Top

Published in:

01-08-2017 | Original Article

Emotion Regulation Mediates the Relationship between a History of Child Abuse and Current PTSD/Depression Severity in Adolescent Females

Authors: Sufna G. John, Josh M. Cisler, Benjamin A. Sigel

Published in: Journal of Family Violence | Issue 6/2017

Abstract

Although experiencing child abuse (i.e., physical abuse, sexual abuse, exposure to violence) is associated with a variety of mental health difficulties, simple exposure to abuse does not produce symptoms in every individual. The current study explored emotion regulation as a mediator in the relationship between a history of child abuse and symptoms of posttraumatic stress and depression. Adolescent females (ages 11–17 years) were asked to retrospectively report on their exposure to child abuse, current symptoms of PTSD/depression, and emotion regulation abilities. Caregiver report of adolescent emotional difficulties was also obtained. Analyses revealed that child abuse-exposed females, when compared to females without a trauma history, had worse emotion regulation abilities and increased mental health difficulties. Moreover, emotion regulation significantly mediated the relationship between child abuse and all assessed mental health symptoms. These findings extend previous work from adult samples, underscoring the importance of assessing emotion regulation abilities in abuse-exposed youth.

Achenbach, T. M. (1991). Integrative guide to the 1991 CBCL/4–18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychology.

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237. doi:10.1016/j.cpr.2009.11.004.CrossRefPubMed

Alisic, E., Zalta, A. K., van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry, 204(5), 335–340. doi:10.1192/bjp.bp.113.131227.CrossRefPubMed

American Academy of Pediatrics (2015). Stages of Adolescence. Retrieved from https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx.

Arata, C. M., Langhinrichsen-Rohling, J., Bowers, D., & O’Farrill-Swails, L. (2005). Single versus multi-type maltreatment: An examination of the long-term effects of child abuse. Journal of Aggression, Maltreatment & Trauma, 11, 29–52. doi:10.1300/J146v11n04_02.CrossRef

Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. doi:10.1007/s10862-012-9280-y.CrossRef

Baron, R. M., & Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological-research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.1037//0022-3514.51.6.1173.CrossRefPubMed

Blakemore, S. (2008). The social brain in adolescence. Nature Reviews Neuroscience, 9, 267–277. doi:10.1038/nrn2353.CrossRefPubMed

Blakemore, S., & Choudhury, S. (2006). Development of the adolescent brain: Implications for executive function and social cognition. Journal of Child Psychology and Psychiatry, 47, 296–312. doi:10.1111/j.1469-7610.2006.01611.x.CrossRefPubMed

Blumenthal, H., Blanchard, L., Feldner, M. T., Babson, K. A., Leen-Feldner, E. W., & Dixon, L. (2008). Traumatic event exposure, posttraumatic stress, and substance use among youth: A critical review of the empirical literature. Current Psychiatry Reviews, 4, 228–254. doi:10.2174/157340008786576562.CrossRef

Briere, J., & Jordan, C. E. (2009). Childhood maltreatment, intervening variables, and adult psychological difficulties in women: An overview. Trauma, Violence & Abuse, 10, 375–388. doi:10.1177/1524838009339757.CrossRef

Bryant, R. A., Mastrodomenico, J. J., Hopwood, S. S., Kenny, L. L., Cahill, C. C., Kandris, E. E., & Taylor, K. K. (2013). Augmenting cognitive behaviour therapy for post-traumatic stress disorder with emotion tolerance training: A randomized controlled trial. Psychological Medicine, 43(10), 2153–2160. doi:10.1017/S0033291713000068.CrossRefPubMed

Choi, J., & Oh, K. (2014). Cumulative childhood trauma and psychological maladjustment of sexually abused children in Korea: Mediating effects of emotion regulation. Child Abuse and Neglect, 38(2), 296–303. doi:10.1016/j.chiabu.2013.09.009.CrossRefPubMed

Cisler, J. M., Amstadter, A. B., Begle, A. M., Resnick, H. S., Danielson, C. K., & Saunders, B. E. (2011a). A prospective examination of the relationships between PTSD, exposure to assaultive violence, and cigarette smoking among a national sample of adolescents. Addictive Behaviors, 36(10), 994–1000. doi:10.1016/j.addbeh.2011.05.014.CrossRefPubMedPubMedCentral

Cisler, J. M., Amstadter, A. B., Begle, A. M., Resnick, H. S., Danielson, C. K., & Saunders, B. E. (2011b). PTSD symptoms, potentially traumatic event exposure, and binge drinking: A prospective study with a national sample of adolescents. Journal of Anxiety Disorders, 25(7), 978–987. doi:10.1016/j.janxdis.2011.06.006.CrossRefPubMedPubMedCentral

Cisler, J. M., Begle, A. M., Amstadter, A. B., Resnick, H. S., Danielson, C. K., & Saunders, B. E. (2012). Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: Data from the NSA-R. Journal of Traumatic Stress, 25(1), 33–40. doi:10.1002/jts.21672.CrossRefPubMedPubMedCentral

Cisler, J. M., Sigel, B. A., Steele, J. S., Smitherman, S., Vanderzee, K., Pemberton, J., Kramer, T.L., & Kilts, C. D. (2016). Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder. Psychological Medicine, 46(14), 3013–3023. doi:10.1017/S0033291716001847.

Cloitre, M., Stovall-McClough, K., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., Gan, W., & Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. The American Journal of Psychiatry, 167(8), 915–924. doi:10.1176/appi.ajp.2010.09081247.CrossRefPubMed

Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36(6), 528–541. doi:10.1016/j.chiabu.2012.03.007.CrossRef

Crow, T., Cross, D., Powers, A., & Bradley, B. (2014). Emotion dysregulation as a mediator between childhood emotional abuse and current depression in a low-income African-American sample. Child Abuse & Neglect. doi:10.1016/j.chiabu.2014.05.015.

Donnelly, C., & Amaya-Jackson, L. (2004). Pediatric post-traumatic stress disorder. In J. Weiner & M. Dulcan (Eds.), The American Psychiatric Publishing textbook of child and adolescent Psychiatry (3rd ed.). Washington, DC: American Psychiatric Publishing.

Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: The role of trauma type and ptsd symptom severity. Behavior Therapy, 41(4), 587–598. doi:10.1016/j.beth.2010.04.004.CrossRefPubMed

Fairholme, C. P., Nosen, E. L., Nillni, Y. I., Schumacher, J. A., Tull, M. T., & Coffey, S. F. (2013). Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample. Behaviour Research and Therapy, 51(9), 540–546. doi:10.1016/j.brat.2013.05.014.CrossRefPubMedPubMedCentral

Foa, E., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alvarez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical, 70, 1022–1028. doi:10.1037//0022-006X.70.4.1022.CrossRef

Goldsmith, R. E., Chesney, S. A., Heath, N. M., & Barlow, M. (2013). Emotion regulation difficulties mediate associations between betrayal trauma and symptoms of posttraumatic stress, depression, and anxiety. Journal of Traumatic Stress, 26(3), 376–384. doi:10.1002/jts.21819.CrossRefPubMed

Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38(3), 256–268. doi:10.1016/j.beth.2006.08.006.CrossRefPubMed

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–55. doi:10.1023/B:JOBA.0000007455.08539.94.CrossRef

Greeson, J., Briggs, E., Layne, C., Belcher, H., Ostrowski, S., Kim, S., Lee, R., Vivrette, R., Pynoos, R., & Fairbank, J. (2014). Traumatic childhood experiences in the 21st century: Broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. Journal of Interpersonal Violence, 29(3), 536–556. doi:10.1177/0886260513505217.CrossRefPubMed

Greif Green, J., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication. I: Associations with first onset of DSM–IV disorders. Archives of General Psychiatry, 67, 113–123. doi:10.1001/archgenpsychiatry.2009.186.CrossRef

Herts, K. L., McLaughlin, K. A., & Hatzenbuehler, M. L. (2012). Emotion dysregulation as a mechanism linking stress exposure to adolescent aggressive behavior. Journal of Abnormal Child Psychology, 40(7), 1111–1122. doi:10.1007/s10802-012-9629-4.CrossRefPubMedPubMedCentral

Jørgensen, M., Zachariae, R., Skytthe, A., & Kyvik, K. (2007). Genetic and environmental factors in alexithymia: A population-based study of 8,785 Danish twin pairs. Psychotherapy and Psychosomatics, 76(6), 369–375. doi:10.1159/000107565.CrossRefPubMed

Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., & Moreci, P. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988. doi:10.1097/00004583-199707000-00021.CrossRefPubMed

Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68(1), 19–30. doi:10.1037//0022-006X.68.1.19.CrossRefPubMed

Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the National Survey of adolescents. Journal of Consulting and Clinical Psychology, 71(4), 692–700. doi:10.1037/0022-006X.71.4.692.CrossRefPubMed

Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51, 706–716. doi:10.1111/j.1469-7610.2009.02202.x.CrossRefPubMed

Kolassa, I. T., Ertl, V., Eckart, C., Glockner, F., Kolassa, S., & Papassotiropoulos, A. (2010a). Association study of trauma load and SLC6A4 promoter polymorphism in posttraumatic stress disorder: Evidence from survivors of the Rwandan genocide. Journal of Clinical Psychiatry, 71(5), 543–547. doi:10.4088/JCP.08m04787blu.CrossRefPubMed

Kolassa, I. T., Kolassa, S., Ertl, V., Papassotiropoulos, A., & De Quervain, D. J. (2010b). The risk of posttraumatic stress disorder after trauma depends on traumatic load and the catechol-o-methyltransferase Val(158)met polymorphism. Biological Psychiatry, 67(4), 304–308. doi:10.1016/j.biopsych.2009.10.009.CrossRefPubMed

Kring, A. M., & Werner, K. H. (2004). Emotion regulation and psychopathology. In P. Philippot & R. S. Feldman (Eds.), The regulation of emotion (pp. 359–385). Mahwah, New Jersey: Lawrence Erlbaum Associates Publishers.

Larson, R., & Richards, M. H. (1991). Daily companionship in late childhood and early adolescence: Changing developmental contexts. Child Development, 62, 284–300. doi:10.2307/1131003.CrossRefPubMed

Lenow, J. K., Steele, J. S., Smitherman, S., Kilts, C. D., & Cisler, J. M. (2014). Attenuated behavioral and brain responses to trust violations among child abused adolescent girls. Psychiatry Research: Neuroimaging, 223, 1–8. doi:10.1016/j.pscychresns.2014.04.005.CrossRefPubMedPubMedCentral

Lilly, M. M., & Lim, B. (2013). Shared pathogeneses of posttrauma pathologies: Attachment, emotion regulation, and cognitions. Journal of Clinical Psychology, 69(7), 737–748. doi:10.1002/jclp.21934.CrossRefPubMed

MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. doi:10.1146/annurev.psych.58.110405.085542.CrossRefPubMedPubMedCentral

McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and Therapy, 49(9), 544–554. doi:10.1016/j.brat.2011.06.003.CrossRefPubMedPubMedCentral

Patton, G., Coffey, C., Romaniuk, H., Mackinnon, A., Carlin, J., Degenhardt, L., Olsson, C., & Moran, P. (2014). The prognosis of common mental disorders in adolescents: A 14-year prospective cohort study. The Lancet, 383, 1404–1411. doi:10.1016/S0140-6736(13)62116-9.CrossRef

Paus, T., Keshavan, M., & Giedd, J. N. (2008). Why do many psychiatric disorders emerge during adolescence? Nature Reviews Neuroscience, 9, 947–957. doi:10.1038/nrn2513.PubMedPubMedCentral

Picardi, A., Fagnani, C., Gigantesco, A., Toccaceli, V., Lega, I., & Stazi, M. (2011). Genetic influences on alexithymia and their relationship with depressive symptoms. Journal of Psychosomatic Research, 71(4), 256–263. doi:10.1016/j.jpsychores.2011.02.016.CrossRefPubMed

Pollak, S. D., & Sinha, P. (2002). Effects of early experience on children's recognition of facial displays of emotion. Developmental Psychology, 38(5), 784–791. doi:10.1037/0012-1649.38.5.784.CrossRefPubMed

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.CrossRefPubMed

Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., & Rogers, J. E. (2010). Reliability and validity of the Mini international neuropsychiatric interview for children and adolescents (MINI-KID). Journal of Clinical Psychiatry, 71(3), 313–326. doi:10.4088/JCP.09m05305whi.CrossRefPubMed

Shipman, K. L., Schneider, R., Fitzgerald, M. M., Sims, C., Swisher, L., & Edwards, A. (2007). Maternal emotion socialization in maltreating and non-maltreating families: Implications for children's emotion regulation. Social Development, 16(2), 268–285. doi:10.1111/j.1467-9507.2007.00384.x.CrossRef

Shipman, K., Zeman, J., Penza, S., & Champion, K. (2000). Emotion management skills in sexually maltreated and nonmaltreated girls: A developmental psychopathology perspective. Development and Psychopathology, 12(1), 47–62. doi:10.1017/S0954579400001036.CrossRefPubMed

Spinrad, T., Eisenberg, N., Cumberland, A., Fabes, R., Valiente, C., Shepard, S., Reiser, M., Losoya, S., & Guthrie, I. (2006). Relation of emotion-related regulation to children's social competence: A longitudinal study. Emotion, 6, 498–510. doi:10.1037/1528-3542.6.3.498.CrossRefPubMedPubMedCentral

Steinberg, L., & Avenevoli, S. (2000). The role of context in the development of psychopathology: A conceptual framework and some speculative propositions. Child Development, 71, 66–74. doi:10.1111/1467-8624.00119.CrossRefPubMed

Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder Reaction Index. Current Psychiatry Reports, 6(2), 96–100. doi:10.1007/s11920-004-0048-2.CrossRefPubMed

Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ippen, C. G., & Ostrowski, S. A. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress, 26(1), 1–9. doi:10.1002/Jts.21780.CrossRefPubMed

Sundermann, J. M., & DePrince, A. P. (2015). Maltreatment characteristics and emotion regulation (ER) difficulties as predictors of mental health symptoms: Results from a community-recruited sample of female adolescents. Journal of Family Violence, 30(3), 329–338. doi:10.1007/s10896-014-9656-8.CrossRef

Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38, 303–313. doi:10.1016/j.beth.2006.10.001.CrossRefPubMed

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2015). Child Maltreatment 2013. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

Ullman, S. E., Peter-Hagene, L. C., & Relyea, M. (2014). Coping, emotion regulation, and self-blame as mediators of sexual abuse and psychological symptoms in adult sexual assault. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations For Victims, Survivors, & Offenders, 23(1), 74–93. doi:10.1080/10538712.2014.864747.CrossRef

Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621. doi:10.1037/a0016669.CrossRefPubMed

Weiss, N. H., Tull, M. T., Viana, A. G., Anestis, M. D., & Gratz, K. L. (2012). Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. Journal of Anxiety Disorders, 26(3), 453–458. doi:10.1016/j.janxdis.2012.01.007.CrossRefPubMedPubMedCentral

Title: Emotion Regulation Mediates the Relationship between a History of Child Abuse and Current PTSD/Depression Severity in Adolescent Females
Authors: Sufna G. John
Josh M. Cisler
Benjamin A. Sigel
Publication date: 01-08-2017
Publisher: Springer US
Published in: Journal of Family Violence / Issue 6/2017
Print ISSN: 0885-7482
Electronic ISSN: 1573-2851
DOI: https://doi.org/10.1007/s10896-017-9914-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Emotion Regulation Mediates the Relationship between a History of Child Abuse and Current PTSD/Depression Severity in Adolescent Females

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2017

Associations Between Experiencing and Witnessing Physical and Psychological Abuse and Internalizing and Externalizing Problems in Yemeni Children

Making Connections across 30 Years of Family Violence Research: an Introductory Editorial

Pilot Study of a Group-Based Psychosocial Trauma Recovery Program in Secure Accommodation in Scotland

Child Maltreatment and Intimate Partner Violence Among Indigenous and Non-Indigenous Canadians

Canada’s First Integrated Domestic Violence Court: Examining Family and Criminal Court Outcomes at the Toronto I.D.V.C.

Adverse Childhood Experiences Affect Health Risk Behaviors and Chronic Health of Iowans