Childhood maltreatment and impaired emotion regulation and processing in remitted affective disorders: Evidence from a large-scale investigation

BACKGROUND: Childhood maltreatment (CM) has been linked to difficulties in emotion regulation and processing in affective disorders, but associations are mixed, underscoring the need for large-scale investigation.

METHODS: This cross-sectional study examined associations between CM (overall and subtypes) and emotion regulation and processing in n = 348 individuals with affective disorders (bipolar disorder (BD) = 81 %; major depressive disorder (MDD) = 19 %) in full or partial remission (68 % female, meanage = 33 ± 9 years) and n = 218 healthy controls (HC) (64 % female, meanage = 32 ± 11 years). Baseline data were pooled for the Childhood Trauma Questionnaire, Social Scenarios Task, and Facial Expression Recognition Test. Analyses included Spearman's rho correlations (rs), multiple linear regression, and analysis of covariance.

RESULTS: In affective disorders, more overall CM correlated with less successful down-regulation of emotions in negative social scenarios (rs = -0.12, p = .03), surviving adjustment for demographic and clinical factors (B = -0.33, 95 % CI [-0.59,-0.08], p = .010; Benjamini-Hochberg adj. p < .05), with preliminary indications suggesting potential contributions from CM-related sexual abuse and physical neglect. Patients with high vs. low CM displayed less successful down-regulation of negative emotions, lower reactivity in aversive scenarios, and poorer discrimination accuracy of positive facial expressions (ps ≤ .04). Across patients and HC, more overall CM correlated weakly with poorer emotion down-regulation, lower positive emotions reactivity, and slower facial expression recognition (ps ≤ .019).

CONCLUSIONS: CM is associated with altered emotion regulation and processing, and specific maltreatment-subtypes may potentially be differentially related to these difficulties across remitted BD and MDD. Assessing CM may inform interventions targeting emotion regulation and processing in affective disorders.