Mood dysregulation and affective instability in emerging adults with childhood maltreatment: An ecological momentary assessment study

Day-to-day affect fluctuations in adults with childhood trauma history: a two-week ecological momentary assessment study

BACKGROUND

Childhood trauma (CT) may increase vulnerability to psychopathology through affective dysregulation (greater variability, autocorrelation, and instability of emotional symptoms). However, CT associations with dynamic affect fluctuations while considering differences in mean affect levels across CT status have been understudied.

METHODS

346 adults (age = 49.25 ± 12.55, 67.0% female) from the Netherlands Study of Depression and Anxiety participated in ecological momentary assessment. Positive and negative affect (PA, NA) were measured five times per day for two weeks by electronic diaries. Retrospectively-reported CT included emotional neglect and emotional/physical/sexual abuse. Linear regressions determined associations between CT and affect fluctuations, controlling for age, sex, education, and mean affect levels.

RESULTS

Compared to those without CT, individuals with CT reported significantly lower mean PA levels (Cohen's d = -0.620) and higher mean NA levels (d = 0.556) throughout the two weeks. CT was linked to significantly greater PA variability (d = 0.336), NA variability (d = 0.353), and NA autocorrelation (d = 0.308), with strongest effects for individuals reporting higher CT scores. However, these effects were entirely explained by differences in mean affect levels between the CT groups. Findings suggested consistency of results in adults with and without lifetime depressive/anxiety disorders and across CT types, with sexual abuse showing the smallest effects.

CONCLUSIONS

Individuals with CT show greater affective dysregulation during the two-week monitoring of emotional symptoms, likely due to their consistently lower PA and higher NA levels. It is essential to consider mean affect level when interpreting the impact of CT on affect dynamics.

The burden of early life stress in chronic inflammatory bowel diseases

The aim of this study was to evaluate the prevalence of early life stress (ELS) in a population with inflammatory bowel diseases (IBD) and to estimate its burden on mental, physical, and digestive health. Ninety-three participants with IBD were asked to anonymously complete questionnaires (Childhood Trauma Questionnaire-Short Form, Early Life Event Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Ways of Coping Checklist, Gastro-Intestinal Quality of Life Index questionnaire, and ad hoc questions about symptoms). The prevalence of patients with IBD who were exposed to at least one childhood abuse was 53%. Mental health and quality of life were significantly poorer in patients with IBD who were exposed to early abuse than in those who were not. Patients exposed to ELS had also more digestive perturbations and fatigue. These results suggest that early abuse should be considered a component of IBD care.

Association between Hpa Axis Functioning and Mental Health in Maltreated Children and Adolescents: A Systematic Literature Review

BACKGROUND

Previous studies have demonstrated that children who experience maltreatment show a more elevated risk of psychopathological disorders than children from the general population. The HPA (hypothalamic-pituitary-adrenal) axis is not mature at birth and undergoes strong social regulation during the first years of life. Consequently, early exposure to stress could modify the usual adaptative response to stress. In stressful situations, perturbations in both cortisol response and cortisol circadian rhythm have been observed. Nevertheless, studies that have evaluated the links between child abuse, dysregulation of the HPA axis, and mental disorders have shown diverse results. Because of the variety of methods employed in the different studies, no formal comparisons have been made. In this systematic review, we have brought together these results.

METHODS

We conducted a systematic review of studies analyzing the correlation between child abuse, mental disorders, and HPA axis activity in patients aged between 6 and 16 years. PubMed, Scopus, Cochrane, and Google Scholar were searched using relevant keywords and inclusion/exclusion criteria (from 2000 to 2020).

RESULTS

Fifteen studies from the 351 identified were included. Most patients were children in the child welfare system. Children who had experienced child abuse presented with more severe mental disorders (particularly in the dimensional measure) than children who had not been abused. HPA axis activity was assessed by measuring basal cortisol for some studies and cortisol reactivity for other studies. For children experiencing child abuse, there was a possible association between abuse and a decrease in the reactivity of the HPA axis. In addition, early life stress could be associated with lower matinal cortisol. However, the association between mental disorders and cortisol secretion in maltreated children did not seem obvious.

CONCLUSIONS

This systematic review demonstrates that mental disorders are more frequent and severe in cases where child abuse has occurred. Moreover, children who experienced child abuse seem to present changes in the reactivity of the HPA axis. Nevertheless, the potential correlation between these changes in the reactivity of the HPA axis and mental disorders in this population needs to be evaluated in further studies.

Childhood maltreatment and emotion regulation in everyday life: an experience sampling study

Childhood maltreatment is a major risk factor for psychopathology, and increasing evidence suggests that emotion regulation is one of the underlying mechanisms. However, most of this evidence comes from single assessments of habitual emotion regulation, which may not overlap with spontaneous emotion regulation in daily life and which fail to account for within-individual variability in emotion regulation across multiple contexts. In the present study, we investigated the relation between history of childhood maltreatment, positive and negative affect, and multiple dimensions of spontaneous emotion regulation (strategy use, emotion regulation goals, emotion regulation success and effort) in everyday life, using experience sampling method (3 assessments/day, for 10 consecutive days), in a sample of healthy volunteers (N = 118). Multilevel modeling results indicated that childhood maltreatment was associated with lower positive affect and higher negative affect. Childhood maltreatment was also related to lower use of reappraisal and savoring (but not suppression, rumination and distraction), reduced emotion regulation success (but not effort), as well as lower levels of and higher within-individual variability of hedonic (but not instrumental) emotion regulation goals. These results provide ecological evidence for multiple differences in emotion regulation in individuals with a history of childhood maltreatment.

Association between childhood maltreatment and social functioning in individuals with affective disorders: A systematic review and meta-analysis

OBJECTIVE

Childhood maltreatment has been linked to impairments in social functioning and social cognition in adults with affective disorders. However, conclusions have been limited by inconsistent findings across different maltreatment subtypes and social domains. We conducted a systematic review and meta-analysis to quantify associations between childhood maltreatment (overall and subtypes - physical, emotional and/or sexual abuse, and/or physical and/or emotional neglect) and different domains of social functioning and social cognition in adults with affective disorders (bipolar disorder or major depressive disorder). We also examined effect moderators and mediators of these associations.

METHODS

A systematic search was performed on 12.12.2022 which identified 29 studies included in qualitative synthesis (n = 3022 individuals with affective disorders), of which 27 (n = 2957) were pooled in meta-analyses. Across studies, five social functioning and five social cognition domains were examined, of which four domains of social functioning and two domains of social cognition had sufficient data for meta-analysis (PROSPERO CRD42022288976).

RESULTS

Social functioning: childhood maltreatment was associated with lower global social functioning (r = -0.11 to -0.20), poorer interpersonal relations (r = -0.18 to -0.33), and with aggressive behaviour (r = 0.20-0.29) but was unrelated to vocational functioning. Emotional abuse and emotional neglect showed the largest magnitudes of effect. Social cognition: there was no meta-analytic evidence of associations between maltreatment and social cognition domains. Exploratory moderation analyses did not identify any consistent moderators. Narrative synthesis identified attachment style as possible moderator, and sensory patterns, anxiety, and depressive symptoms as possible mediators between childhood maltreatment and social outcomes. Overall, the available evidence was limited, particularly in relation to social cognition.

CONCLUSIONS

Adults with affective disorders are at risk of social functioning difficulties after childhood maltreatment exposure, an effect observed across multiple maltreatment subtypes, social functioning domains, and diagnoses. Addressing social functioning problems may benefit maltreated adults with both bipolar disorder and major depressive disorder.

The protective role of secure attachment in the relationship between experiences of childhood abuse, emotion dysregulation and coping, and behavioral and mental health problems among emerging adult Black women: A moderated mediation analysis

To determine the extent to which secure attachment moderates the effects of previous child abuse history on the intermediate variables (putative mediators) of emotion dysregulation and coping, which, in turn, influence adult behavioral health and mental health problems. Black women (N = 440, M age = 20.33, SD = 1.88) were selected from the baseline data collection of a large, randomized trial. Study participants had consumed alcohol, had had unprotected sex in the last 90 days, and either reported abuse prior to age 18 or no lifetime history of abuse. Women completed measures of sociodemographics, abuse history, attachment security, coping, emotion dysregulation, psychological functioning, risky sexual behavior, and substance use problems. At low attachment security, the conditional indirect effects of childhood abuse through the intermediate variable, coping, were statistically significant for all dependent variables except proportion condom use and perceived stress. At high attachment security, none of the conditional indirect effects through coping achieved statistical significance. High attachment security also mitigated the conditional indirect effects of childhood abuse through the intermediate variable, emotion dysregulation, reducing the magnitude of the relationship with trait anger, depression, marijuana problems, and perceived stress by about 50%. These results demonstrate the potential mitigating effects of secure attachment on the relationship between childhood abuse history and select behavioral and mental health problems through the intermediate variables of coping and emotional dysregulation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pinpointing affective disturbances in psychosis: A comparison of temporal affect dynamics in individuals with psychotic disorders, individuals with attenuated psychotic symptoms, and clinical and healthy controls

Affective disturbances in psychosis are well-documented but our understanding of their phenotypic nature in everyday life remains limited. Filling this gap could advance mechanistic models of the affective pathway to psychosis and pave the ground for new research avenues. Therefore, this study focused on temporal affect dynamics in psychosis, i.e., the patterns with which affect fluctuates over time. We applied experience-sampling with nine assessments per day over one week in participants with psychotic disorders (PSY), participants with attenuated psychotic symptoms (AS), clinical controls with obsessive compulsive disorders (OCD) and healthy controls (HC; total N = 139) to assess whether in PSY and AS, dynamics in affective valence and arousal are characterized by higher instability (i.e., extreme and frequent moment-to-moment fluctuations of affect intensities), higher affective variability (i.e., larger range of affect intensities), or lower inertia (i.e., higher frequency of affective changes), compared to the clinical and healthy control samples. Mixed-model ANOVAs revealed higher instability in both PSY and OCD compared to HC, but no significant differences for variability and inertia. AS had an intermediate position and did not differ significantly from any other group. We found evidence for small to medium effect sizes for the influence of mean affect levels on the dynamic indicators. Our findings indicate that individuals with psychotic disorders have increased affective instability and that this could be a transdiagnostic phenomenon. Zooming in on the variability and inertia components did not confer additional benefits. Emotion-focused interventions for psychosis should focus on reducing frequent and extreme affective fluctuations.

Discontinuation of hormonal contraception due to changes in mood and decreases in sexual desire: the role of adverse childhood experiences

PURPOSE

To evaluate if adverse childhood experiences are associated with hormonal contraception discontinuation due to mood and sexual side effects.

MATERIALS AND METHODS

Women, ages 18-40 (N = 826), with current and/or previous hormonal contraceptive use completed surveys on demographics, contraceptive history, and the Adverse Childhood Experiences Questionnaire. We characterised women into high (≥2 adverse experiences) and low (0 or 1) adverse childhood experience groups. We calculated risk ratios for associations between adverse childhood experiences and outcomes of interest using log binomial generalised linear models, and adjusted for relevant demographic variables.

RESULTS

Women in the high adverse childhood experiences group (n = 355) were more likely to report having discontinued hormonal contraception due to decreases in sexual desire (adjusted risk ratio 1.44, 1.03-2.00, p = .030). Covariates included age, current hormonal contraception use, and various demographic variables associated with discontinuation. Adverse childhood experiences were not associated with mood or sexual side effects among current (n = 541) hormonal contraceptive users.

CONCLUSIONS

Self-reported adverse childhood experiences were associated with greater likelihood of discontinuing hormonal contraception due to behavioural side effects, particularly decreases in sexual desire. Identification of risk factors for behavioural side effects can assist patients and clinicians in making informed choices on contraception that minimise risk of early discontinuation.

Recruiting and exploring vulnerabilities among young people at risk, or in the early stages of serious mental illness (borderline personality disorder and first episode psychosis)

INTRODUCTION

Many gaps exist in our understanding of the developmental pathways to severe mental illness (SMI), including borderline personality disorder (BPD) and psychosis. However, those who have experienced adverse childhood experiences (ACEs) are at an increased risk and there is evidence to suggest that one of the earliest markers is emotional dysregulation. An area which has received relatively less research attention is the role neurodevelopmental disorders (NDDs) play. The aim of this feasibility study was therefore to explore the clinical profiles of young people early in the course of SMI, including their profiles of ACEs, emotional regulation difficulties, borderline personality traits and NDDs.

METHODS

A cross-sectional study of young people (aged 15-25) at risk of SMI, currently being seen within NHS mental health services, was conducted. This included those with early symptoms of psychosis and/or BPD as assessed by diagnostic interview. Eligible participants self-completed a battery of sociodemographic, clinical, and psychological measures in the company of a researcher. This included assessments of: symptoms of NDDs; borderline pathology traits; ACEs; and difficulties in emotional regulation. Statistical analyses included Mann-Whitney U tests and multiple regression.

RESULTS

Of the 118 potentially eligible participants who were referred, 48 were ultimately included in the study. Young people early in the course of SMI reported a high prevalence of ACEs and deficits in emotional regulation. In total, 79% met criteria for attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Emotional dysregulation was found to significantly mediate the association between both ACEs and the frequency of NDDs and borderline personality traits, however given the small sample size these results are preliminary in nature.

CONCLUSION

Young people early in the course of SMI are at an increased risk of experiencing multiple childhood adversities and our results indicate a high prevalence of NDDs amongst them. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity. We suggest that the clinical implications of our findings include routine screening for NDDs and ACEs and an increased recognition of the significance of emotional dysregulation. However, larger scale longitudinal studies are needed to investigate these preliminary findings further.

An Extracellular Perspective on CNS Maturation: Perineuronal Nets and the Control of Plasticity

During restricted time windows of postnatal life, called critical periods, neural circuits are highly plastic and are shaped by environmental stimuli. In several mammalian brain areas, from the cerebral cortex to the hippocampus and amygdala, the closure of the critical period is dependent on the formation of perineuronal nets. Perineuronal nets are a condensed form of an extracellular matrix, which surrounds the soma and proximal dendrites of subsets of neurons, enwrapping synaptic terminals. Experimentally disrupting perineuronal nets in adult animals induces the reactivation of critical period plasticity, pointing to a role of the perineuronal net as a molecular brake on plasticity as the critical period closes. Interestingly, in the adult brain, the expression of perineuronal nets is remarkably dynamic, changing its plasticity-associated conditions, including memory processes. In this review, we aimed to address how perineuronal nets contribute to the maturation of brain circuits and the regulation of adult brain plasticity and memory processes in physiological and pathological conditions.

The Association between Adverse Childhood Experiences and Personality, Emotions and Affect: Does Number and Type of Experiences Matter?

Background

There is strong evidence that adverse childhood experiences (ACEs) negatively impact mental health. However, the association between ACEs and personality, emotions and affect are poorly understood. Therefore, we examined the association between composite ACE score and ACE type and personality, emotions and positive and negative affect.

Methods

Three waves of data from the Midlife Development in the United States (MIDUS) study were used. ACE was the primary independent correlate. Covariates included demographic variables and survey wave. Outcome variables included generativity, personality traits (agreeableness, conscientiousness, extraversion, neuroticism, openness, agency), and affect (positive, negative.) Statistical analyses included 3 approaches: 1) treatment of ACE as dichotomous, 2) ordinal composite of ACE score, and 3) three individual ACE type components to assess the association between ACE and psychological constructs.

Results

Of 6,323 adults in the sample, 53% were female, and 56% had a past ACE. In the adjusted analyses, dichotomized ACE was significantly associated with neuroticism (β=0.10; 95% CI 0.07, 0.13) and conscientiousness (β=-0.03; 95% CI -0.05, -0.01). All ACE scores were significantly and positively associated with neuroticism and negatively associated with conscientiousness. Abuse was significantly associated with neuroticism (β=0.20; 95% CI 0.16, 0.24), openness (β=0.08; 95% CI 0.05, 0.11), conscientiousness (β=-0.05; 95% CI -0.08, -0.02), and agency (β=0.06; 95% CI 0.02, 0.10). All ACE categories, except financial strain, were significantly associated with affect.

Conclusion

ACEs are significantly associated with personality, emotions, and affect, with greater effect seen at higher ACE scores and with ACE abuse type, which helps support the cumulative risk hypothesis and our study hypothesis. There is a need for continued research to understand the mechanistic processes and the directionality of the association between ACEs, emotions, and behaviors to help continue to drive biopsychosocial interventions.

Recovery After Genocide: Understanding the Dimensions of Recovery Capital Among Incarcerated Genocide Perpetrators in Rwanda

Utilizing survey data from 302 men and women incarcerated in the Rwandan correctional system for the crime of genocide, and structured interviews with 75 prisoners, this mixed methods study draws on the concept of recovery capital to understand how individuals convicted of genocide navigate post-genocide healing. Genocide smashes physical and human capital and perverts social and cultural capital. Experiencing high levels of posttraumatic stress symptoms with more than two-thirds of the sample scoring above typical civilian cut-off levels, raised levels of depression, and high levels of anxiety, and failing physical health, the genocide perpetrators require multiple sources of recovery capital to foster internal resilience as they look forward to rebuilding their own lives.

Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents

OBJECTIVE

The rate of adolescent suicide and suicidal behavior has risen dramatically in the past decade. The title of this article comes from the classic coming-of-age novel by J.D. Salinger, The Catcher in the Rye. Its protagonist, Holden Caulfield, is a precocious adolescent who, in the face of his inability to cope with his own self-destructives urges, imagines himself saving "little kids playing some game in this big field of rye." He is standing on the edge of a cliff trying to catch "thousands of little kids" before they fall to their demise. This vignette from The Catcher in the Rye provides a useful metaphor for the relationship between mental health professionals and youth at risk for suicide, and suggests more efficient and effective alternative interventions to prevent youth suicide compared to standing by a cliff.

METHOD

These four alternative approaches are described, namely: (1) leading youth away from the cliff (ie, prevention); (2) going to where youth are (ie, improving access to care); (3) working with others to change the rules in the field (ie, changing the way care is delivered); and (4) putting a fence around the cliff (ie, restriction of access to lethal agents). The evidence to support the utility and cost-effectiveness of each of these approaches is reviewed.

CONCLUSION

There are extant, empirically supported, cost-effective approaches to the prevention and management of adolescent suicidal behavior that, if implemented widely, are likely to significantly reverse the decade-long rise in adolescent suicide.

The Impact of Emotional Lability Symptoms During Childhood in Adults With ADHD

OBJECTIVE

To determine whether emotional lability (EL) in adult ADHD patients can already be identified during their childhood and the extent to which this childhood symptomatology can predict EL in adulthood.

METHOD

Seven hundred eighteen adults with ADHD were examined. EL in adulthood was assessed using the Conners' Adult ADHD Rating Scales (CAARS). According to Conners' definition of EL, seven items from the Wender Utah Rating Scale (WURS) were used to determine this symptomatology in childhood.

RESULTS

EL was identified in 31.1% of the participants, and 29.6% of this subgroup reported EL symptoms in childhood. Childhood EL was the strongest predictor of these symptoms in adulthood (odds ratio [OR] = 6.18). ADHD subtype, female sex, family history of ADHD, psychiatric comorbidities, and physical abuse were also related to EL development/persistence.

CONCLUSION

Screening for EL symptoms in children with ADHD is important, as they are the strongest predictor of this symptomatology in adulthood.

No gene-by-environment interaction of BDNF Val66Met polymorphism and childhood maltreatment on anxiety sensitivity in a mixed race adolescent sample

Background: Anxiety disorders in youth are attributable to multiple causal mechanisms, comprising biological vulnerabilities, such as genetics and temperament, and unfavourable environmental influences, such as childhood maltreatment (CM). Objective: A gene-environment (G x E) interaction study was conducted to determine the interactive effect of the BDNF Val66Met polymorphism and CM to increase susceptibility to anxiety sensitivity (AS) in a sample of mixed race adolescents. Method: Participants (n = 308, mean age = 15.8 years) who were all secondary school students and who completed measures for AS and CM were genotyped for the BDNF Val66Met polymorphism. Hierarchical multiple regression analysis was conducted to assess G x E influences on AS. Age and gender were included in the models as covariates as age was significantly associated with AS total score (p < .05), and females had significantly higher AS scores than males (p < .05). Results: A main effect of CM on AS was evident (p < .05), however, no main effect of BDNF genotype on AS was observed (p > .05). A non-significant G x E effect on AS was revealed (p < .05). Conclusions: Our results suggest that CM does not have a moderating role in the relationship between the BDNF Val66Met genotype and the increased risk of anxiety-related phenotypes, such as AS. Given the exploratory nature of this study, findings require replication in larger samples and adjustment for population stratification to further explore the role of BDNF Val66Met and CM on AS in mixed race adolescents.

Association between child maltreatment and prospective and retrospective memory in adolescents: The mediatory effect of neuroticism

The purpose of this study was to examine the relationship between child maltreatment and prospective and retrospective memory in children/adolescents by investigating the mediating role of neuroticism. In total, 662 children/adolescents aged 10-16 years were recruited from a middle school in China, and they completed questionnaires comprising the Childhood Trauma Questionnaire, Prospective and Retrospective Memory Questionnaire, and the Neuroticism subscale of the NEO Five-Factor Inventory. The severity of maltreatment was positively associated with the severity of impairment of memory (prospective and retrospective considered together) in children/adolescents. Children/adolescents exposed to maltreatment tended to display higher levels of neuroticism. Neuroticism partially mediated the association between child maltreatment and memory in all the subjects. The results of multigroup analyses showed neuroticism fully mediated the relationship between child maltreatment and memory for boys, in which the effect size of indirect effect was 0.52, and partially mediated the association for girls with 0.44 effect size of indirect effect. Early intervention aimed to reduce neuroticism might contribute to a better prognosis in children/adolescences with poor memory function.

Ecological Momentary Assessment and Smartphone Application Intervention in Adolescents with Substance Use and Comorbid Severe Psychiatric Disorders: Study Protocol

CONTEXT

Substance use disorders (SUDs) are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA) intervention for all substance users, and of a smartphone application for cannabis users (Stop-Cannabis), for outpatient treatment after hospital discharge.

METHODS AND ANALYSIS

All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app, the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and 1 year.

DISCUSSION

This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age.

ETHICS AND DISSEMINATION

The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals.

TRIAL REGISTRATION

European Clinical Trials Database: Number 2016-001999-30.