title: Trauma and psychosis: The mediating role of self-concept clarity and dissociation.
abstract: Childhood trauma (CT) and psychosis may be associated. Drawing on the dissociation and social psychological literature, the current study examined the mediating role of structural aspects of self in explaining the relationship between childhood trauma and psychosis. Twenty-nine individuals with psychosis were compared with 31 healthy volunteers regarding childhood trauma, dissociation and self-concept clarity (SCC). High rates of maltreatment were found in the psychosis sample. Additionally, clinical participants reported more dissociation and less self-concept clarity. Mediational analyses were carried out on pooled data from across both clinical and non-clinical samples. These suggested that the influence of physical neglect in increasing the likelihood of experiencing psychosis was explicable through the effects of increased dissociation. Self-concept clarity mediated the relationship between psychosis and total childhood trauma, emotional abuse, physical abuse, emotional and physical neglect. Furthermore, dissociation and self-concept clarity were strongly correlated providing evidence that they may form a unitary underlying concept of 'self-concept integration'. The study provides further evidence of the link between childhood trauma and psychosis. Self-concept integration may be adversely affected by negative childhood experiences, which increases psychosis risk. Methodological limitations, clinical implications and suggestions for future research are considered.
authors.affiliation: Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, Manchester, UK.
authors.forename: Gavin John
authors.initials: GJ
authors.lastname: Evans
authors.affiliation: Lancashire Care NHS Foundation Trust/Lancaster University, Ormskirk & District General Hospital, Lancashire, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Reid
authors.affiliation: Early Interventions in Psychosis Team, Sefton & Kirkby, Liverpool, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: Preston
authors.affiliation: Division of Clinical Psychology, School of Psychological Science, University of Manchester, Manchester, UK.
authors.forename: Jasper
authors.initials: J
authors.lastname: Palmier-Claus
authors.affiliation: Division of Health Research, Faculty of Health and Medicine, University of Lancaster, UK. Electronic address: b.sellwood@lancaster.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Sellwood
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology; D004213:Dissociative Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000523:psychology*; D012307:Risk Factors; D012649:Self Concept; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Childhood trauma; Dissociation; Mediation; Psychosis; Self-concept