Article summary with A tangled start: The link between childhood maltreatment, psychopathology, and relationships in adulthood by Shahab a.o. - 2021

Introduction

Childhood maltreatment is an important public health concern impacting both the individual and the relation with others. Four categories of childhood maltreatment are distinguished: physical abuse, sexual abuse, psychological/emotional abuse, and neglect.

Adults with a history of childhood maltreatment are more likely to experience interpersonal relationship difficulties such as distrust, feeling distant from others, and developing insecure attachments style which influence relationship quality. Childhood maltreatment has also been linked to several mental health problems including depression, anxiety, and alcohol dependence severity.

Seeing as some, but not all, people who experience childhood maltreatment have difficulties in adult intimate relationships highlights the complexity of the association between maltreatment and interpersonal relationships in adulthood and indicates that other variables moderate/mediate this association. A potential mediator is adult attachment style. Studies have found that the relationship is mediated partially by avoidant and anxious-ambivalent attachment styles in adulthood. Moreover, negative emotions are more frequent in adults with both anxious and avoidant attachment styles than in securely attached adults, and these negative emotions may lead to additional problems in relationships. Several studies suggest that mental health problems may also mediate the relationship between childhood maltreatment and the quality of intimate relationships.

Altogether, research suggests that symptoms of depression, anxiety, alcohol abuse, and insecure attachment in adulthood may play a role in the diminished quality of intimate relationships in adulthood among individuals with a history of childhood maltreatment.

In order to better understand the association between childhood maltreatment, insecure attachment styles, and the quality of intimate relationships in adulthood, this study aimed to investigate the link between childhood maltreatment, insecure attachment patterns, and the quality of intimate relationships, and to what extent depression, anxiety, and alcohol dependence severity and insecure attachment styles mediate the association between childhood maltreatment and the quality of intimate relationships. This will be done by using the Netherlands Study of Depression and Anxiety (NESDA), a longitudinal epidemiological study designed to investigate the course and consequences of depressive and anxiety disorders.

Methods

Sample

The NESDA is an on-going longitudinal cohort study in depression and anxiety. Including 2981 respondents between the ages of 18-65. Participants underwent an assessment consisting of demographics, a standardized psychiatric interview, a structured interview on childhood maltreatment, and assessment of personality characteristics. Post baseline respondents were invited for five follow up waves (FU1, FU2, FU4, FU6, and FU9). For the present study, a total of 2035 respondents who had a current or previous relationship were selected after the 9-year follow-up.

Measures

• Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), a validated, 28-item self-report questionnaire that assesses emotional and physical neglect, psychological, physical, and sexual abuse. It contains five subscales: three assessing abuse (emotional, physical, and sexual, each of 5 items) and two assessing neglect (emotional and physical, each of 5 items).
• Psychological distress was assessed using the 30-item Inventory of Depressive Symptomatology self-report (IDS-SR). It uses a four-point Likert scale (i.e., feeling sad) and a 7-day timeframe for assessing symptom severity.
• Anxiety severity was assessed using the Beck Anxiety Inventory (BAI), which is a self-report instrument consisting of 21 items. Respondents are asked to indicate how much they had been bothered by each mentioned symptom over the past week using a four-point scale.
• Alcohol dependence symptom severity was assessed using the 10-item Alcohol Use Disorder Identification Test (AUDIT), a self-report questionnaire. Respondents rate how often they have consumed alcohol in the past year, how much they consumed on average, and how often they experienced negative consequences of alcohol use.
• Insecure attachment styles were measured with the Experiences of Close Relationship Scale – Short Version (ECR-S). It consists of 12 items that are designed to assess individual differences with respect to avoidance and anxiety attachment styles.
• The Revised Dyadic Adjustment Scale (R-DAS) is a self-report questionnaire that assess partner relationships in three categories: consensus, satisfaction, and cohesion.

Results

• Model 1 (crude): showed a positive association between childhood maltreatment and anxious attachment as well as avoidant attachment.
• Model 2 (including demographics): showed a significant positive association for anxious attachment and avoidance attachment.
• Model 3 (including partner status and mean duration of relationship): showed a significant positive association for anxious attachment and avoidance attachment.
• Childhood maltreatment was also negatively associated with the quality of intimate relationships in model 1.

The overall model showed an acceptable fit and suggested full mediation of the association of childhood maltreatment with quality of intimate relationships by depression severity and anxious attachment and avoidant attachment. Anxiety and alcohol dependence severity were not significant mediators.

Discussion & Conclusion

This study found an association between childhood maltreatment and the quality of intimate relationships in adulthood and gained a better understanding on how maltreatment and psychopathology are associated with relationship quality in adulthood. Individuals reporting more childhood maltreatment also manifest more insecure attachment patterns and their intimate relationships in adulthood are generally of lower quality. Findings also indicate that there may be two typical pathways:

1. The strongest pathway links childhood maltreatment to increased depression severity, anxious attachment, and lower quality of intimate relationships.
2. The second pathway links childhood maltreatment to depression severity and avoidant attachment. which is quite strongly associated with lower quality of intimate relationships.

In this sample, alcohol dependence severity was only associated with anxious but not avoidant attachment. While childhood maltreatment has been identified as an important risk factor for excessive alcohol use and alcohol use problems in some studies, not all studies found these associations. Furthermore, attachment styles may play a role in the quality of intimate relationships, the reverse may also be the case: a solid and loving relationship may also play a role on attachment styles and longer lasting relationships may yield a stronger sense of secure attachment.

Based on the richness of the NESDA study, with a large sample including healthy participants and individuals with psychological issues, adds clinically relevant insights to the literature. these findings can have clinical implications, by informing parents, teachers, general practitioners, and the general public about the possible destructive impact of childhood maltreatment on mental wellbeing and intimate relations, may lead to better recognition and earlier detection.

In conclusion, the study suggests that

1. Intimate relationships are generally of lower quality in individuals with a history of childhood maltreatment
2. Depression and insecure attachment styles fully mediate the relationship between childhood maltreatment and the quality of intimate relationships in adulthood

Future studies may consider looking more closely at respondents with severe alcohol use in order to better understand the impact it may have on relationships in adulthood. Future long-term longitudinal studies that focus on different types of childhood maltreatment are imperative to the literature to further elucidate the impact effects of different types of childhood maltreatment on adult attachment styles and quality of relationship.