Role of emotion regulation and social problem solving skills in the relationship between childhood maltreatment and post traumatic stress symptoms in an adult male forensic mental health population
Objective: Posttraumatic Stress Disorder (PTSD) is highly prevalent in clinical and forensic mental health populations. Understanding the link between childhood maltreatment and the underlying mechanisms that can increase the vulnerability to developing and maintaining PTSD is imperative in clinical conceptualisations and intervention targets. A significant proportion of research is conducted with non mental health populations and there is a paucity of research with forensic populations. The first objective was to review the literature, in clinically related and forensic samples, investigating the association of emotion regulation with childhood maltreatment and Posttraumatic Stress (PTS) symptoms/PTSD. Emotion dysregulation and social problem solving deficits are commonly reported in the forensic population and have been associated with a number of psychopathologies. The empirical study examined the role of emotion regulation and social problem solving skills in the relationship between childhood maltreatment and adulthood trauma symptomatology in a male forensic population. Method: A systematic search of literature investigating the role of emotion regulation in relation to childhood maltreatment and/or PTS symptoms/PTSD was conducted using electronic databases; Medline, PsycINFO, Cinahl, Behavioural and Sciences Collection, EMBASE and PILOTS. Studies that met predetermined inclusion criteria were systematically reviewed. The empirical study employed a cross sectional design to examine the role of emotion regulation and social problem skills in the relationship between childhood maltreatment and adulthood trauma symptomatology. Fifty two male forensic mental health patients completed four self-report questionnaires; Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, Social Problem Solving Inventory-Revised: Short Form and the Post Traumatic Stress Disorder Checklist – Civilian Version. Results: The systematic review indicated strong evidence to suggest links between childhood maltreatment and emotion dysregulation, and emotion dysregulation and PTS symptoms/PTSD within clinically related and forensic samples. Preliminary evidence suggests a mediating role of emotion regulation in the relationship between childhood maltreatment and PTSD. The empirical study found that overall childhood maltreatment, childhood emotional abuse, sexual abuse and emotional neglect were associated with greater emotion dysregulation. Childhood sexual abuse, emotional neglect and physical neglect were associated with poorer social problem solving skills. With the exception of childhood physical abuse, all forms of childhood maltreatment, emotion dysregulation and poor social problem solving were correlated with greater trauma symptomatology. Mediation analysis indicated that both emotion dysregulation and poor social problem solving mediated the relationship between childhood emotional neglect and PTS symptoms in adulthood. Conclusions: The systematic review identified that further research is required within clinical populations to better understand the underlying causal pathways between childhood maltreatment and the development and maintenance of PTS symptoms/PTSD. The empirical study gives further insight into the forensic psychopathology and highlights the relevance of emotion regulation and social problem solving in the treatment of PTS symptoms.