Mechanisms Underlying the Link Between Child Maltreatment Severity and Psychological Distress in College Women

Mindfulness (2020) 11:1446–1459 https://doi.org/10.1007/s12671-020-01361-2 ORIGINAL PAPER Self-compassion and Fear of Self-compassion: Mechanisms Underlying the Link between Child Maltreatment Severity and Psychological Distress in College Women Terri L. Messman-Moore1 & Prachi H. Bhuptani1 Published online: 17 April 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Objectives Women are at increased risk for depression and anxiety associated with child maltreatment, given higher rates of exposure to childhood maltreatment and a greater sensitivity resulting in maltreatment-related distress. Thus, there is a need to identify mechanisms of resilience among female survivors of child maltreatment. Self-compassion may promote resilience, whereas fear of self-compassion may diminish this protective effect. Moreover, distinct facets of self-compassion (e.g., self- kindness) versus self-coldness (e.g., self-judgment) may differentially explain risk or resilience for child maltreatment outcomes. Methods College women (N = 586) completed anonymous online surveys assessing the severity of different types of child maltreatment, self-compassion, fear of self-compassion, depression, anxiety, and stress. Results Severity of sexual, physical, and emotional abuse, and emotional and physical neglect, was positively associated with elevated fear of self-compassion and the absence of self-compassion (i.e., self-coldness). In contrast, emotional abuse and neglect severity were the only maltreatment variables negatively associated with self-compassion. Models indicated an indirect relation between increased maltreatment severity and heightened psychological distress via fear of self-compassion and self-coldness (i.e., isolation, overidentification). Statistical patterns indicative of suppression among the positive facets of self-compassion occurred. Conclusions The centrality of emotional maltreatment, along with fear of self-compassion, isolation, and overidentification, emerged across analyses. Findings suggest the absence of self-compassion (i.e., self-coldness) is associated with specific forms of distress. Additional research with child maltreatment survivors should examine self-compassion components rather than a unidimensional construct. Keywords Child abuse . Child neglect . Self-compassion . Depression . Anxiety . Stress A meta-analysis of longitudinal studies demonstrated that diagnoses (Teicher and Samson 2013). Exposure to childhood experiencing child maltreatment is associated with increased maltreatment and negative outcomes associated with it differ risk of depression and anxiety in adulthood, with the magnitude according to the victim’s gender. In the NESARC study of of risk varying by maltreatment type (e.g., odds ratios ranged 34,653 US adults, women had significantly higher rates of from 1.7 for neglect to 2.7 for sexual abuse) (Li et al. 2016). childhood physical, sexual, and emotional abuse compared Maltreated individuals diagnosed with depressive or anxiety with men (Hartford et al. 2014). Research considering the co- disorders have an earlier age of onset, greater symptom severity, existence of different types of childhood maltreatment indicates more comorbidity, greater risk for suicide, and poorer treatment women experience higher rates of child emotional abuse, emo- response than non-maltreated individuals with the same tional neglect, and sexual abuse, and higher rates of physical abuse in the context of emotional or sexual abuse compared with men (Rehan et al. 2017; Scher et al. 2004; Taillieu et al. * Terri L. Messman-Moore 2016). Thus, women are more likely than men to experience [email protected] multiple types of child maltreatment, and also experience higher rates of most forms of child maltreatment in isolation. 1 Department of Psychology, Miami University, Oxford, OH 45056, Psychiatric correlates of child maltreatment also vary by USA gender, with women more sensitive to the negative impact Mindfulness (2020) 11:1446–1459 1447 of childhood maltreatment. Among college students exposed individual’s experience at any one point in time; rather self- to childhood maltreatment, a greater proportion of women compassion is experienced in the absence of self-coldness or show poor psychological adjustment compared with men vice versa, from moment to moment. For assessment, Neff (35.2% vs. 17.6%) (Maples et al. 2014). Moreover, among operationalized these bipolar dimensions into six separate adults reporting childhood sexual abuse, emotional neglect, facets of self-compassion, three of which assess a compassion- and physical neglect, women are more likely than men to be ate approach to one’s suffering (i.e., self-kindness, common diagnosed with clinically elevated levels of depression and humanity, and mindfulness) and three of which assess a harsh anxiety (Rehan et al. 2019). There also is evidence that fe- and critical attitude towards oneself (i.e., self-judgment, isola- males are negatively affected by less severe child maltreat- tion, and overidentification). Self-kindness involves the ten- ment. Among female, compared with male, adolescents, child dency to be caring and understanding in the context of diffi- emotional maltreatment had a more severe negative impact on culties or failure, in contrast to self-criticism, self-condemna- symptoms of depression and anxiety at lower levels of abuse tion, blaming, and rumination, which are associated with de- severity (Hagborg et al. 2017). In sum, the threshold for dis- pression and other forms of psychopathology (Van Dam et al. tress associated with child maltreatment is lower among ado- 2011). Common humanity reflects our ability to recognize our lescent females, as less severe levels of maltreatment are re- struggles as an inherently universal aspect of the human ex- quired to trigger depression and anxiety. These findings indi- perience, in contrast to feelings of isolation upon perceiving cate a need for additional research focused on factors that one’s struggles as unusual, abnormal, or uncommon. Finally, explain the impact of child maltreatment on women, given mindfulness is one aspect of self-compassion which involves gender disparities in exposure to, and outcomes associated a stance of equanimity towards difficult and uncomfortable with, child maltreatment. Self-compassion may be such a experiences, rather than overidentifying with, or fixating up- mechanism. on, such difficulties (Van Dam et al. 2011). High levels of self-compassion are associated with lower The buffering impact of self-compassion is argued to occur rates of depression, anxiety, and general stress (MacBeth and because its components (e.g., self-kindness) shift cognitive Gumley 2012). Initial longitudinal studies suggest a buffering factors associated with stress and anxiety, such as self-blame effect of self-compassion on depression, with improvement in and rumination (Van Dam et al. 2011). Yet, research to date self-compassion leading to decreases in depression (Krieger primarily focuses on an overarching self-compassion con- et al. 2016). Diminished self-compassion as well as elevations struct. The overarching concept of self-compassion is com- in shame and self-criticism explains higher rates of depres- prised of the presence of positive self-compassion facets sion, anxiety, and stress associated with child maltreatment (e.g., self-kindness) and the absence of the negative facets (Naismith et al. 2019;Rossetal.2019). Self-compassion (i.e., self-coldness). However, the measurement of self- may be one mechanism that underlies resilience following compassion with the Self-Compassion Scale, an instrument exposure to child maltreatment because it promotes effective developed by Neff (2003), uses reverse-scored self-coldness emotion regulation among female survivors of interpersonal items, which may artificially inflate the negative association violence (Scoglio et al. 2018), and mediates the link between between self-compassion and psychological distress. More child maltreatment and emotion dysregulation (Reffi et al. research is needed to determine whether facets of self- 2019). Moreover, lack of self-compassion explains the signif- compassion show this buffering effect. This is especially per- icant association between child maltreatment and heightened tinent given that self-coldness (i.e., self-judgment, isolation, internalized shame (Ross et al. 2019). Self-compassion is as- and overidentification) shows stronger relations with distress sociated with transdiagnostic mechanisms such as shame and than positive self-compassion facets (e.g., self-kindness), self-criticism (MacBeth and Gumley 2012), which underlie which show weak or negligible associations with psychopa- risk for numerous psychiatric outcomes. Importantly, self- thology (Körner et al. 2015; López et al. 2018). compassion is amenable to change (Fritz et al. 2018; Wilson The seeds of self-compassion are planted in early child et al. 2019). relationships with caregivers and attachment figures (Gilbert Self-compassion involves treating oneself with kindness and Procter 2006; Ross et al. 2019). Because of this, self- and encouragement, and the tendency to be warm, caring, compassion may be compromised among children who grew and understanding in the face of personal difficulties (López up in environments lacking adequate warmth and compassion. et al. 2018; Muris and Petrocchi 2017;Neff2003). One of the Indeed, diminished self-compassion is associated with critical most widely adopted definitions of

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