Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis

Michael A P Bloomfield; Tinya Chang; Maximillian J Woodl; Laura M Lyons; Zhen Cheng; Clarissa Bauer-Staeb; Catherine Hobbs; Sophie Bracke; Helen Kennerley; Louise Isham; Chris Brewin; Jo Billings; Talya Greene; Glyn Lewis

doi:10.1002/wps.20841

Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis

World Psychiatry. 2021 Feb;20(1):107-123. doi: 10.1002/wps.20841.

Authors

Michael A P Bloomfield^{1

2

3

4}, Tinya Chang¹, Maximillian J Woodl², Laura M Lyons², Zhen Cheng¹, Clarissa Bauer-Staeb^{1

5}, Catherine Hobbs^{1

5}, Sophie Bracke¹, Helen Kennerley^{6

7}, Louise Isham^{7

8}, Chris Brewin⁹, Jo Billings¹⁰, Talya Greene^{10

11}, Glyn Lewis¹⁰

Affiliations

¹ Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, UK.
² Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK.
³ NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK.
⁴ National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
⁵ Department of Psychology, University of Bath, Bath, UK.
⁶ University of Oxford, Oxford, UK.
⁷ Oxford Centre for Cognitive Therapy, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
⁸ Department of Psychiatry, University of Oxford, Oxford, UK.
⁹ Research Department of Clinical, Health and Educational Psychology, University College London, London, UK.
¹⁰ Division of Psychiatry, University College London, London, UK.
¹¹ Community Mental Health Department, University of Haifa, Haifa, Israel.

Abstract

Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.

Keywords: Developmental trauma; adolescence; childhood; delusions; dissociation; hallucinations; paranoia; post-traumatic stress disorder; psychological processes; psychotic symptoms.