Comprehensive Reviews Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model

For several decades the conceptualization and treatment of mental health problems, including psychosis, have been dominated by a rather narrow focus on genes and brain functions. Psychosocial factors have been relegated to mere triggers or exacerbators of a supposed genetic predisposition.!is paper advocates a return to the original stress-vulnerability model proposed by Zubin and Spring in 1977, in which heightened vulnerability to stress is not, as o"en wrongly assumed, necessarily genetically inherited, but can be acquired via adverse life events.!ere is now a large body of research demonstrating that child abuse and neglect are signi#cant causal factors for psychosis. Ten out of eleven recent general population studies have found, even a"er controlling for other factors, including family history of psychosis, that child maltreatment is signi#cantly related to psychosis. Eight of these studies tested for, and found, a dose-response. Interpreting these #ndings from psychological and biological perspectives generates a genuinely inte-grated bio-psycho-social approach as originally intended by Zubin and Spring.!e routine taking of trauma histories from all users of mental health services is recommended, and a sta $ training program to facilitate this is described. Understanding the Stress