Abstract
Psychosis, and in particular auditory verbal hallucinations (AVHs), are associated with adversity exposure. However, AVHs also occur in populations with no need for care or distress. This study investigated whether adversity exposure would differentiate clinical and healthy voice-hearers within the context of a 'three-hit' model of vulnerability and stress exposure. Samples of 57 clinical and 45 healthy voice-hearers were compared on the three 'hits': familial risk; adversity exposure in childhood and in adolescence/adulthood. Clinical voice-hearers showed greater familial risk than healthy voice-hearers, with more family members with a history of psychosis, but not with other mental disorders. The two groups did not differ in their exposure to adversity in childhood [sexual and non-sexual, victimisation; discrimination and socio-economic status (SES)]. Contrary to expectations, clinical voice-hearers did not differ from healthy voice-hearers in their exposure to victimisation (sexual/non-sexual) and discrimination in adolescence/adulthood, but reported more cannabis and substance misuse, and lower SES. The current study found no evidence that clinical and healthy voice-hearers differ in lifetime victimisation exposure, suggesting victimisation may be linked to the emergence of AVHs generally, rather than need-for-care. Familial risk, substance misuse and lower SES may be additional risk factors involved in the emergence of need-for-care and distress.
Highlights
Recent work on diathesis-stress models has highlighted the difference between early life events and risk exposure later in life, suggesting three ‘hits’: genetic vulnerability, adverse childhood experiences and subsequent adolescent/adult experiences (Daskalakis, Bagot, Parker, Vinkers, & de Kloet, 2013)
Several studies have investigated the first two ‘hits’ of the three hit model in healthy voice-hearers, with evidence for generally similar exposure to familial risk and childhood trauma in healthy and clinical voice-hearers (Andrew, Gray, & Snowden, 2008; Daalman et al, 2012; Kråkvik et al, 2015; Sommer et al, 2010; Van Lutterveld et al, 2014). These findings suggest that diathesis-stress models are relevant for the emergence of auditory verbal hallucinations (AVHs) across the psychosis continuum, but raise the important question as to what may drive need for clinical care despite seemingly similar risk factor exposure
For hit 1, chi-square showed that a significantly greater percentage of clinical than healthy voicehearers reported a family history of psychosis, but no difference was found for family history of other disorders
Summary
Recent work on diathesis-stress models has highlighted the difference between early life events and risk exposure later in life, suggesting three ‘hits’: genetic vulnerability, adverse childhood experiences and subsequent adolescent/adult experiences (Daskalakis, Bagot, Parker, Vinkers, & de Kloet, 2013). Several studies have investigated the first two ‘hits’ of the three hit model in healthy voice-hearers, with evidence for generally similar exposure to familial risk and childhood trauma in healthy and clinical voice-hearers (Andrew, Gray, & Snowden, 2008; Daalman et al, 2012; Kråkvik et al, 2015; Sommer et al, 2010; Van Lutterveld et al, 2014) These findings suggest that diathesis-stress models are relevant for the emergence of AVHs across the psychosis continuum, but raise the important question as to what may drive need for clinical care despite seemingly similar risk factor exposure
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