% female and racially diverse (46.4% African American, 34.4% Caucasian, 1.6% Native American, 0.8% Asian, and 14.4% multiracial/other; 2.4% left this item blank). Median household income was $40,000 with 31% reporting annual household income of less than $20,000.

Using SIPS criteria, 60 individuals were categorized within the CHR/EP group (46 with a CHR syndrome and 14 with a

Discussion

The prevalence of traumatic events within this sample was high (75%), especially within the CHR/EP participant group (85%). These figures are similar to the rates of 70–100% found within other CHR/EP samples (Bechdolf et al., 2010, Thompson et al., 2009, Tikka et al., 2013, Russo et al., 2014) and in a recent meta-analysis examining child trauma prevalence in CHR literature (87%; Kraan et al., 2015). This prevalence is also similar to that seen in general help-seeking adolescents in inpatient

Role of funding source

The funders had no role in study design, data analyses, interpretation of results, or decision to publish this manuscript.

Contributors

Dr. Kline collected data, designed analyses, interpreted results, and wrote the manuscript. Mr. Millman was instrumental in assisting with data collection, analyses, interpretation, and manuscript preparation. Ms. Denenny, Ms. Wilson, Ms. Demro, and Ms. Thompson aided in data collection and manuscript preparation. Ms. Bussell supervised study implementation and contributed to study design and interpretation of results. Ms. Connors served as an expert consultant in the area of pediatric

Conflict of interest

The authors have no actual or potential conflict of interest to declare.

Acknowledgment

This work was supported in part by funding from the Maryland Department of Health and Mental Hygiene, Behavioral Health Administration through the Center for Excellence on Early Intervention for Serious Mental Illness (OPASS# 14-13717G/M00B4400241).

References (39)

  • R.F. Anda et al.

    The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology

    Eur. Arch. Psychiatry Clin. Neurosci.

    (2006)
  • L. Arseneault et al.

    Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study

    Am. J. Psychiatry.

    (2011)
  • A. Bechdolf et al.

    Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group

    Acta Psychiatr. Scand.

    (2010)
  • S. Bendall et al.

    Childhood trauma and psychotic disorders: a systematic, critical review of the evidence

    Schizophr. Bull.

    (2008)
  • M.C. Cutajar et al.

    Schizophrenia and other psychotic disorders in a cohort of sexually abused children

    Arch. Gen. Psychiatry

    (2010)
  • H.L. Fisher et al.

    Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort

    Schizophr. Bull.

    (2013)
  • P. Fusar-Poli et al.

    The psychosis high-risk state: a comprehensive state-of-the-art review

    JAMA Psychiatry

    (2013)
  • J.L. Herman

    Trauma and recovery

  • I. Janssen et al.

    Childhood abuse as a risk factor for psychotic experiences

    Acta Psychiatr. Scand.

    (2004)
  • Cited by (0)

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