SAN FRANCISCO – Childhood neglect correlated with impaired capacity for close social relationships as an adult in a study of 114 nonpsychotic psychiatric inpatients.
The difficulty for patients with a history of childhood neglect centered more in maintaining than in starting close social relationships as adults, Thachell Tanis and Lisa J. Cohen, Ph.D., reported in a press briefing and a poster presentation at the annual meeting of the American Psychiatric Association.
The study used separate clinical self-report surveys to assess patients’ childhood histories and adult relational capacity. The Multidimensional Neglectful Behavior Scale assessed emotional, physical, cognitive, and supervisory neglect in the patients’ past. Patients also completed the relational domain of the Severity Indices of Personality Problems to assess capacity for intimacy or enduring relationships and the ability to feel recognized in relationships.
Each type of neglect significantly and negatively affected each facet in the relational domain. "Everything correlated with everything," said Ms. Tanis, a doctoral student at City College of New York.
The deficits were most striking in patients’ capacity for enduring relationships, said Dr. Cohen, professor of clinical psychiatry and behavioral sciences at Albert Einstein College of Medicine, New York. Childhood neglect as a whole, for example, correlated with an 81% greater negative effect on adult capacity for enduring relationships, compared with the negative effect on capacity for intimacy.
The cohort was 57% female, with a mean age of 39 years. Psychiatric diagnoses included depression in 55%, substance use disorder in 20%, bipolar disorder in 12%, anxiety in 10%, psychosis in 1%, and other diagnoses in 3%. The cohort was 44% white, 28% Hispanic, 16% black, 6% multiracial, 5% Asian, and 2% other ethnicities. The percentages total more than 100% because of rounding.
Prior studies have well documented the adverse effects of more dramatic forms of childhood maltreatment. Physical and sexual abuses in childhood, for example, have been associated with adult depression, eating disorders, and personality disorders, Dr. Cohen said. Only in recent years have mental health providers recognized the importance of less dramatic forms of childhood maltreatment, such as emotional abuse and neglect, and begun to study those issues.
The topic deserves further exploration, she added, because identifying these impairments in people with histories of childhood neglect might lead to better case conceptualization and possibly better treatment.
"You really do want to pay attention to your patients’ history of childhood neglect," Dr. Cohen said. "There may be more subtle types of maltreatment that have pernicious effects over time." If there is a history of neglect in childhood, pay attention not only to the patient’s ability to engage in relationships but the ability to maintain such relationships over time, she added.
The study was limited by using retrospective, self-report measures and its focus on inpatients, which might restrict the generalizability of the results.
The investigators reported having no financial disclosures.
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