Adverse Childhood Experiences May Increase Risk for Psychotic Experiences

A young girl showing shock or surprise
Among patients with substance use disorder, researchers investigated whether early exposure to adverse childhood experiences may increase risk for psychotic experiences.

Among patients with substance use disorder (SUD), early exposure to adverse childhood experiences (ACEs) may increase risk for psychotic experiences (PE). These findings were published in Psychiatry Research.

This prospective 3-wave cohort study was conducted in Chile between 2018 and 2020. Adults (N=399) entering treatment programs for SUD were interviewed about 6 types of PE using the Composite International Diagnostic Interview V7.1 (CIDI). Risk for PE was assessed on the basis of ACE exposure and the timing of the ACE events.

The patient population comprised 32.3% women, aged mean 39.2 (SD, 10.6) years, 94.5% used alcohol, 87.2% cocaine, 77.9% cannabis, 40.8% benzodiazepines, 69.2% had a history of depression, 49.6% an anxiety disorder, and 41.4% had hallucinations. More than half (55.1%) endorsed having PE. The PE cohort used more substances (mean, 4.5 vs 3.9; P =.01), had a psychiatric comorbidity (85% vs 70.4%; P =0.00), used benzodiazepines (47.5% vs 32.6%; P =0.00), and inhalants (18.4% vs 7.3%; P =0.00).

Patients reporting PE experienced more ACE events (mean, 4.2 vs 3.4; P <.001).

The number of ACE events occurring before 18 years of age increased risk for PE (odds ratio [OR], 1.10; 95% CI, 1.00-1.21; P <.05). Similarly, the number of substances used increased risk for PE (OR, 1.13; 95% CI, 1.00-1.27; P <.05).

Risk for psychiatric comorbidity was associated with ACE at any time during childhood (OR, 2.07; 95% CI, 1.24-3.47; P<.01), at 0 to 12 years of age (OR, 2.13; 95% CI, 1.27-3.56; P <.01), and at 13 to 17 years of age (OR, 2.12; 95% CI, 1.27-3.54; P <.01).

Stratified by broad category of ACE (complex, harmful, and private), complex ACEs had the highest risk for PE (adjusted OR [aOR], 1.78; 95% CI, 1.12-2.85). For specific ACEs, arrests (aOR, 1.88; 95% CI, 1.13-3.15), sexual abuse (aOR, 1.81; 95% CI, 1.07-1.64), and number of ACEs (aOR, 1.10; 95% CI, 1.00-1.21) were the strongest predictors for PE. Stratified by the time of the events, sexual abuse at 0 to 12 years of age (aOR, 1.81; 95% CI, 1.00-3.29) and arrests at 13 to 17 years of age (aOR, 1.92; 95% CI, 1.15-3.22) were predictors for PE.

As a robustness assessment, reevaluating the data without imputing missing information found similar trends.

The major limitation of this study was the reliance on self-reported recall of ACE events.

The study authors concluded, “Our results suggest that early exposure to ACEs is a risk factor for later PE in this population. Also, the type of ACE and the period when they occurred is important, suggesting the existence of critical periods where the individual is more susceptible to adverse environmental stimuli. Specifically, sexual abuse during childhood and deprivation and complex experiences during adolescence significantly increased the probability of presenting later PE in individuals with SUD.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Bórquez-Infante I, Vasquez J, Dupré S, Undurraga EA, Crossley N, Undurraga J. Childhood adversity increases risk of psychotic experiences in patients with substance use disorder. Psychiatry Res. 2022;316:114733. doi:10.1016/j.psychres.2022.114733