Interplay Between Childhood Maltreatment, Alexithymia, Negative Affect and Cognitive Bias in Relation to Psychotic Symptoms and Psychotic‐Like Experiences

Prior research has individually examined childhood maltreatment, alexithymia, negative affect and cognitive biases in the context of psychosis. This study investigated the interplay among these factors in relation to psychotic symptoms and psychotic-like experiences (PLEs) among three groups (n = 1383): hospitalized individuals with schizophrenia (n = 302) and nonclinical individuals at high (n = 205) and at low risk for psychosis (n = 876). Both self-report and clinician-rated scales were conducted. Individuals with schizophrenia and those at high risk exhibited higher measures of cognitive bias, alexithymia, childhood maltreatment and negative affect than those at low risk. Within each group, participants reporting childhood maltreatment and alexithymia also demonstrated elevated cognitive bias, negative affect, psychotic symptoms, schizotypy or PLEs than people without such reports. The same result was replicated across the entire sample regarding cognitive bias and negative affect, with the most adverse profile observed in individuals with both alexithymia and childhood maltreatment. Further, specific dimensions of cognitive bias facets behaved differently in their mediating roles in the links of childhood maltreatment, alexithymia and negative affect to psychotic symptoms and PLEs. The study highlights childhood maltreatment, alexithymia, negative affect and cognitive bias facets as significant risk factors along the psychosis continuum. Additionally, the study emphasizes the role of cognitive bias facets in linking childhood maltreatment, alexithymia and negative affect to psychotic symptoms and PLEs. KEY PRACTITIONER MESSAGES: Individuals with schizophrenia and those at high and low risk for psychosis were evaluated for childhood maltreatment, alexithymia, negative affect, psychotic symptoms and PLEs. The high-risk and schizophrenia groups scored higher on several variables than those at low risk group. In each group, people with childhood maltreatment and alexithymia differed from those without. In the total sample, people with childhood maltreatment and alexithymia showed significant differences, with individuals having both alexithymia and childhood maltreatment demonstrating the most adverse profile. Specific cognitive biases linked childhood maltreatment, alexithymia and negative affect to psychotic symptoms and PLEs.