Childhood maltreatment and adult mental disorders – the prevalence of different types of maltreatment and associations with age of onset and severity of symptoms

Struck, Nele; Krug, Axel; Yűksel, Dilara; Stein, Frederike; Schmitt, Simon; Meller, Tina; Brosch, Katharina; Dannlowski, Udo; Nenadić, Igor; Kircher, Tilo; Brakemeier, Eva‐Lotta

doi:10.1016/j.psychres.2020.113398

Cited by 63 publications

(49 citation statements)

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“…The CBASP model emphasizes childhood maltreatment as a cause of interpersonal dysfunctions that sustain chronicity of depression. Particularly emotional abuse and neglect by significant others during childhood elevate the risk of earlyonset, severe, chronic and treatment-resistant depression (7)(8)(9). An unsafe or threatening home life is expected to redirect the normal cognitive-emotional development of a child toward survival rather than growth (5).…”

Section: Introductionmentioning

confidence: 99%

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

et al. 2021

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Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality.Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors.Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders.Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.

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Section: Introductionmentioning

confidence: 99%

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

et al. 2021

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“…Different types of childhood maltreatment often co-occur and psychiatric symptom severity across disorders seems to increase with the number and severity of experienced maltreatment types (Brodbeck et al, 2018 ; Cecil, Viding, Fearon, Glaser, & McCrory, 2017 ; Zanarini et al, 2002 ). Emotional abuse and neglect are associated with more severe depressive symptoms (Struck et al, 2020 ) and the severity of experienced sexual abuse has been linked to the severity of BPD symptomatology (Sansone, Songer, & Miller, 2005 ; Zanarini et al, 2002 ). There are few studies investigating the differences between patients with depression and patients with BPD regarding childhood maltreatment.…”

Section: Introductionmentioning

confidence: 99%

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

Schaich

Assmann²,

Köhne³

et al. 2021

European Journal of Psychotraumatology

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Background Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD). Objective This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms. Method A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses. Results Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding ‘impulse control difficulties’ ( F (1,299) = 38.97, p < .001, η p 2 = .115), ‘limited access to emotion regulation strategies’ ( F (1,299) = 4.66, p = .032, η p 2 = .015), and ‘lack of emotional clarity’ ( F (1,299) = 9.38, p = .002, η p 2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R 2 = .429). Subscale analyses revealed ‘impulse control difficulties’ as the aspect of difficulties in emotion regulation that has the greatest impact on this association ( B = .021, 95% CI [.003; .045]). Conclusions Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

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“…PDD and BPD share similar risk factors and it has been suggested that high rates of comorbidity between PD and PDD might be due to shared etiological factors such as genetics, temperamental vulnerability, self-generated interpersonal stress or childhood maltreatment (CM) including invalidating educational patterns (13,19). PDD patients experience a higher number of traumatic events during their lifetime than patients with non-chronic forms of depression (1,3,20). CM has been associated with severity and chronicity of depression in numerous studies (21,22).…”

Section: Introductionmentioning

confidence: 99%

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

et al. 2021

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Introduction: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program.Method: Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed.Results: Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment.Discussion: BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.

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Childhood maltreatment and adult mental disorders – the prevalence of different types of maltreatment and associations with age of onset and severity of symptoms

Cited by 63 publications

References 43 publications

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

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