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Early trauma as a risk factor for future psychotic disorder. Part I. Prevalence and methodological problems in research

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Biopsychosocial model of psychotic disorders accounts for the role of extrabiological environmental factors in their development. Early trauma (ET) is often viewed as a potential psychosocial risk factor for future development of psychosis. Prevalence of events considered as ET in general population is estimated at 4-30%, while among persons with mental disorders the phenomenon may concern even up to 50% of examinees. Research of correlations between ET with psychosis is fraught with several methodological problems. One of them is lack of precise and consistent definition of ET. Furthermore, sources of data and ways of their collection are also inconsistent (data from reports of appropriate agencies, past history and questionnaires obtained from the examinees). Studies dealing with the subject often lack control groups or their selection is inadequate, they do not provide for the so-called distracting factors in final statistical analyses. There are not enough prospective studies. The issue of diagnostic difficulties is also highlighted. Authors frequently do not specify the type, clinical phase or severity of psychotic disorders in examined subjects. Disorders possibly associated with ET experience require an in-depth differentiation with post-traumatic stress with dissociation disorders. Problems discussed here greatly delimit reaching of unambiguous conclusions and even may preclude a meta-analysis of hitherto performed studies. In some authors’ opinion, it is necessary to mark off a new category of psychotic disorders, i.e. post-traumatic psychosis. Typical features would be: trauma-associated content of symptoms (particularly auditory hallucinations), fluctuating depressive symptoms with suicidal ideation, abuse of psychoactive substances, poor effects of pharmacological treatment and favourable response to cognitive-behavioural therapy.

Słowa kluczowe
early trauma, childhood physical/sexual abuse, psychotic disorder, prevalence, methodological problems