Parental verbal abuse and the mediating role of self-criticism in adult internalizing disorders

Abstract

Background

Researchers (e.g., [Gibb, B.E., 2002. Childhood maltreatment and negative cognitive styles. A quantitative and qualitative review. Clinical Psychology Review, 22 (2), 223–246]; [Rose, D.T., Abramson, L.Y., 1992. Developmental predictors of depressive cognitive styles: developmental perspectives on depression. In Cicchetti, D., Toth, S.L. (Eds.), Developmental Perspectives on Depression. Rochester symposium on developmental psychopathology, vol. 4, pp. 323–349]) have proposed that when childhood abuse is verbal (rather than sexual or physical), the child is more likely to develop a negative self-schema because the negative self-cognitions are directly supplied to the child by the abuser (e.g., “you are stupid”).

Methods

In a test of this theory in adult participants, and drawing on the National Comorbidity Survey (NCS) (N = 5877), we investigate the mediating role of current levels of self-criticism on the relationship between retrospective reports of parental verbal abuse, as well as sexual and physical abuse, and adult internalizing symptoms.

Results

We found self-criticism, but not dependency traits, to fully mediate the relationship between childhood verbal abuse perpetrated by parents and internalizing (depression, anxiety) symptoms. On the other hand, self-criticism was only a partial mediator of the relationship between the other types of abuse and internalizing symptoms.

Limitations

The NCS data is cross-sectional, which limits any firm conclusions regarding causality. While these results are suggestive that self-criticism is a mediator of the relationship between abuse and internalizing symptoms, longitudinal data are necessary to help rule out alternative explanations.

Conclusions

Results of this study suggest that childhood abuse experiences, and in particular verbal abuse, may confer risk for internalizing disorders in part because verbal abuse influences the development of a self-critical style.

Introduction

Over the last several decades, considerable research has accumulated documenting the long-term negative sequelae of childhood abuse. Most notably, childhood abuse has been linked to psychiatric disorders in adulthood (e.g., (Bergen et al., 2004), including disorders within the internalizing and externalizing spectrums (Toth et al., 2002). There are several mechanisms by which childhood abuse may confer risk for psychopathology. However, there is some evidence that childhood verbal abuse, in particular, confers risk for development of a negative cognitive style (Gibb, 2002), which is a risk factor for depression (Alloy et al., 1999). Negative cognitive style has been defined as a characteristic way of attributing the causes of negative life events to stable, internal, and global factors (e.g., I failed the test because I am stupid), inferring negative consequences (e.g., I will never succeed), and making self-critical judgments of one's character (e.g., I am worthless) (Alloy et al., 2004), as well has having dysfunctional attitudes and maladaptive self-schemas (Beck, 1987). Thus, one aspect of a negative cognitive style can be operationalized as self-criticism (Blatt, 1974).

In the current study we examined the impact of childhood parental verbal abuse on adult internalizing symptoms. We contend that the effect of verbal abuse on internalizing symptoms is mediated by a negative self-schema (i.e., self-criticism). That is, verbal abuse confers risk for internalizing symptoms because verbal abuse is directly related to the development of self-criticism, which, in turn, influences the development of internalizing symptoms.

Childhood abuse has been associated with the development of a negative cognitive style (Gibb et al., 2004). Rose and Abramson (1992) speculated that childhood verbal abuse would be more likely than other forms of maltreatment to lead a negative cognitive style, in that the negative self-schema is supplied by the abuser (e.g., “you are worthless”). In a study testing this theory, Gibb et al. (2003) found retrospective reports of childhood verbal abuse, but not physical or sexual maltreatment, were related to a negative cognitive style. However, not all studies have supported the unique relationship between verbal abuse and negative cognitive style. Gibb (2002) conducted a qualitative and quantitative review of the literature examining the effects of different types of abuse on negative cognitive style (predominately attributional style). Among the handful of studies identified, most included small samples of undergraduate students and adult psychiatric patients; there were two studies that included children. Gibb (2002) concluded that whereas there was an association between verbal abuse and negative cognitive style, there was a similar relation for sexual abuse, although only among the relatively older participants. Gibb did not find an association between physical abuse and negative cognitive style. As the author noted, only a handful of studies has examined the relationships between different types of childhood abuse and cognitive style, and more research in this area is needed.

Self-criticism is a construct related to negative cognitive style, and represents the negative evaluation of the self and a relentless belief that others share one's pernicious view (Blatt, 1974). Researchers have characterized the self-critical type as being consumed by feelings of failure, worthlessness, inferiority and self-doubt (Blatt and Homann, 1992). Self-criticism has been identified as a vulnerability marker for depression (Bagby et al., 1992). Self-criticism is also associated with anxiety disorders. In a series of studies, Cox et al., 2004a, Cox et al., 2004b, Cox et al., 2004c have shown that self-criticism is related to disorders within the internalizing spectrum, including social phobia, PTSD, and depression.

The high comorbidity of anxiety and depression (Kessler et al., 1998) bears relevance to the understanding of self-criticism as a vulnerability for anxiety and depression. Krueger (1999) has suggested that patterns of comorbidity represent meaningful covariance. Specifically, he validated a two-factor model of common mental disorders, with an internalizing factor representing mood and anxiety disorders and an externalizing factor including antisocial personality disorder and substance dependence. This dimensional model suggests that each factor represents a common underlying process of psychopathology (Krueger et al., 2002). Thus anxiety and depressive disorders may be comorbid because they share common vulnerabilities, and in this study, we investigated self-criticism as a potential psychological vulnerability to internalizing symptoms.

The current study will expand upon the extant literature in several ways. First, past studies examining the mechanisms by which verbal abuse confers risk for psychopathology have focused predominantly on one aspect of negative cognitive style, specifically attributional style, whereas there has been less focus on the role of self-criticism in the development of psychopathology. Secondly, prior work has examined relationships between negative cognitive style and depressive symptoms, whereas there is strong evidence for the co-occurrence of depression and anxiety. In this study, we examine self-criticism as a common vulnerability to anxiety and depressive symptoms.

Furthermore, prior work has not investigated the specificity of self-criticism as a mediator of the relationship between verbal abuse and internalizing disorders. For example, a dependent interpersonal style has been posited as vulnerability marker for depression (Blaney and Kutcher, 1991, Blatt, 1974). Dependent characteristics reflect extreme distress in relation to the loss or abandonment of a significant other, or a strong need for approval (Zuroff et al., 1999). Independent effects of dependency and self-criticism on depression have emerged in some studies (Mongrain et al., 2004), but none have investigated the extent to which dependency and self-criticism serve as mediators of the relationship between childhood abuse and internalizing symptoms.

The present study will investigate the mediating role of self-criticism on the relationship between retrospective reports of parental abuse and adult internalizing symptoms using data from the National Comorbidty Survey (NCS). We attempted to determine whether childhood abuse (verbal, sexual or physical) and negative cognitive style (e.g., self-criticism) were associated with adult internalizing symptoms. We also examined to what extent dependency serves as a mediator of the relationship between childhood abuse and adult internalizing symptoms to help establish the specificity of self-criticism as a mediator. Finally, we attempted to control for other important childhood variables that may account for variance in internalizing symptoms (e.g., parental psychopathology, parental absence, and the financial situation of the family-of-origin).

We hypothesized that, while childhood experiences of parental abuse would predict internalizing symptoms, self-criticism would mediate the relationship between verbal abuse (but not physical or sexual abuse) and internalizing symptoms. That is, parental verbal abuse was expected to confer risk for internalizing disorders because it was associated with self-criticism. Whereas we expected that dependency would be related to internalizing symptoms, we hypothesized that dependency, in contrast to self-criticism, would not be a mediator of the relationship between childhood abuse and internalizing symptoms.