The impact of types of childhood maltreatment on the severity of PTSD and comorbid personality disorder symptoms

<b>Background:</b> Childhood maltreatment is associated with various psychiatric disorders, including post-traumatic stress disorder (PTSD) and personality disorders (PDs). Previous research has suggested that PTSD and PD are highly comorbid. However, the impact of different types of childhood maltreatment on the severity of PTSD and PD symptoms in a clinical population with PTSD/PD symptoms remains unclear.<b>Objective:</b> We aimed to clarify the role of (a) the overall severity and (b) the severity of subtypes of childhood maltreatment on the severity of (a) PTSD and (b) comorbid PD symptoms.<b>Methods:</b> Data was collected from participants (<i>N </i>= 197) seeking treatment for PTSD with comorbid PD symptoms at a trauma expertise centre in the Netherlands. We assessed childhood maltreatment using the Childhood Trauma Questionnaire-short form (CTQ-sf), PTSD severity with the Clinician-administered PTSD Scale for DSM-5 (CAPS-5), and PD severity with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Data were analyzed using linear and Poisson regression.<b>Results:</b> We found that emotional neglect was the most prevalent form of childhood maltreatment (80.7%), followed by emotional abuse (72.6%). Sexual and emotional abuse shared independent associations with the severity of PTSD. The overall maltreatment severity and emotional abuse were significantly associated with the severity of comorbid borderline PD symptoms. Sexual abuse was significantly associated with the severity of comorbid avoidant PD symptoms. None of the childhood maltreatment types were significantly associated with the severity of comorbid obsessive-compulsive PD symptoms.<b>Conclusions:</b> We demonstrated the relationship between childhood sexual and emotional abuse and PTSD severity in people with PTSD and comorbid PD symptoms. This has important implications since emotional abuse usually does not fulfil the A-criterion required for the diagnosis of PTSD. We recommend routinely assessing emotional abuse in trauma- and PD treatment, and investigating the effectiveness of adapting trauma treatment for emotional abuse.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT03833453.