Critical Values Based Practice Network

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Childhood Trauma and ‘Psychosis’

Written by Sarah Fairbank on . Posted in Clinical Psychology Bite-Size

Childhood Trauma and ‘Psychosis’

Issue 07 – October 2008

Author: Sarah Fairbank and Steven Coles (sarah.fairbank@nottshc.nhs.uk and steven.coles@nottshc.nhs.uk)

Key points

  • Research suggests that child abuse can lead to ‘psychotic’ experiences such as ‘hallucinations’ and ‘delusions’ later in life
  • This research has caused debate and controversy particularly for biological and genetically oriented psychiatric practitioners
  • The focus on childhood trauma should not mean that other difficulties such as poverty and racism are ignored when considering psychological distress 

Implications for research and practice

  • Researchers and clinicians in the area suggest it is important for staff to sensitively and respectful ask about abuse and trauma
  • It is essential for staff to create a safe space and be guided by the client when discussing difficult experiences
  • Staff should receive appropriate support and supervision when working with these issues.
The experience of childhood abuse and trauma has often been linked to psychological distress labelled as anxiety, depression and post-traumatic stress disorder1, 2. Child abuse and adverse early environments have also been related to a variety of negative social and emotional outcomes3 and effects on the developing brain4. Until recently research looking at whether childhood abuse could cause ‘psychotic’ symptoms has been given little prominence. The neglect of this area largely appears due the dominance of biological and genetic explanations and assumptions. However, many of these biological and genetic arguments are now criticised, including the methodology and assumptions of the ‘schizophrenia’ genetic twin and adoption studies5.

Research on the Relationship between Childhood Trauma and Psychosis

There is growing evidence of a relationship between childhood abuse and experiencing voices and unusual beliefs (‘psychotic’ experiences, including receiving a diagnosis of “schizophrenia”)2,6. Some people are not convinced by such findings (particularly psychiatric professionals holding a biogenetic model) and there continues to be a debate7. However, in 2005 a public debate at the Institute of Psychiatry supported the motion that “child abuse is a cause of schizophrenia” by a large majority. Research suggests that the general population and people who use services endorse the idea that childhood trauma is related to mental health problems including ‘psychosis’ 2,6. Whilst some might still debate the research, in clinical practice the content and themes of people’s unusual beliefs and experience of voices are often obviously related to the sexual or physical violence that has been perpetrated on them8. The research on links between trauma and ‘psychosis’ are to be welcomed, however, there is a need to continue to recognise other factors which influence distress. For example, Johnstone (2007)8 argues that the focus on childhood abuse means that other wider areas might be neglected, such as the effects of poverty, racism, classism and fails to take account of the distress caused by more subtle and long-term damaging circumstances (this excellent article discusses further complexities around this area of research).

Current Clinical Practice

Research suggests that many people within mental health services are not asked whether they have experienced abuse2. Read et al (2007) strongly suggests it is important to ask service users about experiences of abuse. It is often assumed that service users will voluntary disclose past abuse, but this is not always the case due to a number of reasons such as fear of consequences, shame, and worries about not being believed2. By not asking about a person’s history of abuse we are inadvertently giving the message that it is not important and has had no impact on their mental health.

What can staff do?

For further information about working with abuse see Ainscough and Toon (2000)9. Whilst it is important to ask about abuse and trauma, it should not be assumed that people want to go into great details about their experiences. Instead they may prefer to discuss current issues that may be a result of their experiences such as relationship problems, low self esteem, anxiety or social and practical difficulties. If people do want to discuss abuse issues, it is important to create a safe space and sensitively go at their pace within the context of a trusting and respectful relationship. It can often be beneficial to normalise service users’ current difficulties as an understandable reaction to earlier abuse. Some service users find it helpful to access support groups with people who have had similar experiences and there is also self help literature available9. Staff also need to discuss with service users issues around confidentiality and the limitations of this. Discussing issues of abuse may also have an impact on staff, therefore it is vital staff receive appropriate support. Finally, it is important for staff to take these issues to supervision.  

REFERENCES

  1. Mullen, P. E., Martin, J.L., Anderson, J.C.,Romans, S. E. & Herbison, G. P (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry, 163, 721 – 732.
  2. Read, J., Hammersley, P. & Rudgeair, T. (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13, 101 -110
  3. Tyler, K. A. (2002) Social and emotional outcomes of childhood sexual abuse: A review of recent research. Aggression and Violent Behavior, 7, 567 – 589.
  4. Glaser, D. (2000). Child abuse and neglect and the brain: A review. Journal of Child Psychology and Psychiatry, 41, 97 – 116.
  5. Joseph, J. (2004). Schizophrenia and heredity: Why the emperor has no genes. In J. Read, L. Mosher & R. Bentall (Eds.), Models of Madness: Psychological, social and biological approaches to schizophrenia (pp. 67 – 83). Hove: Brunner-Routledge.
  6. Read, J., Rudgeair, T. & Farrelly, S. (2006). The relationship between child abuse and psychosis: Public opinion, evidence, pathways and implications. In W. Larkin & A. P. Morrison (Eds.), Trauma and psychosis: New directions for theory and therapy (pp. 23 – 57). London: Routledge.
  7. Spataro, J., Mullen, P. E., Burgess, P. M., Wells, D. L. & Moss, S. A. (2004). Impact of child sexual abuse on mental health: Prospective study in males and females. British Journal of Psychiatry, 184, 416 – 421. 
  8. Johnstone, L. (2007). Can trauma cause psychosis? Revisiting (another) taboo subject. Journal of critical psychology, counselling and psychotherapy, , 211-220.
  9. Ainscough, C. & Toon, K (2000) Breaking free; helping survivors of child sexual abuse (new edition). London: Sheldon Press.

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