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

Anja Vaskinn,Ingrid Melle,Monica Aas,Akiah Ottesen Berg

doi:10.1016/j.scog.2020.100189

Anja Vaskinn, Ingrid Melle + Show 2 more

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https://doi.org/10.1016/j.scog.2020.100189

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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.

Highlights

Childhood trauma is prevalent in individuals with schizophrenia (Varese et al, 2012), increases the risk of psychosis (Bendall et al, 2008; Varese et al, 2012) and is among stress-related environmental risk factors implicated in the development of psychosis (Misiak et al, 2017)
We examine the association between childhood trauma and theory of mind (ToM) in adults with schizophrenia, compared to healthy control participants
Significant group differences were present for minimization and denial (MD), but numbers indicated that MD+ status was more common in healthy controls than in persons with schizophrenia

Summary

Introduction

Childhood trauma is prevalent in individuals with schizophrenia (Varese et al, 2012), increases the risk of psychosis (Bendall et al, 2008; Varese et al, 2012) and is among stress-related environmental risk factors implicated in the development of psychosis (Misiak et al, 2017). Meta-analytic evidence shows that schizophrenia is characterized by reduced ability to decode the emotional expressions of others (emotion perception), to identify social roles, rules and contexts (social perception), and to infer the mental state of others (mentalizing/theory of mind (ToM)) (Savla et al, 2013) These social cognitive impairments, especially ToM, are strong predictors of outcome in schizophrenia (Fett et al, 2011). One is that reduced cognition may result from the negative effect of childhood adversity on neuronal development, shown to disrupt the hypo-thalamic-pituitary axis (HPA) (Agorastos et al, 2018) This is at the heart of the traumagenic model, which states that early trauma leads to abnormal neurodevelopment that again underlies the heightened responsivity to stress, such as overactivity of the HPA axis (Read et al, 2001). As for ToM, its development rests on a combination of innate developmental processes and external learning experiences that depend on the environment surrounding the child

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