Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study
Open accessAbstract
Background: Complex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. These traumas are hypothesised to cause more severe psychopathology and poorer cognitive function than other non-complex traumas. However, empirical testing has been limited to clinical/convenience samples and cross-sectional designs. Aims: To investigate psychopathology and cognitive function in young people exposed to complex, non-complex or no trauma, from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities. Method: Participants were from the Environmental Risk Longitudinal Twin Study, a population-representative birth cohort of 2232 British children. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma, past-year psychopathology and current cognitive function. We also prospectively assessed early childhood vulnerabilities: internalising and externalising symptoms at 5 years of age, IQ at 5 years of age, family history of mental illness, family socioeconomic status and sex. Results: Participants exposed to complex trauma had more severe psychopathology and poorer cognitive function at 18 years of age, compared with both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology. Conclusions: By conflating complex and non-complex traumas, current research and clinical practice underestimate the severity of psychopathology, cognitive deficits and pre-existing vulnerabilities linked with complex trauma. A better understanding of the mental health needs of people exposed to complex trauma could inform the development of new, more effective interventions.
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Complex trauma often has a major impact on the physical and mental health of victims and on the types of interpersonal relationships they have in different social contexts throughout their lives.
“These traumas often have a major impact on the physical and mental health of victims and the types of interpersonal relationships they have in different social contexts throughout their lives”
From Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment (2023) · cites this paper as Lewis et al., 2021
The Results and Discussion report that young people exposed to complex trauma had more severe psychopathology at age 18, supporting the mental-health portion of the claim. The paper does not establish effects on physical health or on interpersonal relationships across social contexts throughout life; its outcomes were assessed at age 18. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA person's traumatic experiences may be related to psychological symptoms in the primary victim, but also secondary trauma psychological symptoms in the partner, and dysfunctional relational dynamics within the couple system.
“Paired with our findings regarding dysfunctional relational dynamics and past studies on the effects of CM on victims (Lewis et al., 2021; Schar et al., 2022), these results outline that a person’s traumatic experiences may be related to psychological symptoms in the primary victim, but also secondary trauma psychological symptoms in the partner, and dysfunctional relational dynamics within the”
From Partner Effects of Childhood Maltreatment: A Systematic Review and Meta-Analysis (2024) · cites this paper as Lewis et al., 2021
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Cites
A cognitive model of posttraumatic stress disorder
Ehlers, A., & Clark, D. M. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00123-0 · Cited by 6,147 · see citing works
Complex PTSD: A syndrome in survivors of prolonged and repeated trauma
Herman, J. L. (1992) · Journal of Traumatic Stress · doi:10.1002/jts.2490050305 · Cited by 2,609 · see citing works
Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma
van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20047 · Cited by 1,284 · see citing works
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.5.1067 · Cited by 1,097 · see citing works
Self-citationTransdiagnostic approaches to mental health problems: Current status and future directions.
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000482 · Cited by 883 · see citing works
Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., van Ommeren, M., Jones, L. M., Humayan, A., Kagee, A., Llosa, A. E., Rousseau, C., et al. (2013) · World Psychiatry · doi:10.1002/wps.20057 · Cited by 762 · see citing works
Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.20706 · Cited by 751 · see citing works
Trouton, A., Spinath, F. M., & Plomin, R. (2002) · Twin Research · doi:10.1375/136905202320906255 · Cited by 410 · see citing works
Flagged first, then by citations
Research works printed but not linked: 19
- [2]Andreasen NC Acute and delayed posttraumatic stress disorders: a history and some issues Am J Psychiatry 2004 161 1321 3 15285955
- [4]Terr LC Childhood traumas: an outline and overview Am J Psychiatry 1991 148 10 20 1824611
- [6]Pelcovitz D van der Kolk B Roth S Mandel F Kaplan S Resick P Development of a criteria set and a structured interview for disorders of extreme stress (SIDES) J Trauma Stress 1997 10 3 16 9018674
- [12]Wamser-Nanney R Vandenberg BR Empirical support for the definition of a complex trauma event in children and adolescents J Trauma Stress 2013 26 671 8 24490245
- [13]op den Kelder R Ensink JBM Overbeek G Maric M Lindauer RJL Executive function as a mediator in the link between single or complex trauma and posttraumatic stress in children and adolescents Qual Life Res 2017 26 1687 96 28285446 PMC5486900
- [14]Schaefer JD Moffitt TE Arseneault L Danese A Fisher HL Houts R Adolescent victimization and early-adult psychopathology: approaching causal inference using a longitudinal twin study to rule out noncausal explanations Clin Psychol Sci 2018 6 352 71 29805917 PMC5952301
- [15]Danese A Moffitt TE Arseneault L Bleiberg BA Dinardo PB Gandelman SB The origins of cognitive deficits in victimized children: implications for neuroscientists and clinicians Am J Psychiatry 2017 174 349 61 27794691 PMC5378606
- [16]Danese A Lewis SJ Psychoneuroimmunology of early-life stress: the hidden wounds of childhood trauma? Neuropsychopharmacology 2017 42 99 114 27629365 PMC5143500
- [17]Danese A Annual Research Review: Rethinking childhood trauma-new research directions for measurement, study design and analytical strategies J Child Psychol Psychiatry 2020 61 236 50 31762042
- [18]Silberg JL Copeland W Linker J Moore AA Roberson-Nay R York TP Psychiatric outcomes of bullying victimization: a study of discordant monozygotic twins Psychol Med 2016 46 1875 83 26979565 PMC4939844
- [19]Dinkler L Lundström S Gajwani R Lichtenstein P Gillberg C Minnis H Maltreatment-associated neurodevelopmental disorders: a co-twin control analysis J Child Psychol Psychiatry 2017 58 691 701 28094432
- [21]Moffitt TE the E-Risk Study Team Teen-aged mothers in contemporary Britain J Child Psychol Psychiatry 2002 43 727 42 12236608
- [22]Odgers CL Caspi A Russell MA Sampson RJ Arseneault L Moffitt TE Supportive parenting mediates neighborhood socioeconomic disparities in children’s antisocial behavior from ages 5 to 12 Dev Psychopathol 2012 24 705 21 22781850 PMC3551477
- [23]Fisher HL Caspi A Moffitt TE Wertz J Gray R Newbury J Measuring adolescents’ exposure to victimization: the environmental risk (E-Risk) longitudinal twin study Dev Psychopathol 2015 27 1399 416 26535933 PMC4778729
- [24]Koenen KC Moffitt TE Poulton R Martin J Caspi A Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort Psychol Med 2007 37 181 92 17052377 PMC2254221
- [25]Caspi A Houts RM Belsky DW Goldman-Mellor SJ Harrington H Israel S The p factor: one general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci 2014 2 119 37 25360393 PMC4209412
- [26]Deary IJ Pattie A Starr JM The stability of intelligence from age 11 to age 90 years: the Lothian birth cohort of 1921 Psychol Sci 2013 24 2361 8 24084038
- [27]Lewis SJ Arseneault L Caspi A Fisher HL Matthews T Moffitt TE The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales Lancet Psychiatry 2019 6 247 56 30798897 PMC6384243
- [29]Cohen JA Mannarino AP Kliethermes M Murray LA Trauma-focused CBT for youth with complex trauma Child Abuse Negl 2012 36 528 41 22749612 PMC3721141
Cited by
Sorted by citations
Cruz, D., Lichten, M., Berg, K., & George, P. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.800687 · Cited by 158 · see citing works
Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment
Cénat, J. M. (2023) · Perspectives on Psychological Science · doi:10.1177/17456916221120428 · Cited by 145 · see citing works
“These traumas often have a major impact on the physical and mental health of victims and the types of interpersonal relationships they have in different social contexts throughout their lives (Lewis et al., 2021; McCormack & Thomson, 2017; Wong et al., 2016).”
BackgroundPartner Effects of Childhood Maltreatment: A Systematic Review and Meta-Analysis
Vaillancourt-Morel, M.-P., Bussières, È.-L., Nolin, M.-C., & Daspe, M.-È. (2024) · Trauma, Violence, & Abuse · doi:10.1177/15248380231173427 · Cited by 35 · see citing works
“Paired with our findings regarding dysfunctional relational dynamics and past studies on the effects of CM on victims (Lewis et al., 2021; Schar et al., 2022), these results outline that a person’s traumatic experiences may be related to psychological symptoms in the primary victim, but also…”
Result
- Authors
- Lewis, S. J., Koenen, K. C., Ambler, A., Arseneault, L., Caspi, A., Fisher, H. L., Moffitt, T. E., & Danese, A.
- Affiliations
- King's College London (GB)
- Harvard University (US)
- Duke University (US)
- Corresponding author
- Danese, Andrea
- ORCID
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2021-05-11
- Volume
- 219
- Issue
- 2
- Pages
- 448-455
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC7611677
- OpenAlex
- W3159639034
- Cited by
- 80
- References
- 8
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 18 · 2023: 15 · 2022: 17 · 2021: 2
- FWCI
- 8.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research
- Department of Health and Social Care
- King's College London (ES/S012567/1)
- Jacobs Foundation (G1002190, HD077482)
- NIHR Maudsley Biomedical Research Centre
- Medical Research Council (HD077482, P005918, G1002190, MR/S001492/1)
- Economic and Social Research Council (ES/S012567/1, ES/P010113/1, ES/S012567/)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD077482)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- complex trauma, childhood trauma, psychopathology, cognitive impairment, internalizing problems, externalizing problems, IQ, family history of mental illness, socioeconomic status, sex differences, Environmental Risk Longitudinal Twin Study
- MeSH terms
- Adolescent, Mental Disorders, Child, Child, Preschool, Cognition, Cross-Sectional Studies, Humans, Longitudinal Studies, Psychopathology, Cohort Studies
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