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Trauma Exposure, Schizophrenia Symptoms, and the Stress Vulnerability Model

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Comprehensive Guide to Post-Traumatic Stress Disorders

Abstract

Literature from the last 15 years has found an established relationship between trauma exposure, schizophrenia, and PTSD symptoms. The reporting of trauma exposure in people with schizophrenia ranges between 33 % and 98 %, which is much higher than that found in the general population. The prevalence and severity of PTSD symptoms are also significantly higher in people with a diagnosis of schizophrenia. The trends that emerge from this literature indicate that people with schizophrenia are likely to experience exposure to more than one trauma and that there is a dose-response relationship between the number of traumas experienced and the severity of schizophrenia symptoms and PTSD symptoms. Exposure to childhood trauma, sexual assault, and violence is commonly experienced by people with schizophrenia. Evidence suggests that a bidirectional relationship exists between the severity of PTSD and schizophrenia symptoms. There are two potential causal relationships: schizophrenia symptoms and treatment cause PTSD symptoms or trauma causes the development of schizophrenia symptoms. The stress vulnerability model offers the temporal framework to further investigate the nature of the relationship between trauma exposure, schizophrenia symptoms, and PTSD. A number of biopsychosocial vulnerabilities to developing schizophrenia symptoms are associated with trauma exposure.

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Abbreviations

AH:

Auditory hallucinations

BPMS:

British Psychiatric Morbidity Survey

CI:

Confidence intervals

df:

Degrees of freedom

DSM-V:

Diagnostic and statistical manual-5th edition

HPA:

Hypothalamic-pituitary-adrenal axis

NCS:

National Comorbidity Survey

OR:

Odds ratio

PTSD:

Post-traumatic stress disorder

SD:

Standard deviation

SVM:

Stress vulnerability model

VH:

Visual hallucinations

References

  • Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry. 2010;22(5):417–28.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  • Andreasen NC. Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry. 1982;39(7):784–8.

    Article  PubMed  Google Scholar 

  • Badcock JC, Paulik G, Mayberry MT. The role of emotional regulation in auditory hallucinations. Psychiatry Res. 2011;185:303–8.

    Article  PubMed  Google Scholar 

  • Bak M, Krabbendam L, Janssen I, et al. Early trauma may increase the risk for psychotic experiences by impacting on emotional response and perception of control. Acta Psychiatr Scand. 2005;112:360–6.

    Article  PubMed  Google Scholar 

  • Bebbington PE, Bhugra D, Brugha T, et al. Psychosis, victimisation and childhood disadvantage. Evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry. 2004;185:220–6.

    Article  PubMed  Google Scholar 

  • Bendall S, Jackson HJ, Hulbert CA, et al. Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophr Bull. 2007;34(3):568–79.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bendall S, Alvarez-Jimenez M, Hulbert CA, et al. Childhood trauma increases the risk of post-traumatic stress disorder in response to first episode psychosis. Aust N Z J Psychiatry. 2012;46(1):35–8.

    Article  PubMed  Google Scholar 

  • Bentall RP, Kinderman P, Moutoussis M. The role of self-esteem in paranoid delusions: the psychology, neurophysiology, and development of persecutory of persecutory beliefs. In: Freeman D, Bentall R, Garety P, editors. Persecutory delusions assessment, theory and treatment. Oxford: Oxford University Press; 2009. p. 143–74.

    Google Scholar 

  • Castle DJ, Wessley S, Murray RM. Sex and schizophrenia: effects of diagnostic stringency, and associations with premorbid variables. Br J Psychiatry. 1993;162:658–64.

    Article  PubMed  Google Scholar 

  • Corcoran C, Walker E, Huot R, et al. The stress cascade and schizophrenia: etiology and onset. Schizophr Bull. 2003;29(4):671–92.

    Article  PubMed  Google Scholar 

  • Duke LA, Allen DN, Ross SA, et al. Neurocognitive function in schizophrenia with comorbid posttraumatic stress disorder. J Clin Exp Neuropsychol. 2010;32(7):737–51.

    Article  PubMed  Google Scholar 

  • Fleming M, Martin CR. From classical psychodynamics to evidence synthesis; the motif of repression and a contemporary understanding of a key mediatory mechanism in psychosis. Curr Psychiatry Rep. 2012;14(3):252–8.

    Article  PubMed  Google Scholar 

  • Freeman D, Garety PA. Comments on the contents of persecutory delusions: does the definition need clarification? Br J Clin Psychol. 2000;39:407–14.

    Article  PubMed  Google Scholar 

  • Freeman D, Pugh K, Antley A, et al. Virtual reality study of paranoid thinking in the general population. Br J Psychiatry. 2008;192:258–63.

    Article  PubMed  Google Scholar 

  • Goldstein J, Kreisma D. Gender, family environment and schizophrenia. Psychol Med. 1988;18:861–72.

    Article  PubMed  Google Scholar 

  • Goldstein J, Lewine R. Overview of sex differences in schizophrenia. In: Castle D, McGrath J, Kulkharni J, editors. Women and schizophrenia. Cambridge, UK: Cambridge University Press; 2000. p. 111–43.

    Google Scholar 

  • Haas GL, Glick ID, Clarkin JF, et al. Gender and schizophrenia outcome: a clinical trial of an inpatient family intervention. Schizophr Bull. 1990;16:277–92.

    Article  PubMed  Google Scholar 

  • Harding CM, Brooks GW, Ashikaga T, et al. The Vermont longitudinal study of persons with severe mental illness, II: long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. Am J Psychiatry. 1987;144(6):727–35.

    Article  PubMed  Google Scholar 

  • Harrow M, Jobe T, Astrachan-Fletcher EB. Prognosis of persecutory delusions in schizophrenia: a 20-year longitudinal study. In: Freeman D, Bentall R, Garety P, editors. Persecutory delusions: assessment, theory and treatment. Oxford: Oxford University Press; 2009. p. 73–90.

    Google Scholar 

  • Jablensky A, Sartorius N, Ernberg G, et al. Schizophrenia: manifestations, incidence and course in different cultures. Psychol Med Monogr Suppl. 1992;20:1–97. Cambridge: Cambridge University Press.

    Article  PubMed  Google Scholar 

  • Jankowski MK, Leitenberg H, Henning K, et al. Parental caring as a possible buffer against sexual revictimization in young adult survivors of child sexual abuse. J Trauma Stress. 2002;15(3):235–44.

    Article  PubMed  Google Scholar 

  • Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull. 1987;132:261–76.

    Article  Google Scholar 

  • Kelleher I, Keeley H, Corcoran P, et al. Childhood trauma and psychosis in a prospective cohort study: cause, effect and directionality. Am J Psychiatry. 2013;170(7):734–41.

    Article  PubMed  Google Scholar 

  • Kilcommons AM, Morrison AP. Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand. 2005;112:351–9.

    Article  PubMed  Google Scholar 

  • Kilcommons AM, Morrison AP, Knight A, et al. Psychotic experiences in people who have been sexually assaulted. Soc Psychiatry Epidemiol. 2008;43:602–11.

    Article  Google Scholar 

  • Lang FU, Kosters M, Lang S, et al. Psychopathological long-term outcome of schizophrenia-a review. Acta Psychiatr Scand. 2013;127:173–82.

    Article  PubMed  Google Scholar 

  • Lommen MJJ, Restifo K. Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder. Community Ment Health J. 2009;45:485–96.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lu W, Mueser KT, Shami A, et al. Post-traumatic reactions to psychosis in people with multiple psychotic episodes. Schizophr Res. 2011;127:66–75.

    Article  PubMed  Google Scholar 

  • Lu W, Yanos PT, Silverstein S, et al. Public mental health clients with severe mental illness and probable posttraumatic stress disorder: trauma exposure and correlates of symptom severity. J Trauma Stress. 2013;26:266–73.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lubman DI, King JA, Castle D. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry. 2010;22(2):191–201.

    Article  PubMed  Google Scholar 

  • Martin CR, Fleming M. Issues in quality of life assessment in schizophrenia. In: Preedy VR, Watson RR, editors. Handbook of disease burdens and quality of life measures. Germany: Springer; 2009. p.****.

    Google Scholar 

  • Morrison AP. Trauma and psychosis: theoretical and clinical implications. Acta Psychiat Scand. 2005;112:327–329.

    Google Scholar 

  • Morrison AP, Petersen T. Trauma, metacognition and predisposition to hallucinations in non-patients. Behav Cogn Psychother. 2003;31:235–46.

    Article  Google Scholar 

  • Morrison AP, Frame L, Larkin W. Relationships between trauma and psychosis: a review and integration. Br J Clin Psychol. 2003;42:331–53.

    Article  PubMed  Google Scholar 

  • Mueser KT, Trumbetta SL, Rosenberg SD, et al. Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol. 1998;66(3):493–9.

    Article  PubMed  Google Scholar 

  • Mueser KT, Rosenberg SD, Goodman LA, et al. Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophr Res. 2002;53:123–43.

    Article  PubMed  Google Scholar 

  • Mueser KT, Lu W, Rosenberg SD, et al. The trauma of psychosis: posttraumatic stress disorder and recent onset psychosis. Schizophr Res. 2010;116:217–27.

    Article  PubMed  Google Scholar 

  • Neria Y, Bromet EJ, Sievers S, et al. Trauma exposure and post-traumatic stress disorder in psychosis: findings from a first admission cohort. J Consult Clin Psychol. 2002;70:246–51.

    Article  PubMed  Google Scholar 

  • Nuchterlein KH, Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull. 1984a;10:300–12.

    Article  Google Scholar 

  • Nuchterlein KH, Dawson ME. Information processing and attentional functioning in the developmental course of schizophrenia. Schizophr Bull. 1984b;10:160–203.

    Article  Google Scholar 

  • O’Hare T, Sherrer MV. Lifetime traumatic events and high-risk behaviours as predictors of PTSD symptoms in people with severe mental illness. Soc Work Res. 2009;33(4):209–218.c.

    Article  Google Scholar 

  • O’Hare T, Shen C, Sherrer M. High-risk behaviours and drinking-to-cope as mediators of lifetime abuse and PTSD symptoms in clients with severe mental illness. J Trauma Stress. 2010;23(2):255–63.

    PubMed  Google Scholar 

  • Picken A, Tarrier N. Trauma and comorbid posttraumatic stress disorder in individuals with schizophrenia and substance abuse. Compr Psychiatry. 2011;52(5):490–497.

    Google Scholar 

  • Putts M. Recognising trauma and posttraumatic stress disorder symptoms in individuals with psychotic disorders. Assess Diagn. 2014;92:83–9.

    Google Scholar 

  • Read J, Perry BD, Moskowitz A, et al. The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry. 2001;64:319–45.

    Article  PubMed  Google Scholar 

  • Read J, Agar K, Argyle N, et al. Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychol Psychother Theory Res Pract. 2003;76:1–22.

    Article  Google Scholar 

  • Read J, van Os J, Morrison AP, et al. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand. 2005;112:330–50.

    Article  PubMed  Google Scholar 

  • Read J, Bentall RP, Fosse R. Time to abandon the bio-bio-bio model of psychosis: exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiol Psichiatr Soc. 2009;18(4):299–310.

    PubMed  Google Scholar 

  • Saha S, Chant D, Welham J, et al. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):413–33.

    Article  Google Scholar 

  • Saha S, Chant D, McGrath J. Meta-analyses of the incidence and prevalence of schizophrenia: conceptual and methodological issues. Int J Methods Psychiatr Res. 2008;17(1):55–61.

    Article  PubMed  Google Scholar 

  • Shevlin M, Houston JE, Dorahy MJ, et al. Cumulative traumas and psychosis: an analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey. Schizophr Bull. 2008;34(1):193–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Steel C, Fowler D, Holmes E. Trauma-related intrusions and psychosis: an information processing account. Behav Cogn Psychother. 2005;33:139–52.

    Article  Google Scholar 

  • Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, “Just the facts”. What we know in 2008. Part 1: overview. Schizophr Res. 2008;100:4–19.

    Article  PubMed  Google Scholar 

  • Tandon R, Gaebel W, Barch DM, et al. Definition and description of schizophrenia in the DSM-5. Schizophr Res. 2013. doi:10.1016/j.schres.2013.05.028.

    PubMed Central  Google Scholar 

  • Tarrier N, Picken A. Co-morbid PTSD and suicidality in individuals with schizophrenia and alcohol abuse. Soc Psychiatry Psychiatr Epidemiol. 2010;46:1079–86.

    Article  PubMed  Google Scholar 

  • Van Winkel R, Stefanis NC, Myin-Germeys I. Psychosocial stress and psychosis. A review of neurobiological mechanisms and the evidence for gene-stress interactions. Schizophr Bull. 2008;34:1095–105.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yank GR, Bentley KJ, Hargrove DS. The vulnerability-stress model of schizophrenia: advances in psychosocial treatment. Am J Orthopsychiatry. 1993;63(1):55–69.

    Article  PubMed  Google Scholar 

  • Zubin J, Spring B. Vulnerability: a new view of schizophrenia. J Abnorm Psychol. 1977;86:260–6.

    Article  Google Scholar 

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Correspondence to Mick P. Fleming .

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Fleming, M.P., Martin, C.R. (2016). Trauma Exposure, Schizophrenia Symptoms, and the Stress Vulnerability Model. In: Martin, C., Preedy, V., Patel, V. (eds) Comprehensive Guide to Post-Traumatic Stress Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-08359-9_40

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