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Childhood maltreatment and personality disorders in a US representative population sample
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
Childhood maltreatment and personality disorders in a US representative population sample Waxman R.a, Fenton M.a, Skodol A.E.a,b, Grant B.F.c, Hasin D.a a New York, NY b Phoenix, AZ c Rockville, MD Introduction: Prior studies suggest associations between childhood maltreatment and development of adult personality disorders (PDs), which are implicated in many physical, emotional, and behavioral problems. However, because of the regular co-occurrence of distinct maltreatment types (sexual, physical, and emotional abuse; physical and emotional neglect) and comorbidity among PDs, little is known about relationships between each maltreatment type and PD, controlling for their co-occurrence. Whether sex moderates these associations is also unclear. Sample: All data were from the NESARC, a nationally representative face-to-face survey of noninstitutionalized civilian adults residing in the United States (N = 34 653). Blacks, Hispanics, and young adults (age, 18-24 years) were oversampled, with data weighted for accurate population representation. Method: PDs were diagnosed from structured interviews (AUDADIS-IV), and dichotomous indicators of maltreatment types were developed based on responses to the Childhood Trauma Questionnaire. Sexual contact with an adult during childhood counted as sexual abuse. Injury or frequent force by a caregiver constituted physical abuse. Frequent insults or threats reflected emotional abuse. Physical neglect was defined by recurrent lack of available necessities or age-inappropriate supervision and chores. Rarely experiencing family support constituted emotional neglect. We evaluated specific associations of the 10 DSM-IV PDs with the 5 types of childhood maltreatment through logistic regression analyses controlling for age, sex, race/ethnicity, education, parental psychopathology, co-occurring maltreatment types, and comorbid PD. We also examined synergistic interactions of sex with maltreatment types in predicting PDs. Results: A pattern of specific associations emerged, in which sexual abuse and physical neglect each uniquely predicted 4 PDs and the other types of maltreatment each uniquely predicted 3 PDs. Antisocial PD was linked to physical and sexual abuse in childhood. Borderline PD was associated with all maltreatments except emotional neglect, whereas avoidant PD was associated only with emotional neglect. Several interactions of maltreatment with sex were significant in predicting PDs. Sexual abuse was an especially strong predictor of personality pathology in men, and neglect predicted personality disorders more strongly in women. Conclusion: Given the unique contributions of all forms of maltreatment to personality pathology, our results underscore the need to consider each maltreatment separately even when they co-occur, as well as to pay attention to child sex. Our study is limited by its cross-sectional design and use of retrospective self-report regarding childhood maltreatment and self-report for personality symptoms. However, we identify high-risk groups for specific personality disorders in a general population sample, with implications for targeted preventive interventions. doi:10.1016/j.comppsych.2011.04.053 Suicide attempters suffer greater annihilation anxiety S.R. Weinstein , M. Hurvich Brooklyn, NY Background: Annihilation anxiety is defined as the fear of being psychically overwhelmed or disorganized and the experience of psychic annihilation. It results from and further promotes the ego regression that occurs simultaneously. Recently, ego regression has also been conceptualized as playing a role in the experience of suicidality. As of now, this wellestablished theoretical overlap between annihilation anxiety and suicidality has not been adequately discussed or examined; this is the first empirical study to investigate this link. Method: This was an archival study. The clinic sample was composed of data from 130 files of current and terminated clients at the Long Island
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University Psychological Services Center and was split into 2 groups: one with (n = 23) and one without (n = 127) a history of suicide attempts. The community control sample was composed of 62 undergraduate students enrolled in psychology classes. Both clinic and community control samples were young, mostly female, and ethnically diverse. Results: Using analysis of variance, 3 annihilation anxiety measures, total annihilation anxiety, the sum of extreme responses to critical facets of annihilation anxiety, and the count of extreme responses to critical facets of annihilation anxiety, were assessed across the 2 clinic groups and the community control sample. Planned comparisons revealed that, on all 3 measures, the clinic groups combined scored significantly higher than the community control sample (all Ps b .001). Additionally, for the sum of responses to critical facets of annihilation anxiety, the clinic with suicide attempts group scored significantly higher than the clinic without suicide attempts group (P b .05). Discussion: These results suggest a positive relationship between annihilation anxiety and suicidality; thus, the findings imply that annihilation anxiety may be an important, measurable risk factor for suicidality and specifically for suicide attempts. The group differences on annihilation anxiety may also be driven by differences in social desirability; this construct was significantly different across groups and therefore could not be used as a covariate. However, given the significant correlation between social desirability and annihilation anxiety, a person low on social desirability is likely to be high on annihilation anxiety as well. This study was limited by the available data on suicidality and the fact that the severe end of the suicidality range was not represented in this clinic sample. Future research should investigate the relationship between annihilation anxiety and suicidality across all types and severities of suicidality. doi:10.1016/j.comppsych.2011.04.054 Effects of violence exposure on the development of sexual risk behavior in low-income African American girls H.W. Wilson a, C.S. Widom b a Rosalind Franklin University of Medicine and Science, North Chicago, IL b John Jay College of Criminal Justice, City University of New York, New York, NY Introduction: Childhood maltreatment has been linked to risky sexual behavior in adolescence and adulthood; but existing research has focused primarily on sexual abuse, relied on retrospective reports of childhood maltreatment, and used cross-sectional designs. The current study examined (1) whether individuals with documented cases of child abuse and neglect are at greater likelihood of engaging in HIV risk behavior in middle adulthood and (2) whether psychopathology in young adulthood mediates this relationship. Methods: Using a prospective cohort design, a large group of abused (physical and sexual) and neglected children (age, 0-11 years) whose cases were processed during 1967-1971 were matched with nonmaltreated children and followed into middle adulthood. Participants completed inperson interviews in 1989-1995 (average age, 29 years), 2000-2002 (average age, 39 years), and 2003-2004 (average, age 41 years). HIV risk behavior (multiple partners and inconsistent condom use, anal sex without a condom, trading sex for money or drugs, and treatment of a sexually transmitted disease) was assessed in 2003-2004 as part of a comprehensive health evaluation. Psychiatric disorders (PTSD, depression, antisocial personality disorder, and drug abuse) were assessed in 1989-1995 with the NIMH Diagnostic Interview Schedule–Revised (DIS-III-R). Analyses involved logistic regression and structural equation modeling. Results: Childhood abuse and neglect predicted increased likelihood of HIV risk behavior in middle adulthood (OR = 2.84; 95% CI, 1.74-4.64; P ≤ .001). Symptoms of antisocial personality disorder in young adulthood mediated this relationship, controlling for the other types of psychopathology. Conclusion: Findings add to existing knowledge regarding 2 major public health concerns—childhood maltreatment and HIV/AIDS—and indicate that physical abuse and neglect, not only sexual abuse, can lead to HIV risk sexual behavior later in life. Antisocial personality disorder appears to
Childhood maltreatment and personality disorders in a US representative population sample Waxman R.a, Fenton M.a, Skodol A.E.a,b, Grant B.F.c, Hasin D.a a New York, NY b Phoenix, AZ c Rockville, MD Introduction: Prior studies suggest associations between childhood maltreatment and development of adult personality disorders (PDs), which are implicated in many physical, emotional, and behavioral problems. However, because of the regular co-occurrence of distinct maltreatment types (sexual, physical, and emotional abuse; physical and emotional neglect) and comorbidity among PDs, little is known about relationships between each maltreatment type and PD, controlling for their co-occurrence. Whether sex moderates these associations is also unclear. Sample: All data were from the NESARC, a nationally representative face-to-face survey of noninstitutionalized civilian adults residing in the United States (N = 34 653). Blacks, Hispanics, and young adults (age, 18-24 years) were oversampled, with data weighted for accurate population representation. Method: PDs were diagnosed from structured interviews (AUDADIS-IV), and dichotomous indicators of maltreatment types were developed based on responses to the Childhood Trauma Questionnaire. Sexual contact with an adult during childhood counted as sexual abuse. Injury or frequent force by a caregiver constituted physical abuse. Frequent insults or threats reflected emotional abuse. Physical neglect was defined by recurrent lack of available necessities or age-inappropriate supervision and chores. Rarely experiencing family support constituted emotional neglect. We evaluated specific associations of the 10 DSM-IV PDs with the 5 types of childhood maltreatment through logistic regression analyses controlling for age, sex, race/ethnicity, education, parental psychopathology, co-occurring maltreatment types, and comorbid PD. We also examined synergistic interactions of sex with maltreatment types in predicting PDs. Results: A pattern of specific associations emerged, in which sexual abuse and physical neglect each uniquely predicted 4 PDs and the other types of maltreatment each uniquely predicted 3 PDs. Antisocial PD was linked to physical and sexual abuse in childhood. Borderline PD was associated with all maltreatments except emotional neglect, whereas avoidant PD was associated only with emotional neglect. Several interactions of maltreatment with sex were significant in predicting PDs. Sexual abuse was an especially strong predictor of personality pathology in men, and neglect predicted personality disorders more strongly in women. Conclusion: Given the unique contributions of all forms of maltreatment to personality pathology, our results underscore the need to consider each maltreatment separately even when they co-occur, as well as to pay attention to child sex. Our study is limited by its cross-sectional design and use of retrospective self-report regarding childhood maltreatment and self-report for personality symptoms. However, we identify high-risk groups for specific personality disorders in a general population sample, with implications for targeted preventive interventions. doi:10.1016/j.comppsych.2011.04.053 Suicide attempters suffer greater annihilation anxiety S.R. Weinstein , M. Hurvich Brooklyn, NY Background: Annihilation anxiety is defined as the fear of being psychically overwhelmed or disorganized and the experience of psychic annihilation. It results from and further promotes the ego regression that occurs simultaneously. Recently, ego regression has also been conceptualized as playing a role in the experience of suicidality. As of now, this wellestablished theoretical overlap between annihilation anxiety and suicidality has not been adequately discussed or examined; this is the first empirical study to investigate this link. Method: This was an archival study. The clinic sample was composed of data from 130 files of current and terminated clients at the Long Island
E17
University Psychological Services Center and was split into 2 groups: one with (n = 23) and one without (n = 127) a history of suicide attempts. The community control sample was composed of 62 undergraduate students enrolled in psychology classes. Both clinic and community control samples were young, mostly female, and ethnically diverse. Results: Using analysis of variance, 3 annihilation anxiety measures, total annihilation anxiety, the sum of extreme responses to critical facets of annihilation anxiety, and the count of extreme responses to critical facets of annihilation anxiety, were assessed across the 2 clinic groups and the community control sample. Planned comparisons revealed that, on all 3 measures, the clinic groups combined scored significantly higher than the community control sample (all Ps b .001). Additionally, for the sum of responses to critical facets of annihilation anxiety, the clinic with suicide attempts group scored significantly higher than the clinic without suicide attempts group (P b .05). Discussion: These results suggest a positive relationship between annihilation anxiety and suicidality; thus, the findings imply that annihilation anxiety may be an important, measurable risk factor for suicidality and specifically for suicide attempts. The group differences on annihilation anxiety may also be driven by differences in social desirability; this construct was significantly different across groups and therefore could not be used as a covariate. However, given the significant correlation between social desirability and annihilation anxiety, a person low on social desirability is likely to be high on annihilation anxiety as well. This study was limited by the available data on suicidality and the fact that the severe end of the suicidality range was not represented in this clinic sample. Future research should investigate the relationship between annihilation anxiety and suicidality across all types and severities of suicidality. doi:10.1016/j.comppsych.2011.04.054 Effects of violence exposure on the development of sexual risk behavior in low-income African American girls H.W. Wilson a, C.S. Widom b a Rosalind Franklin University of Medicine and Science, North Chicago, IL b John Jay College of Criminal Justice, City University of New York, New York, NY Introduction: Childhood maltreatment has been linked to risky sexual behavior in adolescence and adulthood; but existing research has focused primarily on sexual abuse, relied on retrospective reports of childhood maltreatment, and used cross-sectional designs. The current study examined (1) whether individuals with documented cases of child abuse and neglect are at greater likelihood of engaging in HIV risk behavior in middle adulthood and (2) whether psychopathology in young adulthood mediates this relationship. Methods: Using a prospective cohort design, a large group of abused (physical and sexual) and neglected children (age, 0-11 years) whose cases were processed during 1967-1971 were matched with nonmaltreated children and followed into middle adulthood. Participants completed inperson interviews in 1989-1995 (average age, 29 years), 2000-2002 (average age, 39 years), and 2003-2004 (average, age 41 years). HIV risk behavior (multiple partners and inconsistent condom use, anal sex without a condom, trading sex for money or drugs, and treatment of a sexually transmitted disease) was assessed in 2003-2004 as part of a comprehensive health evaluation. Psychiatric disorders (PTSD, depression, antisocial personality disorder, and drug abuse) were assessed in 1989-1995 with the NIMH Diagnostic Interview Schedule–Revised (DIS-III-R). Analyses involved logistic regression and structural equation modeling. Results: Childhood abuse and neglect predicted increased likelihood of HIV risk behavior in middle adulthood (OR = 2.84; 95% CI, 1.74-4.64; P ≤ .001). Symptoms of antisocial personality disorder in young adulthood mediated this relationship, controlling for the other types of psychopathology. Conclusion: Findings add to existing knowledge regarding 2 major public health concerns—childhood maltreatment and HIV/AIDS—and indicate that physical abuse and neglect, not only sexual abuse, can lead to HIV risk sexual behavior later in life. Antisocial personality disorder appears to