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The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder

Published online by Cambridge University Press:  24 February 2010

H. L. Fisher*
Institute of Psychiatry, King's College London, UK
P. B. Jones
Department of Psychiatry, University of Cambridge, UK
P. Fearon
Institute of Psychiatry, King's College London, UK
T. K. Craig
Institute of Psychiatry, King's College London, UK
P. Dazzan
Institute of Psychiatry, King's College London, UK National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
K. Morgan
Department of Psychology, Westminster University, London, UK
G. Hutchinson
Psychiatry Unit, Faculty of Medical Sciences, University of the West Indies, Trinidad
G. A. Doody
Division of Psychiatry, University of Nottingham, UK
P. McGuffin
Institute of Psychiatry, King's College London, UK
J. Leff
Institute of Psychiatry, King's College London, UK
R. M. Murray
Institute of Psychiatry, King's College London, UK National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
C. Morgan
Institute of Psychiatry, King's College London, UK National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
*Address for correspondence: H. L. Fisher, Ph.D., PO 80 MRC SGDP Centre, Institute of Psychiatry, De Crespigny Park, LondonSE5 8AF, UK. (Email:



Childhood adversity has been associated with onset of psychosis in adulthood but these studies have used only general definitions of this environmental risk indicator. Therefore, we sought to explore the prevalence of more specific adverse childhood experiences amongst those with and without psychotic disorders using detailed assessments in a large epidemiological case-control sample (AESOP).


Data were collected on 182 first-presentation psychosis cases and 246 geographically matched controls in two UK centres. Information relating to the timing and frequency of exposure to different types of childhood adversity (neglect, antipathy, physical and sexual abuse, local authority care, disrupted living arrangements and lack of supportive figure) was obtained using the Childhood Experience of Care and Abuse Questionnaire.


Psychosis cases were three times more likely to report severe physical abuse from the mother that commenced prior to 12 years of age, even after adjustment for other significant forms of adversity and demographic confounders. A non-significant trend was also evident for greater prevalence of reported severe maternal antipathy amongst those with psychosis. Associations with maternal neglect and childhood sexual abuse disappeared after adjusting for maternal physical abuse and antipathy. Paternal maltreatment and other forms of adversity were not associated with psychosis nor was there evidence of a dose–response effect.


These findings suggest that only specific adverse childhood experiences are associated with psychotic disorders and only in a minority of cases. If replicated, this greater precision will ensure that research into the mechanisms underlying the pathway from childhood adversity to psychosis is more fruitful.

Original Articles
Copyright © Cambridge University Press 2010

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