Person. indittd. Dif: Vol. 4, No. 6, pp. 695-697, 1983 0191.8869/83$3.00 + 0.00 Printed in Great Britam. All rights reserved Copyright 0 1983 Pergamon Press Ltd

Childhood loss and disharmony: later effects on personality and psychopathology

F. HASSANYEH

St

and J. M. G. WILLIAMS

Department of Psychiatry, University of Newcastle upon Tyne NE1 4LP, England

(Received IO February 1982)

Summary-In a comparison of psychiatric inpatients and medical controls parental loss in childhood was not a differentiating factor. Psychiatric inpatients, however, had more disturbance in their home background.

In the psychiatric group a disturbed childhood background was associated, on the Eysenck Personality Questionnaire, with abnormal scoring on P in both sexes, and N in males. There was, however, no specific association with psychiatric diagnosis.

INTRODUCTION

A psychiatric interview attempts not only to elicit information about current psychiatric state but also tries to discover any significant events from the past which may have shaped current personality. The effects of childhood experience on adult functioning have been extensively researched and reported on in the literature. Much of the evidence which has accrued has, unfortunately, been contradictory. Of all psychiatric conditions, the one which has received the most attention is depression; and of all childhood experiences, the most commonly studied is the loss of parent by death or separation.

For example, Beck, Sethi and Tuthill (1963) found that severe, but not mild or moderate depressives had more parental loss before I6 yr of age than non-depressives, and Forrest, Fraser and Priest (1965) found more parental bereavement before I5 yr of age in depressed patients compared to medical controls. On the other hand, others have found no difference between depressives and medical controls, or between different severity grades of depression in parental loss before 15-16 yr of age (Munro, 1966; Abrahams and Whitlock, 1969).

There is also dispute as to whether subtypes of depression differ in rates of parent loss. Gay and Tonge (1967) found that reactive depressives had more parent loss before I5 yr than endogenous depressives, especially loss of a parent of the opposite sex. On the other hand, Forrest ef al. (1965) and Abrahams and Whitlock (1969) found no such evidence of differences between endogenous and reactive depressives.

From their community study Brown and Harris (1978) reported that a history of loss was associated with depressive illness in women. For these women, if past loss had been by death the association tended to be with psychotic-type depression, whereas loss by separation was associated with neurotic-type depression. In addition to its role as a ‘symptom-formation factor’ loss (of mother) was also one of four ‘vulnerability’ factors explaining why, in the presence of provoking agents or life events, some women became depressed while others did not.

Paradoxically, Brown and Harris (1978) also reported that loss of mother before 11 was not associated with depressive illness in women referred to a psychiatric clinic. They tried to explain this discrepancy, of a positive association with community but not hospital depressives, by saying that loss of mother before 11 reduced the chance of a woman in the community being referred to a psychiatrist when she became depressed.

Questions still remain, however, whether these associations are unique to depression, or characteristic of the background of many psychiatric patients. It is also unclear whether it is the parent loss per se which is of aetiological significance, or whether it is the disturbed family background which often precedes or follows such a loss which is important. Greer (1964) found an association between a history of suicide attempts among psychoneurotic outpatients and more disturbed background before I6 yr of age, and although neither Munro (1966) nor Abrahams and Whitlock (1969) found any difference between depressed and other psychiatric patients in parental loss before mid-teens, both found that more severe depressives had more disturbed upbringing, or a more disturbed relationship with their parents.

An opportunity to study these variables was afforded by a recent survey of case-history data, personality and psychiatric diagnosis in Newcastle. Interest particularly focussed on incidence of parent loss in a psychiatric and a medical control population, and the associations within the populations, between disturbed family background, and current personality status.

METHOD

Two groups of patients were studied. The first group consisted of psychiatric inpatients. They were all consecutive admissions to 3 of 5 consultant teams at

the Department of Psychological Medicine, Newcastle General Hospital. Psychiatric diagnosis was made bv the consultant concerned, though with patients diagnosed as having endogenous depression or schizophrenia confirmation of these diagnoses was made using the Research and Diagnostic Criteria (RDC) of Spitzer. Endicott and Robins (1978). All patients with a consultant diagnosis of endogenous depression conformed to RDC’criteria for this condition, but 2’patients with a diagnosis of schizophrenia did not do so. These 2 patients were excluded from the schizophrenic group. A total of 200 psychiatric patients were seen.

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696 NOTES AND SHORTER COMMUNICATIONS

The second group of patients, the control group, was seen on two general medical wards. They were consecutive admissions to one of the consultant teams on those wards. No patient included m the control group had a history of psychiatric disorder. Fifty patients formed this group.

In neither group were patients with evidence of organic brain disease included. In addition to case-note study, all patients were given a standardized clinical inten.iew to elicit further details on current

and past psychiatric history as well as information on childhood loss and family environment. All patients were also asked to complete the Eysenck Personality Questionnaire (EPQ; Eysenck and Eysenck. 1975). In the case of the psychiatric patients these interviews took place in the week prior to discharge from hospital. at which time the patients had been considered improved. This was designed to overcome the influence of an adverse mental state on the patient’s response to questioning, especially to the EPQ.

Statistical analyses on the data were by the Chi-squared test using Yates’ correction. Patients were matched for sex (female:male in each group of 2:l). The psychiatric patients were aged 41.4 + 15.3 yr the control group 49.1 + 17.0 yr (mean f SD).

RESULTS

Parent loss in childhood (Table 1) Thirty-nine of the psychiatric inpatients (19.5%) had lost a parent before their 15th birthday. In 20 of these patients the

loss was by death, in 19 it was by permanent separation or divorce.

Table 1. Parental loss and disturbed childhood in conrrols and psychiatric patients

Medrcal controls Psychlanc paf~ents (n = SO) in = 200)

Parental loss 0%14yrs 5’ 39”

w yrs 2 (by death) 20 (8 b> death) o-9 yrs 4 (by death) 28 (12 by death)

Disturbed childhood 2 37

‘4 Father, I mother. *‘25 Father, 9 mother, 5 both.

Of the medical patients 5 (10%) had lost a parent before their 15th birthday. In 4 of these cases the loss was by death and in 1 by divorce.

Analyses of these findings did not reveal any statistically-significant differences between the 2 groups for age O-14 yrs (x2 for death 0.18, for separation/divorce 2.12), or for sub-age group o-4 yr (z’ for death 0.16, for separation/divorce 0.72), O-9 yr (x2 for death 0.03, for separation/divorce 1.6).

Scores on the EPQ (Table 2) Patients who scored 1.96 SD or more [with reference to Eysenck and Eysenck’s (1975) normative data] were rated as

abnormal scorers.

Table 2. Abnormal EPQ in control and psychmtnc patar,

Medical Psychmtric ParenG?l’ Dlsrurbed* controls pat,entr loss chIdhood

Scale (n = 50) (n = 200) ~~_ (n = 39) In = 37)

Introversion 3 32 8 6 Neuroticism 0 37 8 9 Psychoticism 4 13 I 7

‘In psychiatric patient group.

Comparing the psychiatric group as a whole with the medical controls, on the Neuroticism (N) scale the difference between these was significant (psychiatric vs controls, x2(1 df) = 7.7, P < 0.01). However there were no significant differences between the 2 groups on Introversion (I) (x2 = 2.54) or Psychoticism (P) (x2 = 0.14).

There were no significant differences between psychiatric patients, with or without a history of loss on I (x2 = 0.37) or N (x 2 = 0.01). No analysis was done on the P scale as only 1 patient in the ‘loss’ group scored abnormally.

Parental relationship in childhood (Tables I and 2) The patients were asked about the relationship of their parents to one another in the years before their 15th birthday.

Further information was obtained, when available, from the case notes. A patient’s childhood environment was rated as ‘disturbed’ if all three of the following existed: the patient considered

his childhood was ‘very unhappy’; parents frequently and explosively argued in front of the patient; one parent hit another on a number of occasions, these being witnessed by the patient.

Psychiatric patients more often than controls rated their parental relationship (their childhood) as being ‘disturbed’ (x*(1 df) = 5.3, P < 0.05).

A separate assessment of the psychiatric group was made with respect to ‘disturbed’ childhood. Those with and without disturbance were compared. Statistical analysis revealed the following as being significantly associated with the ‘disturbed’ group: abnormal scores on P (x2(1 df) = 9.1, P < O.Ol), and on N in males (x2(1 df) = 6.71, P < 0.01).

For the following items there were no differences between the psychiatric patients with and without disturbance: I (x2 = 0.07); N in females (x2 = 1.97).

Loss, disturbed childhood and psychiatric diagnosis (Table 3) Of the 200 psychiatric patients, 57 had a diagnosis of neurotic (reactive) depression. 43 endogenous depression, 23 anxiety

neurosis, 28 schizophrenia. The rest of the patients were placed in categories of ‘other neuroses’ or ‘other psychoses’.

NOTES AN,, SHORTER COMMUNICATIONS 697

Table 3. Parenral loss and dlsrurbed chlldhood and psychiatnc diagnoses NeUIOtlC Endogenous Anxiety

depresrmn depression neurosis Wuzophrenin (n = 57) (n = 43) (n = 23) (n = 28)

_._~~ ..- Parent loss oS14yrs IO 9 5 3 Disturbed childhood o- 14 yrs IO 8 6 2

For neither ‘parental loss’ or ‘disturbed’ childhood was there any significant association with a diagnosis of neurotic depression, endogenous depression anxiety neurosis or schizophrenia (for parental loss x*(3 df) = 1.5; for disturbed childhood, ~‘(3 df) = 4.54).

DISCUSSlON

These findings suggest that loss of a parent, whether mother or father, before 15 yrs of age did not distinguish psychiatric inpatients from non-psychiatric controls. Furthermore, in the psychiatric patients parental loss was not associated with depressive illness, whether endogenous or neurotic, nor with anxiety neurosis or schizophrenia. This was the case whether the loss had been by death or separation. Loss was also not associated with abnormal scoring on I, N or P on the EPQ.

By contrast the results suggest that a persistently-disturbed childhood (with inter-parental disturbance) significantly differentiated the psychiatric group as a whole from the control medical group. The major association found was that between this disturbance and personality. In both male and female psychiatric patients a disturbed background was associated with abnormal scoring on the P scale, and in males on N. There was no association with introversion. It is not possible to say from these results whether the childhood disturbances caused the abnormal personality or whether the personality factors represent a genetically-determined vartable which, as a family characteristic, tended to produce disturbed relationships. In any event, it is interesting to note that it is this disturbance which distinguishes the psychiatric group from controls, not parent loss.

Interestingly, on the EPQ, the psychiatric patients and controls did not differ in abnormal scoring on either the I or P scales, though they did so on N. It could be that introversion unassociated with neuroticism does not significantly increase the propensity to psychiatric breakdown. With regard to P. Eysenck and Eysenck (1975) state that it may not be just a measure of ‘psychoticism’ but also of behavioural disorder and psychopathy. To this group of probably high P scorers may well be added some who, if it serves their purpose, try to circumvent socially-dictated norms, whose high drive is in the main personally oriented. Such individuals are not normally looked on by society as being character ‘deviant’ or psychiatrically disordered.

An objection to the use of medical inpatients as controls was highlighted by Tennant, Bebbington and Hurry (1980). They rightly point out that such patients may have substantial psychiatric morbidity, which would blur the distinction between them and psychiatric patients. We were aware of this danger and assessed our medical controls for evidence of it. No patient in our control group was considered to have any evidence, current or past, of psychiatric illness.

Our conclusions are that loss of parent in childhood does not of itself augur the future development of a psychiatric illness. Though distressing, a child who loses a parent can surmount the loss if there is for him continuity of good care from his remaining parent. A disturbed childhood, however, marked by fear and hostility (as products of parental instability) must, however, be considered a potent factor predisposing to psychiatric illness though the effect is not specific regarding diagnosis.

REFERENCES

Abrahams M. J. and Whitlock F. A. (1969) Childhood experience and depression. Br. J. Psychiat. 115, 883-888. Beck A. T., Sethi B. B. and Tuthill R. W. (1963) Childhood bereavement from adult depression. Archs gen. Psychiat. 9,

295-302. Brown G. W. and Harris T. (1978) Social origins of depression. A Study of Psychiatric Disorder in Women. Tavistock

Publications, London. Eysenck H. J. and Eysenck S. B. G. (1975) Manual of the Ej,.senck Personality Questionnaire. Hodder & Stoughton, London. Forrest A. D., Fraser R. H. and Priest R. G. (1965) Environmental factors in depressive illness. Br. J. Psych&. 111,

243-253. Gay M. J. and Tonge W. L. (1967) The late effects of loss of parents in childhood. Br. J. Psychiat. 113, 753-759. Greer S. (1964) The relationship between parental loss and attempted suicide: control study. Br. J. Psych&. 110, 698-705. Munro A. (1966) Parental deprivation in depressive patients. Br. J. Psychiar. 112, 443457. Spitzer R. L., Endicott J. and Robins E. (1978) Research and Diagnostic Criteria (RDC) f or a Selected Group of Functional

Disorders. 3rd edn. Tennant C., Bebbington P. and Hurry J. (1980) Parental death in childhood and risk of adult depressive disorders: a review.

Psychol. Med. 10, 289-299.