Personality impairments link childhood maltreatment to adult anxiety

A history of childhood maltreatment is strongly linked to the development of anxiety in adulthood, an association largely explained by disruptions in how a person perceives themselves and connects with others. A recent study published in the journal Psychological Reports details how emotional abuse and neglect shape adult anxiety symptoms by impairing fundamental personality traits. By identifying these underlying psychological pathways, the research points toward more personalized therapeutic strategies for patients dealing with the lasting effects of early trauma.

Generalized anxiety disorder involves excessive, persistent worry about everyday events that is disproportionate to the actual risks. It is one of the most common mental health conditions globally, affecting hundreds of millions of people. Rates of anxiety disorders grew notably during the recent global pandemic.

Childhood maltreatment is an established risk factor for developing severe and treatment-resistant anxiety. This maltreatment encompasses physical abuse, emotional abuse, sexual abuse, emotional neglect, and physical neglect. Stephanie Vaccarezza, a clinical psychologist at the Pontificia Universidad Católica de Chile, led a research team to investigate the psychological mechanisms connecting early adversity to later anxiety. They were particularly interested in how these dynamics unfold in clinical settings where patients are actively seeking mental health treatment.

The researchers focused on a concept called “personality functioning.” In modern psychiatric models, personality functioning describes how well a person navigates their own identity and their relationships with others. Evaluating this functioning helps clinicians understand the severity of personality disruptions in a highly individualized way.

Personality functioning is divided into two main areas. The first is self-functioning, which encompasses a person’s sense of identity, self-esteem, and ability to set meaningful life goals. It also includes the capacity for emotional regulation and productive self-reflection. The second area is interpersonal functioning, which involves empathy, the desire for closeness, and the ability to maintain mutually beneficial relationships with others.

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When these capacities are impaired, individuals often struggle with their self-worth and social interactions. The researchers hypothesized that early emotional and physical maltreatment disrupts the normal development of these core capacities. This disruption leaves individuals more vulnerable to internalized distress, which often surfaces as anxiety later in life.

To test this idea, the researchers recruited 335 adults who were beginning individual psychotherapy. The participants were drawn from four mental health outpatient centers in Santiago, Chile. The group included a mix of patients seeking help for various difficulties, with the majority having completed university or technical education.

The participants completed a series of intake questionnaires designed to assess their early life experiences, current personality functioning, and anxiety levels. The childhood maltreatment survey asked participants to rate how often they experienced different forms of abuse and neglect while growing up. Emotional abuse includes verbal assaults or humiliating actions directed at a child. Emotional neglect refers to a caregiver failing to meet a child’s basic psychological needs for love, belonging, and support.

The researchers measured personality functioning by asking participants to rate statements about their self-perception, emotional regulation, and relationship dynamics. The responses allowed the team to gauge impairments in both self-functioning and interpersonal functioning. Finally, the researchers evaluated the participants for symptoms of generalized anxiety using a standard symptom checklist.

The team then used statistical models to analyze the relationships between the different types of childhood maltreatment, personality impairments, and anxiety levels. They specifically looked for mediation effects, which occur when a third variable explains the relationship between an initial predictor and a final outcome. They utilized a statistical technique that simulates a thousand data samples to ensure the mathematical reliability of their findings.

The researchers found that 64.2 percent of the patients reported experiencing at least one type of childhood maltreatment. Emotional abuse was the most common form, affecting 43 percent of the participants, followed closely by sexual abuse and physical neglect. A smaller subset of patients reported experiencing all five types of maltreatment.

More than half of the total sample met the diagnostic criteria for generalized anxiety disorder. Women in the study had statistically higher odds of experiencing anxiety symptoms compared to men. Women were also more likely to report histories of childhood sexual abuse.

Overall, a higher total score for childhood maltreatment was associated with higher levels of anxiety. When looking at the specific types of maltreatment, only emotional abuse and emotional neglect showed a robust total effect on adult anxiety. Physical abuse, physical neglect, and sexual abuse were not statistically significant predictors of higher anxiety scores in this specific analysis.

Personality functioning proved to be a major factor in connecting early maltreatment to current anxiety. Impairments in overall personality functioning accounted for roughly 73 percent of the total relationship between childhood maltreatment and adult anxiety. Both self-functioning and interpersonal functioning played major roles in this dynamic.

Impairments in self-functioning had a slightly larger impact than impairments in interpersonal relationships. For emotional abuse, self-functioning explained a larger proportion of the resulting anxiety symptoms than interpersonal functioning did. The same pattern held true for emotional neglect, where self-functioning again proved to be the stronger mediator.

For patients who experienced emotional neglect, the relationship with adult anxiety was entirely explained by diminished personality functioning. In other words, emotional neglect did not show a direct statistical link to anxiety except through the way it hindered a person’s self-perception and social skills. Emotional abuse, on the other hand, retained a direct statistical link to adult anxiety, though personality impairments still accounted for more than half of its total effect.

The study relied on retrospective self-reports, meaning participants had to recall events from their childhoods. This method can sometimes introduce memory biases or subjective interpretations of past events. The participants were also predominantly highly educated and recruited mostly from private clinics, which means the results might not perfectly represent the broader public.

Additionally, the data was collected at a single point in time when the patients were starting therapy. This cross-sectional design makes it impossible to establish a firm trajectory of cause and effect, as the researchers could not observe how anxiety symptoms or personality functioning changed over the course of treatment. Future studies will need to track individuals over several years to confirm how these psychological mechanisms unfold during human development.

The researchers noted that therapy for adult anxiety often focuses heavily on reducing immediate symptoms. For patients with a history of emotional maltreatment, clinical interventions might be more successful if they also target core self-esteem, identity, and relationship skills. By treating the underlying personality impairments, clinicians can help patients build the emotional regulation necessary to manage long-term anxiety.

The study, “Childhood Maltreatment and Anxiety in Adulthood: Disentangling the Role of Personality Functioning,” was authored by Stephanie Vaccarezza, Sebastián Opazo, Adrian P. Mundt, Alejandra Cortázar, and Paula Errazuriz.