Cited by 1,574Child Abuse and TraumaChild Welfare and AdoptionChild and Adolescent Psychosocial and Emotional Development

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Validity of the Childhood Trauma Questionnaire in an Adolescent Psychiatric Population

BERNSTEIN, DAVID P., AHLUVALIA, TARUNA, POGGE, DAVID, HANDELSMAN, LEONARD·1997·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/00004583-199703000-00012

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Abstract

Objective To present initial findings on the validity of a recently developed maltreatment inventory, the Childhood Trauma Questionnaire (CTQ), in a sample of adolescent psychiatric patients.Method Three hundred ninety-eight male and female adolescents (aged 12 to 17 years) admitted to the inpatient service of a private psychiatric hospital were given the CTQ as part of a larger test battery. Structured interviews were also conducted with the primary therapists of 190 of the patients to obtain ratings of abuse and neglect based on all available data, including clinical interviews with patients and their relatives and information from referring clinicians and agencies.Results Principal-components analysis of the CTQ items yielded five rotated factors-emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect-closely replicating the factor structure in an earlier study of adult patients. The internal consistency of the CTQ factors was extremely high both in the entire sample and in every subgroup examined. When CTQ factor scores were compared with therapists' ratings in a series of logistic regression analyses, relationships between the two sets of variables were highly specific, supporting the convergent and discriminant validity of the CTQ. Finally, when therapists' ratings were used as the validity criterion, the CTQ exhibited good sensitivity for all forms of maltreatment, and satisfactory or better levels of specificity.Conclusions These initial findings suggest that the CTQ is a sensitive and valid screening questionnaire for childhood trauma in an adolescent psychiatric inpatient setting.

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Clinical, Research and Treatment Approaches to Affective Disorders
Juruena, M. F. (2012) · InTech eBooks · doi:10.5772/1482 · Cited by 14
An Investigation of the Impact of Childhood Trauma on Quality of Caregiving in High Risk Mothers: Does Maternal Substance Misuse Confer Additional Risk?
Hatzis, D., Dawe, S., Harnett, P. H., & Loxton, N. J. (2019) · Child Psychiatry & Human Development · doi:10.1007/s10578-019-00886-5 · Cited by 14
Microstructural integrity of white matter moderates an association between childhood adversity and adult trait anger
Kim, M. J., Elliott, M. L., d’Arbeloff, T. C., Knodt, A. R., Radtke, S. R., Brigidi, B. D., & Hariri, A. R. (2019) · Aggressive Behavior · doi:10.1002/ab.21820 · Cited by 14
“We urge caution in making broader inferences from our data, as our study sample was characterized by generally low scores on the childhood trauma and trait anger questionnaires (e.g., CTQ subscale scores from our sample are within the none or minimal category; Bernstein et al., 1997).”
Adaptação e validação de conteúdo da versão brasileira do Posttraumatic Cognitions Inventory
Sbardelloto, G., Schaefer, L. S., Justo, A. R., Lobo, B. D. O. M., & Kristensen, C. H. (2013) · Revista de Saúde Pública · doi:10.1590/s0034-8910.2013047003474 · Cited by 14
Cluster analysis reveals distinct patterns of childhood adversity, behavioral disengagement, and depression that predict blunted heart rate reactivity to acute psychological stress
Keogh, T. M., Howard, S., Gallagher, S., & Ginty, A. T. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac019 · Cited by 15
The role of the thalamic subregions in major depressive disorder with childhood maltreatment: Evidences from dynamic and static functional connectivity
Yu, T., Zou, Y., Nie, H., Li, Y., Chen, J., Du, Y., Peng, H., & Luo, Q. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.11.074 · Cited by 13
Body-related attentional biases in patients with posttraumatic stress disorder resulting from childhood sexual abuse with and without co-occurring borderline personality disorder
Witthöft, M., Borgmann, E., White, A. J., & Dyer, A. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.07.010 · Cited by 13
“, 2006); CTQ-SA 1⁄4 Childhood Trauma Questionnaire Sexual Abuse Subscale (Bernstein et al., 1997); BSL 1⁄4 Borderline Symptom List (Bohus et al., 2009). *Indicates the use of Х Test. M. Witth€ oft et al. / J. Behav. Ther. & Exp. Psychiat. 46 (2015) 72e77 75”
Method
Exploratory Factor Analysis and Psychometric Properties of the Sexual Coercion Inventory
French, B. H., Suh, H. N., & Arterberry, B. J. (2016) · The Journal of Sex Research · doi:10.1080/00224499.2016.1235129 · Cited by 13
“In addition, construct validity of scores was supported among a sample of racially diverse adolescent psychiatric patients, consistent with therapists’ independent ratings of maltreatment type (Bernstein et al., 1997, 2003).”
Result
Childhood Maltreatment, Emotional Lability, and Alcohol Problems in Young Adults At-Risk for ADHD: Testing Moderation and Moderated Moderation
Bunford, N., Wymbs, B. T., Dawson, A. E., & Shorey, R. C. (2017) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2017.1325031 · Cited by 14
“…with other measures of trauma (Bernstein et al. 1994; Fink, Bernstein, Handelsman Foote and Lovejoy 1995), and is corroborated when independent evidence, such as child welfare records as well as reports of family members and referring clinicians and agencies, is available (Bernstein et al. 1997).”
Background
Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial
Hoge, E. A., Bui, É., Mete, M., Philip, S. R., Gabriel, C. D., Ward, M. J., Suzuki, R. R., Dutton, M. A., & Simon, N. M. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.105965 · Cited by 15
Improving mental wellbeing of forensic psychiatric outpatients through the addition of an informal social network intervention to treatment as usual: a randomized controlled trial
Swinkels, L. T. A., van der Pol, T. M., Popma, A., ter Harmsel, J. F., & Dekker, J. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02819-2 · Cited by 14
“The questionnaire has demonstrated high [98] to acceptable [99] internal consistency, good convergent and discriminant validity [98] and good criterion-related validity [97].”
Background
Profiles of Childhood Maltreatment: Associations with Sexual Risk Behavior during Adolescence in a Sample of Racial/Ethnic Minority Girls
Niu, L., Brown, J. L., Hoyt, L. T., Salandy, A. D., Nucci-Sack, A. T., Shankar, V., Burk, R. D., Schlecht, N. F., & Díaz, Á. (2021) · Child Development · doi:10.1111/cdev.13498 · Cited by 13
Eating Disorder Neuroimaging Initiative (EDNI): a multicentre prospective cohort study protocol for elucidating the neural effects of cognitive–behavioural therapy for eating disorders
Hamatani, S., Hirano, Y., Sugawara, A., Isobe, M., Kodama, N., Yoshihara, K., Moriguchi, Y., Ando, T., Endo, Y., Takahashi, J., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042685 · Cited by 13
A Comparison of Oral Health Outcomes of Self-Reported and Agency-Notified Child Maltreatment in a Population-Based Birth Cohort at 30-Year-Old Follow-Up
Kisely, S. R., Strathearn, L., & Najman, J. M. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001029 · Cited by 14
“The short form of the CTQ used in this study has been found to have a consistent factor structure across diverse samples and response patterns that discriminate between criterion groups (23,25).”
Method
Childhood maltreatment, emotion regulation strategies and depressive symptoms during spousal bereavement
Chen, M. A., & Fagundes, C. P. (2022) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105618 · Cited by 18
Childhood emotional abuse and motor impulsiveness among male violent inmates with antisocial personality disorder
Chen, H., Zhou, H., Zhang, M., Chen, C., Liu, N., Wang, C., & Zhang, N. (2022) · Personality and Mental Health · doi:10.1002/pmh.1557 · Cited by 16
Epidemiology of childhood trauma and its association with insomnia and psychotic-like experiences in Chinese Zhuang adolescents
Wei, Q., Pan, Y., Zhang, S., Yin, W., Lin, Q., Pan, S., Dai, C., Zhou, L., & Wu, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.974674 · Cited by 13
“To estimate the incidence of each type of childhood trauma, we used the cut-off values EA ≥ 13, PA ≥ 10, SA ≥ 8, EN ≥ 15, or PN ≥ 10, suggested by Bernstein (40).”
Method
Abuse and dysfunctional affiliations in childhood: an exploration of their impact on voice-hearers’ appraisals of power and expressed emotion
Connor, C., & Birchwood, M. (2012) · Psychosis · doi:10.1080/17522439.2011.630745 · Cited by 17
The Relationship between Dimensions of Physical Abuse and Aggressive Behavior in a Child Protective Services Involved Sample of Adolescents
Ellenbogen, S., Trocmé, N., & Wekerle, C. (2013) · Journal of Child & Adolescent Trauma · doi:10.1080/19361521.2013.781562 · Cited by 13
Measuring child exposure to violence and mental health reactions in epidemiological studies: challenges and current issues
Duarte, C. S., Bordin, I. A., Green, G. R., & Hoven, C. W. (2009) · Ciência & Saúde Coletiva · doi:10.1590/s1413-81232009000200017 · Cited by 15
The role of social support in the association between childhood trauma and depression among HIV-infected and HIV-uninfected individuals
Rodriguez, V. J., Butts, S. A., Mandell, L. N., Weiss, S. M., Kumar, M., & Jones, D. L. (2018) · International Journal of STD & AIDS · doi:10.1177/0956462418793736 · Cited by 14
“Respondents provided scale scores to scenarios in the context of ‘when I was growing up’.(38) Internal reliability in this sample was excellent (a1⁄4 0.”
Development and validation of a retrospective self-report measure of childhood neglect
Carmel, T., & Widom, C. S. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104555 · Cited by 15
“Here, despite the fact that the participants were about 40 years old when they were asked to recall their childhood experiences of neglect, the accuracy of classification, as is evident in the Area Under Curve, was comparable to that of instruments validated with adolescents (Bernstein et al., 1997).”
Result
Intranasal vasopressin modulates resting state brain activity across multiple neural systems: Evidence from a brain imaging machine learning study
Chen, X., Xu, Y., Li, B., Wu, X., Li, T., Wang, L., Zhang, Y., Lin, W., Qu, C., & Feng, C. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108561 · Cited by 13
Affective variability and childhood abuse increase the risk for nonsuicidal self‐injury following psychiatric hospitalization
Brick, L. A. D., Nugent, N. R., & Armey, M. F. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22739 · Cited by 15
Childhood Trauma Associations With the Interpersonal Psychological Theory of Suicide and Social Cognitive Biases in Psychotic Disorders
Chalker, S. A., Parrish, E. M., Cano, M., Kelsven, S., Moore, R. C., Granholm, E. L., Pinkham, A. E., Harvey, P. D., & Depp, C. A. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001462 · Cited by 13
“Studies using the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1997, 2003)—a standard in the field—show differential findings between the association of trauma subtypes (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and increased risk for SI (Cui…”
Method
Positive change following adversity and psychological adjustment over time in abused foster youth
Valdez, C. E., Lim, B. H., & Parker, C. P. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.07.007 · Cited by 13
Sexual Coercion Among Black and White Teenagers
French, B. H., & Neville, H. A. (2012) · The Counseling Psychologist · doi:10.1177/0011000012461379 · Cited by 13
Childhood maltreatment influences coping in youths with major depression and bipolar depression through resilience and impulsivity
Zhou, J.-W., Zhang, Z., Li, S.-H., Chen, H., Chen, X.-L., Tang, H.-J., & Zhou, J.-S. (2025) · Scientific Reports · doi:10.1038/s41598-025-96021-7 · Cited by 13
Default Mode Network Alterations Induced by Childhood Trauma Correlate With Emotional Function and SLC6A4 Expression
Tian, T., Li, J., Zhang, G., Wang, J., Liu, D., Wan, C., Fang, J., Wu, D., Zhou, Y., Qin, Y., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.760411 · Cited by 12
“Childhood trauma experiences were assessed by administering the Chinese version of the CTQ-Short Form (23, 24).”
Method
The effect of traumatic experiences on attachment styles
Yılmaz, H., Arslan, C., & Arslan, E. (2022) · Anales de Psicología · doi:10.6018/analesps.489601 · Cited by 13
“It was developed by Bernstein et al. (1997) in order to measure the traumatic experiences experienced before the age of 8.”
Background
Replication of distinct trajectories of antidepressant response to intravenous ketamine
O’Brien, B., Lee, J., Kim, S., Nandra, G. S., Pannu, P., Swann, A. C., Murphy, N., Tamman, A. J. F., Amarneh, D. Y., Lijffijt, M., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.10.031 · Cited by 12
From childhood trauma to hyperarousal in adults: The mediating effect of maladaptive shame coping and insomnia
Schalkwijk, F. W., Someren, E. J. W. V., Nicolai, N. J., Uijttewaal, J. L., & Wassing, R. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.990581 · Cited by 12
“The mean and SD values of the five CTQ subscales are shown in Table 1.”
MethodInfluential
Characteristics of white matter structural connectivity in healthy adults with childhood maltreatment
He, J., Zhong, X. B., Chang, C., Dong, D., Zhang, B., Wang, X., & Yao, S. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2179278 · Cited by 12
“This questionnaire is a 28-item self-report questionnaire, and the subscales included sexual, physical, and emotional abuse, and physical and emotional neglect (Bernstein et al., 1997; Bernstein et al., 2003).”
BackgroundMethod
Childhood trauma and problematic internet use: A meta-analysis based on students in mainland China
Wang, X., Li, D., & Li, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1115129 · Cited by 12
“The Childhood Trauma Questionnaire-Short Form (CTQ-SF) with only 28 questions has been developed, which has been widely verified in different groups (Bernstein et al., 1997; Garrusi and Nakhaee, 2009; Wingenfeld et al., 2010).”
Method
Oral Oxytocin Facilitates Responses to Emotional Faces in Reward and Emotional-Processing Networks in Females
Lan, C., Chen, Y., Zhang, Y., Kou, J., Huang, L., Xu, T., Yang, X., Xu, D., Yang, W., Kendrick, K. M., et al. (2023) · Neuroendocrinology · doi:10.1159/000531064 · Cited by 12
Gene–environment interaction study on the polygenic risk score for neuroticism, childhood adversity, and parental bonding
Klingenberg, B., Gülöksüz, S., Pries, L.-K., Cinar, O., Menne‐Lothmann, C., Decoster, J., van Winkel, R., Collip, D., Delespaul, P., Binder, M. D., et al. (2023) · Personality Neuroscience · doi:10.1017/pen.2023.2 · Cited by 12
“” The CTQ has been validated for the Dutch population showing a Cronbach ’ s alpha of .91 for the physical abuse scale, .89 for emotional abuse, .95 for sexual abuse, .63 for physical neglect, and .91 for emotional neglect (Thombs, Bernstein, Lobbestael & Arntz, 2009).”
MethodInfluential
Characterization and prediction of individual functional outcome trajectories in schizophrenia spectrum disorders (PREDICTS study): Study protocol
Agarwal, S. M., Dissanayake, J., Agid, O., Bowie, C. R., Brierley, N., Chintoh, A. F., Luca, V. D., Diaconescu, A. O., Gerretsen, P., Graff‐Guerrero, A., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288354 · Cited by 13
The association between childhood maltreatment and internet addiction among Chinese junior middle school students: prospective cohort study
Jin, X., Wang, Y., Huang, C., Luo, X., Gao, X., & Shen, Y. (2023) · BJPsych Open · doi:10.1192/bjo.2023.606 · Cited by 12
The association between childhood maltreatment and multidimensional sleep health in adolescents at high risk of emotional and behavioral problems
Zarchev, M. G., Kamperman, A. M., Hoepel, S. J. W., Hoogendijk, W. J. G., Mulder, C. L., & van Mil, N. H. G. (2024) · SLEEP · doi:10.1093/sleep/zsae281 · Cited by 13
“Childhood maltreatment was measured using the Dutch version of the 28-item Childhood Trauma Questionnaire—Short Form (CTQ-SF) [37].”
Mineralocorticoid receptor genotype moderates the association between physical neglect and serum BDNF
Bortoluzzi, A., Salum, G. A., Blaya, C., Silveira, P. P., Grassi‐Oliveira, R., da Rosa, E. D., de Aguiar, B. W., Stertz, L., Bosa, V. L., Schuch, I., et al. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.08.022 · Cited by 12

Authors: BERNSTEIN, D. P., AHLUVALIA, T., POGGE, D., & HANDELSMAN, L.
Affiliations: Icahn School of Medicine at Mount Sinai (US)
Fairleigh Dickinson University (US)
Corresponding author: BERNSTEIN, DAVID P.
ORCID: BERNSTEIN, DAVID P.
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 1997-03
Volume: 36
Issue: 3
Pages: 340-348
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/00004583-199703000-00012
OpenAlex: W2009780891
Cited by: 1,574
References: 25
Citations by year: 2026: 66 · 2025: 107 · 2024: 112 · 2023: 105 · 2022: 131 · 2021: 93 · 2020: 105 · 2019: 97 · 2018: 76 · 2017: 69 · 2016: 69 · 2015: 59 · 2014: 67 · 2013: 60 · 2012: 47
FWCI: 15.25
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Sociology and Political Science › Child Welfare and Adoption
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: Childhood Trauma Questionnaire, child abuse, adolescent psychiatric inpatients, factor structure, convergent and discriminant validity, emotional abuse, emotional neglect, sexual abuse, physical abuse, physical neglect, abuse screening, therapist ratings
MeSH terms: Adolescent, Mental Disorders, Child, Child Abuse, Child Abuse, Sexual, Female, Humans, Male, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results, Logistic Models

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Validity of the Childhood Trauma Questionnaire in an Adolescent Psychiatric Population

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