Trauma-focused CBT for youth who experience ongoing traumas

Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: (1) enhancing safety early in treatment; (2) effectively engaging parents who experience personal ongoing trauma; and (3) during the trauma narrative and processing component focusing on (a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; (b) addressing youths’ maladaptive cognitions about ongoing traumas; and (c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas.     

An evaluation of trauma focused cognitive behavioral therapy for children in Zambia

To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5–18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N = 58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p < 0.0001), and severity of shame symptoms (p < 0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.     

Development and psychometric evaluation of a new assessment method for childhood maltreatment experiences: The interview for traumatic events in childhood (ITEC)

ObjectiveWe conducted a comprehensive assessment of the reliability and validity of the Interview for Traumatic Events in Childhood (ITEC, Lobbestael, Arntz, Kremers, & Sieswerda, 2006), a retrospective, semi-structured interview for childhood maltreatment. The ITEC aims to yield dimensional scores for severity of experiences of different childhood maltreatment dimensions.MethodsInitial psychometric properties were tested with the pilot version of the ITEC in 362 participants. A second study assessed the revised ITEC in 217 participants, patients and non-patients.ResultsFactor analyses produced the best fit for a five-factor model (sexual, physical and emotional abuse, physical and emotional neglect). The scales had good internal consistency, except for the physical neglect subscale, and excellent inter-rater reliability. The scales were highly associated with equivalent scales of the Childhood Trauma Questionnaire (i.e., good convergent validity), and showed good correspondence with patient file information (i.e., good criterion validity).ConclusionThese results support the reliability and validity of the ITEC, making it a potentially useful tool for assessing a broad range of traumatic events in childhood.Practice implicationThe first step in therapy for dealing with childhood maltreatment is to map abusive experiences and assess their severity and impact. Since maltreatment is a sensitive topic that is not reported on easily, trauma interviews are promising assessment instruments since they provide the opportunity to probe and clarify. There are hardly any well-validated trauma interviews available that assess the extent of maltreatment in and outside the family in various dimensions. The current study tries to fill this gap by presenting a new trauma interview; the Interview for Traumatic Events in Childhood.     

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BackgroundJuvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.ObjectiveTo simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.’s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.Participants and SettingThe sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.MethodsClinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.ResultsResults showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.ConclusionsFindings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.     

Factors related to attrition from trauma-focused cognitive behavioral therapy

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3–18; M = 9.97, SD = 3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children’s caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.     

Othermotherwork: testimonio and the refusal of historical trauma

Abstract

This paper is an ofrenda (offering), a testimonio (testimony) of the healing power of reconstituting severed relationships and reconstructing agentic creation stories in the pathology of soul-wounds where pictures and cuentos serve to mend genealogical traumas. This paper is a refusal of neglecting traumas, it is othermotherwork as an invitation of kin towards the healing soul-wounds by engaging my ageing father (apá), who has been battling a debilitating disease for over 30 years. In choosing to erase his memory and refusing well-being, I engage my apá by remembering and restoring cuentos (stories) retrieved from pictures in my abuela’s archival orange box. I retell the cuentos as told by my apá of his mother, father, great-grandmother and great-grandfather, while he offers an unexpected remedy for both our soul-wounds. In this exchange of ancestral herstories, it is an important move towards an Indigenous Else, transits beyond borders and separation, towards the restorative act of forging unity, love and compassion amongst my father, my ancestors and myself.     

Childhood adversity and cognitive functioning in patients with major depression

ObjectiveMajor depression is often accompanied by deficits in cognitive functioning and lowered executive functions. However, not all depressed patients show impairments in these domains. The aim of this study was to examine whether different kinds of childhood adversity might account for cognitive deficits in patients with major depression.MethodsNinety-one patients with major depression (DSM-IV) and 40 healthy controls completed a neuropsychological test battery assessing memory, processing speed and executive functions. The Childhood Trauma Questionnaire (CTQ) was used to measure the severity and number of incidences of sexual, physical and emotional abuse and physical and emotional neglect.ResultsPatients with major depression had a significantly higher number of traumas and reported more severe emotional abuse, emotional neglect and physical neglect than healthy controls. Patients performed less well in memory tasks, general knowledge and processing speed than healthy controls. Hierarchical regression analyses indicated that the overall number of traumas was significantly associated with poorer general knowledge, lower processing speed and impaired executive functions in patients with major depression. A second model including all CTQ-subscales simultaneously demonstrated an association between physical neglect and poorer verbal learning, and physical abuse and diminished executive functions.ConclusionA higher number of childhood adversities may influence general knowledge, processing speed and executive functions in patients with major depression. In addition, physical abuse and neglect seemed to be associated with verbal learning deficits and poorer executive functions.     

Do dialectical self-beliefs moderate the indirect effect of betrayal traumas on posttraumatic stress through self-compassion?

BackgroundTraumatic events experienced in childhood, particularly those that are perpetrated by someone whom the child trusts or depends upon (i.e., high betrayal traumas [HBTs], such as abuse by a parent) can lead to long-term negative consequences, including a tendency to see oneself in a negative light, low self-compassion, and posttraumatic stress disorder. Although negative psychological consequences of HBTs are well-documented in the literature, little is known surrounding the protective factors that may reduce the effects of HBTs on individuals’ functioning. The present study focused on one potential protective factor, dialectical self-beliefs, that may moderate the negative effects of HBTs experienced in childhood on self-compassion, and hence reduce posttraumatic stress (PTS).ObjectiveThe present study is aimed at determining whether dialectical self-beliefs moderate the indirect effect of HBTs on PTS via self-compassion.Participants and settingData of the present study were collected from 747 college students attending a university in the Northeast region of the United States.MethodUsing a correlational study design, the data of this study were collected from college students through an online survey.ResultsThe results of a moderated mediation analysis indicated that the hypothesized model explained 25% of the variance in PTS. After controlling for low betrayal traumas, the indirect effect of HBTs on PTS through self-compassion was moderated by dialectical self-beliefs. These findings provide support for our hypotheses and suggest that having a dialectical self-view may enhance the adjustment of individuals with a history of HBTs by reducing the negative effect of HBTs on self-compassion.     

Executive function performance and trauma exposure in a community sample of children

ObjectiveThough children exposed to familial violence are reported to have difficulties with a range of emotional and behavioral problems (e.g., lower school achievement) that implicate executive function (EF) deficits, relatively little research has specifically examined EF as a function of trauma exposure in children.MethodsBased on parent report of children's exposure to potentially traumatic events, children (N = 110; Age_Mean = 10.39) from an ethnically diverse community sample were compared across three trauma-exposure groups: familial trauma, non-familial trauma, and no trauma. Children completed a battery of tests to assess working memory, behavioral inhibition, processing speed, auditory attention, and interference control.ResultsFamilial trauma (relative to non-familial and no trauma exposure) was associated with poorer performance on an EF composite (composed of working memory, inhibition, auditory attention, and processing speed tasks); the effect size was medium. Both trauma-exposure status and dissociation symptoms explained unique variance in EF performance after controlling for anxiety symptoms, socio-economic status, and potential traumatic brain injury. While IQ and EF performance were related, SES predicted unique variance in IQ (and not EF) scores, while familial-trauma exposure did not.ConclusionsThe contribution of trauma exposure to basic executive functioning held after taking into account symptoms (anxiety and dissociation), socio-economic status, and possible traumatic brain injury exposure. EF problems may provide one route via which maltreated children become at risk for peer, academic, and behavior problems relative to their peers.Practice implicationsEF problems may provide one route via which maltreated children become at risk for peer, academic, psychological, and behavior problems relative to their peers. Recently, intervention strategies have emerged in the anxiety and mood disorder treatment literatures that appear to effectively target EFs. As future research continues to specify the relationship between child trauma exposure and EF performance, these innovative treatments may have important practice implications for addressing EF deficits.     

Giving a voice to traumatized youth—Experiences with Trauma-Focused Cognitive Behavioral Therapy

The efficacy of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown in several randomized controlled trials. However, to our knowledge no one has studied the TF-CBT model from a user's perspective. The objective of this study was to explore traumatized youths’ experiences of receiving TF-CBT. Thirty youths between 11 and 17 years old (M = 15, SD = 1.8) were interviewed using a semi-structured interview guide after they had received TF-CBT as part of an effectiveness trial. The interviews were analyzed according to thematic analysis. The youths’ responses were grouped into four themes: (1) expectations, (2) experiences of talking to the therapist and sharing information, (3) experiences of trauma narrative work, and (4) experiences of change and change processes. Findings showed how an initial fear of talking about traumatic events and not knowing what to expect from therapy was reduced when the youth experienced the therapist as empathetic and knowledgeable. Talking to the therapist was experienced as positive because of the therapist's expertise, neutrality, empathy, and confidentiality. Talking about the trauma was perceived as difficult but also as most helpful. Learning skills for reducing stress was also perceived as helpful. Important change processes were described as resuming normal functioning and getting “back on track,”, or as acquiring new perspectives and “moving forward.” Because TF-CBT is recommended as a first line treatment for traumatized youth and treating posttraumatic stress may entail special challenges, understanding more about how youths experience this mode of treatment contributes to our knowledge base and may help us tailor interventions.     

A Framework for College Counseling Responses to Large Scale Traumatic Incidents

Abstract

Although most psychotherapists have limited experience dealing with large scale catastrophic incidents, college and university counseling centers today need to be prepared for crisis events such as terrorist attacks, war, and local catastrophes. This article presents a conceptual model for designing counseling center responses to large scale traumatic incidents. Familiar college mental health constructs are applied to the relatively unfamiliar territory of responding to traumatic incidents. First, DSM-IV-TR diagnostic criteria are used to define three levels of student need based on different types of stressful or traumatic events and expected reactions. Next, a corresponding three-part response plan is discussed, including preventive, intermediate, and advanced counseling and psychotherapy interventions. Finally, the college counseling roles of crisis intervention and student development consultation are discussed in relation to the aftermath of large scale traumas. The influence of staff attitudes and values, and other limitations of the model, also are described.     

It all adds up: Addressing the roles of cumulative traumatic experiences on military veterans

BackgroundPosttraumatic stress symptoms are common after discharge from military service in male and female Post-9/11 veterans, many of whom experienced combat.ObjectiveThis is a study of the impacts of childhood and adult assaults are studied both separately and together on the level of posttraumatic stress symptoms in male and female Post-9/11 veterans (N = 850) after discharge from military service.Participants and settingThis cross-sectional secondary analysis uses data from the baseline interviews of the Survey of Experiences of Returning Veterans (SERV) cohort study.MethodsChildhood sexual and physical abuse, adult sexual and physical assault, and combat exposure were the main exposures of interest and the primary outcome measurement was the Posttraumatic Symptom Checklist-Civilian, assessing symptom severity post discharge from military service.ResultsOur sample reported high rates of childhood abuse, adult victimization, combat exposure, and posttraumatic stress symptoms. Tested separately, models including different types of victimization had both unique (f² = 0.30) and cumulative (f² = 0.32) effects on severity of posttraumatic stress symptoms in male and female veterans.ConclusionsOur results underscore the importance of assessing childhood and adult trauma history in returning veterans in addition to traumas they experienced during their service. These findings highlight the importance of focusing on building resilience in our military servicemembers.     

The impact of childhood maltreatment on adolescent gang involvement

BackgroundA number of risk factors for gang involvement have been identified in the literature, such as victimization, poor parental monitoring, aggressive behavior, and affiliation with delinquent peers. However, few studies have examined the influence of maltreatment experiences during childhood on gang involvement later in adolescence.ObjectiveThis study examines how differential experiences of maltreatment might impact future gang involvement.Participants and settingWe analyze self-report data and official maltreatment records on 611 youth (52% female; 76% non-white) in the US, from a larger dataset (Longitudinal Studies on Childhood Abuse and Neglect; N = 1354).MethodsMultinomial logistic regression models were used to examine the influence of experiencing different types of maltreatment on gang involvement.ResultsResults show that childhood experiences of maltreatment (p = .005) generally and neglect (p = .013) specifically were significantly associated with an increased risk of involvement in stable gang affiliations later in adolescence.ConclusionsThese findings demonstrate the value of considering gang involvement as an outcome of maltreatment and tailoring best practice interventions to support maltreated youth at risk of gang involvement.     

Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress

ObjectiveTo investigate the extent to which childbirth may function as a retraumatization of childhood sexual abuse, and may exacerbate postpartum posttraumatic stress reactions.MethodsData was obtained from a convenience sample of 837 women in mid-pregnancy, at 2 and 6 months following childbirth. Three groups were drawn from this sample: women who experienced childhood sexual abuse (CSA), women survivors of trauma other than CSA, and women who reported no-trauma experiences.ResultsPTSD subcategories of intrusion and arousal were increased in the CSA group following childbirth, although the overall PTSD score did not increase following childbirth in any of the groups CSA survivors scored higher at all data collection time points.ConclusionsCSA is a traumatic event that has greater negative long-term effects than other traumas in the population of pregnant women.Practice implicationsIdentifying women who are survivors of CSA early in their pregnancy and establishing a risk assessment may significantly reduce delivery complications and consequently mitigate postpartum PTS outcomes.     

Gleaning hope in a vacillating DACA sociopolitical context: undocumented Latinx students’ systems of support and success in K-16 education

Abstract

In light of the lingering threat of recession of Deferred Action for Childhood Arrivals (DACA), this paper examines the ways in which undocumented Latinx students glean hope in a vacillating DACA context to persist through college. A review of immigration policy particularly as it relates to K-12 and higher education is provided as a springboard to investigate the salience of student voice in policy considerations. Findings indicate the critical supports of familial capital as undocumented Latinx students navigate the complex anti-immigrant terrain. As the long-term legislative fate of undocumented students remains unknown, we provide recommendations for educators and policymakers.     

Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies

The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.     

Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors

Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy – Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r = −0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r = 0.35, p = 0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.     

Multiple traumas and resilience among street children in Haiti: Psychopathology of survival

In Haiti, as in several developing countries, the phenomenon of street children has become a major public health issue. These children are often victims of traumas and adverse life events. This article aimed to investigate traumas experienced by street children and their coping and resilience strategies used to deal with adversities in a logic of survival, relying on a mixed method approach. A group of 176 street children, aged 7–18 (n = 21 girls), recruited in Port-au-Prince, completed measures assessing PTSD, social support and resilience. Semi-structured interviews were conducted to document traumatic experiences, factors related to resilience and coping strategies. After performing statistical analyses to evaluate prevalence and predictors associated with PTSD, and level of social support satisfaction and resilience, qualitative analysis using a grounded theory approach was conducted. Results showed that street children experienced multiple traumas such as neglect, maltreatment, psychological, physical and sexual abuse. However, they also showed self-efficacy to face their traumatic experiences and few of them (less than 15%) obtained scores reaching clinical rates of PTSD, while a large majority presented a level of resilience between moderate to very high. A socio-ecological model of multiple traumas and a model of coping, survival and resilience strategies are conceptualized. Data provide a better understanding of the traumas experienced by street children, their coping and resilience strategies. Results underscore ways to develop practices to offer psychological support, social and vocational integration based on the real needs of these children, in a perspective of social justice.     

Home-Based Child Care Provider Education and Specialized Training: Associations With Caregiving Quality and Toddler Social-Emotional and Cognitive Outcomes

ABSTRACT

Research Findings: Although there has been considerable research on the associations between the qualifications of teachers in center-based settings and preschool-age children’s developmental outcomes, very little is known about the relationships between home provider qualifications and the developmental outcomes of toddlers who attend licensed family child care settings or unregulated family, friend, and neighbor care settings. Analyzing a sample of toddlers and their providers drawn from the Early Childhood Longitudinal Study, Birth Cohort, we found positive relationships between home-based quality and higher education degree (defined as an associate’s degree or at least a bachelor’s degree), field of major, and coursework in early childhood education or a related field. However, provider qualifications were unrelated to children’s cognitive outcomes and related to a limited number of social-emotional outcomes. Practice or Policy: Our results suggest that as states consider the spectrum of supports needed for strengthening home-based child care in ways that facilitate responsive and developmentally supportive caregiving, strategies should include opportunities for home-based care providers to pursue higher education. A more nuanced analysis of the content and comprehensiveness of providers’ formal education is needed to better understand relationships between toddlers’ social and cognitive development and providers’ formal education.     

The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect

ObjectiveTo assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia.MethodNinety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT).ResultsChildhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p = .023) and Global Evaluation (p = .032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p < .000), Social Role Performance (p = .037) and Global Evaluation (p = .014). Higher emotional abuse was associated with impaired Overall Behavior (p = .026), and higher emotional neglect with poor Global Evaluation (p = .047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p = .042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality.ConclusionsChildhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability.Practice implicationsFurther investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.