Psychiatric comorbidity in treatment-seeking alcoholics: the role of childhood trauma and perceived parental dysfunction.
BACKGROUND
This study among treatment-seeking alcoholics examined the relationship between childhood abuse (sexual abuse only [CSA], physical abuse only [CPA], or dual abuse [CDA]) and the presence of comorbid affective disorders, anxiety disorders, and suicide attempts, controlling for the potential confounding effects of other childhood adversities (early parental loss, witnessing domestic violence, parental alcoholism, and/or dysfunction) and adult assault histories.


METHODS
We assessed 155 (33 females, 122 males) treatment-seeking alcoholics using the European Addiction Severity Index, the Structured Trauma Interview, and the Composite International Diagnostic Interview.


RESULTS
The severity of childhood abuse was associated with posttraumatic stress disorder (PTSD) and suicide attempts in females and with PTSD, social phobia, agoraphobia, and dysthymia in males. Among men, multiple logistic regression models showed that CPA and CDA were not independently associated with any of the examined comorbid disorders or with suicide attempts. However, CSA independently predicted comorbid social phobia, agoraphobia, and PTSD. For the presence of comorbid affective disorders (mainly major depression) and suicide attempts, maternal dysfunctioning was particularly important. CSA also independently contributed to the number of comorbid diagnoses. For females, small sample size precluded the use of multivariate analyses.


CONCLUSIONS
Childhood abuse is an important factor in understanding clinical impairment in treated alcoholics, especially regarding comorbid phobic anxiety disorders, PTSD, and suicidality. These findings underline the importance of routine assessment of childhood trauma and possible trauma-related disorders in individuals presenting to alcohol treatment services. More studies with bigger samples sizes of female alcohol-dependent patients are needed.
Langeland
Willie
W
Amsterdam Institute for Addiction Research, Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
Draijer
Nel
N
van den Brink
Wim
W
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data* / Q000628:therapy; D015897:Comorbidity; D016001:Confidence Intervals; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D015999:Multivariate Analysis; D016017:Odds Ratio; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data