Multiple Adverse Childhood Experiences (ACEs) and experience of shame in adults: a systematic review of the relationship between multiple ACEs and shame; and, An empirical study of the associations between ACEs, shame, and proneness to psychosis
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Date
05/12/2022Author
Marten, Alice
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Abstract
BACKGROUND: Research has suggested that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and poor outcomes in adulthood, including psychopathology. Recently, research has focused on investigating mediating variables which could help explain the relationship between psychopathology and the cumulative effect of ACEs or ‘multiple ACEs’.. Despite strong links between multiple ACEs, experiences of shame and psychopathology, little research has investigated shame as a mediating variable.
OBJECTIVES: The systematic review set out to identify and synthesize studies which investigate the relationship between multiple ACEs and experiences of shame in adulthood. The empirical project set out to investigate the relationships between multiple ACEs, social emotions and proneness to psychosis and psychotic symptoms, specifically assessing whether internal shame mediates the relationship between ACEs and proneness to psychosis and psychotic symptoms.
METHOD: For the systematic review, multiple databases were methodically searched to identify studies which investigated the relationship between multiple ACEs and shame, within both clinical and non-clinical populations. For the empirical project, participants were recruited online through various methods and completed questionnaires asking questions regarding their experiences of childhood adversities, psychosis proneness, proneness to psychotic symptoms and social emotions.
RESULTS: Results of the systematic review found that from 13 studies with a total of 2967 participants, all studies supported a relationship between multiple ACEs and experiences of shame in adults. However, no clear comparison was found between internal and external shame. For the empirical project analysis revealed that there were positive correlations between all variables including ACEs, social emotions and proneness to psychosis and psychotic symptoms. Prediction analysis revealed that ACEs and internal shame significantly predicted psychosis proneness and proneness to psychotic symptoms, however other social emotions did not when added to the model.
Finally, mediation analysis showed that internal shame significantly mediated the relationship between ACEs and proneness to psychosis and psychotic symptoms. Conclusions: Taken together, the results highlight the importance of assessing shame and its impact within individuals with multiple ACEs and psychopathology, including psychosis. Furthermore, it can help to inform treatment methods to help reduce experiences of shame and psychopathology, including psychosis.
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