Recalling a personal account of childhood maltreatment is more closely linked to mental health problems than legal proof that the maltreatment occurred, according to a new study published in the journal Nature Human Behaviour.
The findings suggest that the subjective experience of maltreatment as a child may play a more vital role in adult emotional disorders than the event itself, and as a result, clinical work focusing on a patient’s memories and thinking patterns around abuse and neglect could be more influential on mental health than previously thought.
A research team from King’s College London and City University of New York analyzed data of nearly 1,200 people. They found that individuals who had been identified as victims of child maltreatment by official court records, but who did not recall the experience, were at no greater risk of adult psychiatric disorders than those with neither objective nor subjective experiences of abuse or neglect.
However, court-documented victims of maltreatment who also remembered the experience were nearly twice as likely to have emotional disorders in adulthood, such as depression and anxiety. In addition, those who remembered the experience of child maltreatment but did not have court evidence were at a similarly higher risk of psychiatric disorders.
“This is the first study that has comprehensively investigated the relative contribution of objective and subjective experience of childhood maltreatment in the development of psychiatric disorders,” said Professor Andrea Danese from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King’s College London and South London and Maudsley NHS Foundation Trust.
“We often think that objective and subjective experiences are one of the same, but we have found here that this is not quite true for childhood maltreatment — and that people’s own accounts of their experience are very important for their risk of psychopathology.”
“Our findings offer new hope that psychological treatments that address memories, cognitions and attitudes related to child maltreatment can help relieve the heavy mental health toll associated with this experience. This is a valuable insight at a time when there may be a rise in cases of child maltreatment due to restrictions to normal life and social care imposed by the COVID-19 pandemic.”
Specifically, the study showed that subjects with a combination of subjective reports and official records of childhood maltreatment had a 35% greater risk of experiencing any form of psychopathology compared to those with no measures of maltreatment at all.
Participants who identified themselves as victims of childhood maltreatment but with no official record of abuse or neglect had a 29% greater risk of any psychopathology. However, those who had official records of childhood maltreatment but no subjective reports of the experience appeared to be at no greater risk of developing any psychopathology.
The researchers looked at data from a unique sample in the U.S. Midwest, consisting of 908 people who had been identified as victims of child abuse or neglect on official court records from 1967-1971, alongside a comparison group of 667 people who had been matched on age, sex, ethnicity and family social class but who had no official records of abuse or neglect.
The participants were followed up about 20 years later at an average age of 28.7 years and were evaluated for psychiatric problems and asked to provide their own accounts of abuse and neglect as children. At follow-up there remained a total of 1,196 in the sample.
A major strength of the study was the use of objective measures of child abuse and neglect based on official records from juvenile and adult criminal courts, which were the basis for legal actions to protect children and prosecute perpetrators. Subjective measures of maltreatment were based on retrospective reports of physical abuse, sexual abuse and neglect.
The study looked at a range of psychiatric disorders including depression, dysthymia, generalized anxiety, post-traumatic stress disorder (PTSD), antisocial personality disorder, alcohol abuse and/or dependence, and drug abuse and/or dependence.
Further analysis into the different types of mental health conditions found that those with personal recall of childhood maltreatment were almost twice as likely to experience the emotional problems, such as depression and anxiety. They were also more than five times as likely to develop behavioral problems, such as antisocial personality, and also more likely to develop alcohol or substance abuse and/or dependence.
“Traditionally, as researchers, we have been concerned about establishing whether abuse and neglect have occurred, or what neurological or physical damage these experiences may have caused to the victims,” said Danese.
“This is, of course, very important, but the reality may be less deterministic. The actual occurrence of the event may not be as important in the development of psychiatric disorders as how the victim has experienced and responded to the event or, more generally, how people think about their childhood experiences.”
Source: King’s College London