title: Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries.
abstract: BACKGROUND
  Meta-analyses link childhood trauma to depression, mania, anxiety disorders, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life.
  
  
  METHODS
  We used data from a representative general population sample (NEMESIS-2, n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP, n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture.
  
  
  RESULTS
  In NEMESIS-2, largely comparable associations were found between childhood trauma and depression, mania, anxiety and psychosis. However, childhood trauma was considerably more strongly associated with their lifetime admixture. These results were confirmed in the patient samples, in which it was consistently found that patients with a history of childhood trauma were more likely to have a combination of multiple symptom domains compared to their non-traumatized counterparts. This pattern was also found in exposed individuals who did not meet criteria for a psychotic, affective or anxiety disorder and who did not seek help for subclinical psychopathology.
  
  
  CONCLUSIONS
  Childhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries, and this admixture may already be present in the earliest stages of psychopathology. These findings may have significant aetiological, pathophysiological, diagnostic and clinical repercussions.
authors.affiliation: Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Nierop
authors.affiliation: Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Viechtbauer
authors.affiliation: Faculty of Psychology and Educational Sciences,Open University,The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Gunther
authors.affiliation: Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Zelst
authors.affiliation: Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Dorsselaer
authors.affiliation: Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Bak
authors.affiliation: Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Winkel
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: stratified medicine