Understanding the long-term effects of childhood adversities: Beyond diagnosis and abuse

Aims: Studies of the effects of childhood adversities often use psychiatric diagnoses and focus on physical or sexual abuse. This study explored relationships between a broader range of adversities and both diagnoses and specific symptoms. Methods: The files of 217 child and adolescent mental health service users were audited. Information regarding 14 adverse childhood experiences, 20 diagnoses and 38 symptoms was analysed. Results: Only two diagnoses (Psychosis and Oppositional Defiant Disorder) were predicted by mean number of adversities. However, the symptom clusters indicative of six diagnoses were related to one or more childhood adversities. Strong specific relationships were found between sexual abuse and hyperarousal, parental substance abuse and rule violation, and loss and avoidance/numbing. Mean number of adversities predicted six specific symptoms as well as global functioning, risk to self, and risk to others. Parental mental health, a proxy for genetic influence, was unrelated to all diagnoses, all symptom clusters and all but one of the 38 symptoms. Conclusions: Understanding the complex nature of the effects of childhood adversities are constrained by focusing on diagnoses and a restricted range of adversities. The need to take a full psychosocial history in child and adolescent mental health services, and the implications for primary prevention, are discussed