Complex PTSD as mediator of psychosis after childhood trauma

Developmental trauma, or childhood trauma, is highly prevalent across the globe. It is an ubiquitous problem that often takes place behind closed family doors. Exposed children have an increased risk for developing psychopathology, such as post-traumatic stress, depressive, and psychotic disorders. 1 McKay MT Kilmartin L Meagher A Cannon M Healy C Clarke MC A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder. J Psychiatr Res. 2022; 156: 268-283 Crossref Scopus (6) Google Scholar The association with psychotic disorders has been under debate as recollections in a psychotic state were previously deemed unreliable, but empirical evidence has been accumulating showing that childhood trauma is highly prevalent in individuals with psychotic disorders. 2 Schäfer I Fisher HL Childhood trauma and psychosis—what is the evidence?. Dialogues Clin Neurosci. 2011; 13: 360-365 Crossref PubMed Google Scholar , 3 Pastore A de Girolamo G Tafuri S Tomasicchio A Margari F Traumatic experiences in childhood and adolescence: a meta-analysis of prospective studies assessing risk for psychosis. Eur Child Adolesc Psychiatry. 2022; 31: 215-228 Crossref Scopus (9) Google Scholar A new study by Ava Mason and colleagues 4 Mason AJC Jung PG Sim H et al. Is there a cross-cultural association between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma?. Lancet Psychiatry. 2023; 10: 760-767 Google Scholar in The Lancet Psychiatry investigated post-traumatic stress disorder (PTSD) and complex PTSD as intermediates in the relationship between developmental trauma and psychosis. The authors found that complex PTSD (β=22·62 [SE 1·65]; p<0·0001) but not PTSD (β=–2·40 [SE 3·28]; p=0·47) was associated with total psychotic symptom severity in two independent samples of adults with developmental trauma from the UK and South Korea, even after adjustment for severity of trauma exposure. Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South KoreaHealth systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis. Full-Text PDF Open Access