Self-disgust mediates the relationship between childhood adversities and psychosis

Simpson, Jane and Helliwell, Benjamin and Varese, Filippo and Powell, Philip (2020) Self-disgust mediates the relationship between childhood adversities and psychosis. British Journal of Clinical Psychology, 59 (2). pp. 260-275. ISSN 0144-6657

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Abstract

Objective Traumatic events in childhood have been implicated in the development of psychosis, but given that trauma is not in itself sufficient to cause psychosis, researchers have started to investigate other psychological constructs potentially involved in explaining this relationship. Given that self‐disgust as a transdiagnostic construct plays a role in the development/maintenance of a range of mental health difficulties, the objective of this study was to investigate whether self‐disgust mediates the relationship between childhood trauma and psychosis. Method A cross‐sectional quantitative study design was used. Seventy‐eight participants (Mage = 37.64 years, SDage = 11.57 years; 77% women; 88% White Caucasian) who reported experiencing clinical levels of psychosis were recruited using social media. The participants completed online survey measures of childhood trauma, self‐disgust, experiences of psychosis, self‐esteem, and external shame. The data were analysed using correlation and mediation analyses. Results Significant indirect effects of childhood trauma on both positive (β = .17, BC 95% CI [0.06, 0.30]) and negative symptoms (β = .26, BC 95% CI [0.14, 0.40]) of psychosis via self‐disgust were observed. These effects remained despite the inclusion of self‐esteem and external shame as control variables in the mediation models. Conclusion This study is the first to show a mediating role for self‐disgust in the relationship between childhood trauma and later psychosis. Although the findings should be considered preliminary until strengthened by further research, they nevertheless provide corroboration of the potential utility of self‐disgust as a transdiagnostic construct not only from a theoretical perspective, but also from its potential to inform formulation and interventions. Practitioner points When assessing individuals with psychosis, especially those with a trauma history explore experiences and feelings related to the construct of self‐disgust. Such experiences are likely to centre on feelings of repulsion towards the self/need for distance and might also manifest in the content of their psychotic experiences. Individuals with significant levels or experiences of self‐disgust are likely to need specific interventions to address these; while interventions seeking to improve positive aspects of their identity might well be useful, they are unlikely to address the specific maladaptive elements of self‐disgust. While self‐disgust‐focused interventions have not been widely researched, limited current evidence suggests cognitive restructuring and affirmation techniques might be useful.