[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Child abuse and schizophrenia
    John Read, PhD | University of Auckland,
    In the November 2010 issue Cutajar et al 1 reported that 2759 adults who were sexually abused as children had significantly higher rates of psychosis than the general population. Children raped in early adolescence by more than 1 perpetrator were 15 times more likely to have developed psychosis. The authors, however, may have been overly cautious in their interpretation of their findings and of previous studies. A 2008 review 2 recorded that 10 of 11 general population studies (of a range of adverse childhood events including sexual and physical abuse) found, after controlling for other factors - including genetic liability for psychosis, that child maltreatment is significantly related to psychosis. Eight of the 11 studies tested for, and found, a dose response(as did Cutajar et al). The most recent review, in Nature, reports that “an explosion of new studies have consistently demonstrated dose–response associations across a range of designs, natural experiments and endpoints, including a number of strong prospective studies establishing temporal order and ruling out reverse causality.”3
    In fact the only study not to have found the relationship between childhood trauma and psychosis was an earlier version4 of the Cutajar et al study. The abused group was significantly younger than the population control group and, therefore, had had less time to develop psychosis. In their follow up study1 Cutajar et al used properly matched controls and the relationship, found by all the other studies, emerged.
    An argument used to challenge the many clinical studies that confirm the relationship2found in all the population studies, is that ‘recalled histories of CSA in people with acute psychosis may sometimes be a manifestation of their illness’.1 This oft repeated claim of ‘postdisorder reconstructions’1 partly explains the unfortunate fact that people diagnosed with psychosis are very rarely asked about child abuse.2 There is no evidence to support the claim and much to refute it.2,5 Moreover, it is irrelevant to the Cutajar et al study because one of its many strengths is that the abused cohort was identified from the records of legal authorities at the time of the abuse.
    This fact makes it even more remarkable that significant findings emerged from their study. These children represent the tiny minority of sexually abused children who tell someone, are believed, and whose abuse is reported to the authorities. They are more likely than other abused children to have received some support and to have had the abuse terminated.
    It seems to us that the relationship between child abuse and psychosis has now, after decades of being ignored, been well demonstrated, and that the evidence indicates that the relationship is a causal one.
    1. Cutajar M, Mullen P, Ogloff J, Thomas S, Wells D, Spataro J. Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Arch Gen Psychiatry. 2010;67(11): 1114-1119.
    2. Read R, Fink P, Rudegeair T, Felitti V, Whitfield C. Child maltreatment and psychosis: A return to a genuinely integrated bio-psycho -social model. Clin Schizophr. 2008;7: 235-254.
    3. van Os J, Gunter K, Rutten F. The environment and schizophrenia. Nature. 2010;468:203-212.
    4. Spataro J, Mullen P, Burgess P, Wells D, Moss S. Impact of child sexual abuse on mental health: A prospective study in males and females. Br J Psychiatry. 2004;184(5):416-421.
    5. Fisher H, Craig T, Fearon P, Morgan K, Dazzan P, Lappin J, Hutchinson G, Doody G,Jones P, McGuffin P, Murray R, Leff J, Morgan C. Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophr Bull. in press. doi:10.1093/schbul/sbp103

    Conflict of Interest: None declared
    Original Article
    November 1, 2010November 2010

    Schizophrenia and Other Psychotic Disorders in a Cohort of Sexually Abused Children

    Author Affiliations

    Author Affiliations: Centre for Forensic Behavioural Science, Monash University, Clifton Hill (Drs Cutajar, Mullen, Ogloff, and Thomas), Victorian Institute of Forensic Medicine, Monash University, South Bank (Dr Wells), and Noesis Clinical Psychology Centre, Kew (Dr Spataro), Victoria, Australia.

    Arch Gen Psychiatry. 2010;67(11):1114-1119. doi:10.1001/archgenpsychiatry.2010.147

    Context  The evidence for an association between child sexual abuse and subsequently developing psychotic disorders, including the schizophrenias, remains inconclusive.

    Objective  To explore whether child sexual abuse is a risk factor for later psychotic disorders.

    Design  Case-control study.

    Setting  Sample drawn from all notified cases of child sexual abuse over a 30-year period in Victoria, Australia.

    Participants  A cohort of 2759 individuals ascertained as having been sexually abused when younger than 16 years had their subsequent contacts with mental health services established by data linkage. They were compared with a community-based control group matched on sex and age groupings whose rates of disorder were established using identical methods.

    Main Outcome Measures  Rates of psychotic and schizophrenic illnesses.

    Results  Rates were significantly higher among child sexual abuse subjects compared with controls for psychosis in general (2.8% vs 1.4%; odds ratio, 2.1; 95% confidence interval, 1.4-3.1; P < .001) and schizophrenic disorders in particular (1.9% vs 0.7%; odds ratio, 2.6; 95% confidence interval, 1.6-4.4; P < .001). Those exposed to penetrative abuse had even higher rates of psychosis (3.4%) and schizophrenia (2.4%). Abuse without penetration was not associated with significant increases in psychosis or schizophrenia. The risks were highest for those whose abuse involved penetration, occurred after age 12 years, and involved more than 1 perpetrator, the combination producing rates of 8.6% for schizophrenia and 17.2% for psychosis.

    Conclusions  Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes. The risk is greater for adolescents subjected to penetration. Irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment.