[Adversity, adolescent psychiatric disorders and complex trauma: Comorbidities or overlap?]

Abstract

Objective: In a context of debates on the place of complex trauma within psychiatric pathology, it is essential to accurately measure the extent of the effects of adversity across different disorders. Such studies are rare, however, because they often focus on a single diagnosis. The measurement of adversity is usually self-reported, retrospective, and usually includes a single dimension. Furthermore, at-risk family interactions and maltreatment constitute two distinct and central risk factors for both complex trauma and psychiatric disorders. Yet they are rarely studied together, nor through an overview of psychiatric disorders. This is the aim of this study, which hypothesizes that adversity is widely distributed across all the psychiatric disorders of adolescents admitted to psychiatric hospitals, and postulates that it is possible to discern distinct adversity profiles depending on the diagnosis.

Methodology: This cross-sectional analysis stems from the Family & Care study, which aims to measure various adversity factors in hospitalized adolescents aged 13 to 19 (n=425). Data on abuse and neglect were collected by hetero-assessment using the European abuse and neglect database Child Abuse and Neglect via Minimum Data Set (CAN-via-MDS), and family interactions were measured using the At-Risk Family Interactions and Levers (ARFIL) scale, a 30-item clinical tool also rated by hetero-assessment.

Results: Among the 425 participants, the prevalence of emotional abuse was 46.1%, physical abuse 21.4%, sexual abuse 25.1% and neglect 70.5%. The psychiatric disorders measured were all associated with significant rates of childhood adversity, and different adversity profiles could be identified according to diagnosis. Trauma- and stress-related disorders accounted for only 13.4% of disorders. The latter, as well as borderline personality disorder and oppositional defiant disorder, were associated with higher scores of at-risk family interactions than the other diagnoses, highlighting the distinct influence of at-risk family dynamics independently of abuse or neglect.

Conclusion: The determinants linked to adversity cut across all the nosographic fields in child psychiatry, and support the idea that the complex trauma clinic overlaps strongly with all the usual diagnostic categories. Depending on the diagnosis, it seems possible to identify distinct adversity profiles, with borderline personality disorder appearing as one face of complex trauma among others. The Family & Care study reinforces the value of multiplying the sources of observation in clinical practice and in future research, by combining diagnostic aspects with the relational correlates of patients under psychiatric care, which represent both risk factors and essential therapeutic levers.