Childhood abuse and the content of delusions.

A growing literature suggests an association between childhood abusive experiences and psychotic disorders, with some reviewers suggesting that this amounts to a causal relationship (Larkin & Morrison, 2006; Read, van Os, Morrison, & Ross, 2005), though this remains contentious. Estimates from among in-patients (majority with a psychotic diagnosis, Read et al., 2005) suggest that around one-half have suffered childhood physical abuse (CPA): furthermore, one-half of females and one-quarter of males have suffered childhood sexual abuse (CSA). Details from patients’ casenotes suggested that those who have experienced sexual abuse are significantly more likely to endorse two or more positive symptoms characteristic of schizophrenia (Read, Agar, Argyle, & Aderhold, 2003). Though concern about accuracy is understandable, the evidence supports reliability estimates no different to the general population, and that the reported rates are more likely to be underestimates (Goodman, Rosenberg, & Mueser, 1997). The exact nature of the relationship of childhood abuse with delusions remains unclear: Ross, Anderson, and Clarke (1994) found ideas of reference to relate to presence of CSA, a finding absent fromRead et al. (2003)who instead found increased rates of paranoid delusions. In summary, though not necessarily a causal relationship, thewealth of data now emerging supports a strong and relevant association, in particular to positive symptoms, delusions amongst them. Beyond evidence that childhood abuse predicts the presence of psychotic symptoms, some authors have suggested that it might also impact upon the content of symptoms, especially delusions and hallucinations. Beck and van der Kolk (1987) noted frequent sexual delusions in chronically hospitalized female incest survivors with psychosis. Olfactory delusions (and anomalous experiences) have been suggested as linked to sexual abuse. Paranoid delusions have sometimes been identified at a higher rate in individuals who have a history of familial childhood abuse compared to those who do not; and individuals