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Schizophr Bull. 2016 Jul;42 Suppl 1:S34-43. doi: 10.1093/schbul/sbv175.

Psychological Mechanisms Mediating Effects Between Trauma and Psychotic Symptoms: The Role of Affect Regulation, Intrusive Trauma Memory, Beliefs, and Depression.

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Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
Centre for Biostatistics, University of Manchester, Manchester, UK;
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
UCL Mental Health Sciences Unit, University College London, London, UK;
Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK;
School of Psychology, University of Sussex, Brighton, UK.


Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, intrusive trauma memory, beliefs, and depression. The majority of participants (74.1%) reported victimization trauma, and a fifth (21.5%) met symptomatic criteria for Posttraumatic Stress Disorder. We found a specific link between childhood sexual abuse and auditory hallucinations (adjusted OR = 2.21, SE = 0.74, P = .018). This relationship was mediated by posttraumatic avoidance and numbing (OR = 1.48, SE = 0.19, P = .038) and hyperarousal (OR = 1.44, SE = 0.18, P = .045), but not intrusive trauma memory, negative beliefs or depression. In contrast, childhood emotional abuse was specifically associated with delusions, both persecutory (adjusted OR = 2.21, SE = 0.68, P = .009) and referential (adjusted OR = 2.43, SE = 0.74, P = .004). The link with persecutory delusions was mediated by negative-other beliefs (OR = 1.36, SE = 0.14, P = .024), but not posttraumatic stress symptoms, negative-self beliefs, or depression. There was no evidence of mediation for referential delusions. No relationships were identified between childhood physical abuse and psychosis. The findings underline the role of cognitive-affective processes in the relationship between trauma and symptoms, and the importance of assessing and treating victimization and its psychological consequences in people with psychosis.


avoidance; hyperarousal; psychosis; reexperiencing; schema; victimization

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