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. 2024 Jul 10;15(1):2370174. doi: 10.1080/20008066.2024.2370174

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety

El auto-estigma media la relación entre el maltrato infantil y el nivel de síntomas del Trastorno de Estrés Postraumático (TEPT), la depresión y la ansiedad

Shilat Haim-Nachum a,b,c,CONTACT, Amit Lazarov d, Reut Zabag e, Andrés Martin f, Maja Bergman b, Yuval Neria a,b,g, Doron Amsalem a,b
PMCID: PMC11238652  PMID: 38985020

ABSTRACT

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.

Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.

Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.

Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse – but not physical or emotional abuse – a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.

Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

KEYWORDS: Childhood maltreatment, self-stigma, depression, PTSD, anxiety

HIGHLIGHTS

  • Childhood maltreatment is linked to depression, PTSD, and anxiety symptoms.

  • Self-stigma, or internalizing negative stereotypes, plays a significant role in mediating this relationship.

  • Different types of maltreatment are linked to varying levels of self-stigma and symptom severity.

One out of four children experiences childhood maltreatment (CM), with abuse and neglect being its most prevalent forms (Brown et al., 2022; Lippard & Nemerof, 2020). CM significantly increases the risk of developing mental health disorders later in life, including depression, post-traumatic stress disorder (PTSD), and anxiety (Haim-Nachum et al., 2022; McLaughlin et al., 2012; 2017; 2019; for reviews, see Li et al., 2016; McKay et al., 2021; Pfaltz et al., 2022; Yap et al., 2014). However, the mechanisms by which CM contributes to the ensuing development of these psychopathologies are yet to be fully understood (McLaughlin et al., 2020; Noll, 2021).

One intriguing avenue worth investigating centres on self-stigma – the internalization of societal prejudices or negative stereotypes about one's own identity or experiences, instilling shame, embarrassment, and self-blame (Corrigan & Rao, 2012; Link et al., 2002). Recent research has shown self-stigma to be associated with both CM experiences (Schomerus et al., 2021; Schröder et al., 2021) and various forms of psychopathology (Du et al., 2023; Dubreucq et al., 2021), providing initial evidence for the important role it may play in the development of diverse mental health outcomes among survivors of CM. Studies investigating the self-stigma-CM association indicate that individuals who have experienced CM may hold negative, self-stigmatizing beliefs, such as feeling like ‘a bad person because of the maltreatment’, believing that ‘the abuse or neglect was their fault’, or thinking that they ‘will always end up in abusive relationships’ (Kennedy & Prock, 2018). Such childhood maltreatment-related self-stigma can persist long after the abuse or neglect has ended and may resurface or intensify later in adulthood (Briere & Jordan, 2009; Feiring & Taska, 2005) when developing new relationships or while forming parental identities (Wright et al., 2012). The link between self-stigma and psychopathology is well-established, implicating self-stigma as a significant factor in various psychiatric disorders (Dubreucq et al., 2021; Hofmann et al., 2023). Specifically, self-stigma is associated with symptom chronicity, severity, and limited remission across schizophrenia, alcohol dependence, psychosis (Outcalt & Lysaker, 2012; Van Zelst, 2009), mood disorders (Hofmann et al., 2023), and PTSD (Schröder et al., 2021).

While past research on self-stigma has advanced our understanding of its associations with CM and psychopathology, there are still notable gaps. First, most self-stigma studies have focused on the association between self-stigma and schizophrenia/psychosis-related disorders, rather than trauma-related conditions such as PTSD, depression, and anxiety (Lewis et al., 2022). Second, the few studies exploring self-stigma associations with trauma-related conditions have predominately focused on veterans (combat-related traumatic events), rather than CM survivors (Bonfils et al., 2018; Harris et al., 2022; Mittal et al., 2013). Third, research that examined the interplay between CM, self-stigma, and trauma-related psychopathology is relatively scarce. To our knowledge, one study that did explore all three concepts found that internalized/self-stigma fully mediated the detrimental effect of victim-blaming on PTSD symptom severity (Schröder et al., 2021). However, this important study exclusively addressed PTSD and did not explore other trauma-related symptoms such as depression and anxiety. Moreover, it involved only female participants. Most importantly, it did not disaggregate the concept of CM into childhood abuse and neglect or explore different CM types; instead, it primarily focused on childhood sexual abuse.

Importantly, CM may take different forms, including childhood abuse – the presence of threatening input, physical, emotional, or sexual, and childhood neglect – deprivation of key conditions, which could be physical (e.g., poor hygiene/malnutrition) or emotional (e.g., lack of emotional support; Moody et al., 2018). Childhood abuse and neglect often co-occur (Kim et al., 2017). Research has increasingly studied the term polyvictimization, defined as an exposure to various forms of childhood victimization (Finkelhor et al., 2007a), and its effects on mental health. Researchers have identified a high-risk subgroup of children and youth exposed to polyvictimization, who often experience significant persistent biopsychosocial impairments (Finkelhor et al., 2007b; Turner et al., 2016). Experiencing polyvictimization during developmental periods can lead to severe and lasting impacts, beyond the effects of individual traumatic events (Hovens et al., 2015). Evidence shows a dose – response relationship between the number of victimization types and the severity of physical and mental health problems (Horan & Widom, 2015). However, specific childhood traumatic exposures can also contribute to impairment independently of cumulative exposure (Wong et al., 2016).

Survivors of childhood abuse and neglect may exhibit different behaviours and beliefs (McLaughlin et al., 2014; McLaughlin & Sheridan, 2016; Sheridan & McLaughlin, 2014). For example, individuals who have experienced emotional – but not physical – abuse, developed negative self-beliefs (Sachs-Ericsson et al., 2006) and emotional rejection (Steinberg et al., 2003). Moreover, Dye (2020) found that those who reported emotional abuse had higher scores for depression, anxiety, stress, and neuroticism personality compared to those who reported only physical, only sexual, or combined physical and sexual abuse. Furthermore, recent studies suggest that both emotional neglect and physical neglect might foster negative self-beliefs by implicitly conveying that victims are undeserving of care and attention (Jopling et al., 2020). These findings stress the need to explore different childhood abuse and neglect experiences separately and their different associations with mental health outcomes. Yet, to our knowledge, no study to date has explicitly tested whether self-stigma may be the mechanism that mediates the relationship between different CM forms (i.e., abuse and neglect) and symptoms of depression, PTSD, and anxiety. Understanding the role of self-stigma in the association between different CM forms and trauma-related psychopathology can shed light on its potential impact on clinical outcomes (Benfer et al., 2023).

The current study aimed to address the above noted gaps by examining the potential mediating role of self-stigma in the relationships between CM experiences and symptoms of depression, PTSD, and anxiety. We hypothesized that self-stigma would mediate the relationships between CM and all three types of symptoms. On an exploratory basis, we additionally hypothesized that it would mediate the relationships between both childhood abuse and neglect experiences and these symptoms. Confirmation of this hypothesis could refine our understanding of how CM may be linked to varying mental health risks through the lens of self-stigma.

1. Methods

1.1. Participants

Participants were recruited through the Amazon Mechanical Turk (MTurk) toolkit of Cloud-Research from May to July 2023. This crowdsourcing platform is used often in psychology and psychiatry research with evidence of validity across different tasks (Peer et al., 2017). To ensure high validity in the present study, we excluded respondents who failed more than one of our three attention-checks (e.g. ‘In the following question, please choose “I agree”’) or which were classified as bots (using Re-captcha questions).

All participants were English-speaking US residents, aged 18–80, who reported childhood maltreatment (see below). Participants were compensated $3 for participation. Study procedures were approved by the New York State Psychiatric Institute Institutional Review Board (#8453). Prior to the study, participants reviewed an informed consent form. Consenting participants completed the study procedures via Qualtrics.com, a secure, online data collection platform.

1.2. Measures

1.3. Instruments

1.3.1. Childhood maltreatment

Here we focused on abuse and neglect experiences including physical, emotional, or sexual abuse, or physical and emotional neglect during age <18 of the participant. To assess one’s abuse and neglect experiences, participants were asked: While you were growing up, during your first 18 years of life, did you experience any of the following? (Select all that apply.) (1) On one or more occasion(s), a family or household member was physically aggressive with either you or another family member; (2) a family member swore at you, criticized you, humiliated you, or threatened you; (3) you experienced an unwanted or inappropriate sexual experience(s); (4) on one or more occasion(s), you didn’t have enough to eat, had to wear dirty clothes, had no one to take care of you, or had caregivers who were too drunk or high to take care of you; (5) you felt unloved or unsupported by your family, or felt like family members were not concerned about, or supportive of, each other. These questions are based on the Adverse Childhood Experiences Scale (Felitti et al., 1998). To better understand the chronicity and severity of these experiences, participants who endorsed a CM experience were asked two additional questions: ‘Was it a single incident or recurrent?’ and ‘At what age did this start?’

1.3.2. Self-stigma

We assessed self-stigma items across four domains using corresponding subscales: Alienation, Stereotype Endorsement, Secrecy, and Perceived Recovery. For Alienation and Stereotype Endorsement, we utilized two widely used Internalized Stigma subscales (Ritsher et al., 2003), each consisting of four items. These assessed feelings of being socially disconnected (e.g., ‘People who were not abused could not possibly understand me’), and agreement with negative stereotypes about CM (e.g., ‘People who were abused during childhood should not get married”). Cronbach’s alphas for Alienation and Stereotypes in our sample were .76 and .80, respectively. The Secrecy subscale, derived from Link et al. (2002), included three items assessing beliefs about whether ‘a person who experienced CM should reveal it to others’ (α = .87). Perceived Recovery used four items from the Recovery Assessment Scale (Corrigan et al., 2004), capturing ‘hopefulness about the future’ and ability to handle life events (α = .75). Responses were on a scale from 1 (‘strongly agree’) to 4 (‘strongly disagree’), with an additional option of ‘prefer not to answer’. Higher scores indicated higher self-stigma. Total scores ranged from 15 to 50, M = 27.38, α = .85. Items were modified to align with CM experiences (see Haim-Nachum et al., under review, for a previous study on CM using these scales). These scales were standardized in previous studies by a group of stigma experts in the field (see Amsalem et al., 2024).

1.3.3. Depression

Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001), a brief instrument assessing nine depressive symptoms experienced over the past two weeks. Responses are scored from 0 =  ‘not at all’ to 3 = ‘nearly every day’. Symptom severity is indicated by the sum of all item scores. The psychometric properties of this measure proved to be adequate with a robust factor structure and good internal consistency (Richardson & Richards, 2008). Internal consistency in the current study was α = .90.

1.3.4. PTSD

We assessed clinical symptoms of PTSD using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5; Prins et al., 2016; see our previous work: Amsalem et al., 2021). We adjusted PC-PTSD-5 items to focus on CM-related events (e.g., ‘In the past month, have you felt guilty or unable to stop blaming yourself for the childhood-abuse related events?’). Higher scores indicating greater self-reported symptom severity. Internal consistency in the current sample α = .74.

1.3.5. Anxiety

We used the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006) to assess seven generalized anxiety symptoms during the past two weeks, each rated on a scale ranging from 0 (‘not at all’) to 3 (‘nearly every day’), with an overall score range of 0–21 (33). Higher scores indicate greater self-reported anxiety. Internal consistency in the current study a = .92.

1.3.6. Socio-economic Status

We used the MacArthur Scale of Subjective Social Status (Adler et al., 2000), which depicts social status as a 10-rung ladder (range 1–10). Individuals were asked to rank themselves on this ladder relative to others in their local neighbourhood or wider society, during their childhood. Respondents read: ‘At the top of the ladder are the people who are the best off, those who have the most money, most education, and best jobs. At the bottom are the people who are the worst off, those who have the least money, least education, worst jobs, or no job.’ Participants placed an ‘X’ on the rung that best represented where they stood during their childhood.

Other sociodemographic variables, including age, gender, race, and ethnicity, were assessed using a brief self-report questionnaire.

1.4. Procedure

The study was pre-registered on Clinical Trials in April 2023 (NCT05818228). It contains new unpublished data which was collected as part of a larger non-clinical interventional study conducted to assess the efficacy of a brief video intervention in reducing self-stigma among CM survivors (see Haim-Nachum et al., under review). The study was described as a research project on ‘self-stigma among childhood maltreatment survivors.’ Consenting participants first completed a demographic questionnaire, followed by the above-described measures.

1.5. Data analysis

Data analysis was performed using IBM SPSS Statistics 29. We used G*Power software (Faul et al., 2007) to calculate the required sample size based on our previous study (see Haim-Nachum et al., under review).

To test our hypotheses, we conducted mediation models using Hayes Process Model 4 (Hayes, 2013), with CM as the independent variable, self-stigma as the mediator, and symptoms of depression, PTSD, and anxiety as dependent variables (for a similar approach see Haim-Nachum et al., 2023). Specifically, three analyses were performed to gradually clarify the role of CM. First, we used the CM total score as the independent variable. Next, to explore the two main forms of CM (i.e., abuse, neglect), we conducted the same analysis but separately for Childhood Abuse and Childhood Neglect as the independent variables. Finally, to better understand the mediating effect of specific abuse and neglect experiences, we conducted an exploratory analysis of these mediation models, considering emotional, sexual, and physical abuse, as well as emotional and physical neglect, as independent variables. To control the potential cohort effect of age on the occurrence and impacts of CM, we included age as a covariate in these analyses.

2. Results

2.1. Sample characteristics

We recruited 685 individuals, 43 (6.2%) of whom were excluded for failing the inherent validity tests or had missing data (e.g. participants who chose ‘prefer not to answer’) for all CM types, yielding a final sample of 642 individuals (Mage = 36.8, SD = 11.3, 63.4% female; see Table 1 for a description of sample characteristics). Regarding race and ethnicity, the largest group was non-Hispanic White individuals, accounting for almost 70% of the participants. Hispanic/Latinx individuals and non-Hispanic Black individuals each comprised around 12% of the sample, non-Hispanic Asian individuals comprised around 4%, and non-Hispanic Native American/Pacific Islander individuals less than 1%. The mean socio-economic level of the participants was 4.5 (SD = 1.8), suggesting that, on average, participants placed themselves around the midpoint of the socio-economic ladder during the time of the CM, indicating moderate variability in perceived socio-economic status within the sample.

Table 1.

Demographic and Clinical Characteristics, N = 642.

Variable (n %)
Mean age (SD) 36.8 ± 11.3
Gender – female (%) 407 (63.4)
Race and ethnicity  
 Hispanic/Latinx (%) 78 (12.1)
 Non-Hispanic White (%) 446 (69.5)
 Non-Hispanic Black (%) 76 (11.8)
 Non-Hispanic Asian (%) 25 (3.9)
 Non-Hispanic Native American/Pacific Islander (%) 5 (0.8)
 Non-Hispanic Other a (%) 12 (1.9)
Mean socio-economic levels (SD) 4.5 (1.8)
Childhood maltreatment (range 1–5, %)  
 Physical abuse 558 (86.9)
 Emotional abuse 582 (90.7)
 Sexual abuse 265 (41.3)
 Physical neglect 234 (36.4)
 Emotional neglect 509 (79.3)
Depression severity (PHQ-9, range 0–27, %)  
 Mild depression (PHQ-9 ≥ 5 and <10) 157 (24.5%)
 Moderate depression (PHQ-9 ≥ 10 and <14) 141 (22%)
 Moderately severe depression (PHQ = ≥15) 169 (26.3%)
PTSD severity (PC-PTSD, range 0–5, %)  
 PC-PTSD <3 365 (56.9%)
 PC-PTSD ≥3 277 (43.1%)
General anxiety severity (GAD-7, range 0–21, %)  
 Mild general anxiety (GAD-7 ≥ 5 and <10) 202 (31.5%)
 Moderate severe anxiety (GAD-7 ≥ 10) 258 (40.2%)
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Note. a Non-Hispanic Other: multiracial (n = 11), unspecified (n = 2).

PHQ = Patient health questionnaire, PC-PTSD = Patient care screen for posttraumatic stress disorder, GAD = General anxiety disorder.

All participants in our sample experienced at least one type of CM, including Physical abuse (86.9%), Emotional abuse (90.7%), Sexual abuse (41.3%), Physical neglect (36.4%), and Emotional neglect (79.3%). We observed a significant level of co-occurrence among CM types (i.e., abuse and neglect). Specifically, only 107 participants (16.7%) reported experiencing abuse (whether sexual, physical, or emotional) without neglect (whether sexual, physical, or emotional), with an extreme low number of six participants (0.9%) reporting experiencing neglect (either physically or emotionally) but not abuse. Most reported CM experiences (81.98%) were recurrent rather than single (12.66%) incidents (5.36% preferred not to answer or had missing data). Specifically, recurrent incidents were reported by 74.6% for physical abuse, 83.3% for emotional abuse, 25.1% for sexual abuse, 74.8% for emotional neglect, and 32.4% for physical neglect. Regarding age at onset, most participants (83%) reported experiencing these CM events below age 12. Symptom levels of the sample were high, with about 50% of participants meeting moderate (PHQ-9 ≥ 10 and ≤14) or moderately severe depression (PHQ = ≥15), more than 40% meeting the cut-off for PTSD (PC-PTSD ≥3), and 70% for anxiety (GAD-7 ≥ 10; see Table 1).

2.2. Main analysis

2.2.1. Total CM scores

Correlation coefficients are detailed in Supplementary 1. The association between CM (X) and self-stigma (M, path a, Figure 1A, B and C) was significant and positive (this association is similar in all three models). Furthermore, the associations between self-stigma (M) and depression (Y1, path b, Figure 1A), as well as PTSD (Y2, path b, Figure 1B) and anxiety (Y3, path B, Figure 1C) were also positive and significant. The indirect effect was significant for depression (β = .07, 95% CI = .04,.11), accounting for 28% of the total explained variance (R2) of 6.2%, for PTSD (β = .07, 95% CI = .04,.10) accounting for 22.6% of the total explained variance of 9.55% and for anxiety (β = .06, 95% CI = .03,.10), accounting for 26.09% of the total explained variance (R2) of 5.22%.

Figure 1.

Figure 1.

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Mediation Analyses of Self-Stigma in the Relationships Between Total CM Scores and Depression (A), PTSD (B), and Anxiety (C).

2.2.2. Childhood abuse and neglect

Results showed that self-stigma mediated the relationship between both Childhood Abuse (β = .05, 95% CI = .01,.09; β = .05, 95% CI = .01,.08; β = .05, 95% CI = .01,.08), and Childhood Neglect (β = .07, 95% CI = .04,.10; β = .07, 95% CI = .03,.10; β = .06, 95% CI = .03,.10), for depression, PTSD, and anxiety symptoms, respectively (see Figures 2 and 3).

Figure 2.

Figure 2.

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Mediation Analyses of Self-Stigma in the Relationship Between Childhood Abuse and Depression (A), PTSD (B), and Anxiety (C).

Figure 3.

Figure 3.

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Mediation Analyses of Self-Stigma in the Relationship Between Childhood Neglect and Depression (A), PTSD (B), and Anxiety (C).

2.3. Exploratory analysis – different abuse and neglect subtypes

2.3.1. Sub-types of childhood maltreatment

Results showed mediation effects in those who were sexually abused (β = .06, 95% CI = .03, .10; β = .06, 95% CI = .03, .10; β = .06, 95% CI = .02, .10), for depression, PTSD, and anxiety respectively (see Supplementary Fig. 1). No such effects were noted for individuals who reported physical abuse (β = .01, 95% CI = −.03, .04; β = .01, 95% CI = −.03, .04; β = .01, 95% CI = −.03, .04), or emotional abuse (β = .01, 95% CI = −.03, .04; β = .01, 95% CI = −.02, .05; β = .01, 95% CI = −.02, .04), for either depression, PTSD, or anxiety, respectively. However, results revealed significant effects in those who were physically (β = .06, 95% CI = .03, .10; β = .06, 95% CI = .03, .10; β = .06, 95% CI = .02,.09) or emotionally (β = .05, 95% CI = .02, .08; β = .05, 95% CI = .02, .08; β = .04, 95% CI = .02, .08) neglected, for depression, PTSD, and anxiety symptoms, respectively (see Supplementary Fig. 2 and Fig. 3).

3. Discussion

The current study tested the mediating role of self-stigma in the relationships between CM and symptoms of depression, PTSD, and anxiety. In line with previous findings, the present sample of childhood maltreatment survivors was characterized by high prevalence of clinical symptoms (Haim-Nachum et al., 2023; Haim-Nachum et al., under review; McKay et al., 2021). As predicted, we found significant mediation effects of self-stigma of the relationship between CM and symptoms of depression, PTSD, and anxiety, which was true for both abuse and neglect. A more specific examination showed that these effects were present in those who had experienced childhood sexual abuse, but not physical or emotional abuse, as well as in those who had experienced physical as well as emotional neglect. To our knowledge, this is the first study to demonstrate the mediating role of self-stigma in the relationship between distinct CM experiences and depression, PTSD, and anxiety symptoms.

Our findings are congruent with previous research suggesting that self-stigma is strongly associated with CM (Schomerus et al., 2021; Schröder et al., 2021) and that it is a central characteristic of different mental health conditions such as PTSD, depression, and anxiety (Alkathiri et al., 2022; Benfer et al., 2023; Dubreucq et al., 2021). Our study contributes to existing research by simultaneously examining three concepts (i.e., CM, self-stigma, and symptoms of depression, PTSD, and anxiety) and by assessing different CM sub-types and using a large sample size. Expanding upon this, our findings reveal that self-stigma acts as a mediator of the relationships between both childhood abuse and neglect experiences and these symptoms. Taken together, our findings underscore the significant role of self-stigma in the complex interplay between CM experiences and the manifestation of symptoms related to depression, PTSD, and anxiety (Hofmann et al., 2023; Lewis et al., 2022; Schröder et al., 2021). This is especially relevant, considering the high prevalence rates of stigma in these disorders (Lewis et al., 2022) and their low treatment effectiveness (Campbell et al., 2016; Ociskova et al., 2018). Longitudinal studies may offer further insights into the potential role of self-stigma in the development of these outcomes in the aftermath of CM.

Our results indicate that self-stigma and symptoms of depression, PTSD, and anxiety were significantly associated with childhood sexual abuse but not with physical or emotional abuse. This finding is supported by previous research (Feiring et al., 2009; Finkelhor & Browne, 1985; Kennedy & Prock, 2018) that has demonstrated links between self-stigma, depression, PTSD, and sexual difficulties among survivors of sexual abuse. It is also in line with past research, such as the work of Kessler et al. (2017), which shows that sexual victimization has a higher risk of causing traumatizing effects compared to other trauma types, and by studies indicating that stigma plays a significant mediating role between sexual violence and mental illness, such as depression and PTSD (Verelst et al., 2014). Moreover, survivors of sexual violence often report stigma, depression, PTSD, and anxiety (Murray et al., 2018). However, due to the frequent co-occurrence of different subtypes of CM in the literature and our study, it is challenging to draw definitive conclusions about the relationship between specific CM types and these symptoms. Future studies should employ more sensitive assessments to explore how different CM types contribute to these mental health outcomes, considering their common co-occurrence, and involve larger sample sizes for each CM type.

Unlike the divergence between the different abuse subtypes, our findings suggest that both types of neglect may be linked to self-stigma in predicting depression, PTSD, and anxiety symptoms. There are at least two possible explanations for this results pattern. First, it is possible that both physical and emotional neglect are associated with self-stigma/negative self-beliefs as both implicitly convey that victims are undeserving of care and attention, whether physical or emotional (Jopling et al., 2020; Soffer et al., 2008). Alternatively, the frequent co-occurrence of the different subtypes of CM may also explain this finding. Given the prevalence of polyvictimization both in the literature and in our study, it is challenging to differentiate these experiences. A nuanced approach is required to assess the impact of each type of adverse exposure and its interactions with other forms of victimization on self-stigma and mental health outcomes. This will help to understand the protective adaptations and morbidity caused by different childhood trauma profiles (McLaughlin & Sheridan, 2016). Further research specifically focused on neglect is needed to unravel the nuanced associations between neglect subtypes, self-stigma, and mental health outcomes.

Most of the reported childhood maltreatment experiences in our sample were recurrent (81.98%) rather than single (12.66%) incidents. Additionally, the majority (83%) of participants reported experiencing these CM events below the age of 12. While assessing objective trauma is crucial, the subjective experience is also significant, especially among youth who experience repeated incidents at an early age. Accumulating evidence suggests that exposure to parental violence against a sibling can be equally traumatizing. For example, Tucker et al. (2021) found that after controlling for child maltreatment and exposure to interparental violence, those exposed to parental assault on a sibling showed higher levels of mental distress, such as anger, depression, and anxiety. In families where children observe a sibling being physically mistreated by a parent, such occurrences may be distressing and induce fear, guilt, shame, and ‘survivor’ guilt.

3.1. Clinical implications

Taken together, our findings highlight the association between CM and self-stigma, which in turn is linked to trauma-related mental health conditions such as depression, PTSD, and anxiety. As such, addressing self-stigma emerges as an important therapeutic aim in the treatment of these disorders in the aftermath of CM. This approach is substantiated by existing research (Haim-Nachum et al., under review; Schröder et al., 2021) that underscores the importance of self-stigma in the context of CM survivors and their mental health outcomes.

3.2. Limitations

This study has several limitations. First, we used self-report measures which are influenced by memory biases (Baldwin et al., 2019). Second, the items used to measure different domains of CM varied in specificity. For instance, the phrasing of items assessing physical and emotional abuse could encompass both normative and traumatic experiences, while the item measuring sexual abuse was more closely linked to sexual trauma. Moreover, although we assessed for chronicity and onset of the CM, the screening approach used may thus lead to categorizing diverse experiences of CM into a single group of ‘survivors.’ This overlooks variations in the severity and frequency of abuse, potentially affecting the interpretation of results. Third, the data quality of online panels has been criticized recently for representativeness of samples and their susceptibility to response bias (Kees et al., 2017) Moreover, our sample included a wide age range, and older participants may be more susceptible to recall bias. While Chmielewski and Kucker (2020) suggest that these effects can be mitigated by using response validity indicators and screening the data, which we implemented via attention checks, more research is needed to affirm these results in CM survivors. Fourth, while the current clinical status of the sample allows for generalization of findings to more segments of society (in line with the RDoC framework; Carcone & Ruocco, 2017), future examinations may test the mediating role of self-stigma in the relationships between CM and these symptoms in clinically diagnosed individuals with elevated symptom levels. Such studies may assess whether and how self-stigma predicts specific symptom clusters. Relatedly, future research endeavours should include more contextual information about participants (i.e. rural/urban settings and geographic locations) to provide a more comprehensive understanding of the sample's context and enhance the generalizability of the study findings.

In summary, our findings highlight the role of self-stigma in mediating the relationships between childhood abuse and neglect and symptoms of depression, PTSD, and anxiety. The results extend previous findings by suggesting that self-stigma is especially relevant for depression, PTSD, and anxiety in sexually abused and emotionally and physically neglected individuals. Ultimately, this research could help guide the development of interventions and treatment strategies that target self-stigma to reduce symptoms of depression, PTSD, and anxiety in survivors of CM.

Supplementary Material

Supplementary_Figure_1.tif
ZEPT_A_2370174_SM8323.tif (40.1KB, tif)
Supplementary_Figure_2.tif
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Supplementary_Figure_3.tif
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R_Supplementary 1_anonymous.docx
ZEPT_A_2370174_SM8320.docx (30.6KB, docx)

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study will be made available via OSF upon publication.

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Associated Data

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Supplementary Materials

Supplementary_Figure_1.tif
ZEPT_A_2370174_SM8323.tif (40.1KB, tif)
Supplementary_Figure_2.tif
ZEPT_A_2370174_SM8322.tif (39.9KB, tif)
Supplementary_Figure_3.tif
ZEPT_A_2370174_SM8321.tif (39.8KB, tif)
R_Supplementary 1_anonymous.docx
ZEPT_A_2370174_SM8320.docx (30.6KB, docx)

Data Availability Statement

The data that support the findings of this study will be made available via OSF upon publication.

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