School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia.
Neuroscience Research Australia, Randwick, New South Wales, Australia.
Br J Clin Psychol. 2018 Nov;57(4):397-419. doi: 10.1111/bjc.12187. Epub 2018 Jun 20.
Childhood trauma is a common risk factor for adult psychiatric disorders, such as schizophrenia (SZ) and bipolar-I disorder (BD). However, its association with schizotypal personality traits, as well as cognitive and social cognitive abilities, is less well studied in these populations.
In a cohort of 79 SZ cases, 84 BD cases, and 75 healthy controls (HCs), clinically significant levels of childhood trauma exposure (according to scores on the Childhood Trauma Questionnaire; CTQ) were evident in 54 SZ, 55 BD, and 26 HC individuals. Trauma-exposed and non-exposed groups were compared on schizotypal personality features (schizotypy) measured with the Schizotypal Personality Questionnaire (SPQ). Cognitive assessments included executive function, working memory, attention, and immediate and delayed memory. Social cognitive measures assessed facial emotion processing and theory-of-mind abilities.
Trauma-exposed participants showed higher levels of schizotypy, especially suspiciousness, relative to non-exposed individuals, regardless of clinical or HC status. Furthermore, trauma-exposed individuals showed deficits specifically in social cognitive, but not general cognitive abilities, regardless of clinical or HC status. These trauma-related results were found in the context of higher schizotypy levels in both SZ and BD relative to HC, and lower cognitive and social cognitive performance in SZ, relative to BD and HC groups.
These findings suggest that childhood trauma exposure impacts long-term schizotypy outcomes, especially paranoid ideation (suspiciousness), as well as complex social cognitive abilities in both healthy and psychotic populations. However, cognitive deficits associated with psychotic illness may not be distinguishable from those related to trauma exposure in previous studies.
Findings Childhood trauma exposure is associated with increased schizotypal features (in particular paranoid ideation) and complex social cognitive abilities, independently of the diagnosis of psychotic disorder. Cognitive and social cognitive deficits were larger in schizophrenia compared to bipolar-I cases and healthy controls, but increased schizotypal features were observed in both schizophrenia and bipolar-I disorder relative to healthy controls. Limitations We were unable to distinguish the specific effects of particular childhood trauma exposures due to the high rate of exposure to more than one type of maltreatment. Retrospective assessment of childhood trauma in adulthood cannot be externally validated, and associations with behavioural traits in later life may be confounded by other factors not studied here.
童年创伤是成人精神疾病（如精神分裂症（SZ）和双相 I 型障碍（BD））的常见危险因素。然而，其与分裂型人格特质以及认知和社会认知能力的关系在这些人群中研究得较少。
在 79 例 SZ 病例、84 例 BD 病例和 75 例健康对照组（HC）的队列中，根据儿童期创伤问卷（CTQ）的得分，有 54 例 SZ、55 例 BD 和 26 例 HC 个体存在明显的临床显著水平的儿童期创伤暴露。创伤暴露组和非暴露组在分裂型人格特征（使用分裂型人格问卷（SPQ）测量的分裂型特质）上进行了比较。认知评估包括执行功能、工作记忆、注意力以及即时和延迟记忆。社会认知测量评估了面部情绪处理和心理理论能力。
与非暴露个体相比，无论临床或 HC 状态如何，创伤暴露组的参与者表现出更高水平的分裂型特质，尤其是多疑。此外，无论临床或 HC 状态如何，创伤暴露组在社会认知方面表现出缺陷，而在一般认知能力方面没有缺陷。这些与创伤相关的结果是在 SZ 相对于 HC 表现出更高的分裂型特质水平和 SZ 相对于 BD 和 HC 组表现出更低的认知和社会认知表现的背景下发现的。
这些发现表明，童年创伤暴露会影响长期的分裂型特质结果，特别是偏执观念（多疑），以及健康和精神病患者群体中复杂的社会认知能力。然而，与精神病相关的认知缺陷可能与之前研究中与创伤暴露相关的认知缺陷无法区分。
研究结果表明，童年创伤暴露与增加的分裂型特征（特别是偏执观念）和复杂的社会认知能力有关，与精神病障碍的诊断无关。与双相 I 型病例和健康对照组相比，精神分裂症患者的认知和社会认知能力缺陷更大，但与健康对照组相比，精神分裂症和双相 I 型障碍患者都表现出更高的分裂型特征。
由于暴露于多种虐待类型的比例较高，我们无法区分特定的童年创伤暴露的具体影响。成年后对儿童期创伤的回顾性评估无法进行外部验证，并且与以后生活中的行为特征的关联可能会受到此处未研究的其他因素的影响。
