Elsevier

Child Abuse & Neglect

Volume 62, December 2016, Pages 51-62
Child Abuse & Neglect

Research article
Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model

https://doi.org/10.1016/j.chiabu.2016.10.015Get rights and content

Abstract

The present study investigated the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology. An adult sample (N = 701) from diverse backgrounds of psychopathology completed the Childhood Trauma Questionnaire (CTQ), the Difficulties in Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the negative affect subscale of the Positive and Negative Affect Schedule (PANAS) in a cross-sectional online survey. Correlational analyses showed that all types of child maltreatment were uniformly associated with emotion dysregulation, and dimensions of emotion dysregulation were strongly related to psychopathology. Limited access to strategies for emotion regulation emerged as the most powerful predictor. Structural equation modeling analyses revealed that emotion dysregulation partially mediated the relationship between child maltreatment and psychopathology, even after controlling for shared variance with negative affect. These findings emphasize the importance of emotion dysregulation as a possible mediating mechanism in the association between child maltreatment and later psychopathology. Additionally, interventions targeting specific emotion regulation strategies may be effective to reduce psychopathology in victims of child maltreatment.

Introduction

Child maltreatment (i.e. emotional, physical, and sexual abuse, and/or emotional and physical neglect) has been widely documented as a risk factor for diverse negative consequences in adolescence and adulthood (Cicchetti and Toth, 1995, Sundermann and DePrince, 2015). For adolescents, these consequences include educational problems, heightened rates of law infringement, aggressive behavior, as well as various mental disorders such as mood, anxiety, and eating disorders (Moggi, 2005). Adults who were victims of maltreatment as children are at increased risk for substance abuse, depression, posttraumatic stress disorder (PTSD), borderline personality disorder (BPD), and suicidal behavior (Felitti et al., 1998; Gaher, Hofman, Simons, & Hunsaker, 2013; Lilly, London, & Bridgett, 2014). It is therefore an important research task to understand the mechanisms leading to these consequences in order to prevent these negative effects after experiences of child maltreatment. As such, the investigation of mediating variables, which associate child maltreatment with psychopathology in adulthood, is fundamental. The significance of this issue is highlighted by the fact that child maltreatment is also highly prevalent within the general population. Meta-analytic data suggest global rates of 17.4% for self-reported child neglect (Stoltenborgh, Bakermans-Kranenburg, & van IJzendoorn, 2013) and 12.7% for self-reported child sexual abuse (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011). A representative survey conducted in Germany indicates self-reported rates of 15.0% for experiences of emotional abuse, 12.0% for physical abuse, 12.6% for sexual abuse, 49.5% for emotional neglect, and 48.4% for physical neglect in childhood and/or adolescence (Häuser, Schmutzer, Brähler, & Glaesmer, 2011).

Taken together, child maltreatment is a macrosocial problem with severe consequences and mediating mechanisms associating child maltreatment with psychopathology in adulthood should be investigated. Accordingly, recent research interest has primarily focused on emotion regulation as a possible mediator (e.g. Choi, Choi, Gim, Park, & Park, 2014; Kim & Cicchetti, 2010).

The current study is based on Gratz’ and Roemer’s (2004) widely accepted integrative conceptualization of emotion regulation. The authors distinguish between four key dimensions of emotion (dys-)regulation: (a) awareness and understanding of one’s emotions, (b) acceptance of one’s emotions, (c) the ability to control impulsive behavior and engage in goal-directed behavior when experiencing negative emotions, and (d) the ability to use emotion regulation strategies flexibly and to modulate emotional responses to attain one’s goals. On the basis of this conceptualization, the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) was developed to comprehensively assess emotion dysregulation. Since there is no universal definition or explanatory model of emotion regulation (Barnow, 2012), a review of the existing literature is beyond the scope of this article. Readers are instead referred to detailed review articles (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Koole, 2009).

Successful emotion regulation is one of the core developmental tasks in early childhood and is highly determined by interactions with primary caregivers (Cicchetti & Toth, 1995). Children acquire emotion regulation skills within the family context via observation, parenting practices such as validating the child’s emotions, and the emotional climate of the family (Morris, Silk, Steinberg, Myers, & Robinson, 2007). In a family environment where maltreatment is present, the infant is most likely exposed to caregivers who fail to serve as role models for effective emotion regulation and dismiss or punish their child’s emotional responses instead of validating them (Morris et al., 2007). The maltreated child therefore has difficulties in learning which emotions are appropriate and expected in a particular situation. The lack of sensitive interactions between the maltreating caregiver and the child thus impedes the development of effective emotion regulation capacities (Kim & Cicchetti, 2010). In accordance with this, several investigations confirm medium to high correlations between child maltreatment and emotion dysregulation in adulthood (e.g. Moulton, Newman, Power, Swanson, & Day, 2015; Rellini, Vujanovic, Gilbert, & Zvolensky, 2012).

Emotion dysregulation must also predict psychopathology to qualify as a potential mediator of the relationship between child maltreatment and psychopathology (Baron & Kenny, 1986). In fact, numerous studies relate emotion dysregulation with psychological problems such as PTSD (Bardeen, Kumpula, & Orcutt, 2013), depression vulnerability (Barnow, Aldinger, Ulrich, & Stopsack, 2013), eating psychopathology (Moulton et al., 2015), anxiety (Goldsmith, Chesney, Heath, & Barlow, 2013), and BPD (Limberg, Barnow, Freyberger, & Hamm, 2011). These findings, which indicate that emotion dysregulation affects psychopathology, were confirmed by a meta-analysis (Aldao et al., 2010).

Taken together, the extant literature suggests an association between child maltreatment and emotion dysregulation, as well as between emotion dysregulation and psychopathology, and therefore gives rise to the idea that emotion dysregulation is a potential mediating mechanism in the relation between child maltreatment and psychopathology. Initial empirical findings support this assumption. Emotion dysregulation was found to mediate the relationship between traumatic experiences in childhood and symptoms of PTSD (Lilly et al., 2014), BPD (Gaher et al., 2013), eating disorders (Moulton et al., 2015), depression (Crow, Cross, Powers, & Bradley, 2014), and anxiety (Goldsmith et al., 2013). However, given the high comorbidity after experiences of child maltreatment (Widom, DuMont, & Czaja, 2007), a simultaneous examination of various aspects of psychopathology seems reasonable. To date, only a few studies have investigated the mediating effect of emotion dysregulation on the relationship between child maltreatment and broadly assessed psychopathology. These studies demonstrated mediation in samples of children from families of low socioeconomic status, adolescents, and adult outpatients (Alink, Cicchetti, Kim, & Rogosch, 2009; Choi et al., 2014; Heleniak, Jenness, Vander Stoep, McCauley, & McLaughlin, 2016; Kim & Cicchetti, 2010). While these initial findings are encouraging, an important shortcoming of the studies is that none of them included negative affect as a covariate in their mediation models.

Negative affect constitutes individual differences in the extent to which subjective distress and aversive mood states are experienced (Watson, Clark, & Tellegen, 1988). There is evidence for negative affect both as a predictor and an outcome of unsuccessful emotion regulation (Brans, Koval, Verduyn, Lim, & Kuppens, 2013; Ekas, Braungart-Rieker, Lickenbrock, Zentall, & Maxwell, 2011). Furthermore, high correlations (ranging up to r = .57) suggest a substantial overlap between the constructs of emotion dysregulation and negative affect (Bradley et al., 2011; Smith, Cross, Winkler, Jovanovic, & Bradley, 2014; Weiss et al., 2012). A possible explanation for the association between negative affect and emotion dysregulation is that experiencing subjective distress to a greater extent (i.e. negative affect) could lead to increased difficulties in the regulation of one’s distress (i.e. emotion dysregulation) and also to an enhanced perception of psychological problems. In fact, negative affect has been associated both with emotion dysregulation (Diamond & Aspinwall, 2003) and indicators of psychopathology (Crawford & Henry, 2004). Therefore, negative affect should be included as a covariate when investigating associations between emotion dysregulation and psychopathology to exclude the possibility that associations between these two constructs simply reflect underlying individual differences in negative affect.

The study was conducted to extend previous findings and address various limitations in the extant literature on the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology. As a first step, we investigated associations between child maltreatment, emotion dysregulation, and psychopathology, controlling for negative affect. We then examined a model in which emotion dysregulation mediates the relationship between child maltreatment and psychopathology, controlling for negative affect as a covariate. We conducted our study in a diverse adult sample to maximize the generalizability of our findings.

Section snippets

Participants and procedure

The sample consisted of 701 participants (76.3% female, 23.4% male, two nonrespondents) between the ages of 18 and 81 (M = 27.82, SD = 9.94). A convenience sample was employed, recruiting participants via advertisements on blackboards at the University of Heidelberg (Germany) and at various psychological counseling centers as well as via student mailing lists and online communities for individuals with mental disorders. The advertisements informed potential participants that the study investigated

Descriptive statistics

A total of 1648 individuals accessed the welcome page of our online survey. However, since 947 subjects provided incomplete data, did not meet inclusion criteria, or were identified as multivariate outliers, our final sample consisted of 701 participants. Means and standard deviations of all study variables are presented in Table 1. A total of 434 individuals (61.9%) experienced at least one type of child maltreatment. In detail, 287 individuals (40.9%) experienced emotional abuse, 132

Discussion

The purpose of this study was to extend previous findings by examining the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology, controlling for shared variance with negative affect. The study was conducted in a diverse adult sample to maximize the generalizability of our findings. Initial correlational analyses revealed strong associations between child maltreatment, emotion dysregulation, and psychopathology. All correlations dropped

Conclusions

The findings of this investigation address various limitations and extend the previous literature by demonstrating that emotion dysregulation partially mediates the association between child maltreatment and psychopathology, even after controlling for shared variance of the constructs with negative affect. The commonly accepted types of child maltreatment are equally important in predicting emotion dysregulation, thereby filling the gap of “neglect of neglect”. Dimensions of emotion

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