Emotion Dysregulation & Maladaptive Personality Mediate Trauma Exposure & Psychopathology

Abstract
Previous studies have elucidated the cumulative effect of multiple traumas on psychopathology, particularly depression and post-traumatic stress disorder (PTSD). However, less is known about potential mediators in the relationship between cumulative trauma and psychopathology in an Asian context. We identified emotion dysregulation and maladaptive personality as possible mediators. Emotion dysregulation can be defined as ability deficits in regulating one’s emotions which can include difficulties in awareness, understanding and responding to emotions in a desired way. Maladaptive personality traits are persistent and set patterns of behaviour and thinking that are dysfunctional and cause distress.



Research supports emotion dysregulation as a predictor of PTSD and depressive symptoms, and a mediator between trauma types and PTSD. Despite this, few studies have investigated the cumulative impact of lifetime trauma in this relationship. Additionally, maladaptive personality mediates the relationship between cumulative lifetime trauma and PTSD. However, no studies have been conducted with depression as the outcome despite evidence of maladaptive personality’s deleterious effects on the development of mental disorders.



Hence, we examined two separate parallel mediation models with two mediators (i.e., maladaptive personality traits and global emotion dysregulation) that could underlie the relationship between cumulative trauma and PTSD symptoms, and cumulative lifetime trauma and depressive symptoms. Additionally, we looked at whether individual domains of maladaptive personality and emotion dysregulation would significantly mediate these relationships.



200 outpatients with mood disorders (Mean age= 36.53, 54% females) were recruited from the Institute of Mental Health, Singapore’s only psychiatric hospital. Participants completed self-report measures for cumulative lifetime trauma (Stressful Life Events Screening Questionnaire- Revised), depressive symptoms (Patient Health Questionnaire), PTSD symptoms (PTSD Checklist for DSM-5), global emotion dysregulation (Difficulties in Emotion Regulation Scale-Short) and maladaptive personality traits (Personality Inventory for DSM-5 Brief Form). We included participants with a primary diagnosis of depression or bipolar disorder who were aged 21-65 with the ability to understand English.



Overall, our results revealed that the relationship between cumulative lifetime trauma (Mean= 3 events; range 1 to 8 events) and depression (b=0.65, 95% CI [0.29,1.05]) was mediated by global emotion dysregulation domains (poor emotional clarity, non-acceptance of emotions, impulsivity, lack of goal directed behaviours, and lack of access to adaptive emotion regulation strategies) and maladaptive personality domains (detachment and psychoticism). The same domains from emotion dysregulation and maladaptive personality mediated the relationship between cumulative lifetime trauma (Mean= 2.5 events; range 0 to 8 events) and PTSD (b=1.84, 95% CI [0.86, 2.82]). Both models controlled for age, gender, and child/adult index trauma.



These findings suggest that maladaptive personality traits and emotion dysregulation maintain PTSD and depressive symptoms after exposure to cumulative lifetime trauma in a non-western context. Hence, emotion dysregulation and personality might constitute prognostic markers of psychopathology and translate to potential points of intervention.