Skip to main content Accessibility help

The association between psychotic experiences and traumatic life events: the role of the intention to harm

  • Tais Silveira Moriyama (a1) (a2) (a3) (a4), Marjan Drukker (a4), Ary Gadelha (a2) (a3), Pedro Mario Pan (a2) (a3), Giovanni Abrahão Salum (a3) (a5), Gisele Gus Manfro (a3) (a5), Jair de Jesus Mari (a2) (a3), Eurípedes Constantino Miguel (a3) (a6), Luis Augusto Rohde (a3) (a5), Guilherme Vanoni Polanczyk (a3) (a6), Jim van Os (a4) (a7) (a8) and Rodrigo Affonseca Bressan (a2) (a3) (a7)...



Previous work showed traumatic life events (TLE) with intention to harm, like bullying and abuse, to be more strongly associated with psychotic experiences (PE) than other types of trauma, like accidents. However, this association is subject to reporting bias and can be confounded by demographic characteristics and by differences in dose of exposure across different trauma categories. We studied the association between TLE with and without intention to harm and PE, taking into account potential confounders and biases.


A total of 2245 children and adolescents aged 6–14 years were interviewed by psychologists. The interview included the presence of 20 PE (both self-report and psychologist evaluation). In addition, parents provided information on child exposure to trauma, mental health and PE.


Results showed no significant association between TLE without intention to harm only and PE for the three methods of assessment of PE (self-report, parent report and psychologist rating). On the other hand, there was a positive association between PE and TLE in groups exposed to traumatic experiences with intention to harm (with intention to harm only and with and without intention to harm). Results remained significant after controlling for demographic and clinical confounders, but this positive association was no longer significant after adjusting for the number of TLE.


TLE with intention to harm display a stronger association with PE than TLE without intention to harm, and this difference is likely reducible to a greater level of traumatic exposure associated with TLE with intention to harm.


Corresponding author

Author for correspondence: Jim van Os, E-mail:,


Hide All
Amorim, P, Lecrubier, Y, Weiller, E, Hergueta, T and Sheehan, D (1998) DSM-IH-R psychotic disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. European Psychiatry 13, 2634.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE and Caspi, A (2011) Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Associação Brasileira de Empresas de Pesquisa (2012) Critério de Classificação Econômica Brasil – Alterações na aplicação do Critério Brasil, válidas a partir de 01/01/2013. Available at (Accessed 19 September 2017).
Barrigon, ML, Diaz, FJ, Gurpegui, M, Ferrin, M, Salcedo, MD, Moreno-Granados, J et al. (2015) Childhood trauma as a risk factor for psychosis: a sib-pair study. Journal of Psychiatric Research 70, 130136.
Bartels-Velthuis, AA, van de Willige, G, Jenner, JA, van Os, J and Wiersma, D (2011) Course of auditory vocal hallucinations in childhood: 5-year follow-up study. British Journal of Psychiatry 199, 296302.
Bernstein, DP, Ahluvalia, T, Pogge, D and Handelsman, L (1997) Validity of the childhood trauma questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry 36, 340348.
Bordin, IA, Rocha, MM, Paula, CS, Teixeira, MC, Achenbach, TM, Rescorla, LA et al. (2013) Child behavior checklist (CBCL), youth self-report (YSR) and teacher's report form (TRF): an overview of the development of the original and Brazilian versions. Cadernos de Saúde Publica 29, 1328.
Bourque, F, van der Ven, E and Malla, A (2011) A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 41, 897910.
Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC and Andreski, P (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626632.
Caspi, A, McClay, J, Moffitt, TE, Mill, J, Martin, J, Craig, IW et al. (2002) Role of genotype in the cycle of violence in maltreated children. Science 297, 851854.
Caspi, A, Sugden, K, Moffitt, TE, Taylor, A, Craig, IW, Harrington, H et al. (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 301, 386389.
Dong, M, Anda, RF, Felitti, VJ, Dube, SR, Williamson, DF, Thompson, TJ et al. (2004) The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse and Neglect 28, 771784.
Figueiredo, VLM (2001) Uma adaptação brasileira do teste de inteligência WISC-III. Brasília, DF: Curso de Pós-Graduação em Psicologia, Instituto de Psicologia – Universidade de Brasília.
Finkelhor, D, Ormrod, RK and Turner, HA (2007) Poly-victimization: a neglected component in child victimization. Child Abuse and Neglect 31, 726.
Fisher, HL, Schreier, A, Zammit, S, Maughan, B, Munafo, MR, Lewis, G et al. (2013) Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin 39, 10451055.
Fleitlich-Bilyk, B and Goodman, R (2004) Prevalence of child and adolescent psychiatric disorders in southeast Brazil. Journal of the American Academy of Child and Adolescent Psychiatry 43, 727734.
Goodman, R, Ford, T, Richards, H, Gatward, R and Meltzer, H (2000 a) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines 41, 645655.
Goodman, R, Ford, T, Simmons, H, Gatward, R and Meltzer, H (2000 b) Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry 177, 534539.
Guloksuz, S, van Nierop, M, Lieb, R, van Winkel, R, Wittchen, HU and van Os, J (2015) Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology. Psychological Medicine 45, 23892401.
Harley, M, Kelleher, I, Clarke, M, Lynch, F, Arseneault, L, Connor, D et al. (2010) Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychological Medicine 40, 16271634.
Herman, JP, Figueiredo, H, Mueller, NK, Ulrich-Lai, Y, Ostrander, MM, Choi, DC et al. (2003) Central mechanisms of stress integration: hierarchical circuitry controlling hypothalamo-pituitary-adrenocortical responsiveness. Frontiers in Neuroendocrinology 24, 151180.
Isvoranu, AM, Borsboom, D, Van Os, J and Guloksuz, S (2016) A network approach to environmental impact in psychotic disorder: brief theoretical framework. Schizophrenia Bulletin 42, 870873.
Kelleher, I and Cannon, M (2011) Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychological Medicine 41, 16.
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harley, M and Cannon, M (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 18571863.
Kelleher, I, Harley, M, Lynch, F, Arseneault, L, Fitzpatrick, C and Cannon, M (2008) Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. British Journal of Psychiatry 193, 378382.
Kelleher, I, Keeley, H, Corcoran, P, Ramsay, H, Wasserman, C, Carli, V et al. (2013) Childhood trauma and psychosis in a prospective cohort study: cause, effect, and directionality. American Journal of Psychiatry 170, 734741.
Kieling, C, Hutz, MH, Genro, JP, Polanczyk, GV, Anselmi, L, Camey, S et al. (2013) Gene-environment interaction in externalizing problems among adolescents: evidence from the Pelotas 1993 Birth Cohort Study. Journal of Child Psychology and Psychiatry and Allied Disciplines 54, 298304.
Konings, M, Bak, M, Hanssen, M, van Os, J and Krabbendam, L (2006) Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica 114, 5561.
Krishnan, V, Han, MH, Graham, DL, Berton, O, Renthal, W, Russo, SJ et al. (2007) Molecular adaptations underlying susceptibility and resistance to social defeat in brain reward regions. Cell 131, 391404.
Lataster, T, van Os, J, Drukker, M, Henquet, C, Feron, F, Gunther, N et al. (2006) Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: victimisation and non-clinical psychotic experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423428.
Lee, KW, Chan, KW, Chang, WC, Lee, EH, Hui, CL and Chen, EY (2016) A systematic review on definitions and assessments of psychotic-like experiences. Early Intervention in Psychiatry 10, 316.
Linscott, RJ and van Os, J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 11331149.
Mackie, CJ, Castellanos-Ryan, N and Conrod, PJ (2011) Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
Matheson, SL, Shepherd, AM, Pinchbeck, RM, Laurens, KR and Carr, VJ (2013) Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225238.
Norman, RE, Byambaa, M, De, R, Butchart, A, Scott, J and Vos, T (2012) The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Medicine 9, e1001349.
Norman, RM and Malla, AK (1993 a) Stressful life events and schizophrenia. I: a review of the research. The British Journal of Psychiatry: the Journal of Mental Science 162, 161166.
Norman, RM and Malla, AK (1993 b) Stressful life events and schizophrenia. II: conceptual and methodological issues. The British Journal of Psychiatry: the Journal of Mental Science 162, 166174.
Polanczyk, G, Moffitt, TE, Arseneault, L, Cannon, M, Ambler, A, Keefe, RS et al. (2010) Etiological and clinical features of childhood psychotic symptoms: results from a birth cohort. Archives of General Psychiatry 67, 328338.
Ribeiro, WS, de Jesus Mari, J, Quintana, MI, Dewey, ME, Evans-Lacko, S, Vilete, LM et al. (2013) The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil. PLoS ONE 8, e63545.
Salum, GA, DeSousa, DA, Manfro, GG, Pan, PM, Gadelha, A, Brietzke, E et al. (2016) Measuring child maltreatment using survey data: a multi-informant higher-order confirmatory factor analysis. Trends in Psychiatry Psychotherapy 38, 2332.
Salum, GA, Gadelha, A, Pan, PM, Moriyama, TS, Graeff-Martins, AS, Tamanaha, AC et al. (2015) High risk cohort study for psychiatric disorders in childhood: rationale, design, methods and preliminary results. International Journal of Methods in Psychiatric Research 24, 5873.
Schreier, A, Wolke, D, Thomas, K, Horwood, J, Hollis, C, Gunnell, D et al. (2009) Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Selten, JP and Cantor-Graae, E (2005) Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101102.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E et al. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59(Suppl. 20), 2233; quiz 34–57.
Snijders, T and Bosker, R (1999) Multilevel Analysis, an Introduction to Basic and Advanced Modeling. London: SAGE Publications.
StataCorp (2013) Stata Statistical Software. College Station, TX: StataCorp LP.
Stowkowy, J and Addington, J (2012) Maladaptive schemas as a mediator between social defeat and positive symptoms in young people at clinical high risk for psychosis. Early Intervention in Psychiatry 6, 8790.
Suliman, S, Mkabile, SG, Fincham, DS, Ahmed, R, Stein, DJ and Seedat, S (2009) Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry 50, 121127.
Tellegen, A and Briggs, PF (1967) Old wine in new skins: grouping Wechsler subtests into new scales. Journal of Consulting Psychology 31, 499506.
Thierry, AM, Tassin, JP, Blanc, G and Glowinski, J (1976) Selective activation of mesocortical DA system by stress. Nature 263, 242244.
Turner, HA, Finkelhor, D and Ormrod, R (2010) Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine 38, 323330.
van Nierop, M, Lataster, T, Smeets, F, Gunther, N, van Zelst, C, de Graaf, R et al. (2014 a) Psychopathological mechanisms linking childhood traumatic experiences to risk of psychotic symptoms: analysis of a large, representative population-based sample. Schizophrenia Bulletin 40(Suppl. 2), S123S130.
van Nierop, M, van Os, J, Gunther, N, van Zelst, C, de Graaf, R, ten Have, M et al. (2014 b) Does social defeat mediate the association between childhood trauma and psychosis? Evidence from the NEMESIS-2 study. Acta Psychiatrica Scandinavica 129, 467476.
van Os, J and Guloksuz, S (2017) A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry 16, 200206.
van Os, J, Kenis, G and Rutten, BP (2010) The environment and schizophrenia. Nature 468, 203212.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W et al. (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Vassos, E, Pedersen, CB, Murray, RM, Collier, DA and Lewis, CM (2012) Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 38, 11181123.
Wechsler, D (2002) WISC-III: Escala de Inteligência Wechsler para Crianças: Manual. São Paulo: Casa do Psicólogo.
Weissman, MM, Wickramaratne, P, Adams, P, Wolk, S, Verdeli, H and Olfson, M (2000) Brief screening for family psychiatric history: the family history screen. Archives of General Psychiatry 57, 675682.


Type Description Title
Supplementary materials

Moriyama et al. supplementary material 1
Moriyama et al. supplementary material

 Word (22 KB)
22 KB
Supplementary materials

Moriyama et al. supplementary material 2
Moriyama et al. supplementary material

 Word (20 KB)
20 KB
Supplementary materials

Moriyama et al. supplementary material 3
Moriyama et al. supplementary material

 Word (25 KB)
25 KB
Supplementary materials

Moriyama et al. supplementary material 4
Moriyama et al. supplementary material

 Word (24 KB)
24 KB
Supplementary materials

Moriyama et al. supplementary material 5
Moriyama et al. supplementary material

 Word (24 KB)
24 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed