Childhood Trauma in Clozapine-Resistant Schizophrenia: Prevalence, and Relationship With Symptoms

Robert Dudley*, Douglas Turkington, Naomi Coulthard, Melissa Pyle, Andrew Gumley, Matthias Schwannauer, David Kingdon, Anthony P. Morrison

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and Hypothesis: The role of early adversity and trauma is increasingly recognized in psychosis but treatments for trauma and its consequences are lacking. Psychological treatments need to understand the prevalence of these experiences, the relationship with specific symptoms and identify potentially tractable processes that may be targeted in therapy. It was hypothesized that greater adversity, and specifically abuse rather than neglect, would be associated with positive symptoms and specifically hallucinations. In addition, negative beliefs would mediate the relationship with positive symptoms. Study Design: 292 Patients with treatment resistant psychosis completed measures of early adversity as well as current symptoms of psychosis. Study Results: Early adversity in the form of abuse and neglect were common in one-third of the sample. Adversity was associated with higher levels of psychotic symptoms generally, and more so with positive rather than negative symptoms. Abuse rather than neglect was associated with positive but not with negative symptoms. Abuse rather than neglect was associated with hallucinations but not delusions. Abuse and neglect were related to negative beliefs about the self and negative beliefs about others. Mediation demonstrated a general relationship with adversity, negative-self, and other views and overall psychotic symptoms but not in relation to the specific experience of abuse and hallucinations. Females were more likely to be abused, but not neglected, than males. Conclusions: Whilst most relationships were modest, they supported previous work indicating that adversity contributes to people with psychosis experiencing distressing symptoms especially hallucinations. Treatments need to address and target adversity.

Original languageEnglish
Article numbersgad030
Number of pages10
JournalSchizophrenia Bulletin Open
Issue number1
Publication statusPublished - 1 Jan 2023

Bibliographical note

Funding Information:
This study/project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (10/101/02). The funder had no role in data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data and had final responsibility to submit for publication.

Funding Information:
We thank all the participants who agreed to take part in the trial. This study was supported by NHS Research Scotland, through the Chief Scientist Office and the Scottish Mental Health Research Network, and the Mental Health Research Network. We are grateful to the Psychosis Research Unit Service User Reference Group and the many researchers, network staff, and trial therapists who supported the study.

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.


  • childhood abuse
  • childhood neglect
  • psychosis
  • trauma

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