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Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)448-455
Number of pages8
JournalBritish Journal of Psychiatry
Issue number2
Early online date11 May 2021
Accepted/In press16 Apr 2021
E-pub ahead of print11 May 2021
PublishedAug 2021

Bibliographical note

Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.


  • LewisComplexTrauma_withFigsTab_210406

    LewisComplexTrauma_withFigsTab_210406.docx, 693 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:16 Apr 2021

    Version:Accepted author manuscript

    Licence:CC BY

King's Authors


Background Complex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. These traumas are hypothesised to cause more severe psychopathology and poorer cognitive function than other non-complex traumas. However, empirical testing has been limited to clinical/convenience samples and cross-sectional designs. Aims To investigate psychopathology and cognitive function in young people exposed to complex, non-complex or no trauma, from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities. Method Participants were from the Environmental Risk Longitudinal Twin Study, a population-representative birth cohort of 2232 British children. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma, past-year psychopathology and current cognitive function. We also prospectively assessed early childhood vulnerabilities: internalising and externalising symptoms at 5 years of age, IQ at 5 years of age, family history of mental illness, family socioeconomic status and sex. Results Participants exposed to complex trauma had more severe psychopathology and poorer cognitive function at 18 years of age, compared with both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology. Conclusions By conflating complex and non-complex traumas, current research and clinical practice underestimate the severity of psychopathology, cognitive deficits and pre-existing vulnerabilities linked with complex trauma. A better understanding of the mental health needs of people exposed to complex trauma could inform the development of new, more effective interventions.

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