Childhood Abuse and the Content of Adult Psychotic Symptoms

High rates of childhood abuse (CA) have been reported among people with severe mental illness, but the content of psychotic symptoms is not generally considered pertinent to diagnosis and treatment. This study explores associations between CA and the content of adult psychotic symptoms. A sample of 30 respondents was selected from a larger study of individuals interviewed using standardized and open-ended questions to assess history of CA, and to elicit content of hallucinations and delusions (HD). Interviews included detailed descriptions of psychotic symptoms and CA experiences, which were coded using qualitative techniques. Based on a review of the research, we constructed a measure comprising nine categories of symptom content found to occur among individuals reporting CA (Threat, Somatic/Tactile, Olfactory, or Kinetic sensations, Real person involved, Fear, Malevolence, Sexuality, and Memories). This "trauma-relevant content score" was used to compare abused and nonabused groups, and was found to be higher among abused than nonabused respondents. Additionally, we examined parallels between interpersonal relationships described in HD and those experienced in the context of childhood trauma, using a multiple case study approach, and drawing on the Core Conflictual Relationship Theme (CCRT) method of analysis. Congruent patterns of interaction were identified in trauma and symptom descriptions of abused respondents. Implications for research and clinical practice include identifying symptom characteristics relevant to CA history, and developing a strategy to assess correspondence between individuals' trauma and symptom reports. Identification of trauma-relevant characteristics in symptom content can provide clinicians with an effective means of recognizing trauma-related illness.