Research suggests that victimisation in childhood increases risk of psychotic disorders, such as schizophrenia or manic depression

People with psychosis report a marked excess of victimising experiences, many of which occurred during childhood, according to a new study.

Research suggests that adverse circumstances early in life may be more common in people who later develop psychotic disorders, such as schizophrenia or manic depression.

This study, published in the September issue of the British Journal of Psychiatry, used data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences.

Psychiatric disorders were identified through structured assessment of 8580 adults living in private households in Britain. Respondents were asked whether they had experienced selected events, which were displayed on cards.

The three areas covered included relationship problems, illness and bereavement; the employment and financial crises; and thirdly victimisation experiences. The victimisation experiences included sexual abuse, bullying, violence in the home, running away from home, time in a children’s institution, being expelled from school, being homeless or being a victim of serious illness, injury or assault

It was found that all but one of the experiences were reported significantly more frequently by people with psychotic disorders than by those with no psychiatric problems, the most frequent victimisation experience being sexual abuse. People with common mental disorders, alcohol dependence or drug dependence also had high rates of reporting such experiences.

In the case of each experience the relative risk was highest in the psychosis group, with one interesting exception: being expelled from school was not more frequent in the psychosis group than in the normal control group, but it was reported considerably more often in the alcohol-dependent group, and was particularly more frequent in the drug-dependent group.

The authors of the study comment that being expelled involves the response of school authorities to unacceptable behaviour, suggesting that people with psychosis might have been socially reticent in adolescence, in contrast to the early ‘acting-out’ behaviour of those with alcohol and drug misuse problems.

Research studies have previously suggested that maltreatment in early years may influence the development of schizophrenia, but equally that behavioural oddities in childhood may lead to maltreatment and be an early sign of developing schizophrenia. The authors conclude that there is an important social contribution to the causes of psychosis.

They suggest that clinicians should seek to establish the existence and relevance of victimising experiences in their patients. Cognitive-behavioural therapy for psychosis should continue to focus on the meaning of earlier traumas in relation to psychotic experiences.

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