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Contents lists available at ScienceDirect

Child Abuse & Neglect

Childhood trauma is associated with maladaptive personality

traits
Hudson W. de Carvalho a , Rebeca Pereira b , Julia Frozi c , Luísa W. Bisol b ,
Gustavo L. Ottoni e , Diogo R. Lara b,c,d,∗
a
Departamento de Psicologia, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
b
Serviço de Psiquiatria, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
c
Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
d
Faculdade de Biociências, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
e
Hospital Presidente Vargas, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: The association between childhood trauma and personality traits has been poorly charac-
Received 2 January 2014 terized and reported. Our aim was to evaluate whether distinct types of childhood abuse
Received in revised form 2 October 2014 and neglect are associated with various personality dimensions using data from a large web-
Accepted 14 October 2014
based survey. A total of 12,225 volunteers responded anonymously to the Internet versions
Available online xxx
of the Temperament and Character Inventory-Revised (TCI-R) and the Childhood Trauma
Questionnaire (CTQ) via our research website, but only 8,114 subjects (75.7% women, mean
Keywords:
age 34.8 ± 11.3 yrs) who met the criteria for validity were included in the analysis. Child-
Childhood trauma
hood trauma was positively associated with harm avoidance and was negatively associated
Personality
Traits with self-directedness and, to a lesser extent, with cooperativeness. The associations were
Temperament robust with emotional abuse and neglect but were non-significant or mild with physical
Character trauma. Emotional neglect was associated with reduced reward dependence and persis-
Internet research tence. All types of abuse, but not neglect, were associated with increased novelty seeking
scores. Reporting of childhood trauma, especially of an emotional nature, was associated
with maladaptive personality traits. Further investigation of the effects of different types
of childhood trauma on psychological and neurobiological parameters is warranted.
© 2014 Elsevier Ltd. All rights reserved.

Introduction

Traumatic childhood experiences are derived from noxious actions or events inflicted on the child and from the lack of
a supporting environment. Early traumatic events have been widely recognized as key factors in psychological adjustment
that can compromise a child’s development (Allen & Lauterbach, 2007; Franklin, Linder, Russig, Thony, & Mansuy, 2011;
Rademaker, Vermetten, Geuze, Muilwijk, & Kleber, 2008). Studies of child abuse and neglect have increased significantly
(Cicchetti & Toth, 2005), which are primarily focused on the association between childhood trauma and psychiatric disorders,
including mood disorders (Weiss, Longhurst, & Mazure, 1999; Widom, DuMont, & Czaja, 2007; Wingo et al., 2010), substance
abuse (Conroy, Degenhardt, Mattick, & Nelson, 2009; Tucci, Kerr-Correa, & Souza-Formigoni, 2010), psychosis (Heins et al.,
2011), posttraumatic stress disorder (Koenen, Moffitt, Poulton, Martin, & Caspi, 2007; Vranceanu, Hobfoll, & Johnson, 2007),
eating disorders (Kong & Bernstein, 2009), personality disorders (Afifi et al., 2011), suicidality (Pompili et al., 2009), and the

∗ Corresponding author.

http://dx.doi.org/10.1016/j.chiabu.2014.10.013
0145-2134/© 2014 Elsevier Ltd. All rights reserved.

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
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decreased response to psychopharmacological interventions (Nemeroff et al., 2003). Nevertheless, studies of the association
between childhood trauma and psychological traits are scarce (Rademaker et al., 2008).
The scarcity of trait–trauma relationship studies may be due to clinical and conceptual reasons. In clinical practice, patients
with a traumatic history are a common occurrence, leading to an intrinsic association between trauma and maladjustment
and to the aforementioned research emphases on the association between trauma and psychopathology. From a conceptual
perspective, it may appear to be of minor importance to examine the relationships between traits and trauma if temperament
and personality are conceptualized as domains in a normal range of individual differences (Mathews, Deary, & Whiteman,
2003) Additionally, temperament and personality traits are believed to be largely inherited (Cloninger, 1994), which may
lead to the false assumption that trait manifestation was programmed before any experience of abuse or negligence occurred.
Nevertheless, the results relating trauma to traits have demonstrated heuristic power.
Allen and Lauterbach (2007) found that individuals with traumatic lifetime experiences display higher scores in neuroti-
cism and openness to experience than controls. Rademaker et al. (2008) found significant negative associations between
traumatic events and trait self-directedness and cooperativeness in a military sample. Other studies have described the
potentially detrimental effects of early trauma on personality-related outcomes, such as identity development, socializa-
tion (Cole & Putnam, 1992), self-esteem, coping behaviour (Toker, Tiryaki, Ozcurumez, & Iskender, 2011), impulse control,
defensive styles, affect regulation and the formation of stable attachments (Cicchetti & Toth, 2005; Rademaker et al., 2008).
This evidence suggests that traumatic events influence not only psychopathology but also psychological traits.
One limitation warrants noting: most studies that focus on the relationships between trauma and psychological or
psychiatric characteristics were conducted using classic face-to-face interviews or paper-and-pencil questionnaires. The
participant may feel exposed when communicating directly with research staff or by assuming that he or she could be
somehow identified. Alternatively, evidence suggests that Internet-based data collection is more reliable than face-to-face
interviews, paper-and-pencil anonymous instruments and telephone interviews (Birnbaum, 2004; Couper, 2000) for sensi-
tive issues such as illicit drug use, sexual behaviour and violence (Turner et al., 1998). However, to the best of our knowledge,
no published study has examined the relationship between traits and childhood trauma using collected data via a web-based
survey.
Thus, the objective of this Internet-based study was to evaluate the association between personality traits and childhood
trauma, with an emphasis on the differences related to the severity (none, low, moderate and severe) and type of trauma:
physical trauma, emotional trauma, physical neglect, emotional neglect, and sexual abuse. We hypothesized that individuals
who reported more severe adversities during childhood would exhibit a personality profile displaying greater proneness to
general maladjustment, such as higher scores in harm avoidance and lower scores in self-directness (de la Rie, Duijsens, &
Cloninger, 1998; Rademaker et al., 2008).

Methods

Participants and Procedures

Along with other instruments, participants responded to the Internet versions of the Temperament and Character
Inventory-Revised (TCI-R, Cloninger, Svrakic, & Przybeck, 1993) and the Child Trauma Questionnaire (CTQ, Bernstein et al.,
1994; Bernstein et al., 2003) via our research website (www.temperamento.com.br) in this order. National TV and local
newspaper broadcasts motivated participation by reporting preliminary results of individual differences in temperament
and by clarifying that this website offers a summary of results (a psychological profile) in exchange for participation as soon
as the participant finishes responding to the survey. Electronically informed consent forms were obtained from the partici-
pants before completing the assessments. This form was designed to fulfil the requirements of the National Health Council
of Brazil (Resolution 196/1996) and the Code of Ethics of the World Medical Association (Declaration of Helsinki). The study
protocol was approved by the Institutional Review Board of the Hospital São Lucas at Pontificia Universidade Catolica do Rio
Grande do Sul. A complete description of the study protocol is available elsewhere (Lara et al., 2012).
To participate in the current study, the respondents had to be aged between 18 and 80 years and had to respond correctly
to the validity assessments available on the website. The validity assessments aimed to determine the respondent’s level
of attention and involvement by asking the participant to select a certain item (i.e., check option c) and by evaluating via
self-report the level of involvement and truthfulness in responding. A total of 12,225 participants completed the survey, but
4,111 were excluded due to the validity assessment responses. Table 1 shows and compares the demographic characteristics
and the prevalence of trauma/neglect variables for the included and excluded participants.
As shown in Table 1, the resulting sample was composed of 8,114 adult men (1,970, 24.3%) and women (6,144, 75.7%)
with a mean age of 34.84 years (SD = 11.37) and who were well educated: 41% completed high school, and 54.4% held a
college degree. Half of the participants reported previous use of a psychotropic treatment of any type (50.4%), while 32.5%
reported having been diagnosed with a mental disorder at least once in their lives. The most common types of trauma in
the moderate–severe range were emotional neglect (28.6%) and abuse (27.5%), followed by physical abuse (18.2%), physical
neglect (17.2%), and sexual abuse (14.9%). Additionally, in the moderate–severe range, 165 (2%) participants declared to
have been victimized in all assessed modalities of abuse and neglect. Women reported significantly higher prevalence of
emotional (30.4%, x2 = 128.76, p < 0.001) and sexual abuse (15.7%, x2 = 15.99, p < 0.001) than men (18.5% and 12.4%). The
excluded participants (due to the validity assessments) exhibited a less favourable profile than the included participants,

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
traits. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.10.013
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Table 1
Demographic characteristics and prevalence of trauma/neglect variables of the included and exclude participants.

Excluded (6,144, 75.7%) Included (8,114, 100%)

Age (mean, SD) 33.86 (12.61) 34.84 (11.37)

Men 23.8% 24.3%

Sex
Women 76.2% 75.7%

Elementary* 10.8% 4.6%

Education High school* 48.2% 41.0%
University* 41% 54.4%

Psychiatric diagnosis* 37% 32.5%

Psychiatric medication 52.5% 50.4%

Physical abuse 20.7%* 18.2%

Sexual abuse 17.1%* 14.9%
Moderate/severe
Emotional abuse 36.5%* 27.5%
trauma
Emotional neglect 36.6%* 28.6%
Physical neglect 21.8%* 17.2%
*
Significant sex-related differences at p value < 0.05.

as the excluded participants reported lower educational levels and a higher prevalence of lifetime psychopathology and
moderate–severe trauma.

Measures

Childhood trauma was assessed using a 28-item CTQ version translated into Brazilian Portuguese (Grassi-Oliveira, Stein,
& Pezzi, 2006), a widely used self-reported scale to assess early abuse and neglect experiences in adults. Scores were
obtained for the categories of sexual abuse, physical abuse and neglect, emotional abuse and neglect and total trauma.
This scale consisted of five-point items (Likert-type) varying from ‘never’ to ‘frequently’ according to the frequency of
the experience. The five subscales of trauma varied from 5 (no trauma) to 25 (extreme trauma), and a total scale score
varied from 25 (no trauma) to 125 (extreme trauma in all subscales). The severity of trauma was categorized accord-
ing to Tucci et al. (2010): emotional abuse: ≤8 = minimal, 9–12 = low, 13–15 = moderate, >15 = severe; emotional neglect:
≤9 = minimal, 10–14 = low, 15–17 = moderate, >17 = severe; physical abuse: ≤7 = minimal, 8–9 = low, 10–12 = moderate,
>12 = severe; physical neglect: ≤7 = minimal, 8–9 = low, 10–12 = moderate, >12 = severe; and sexual abuse: ≤5 = minimal,
6–7 = low, 8–12 = moderate, >12 = severe.
The TCI-R is a self-reported 240-item questionnaire (including 5 validity items) designed to assess four temperaments
(harm avoidance, novelty seeking, reward dependence, and persistence) and three character/personality dimensions (self-
directedness, cooperativeness, and self-transcendence). Each dimension is composed of several facets (3–5) corresponding to
5–10 questions scored using a Likert-type scale. The Brazilian Portuguese version of the TCI-R has been validated (Goncalves
& Cloninger, 2010), and a computerized version of the TCI has correlation coefficients with paper-and-pencil version scores
from 0.71 to 0.91 for the temperament and character dimensions (Pelissolo, Veysseyre, & Lepine, 1997), respectively. Internal
consistency reliability analysis of this Internet version of the TCI-R (Lara et al., 2012) showed that all scales displayed high
alpha coefficients: harm avoidance, 0.91; novelty seeking, 0.84; reward dependence, 0.87; persistence, 0.93; self-directness,
0.92; cooperativeness, 0.90; self-transcendence, 0.85.

Statistical Analysis

Descriptive statistics of the demographic and trauma/negligence variables are presented as the proportions, means, and
standard deviations. Comparisons between the retained and excluded samples were obtained via the chi-square test and
Student’s t-test for independent samples. The associations between the TCI-R dimensions and the types of childhood trauma
were calculated using ANCOVA with Bonferroni confidence interval adjustment, considering sex and age as covariates. The
results are shown as the F values, mean scores and 95% confidence intervals. The data were analyzed using Statistical Package
for the Social Sciences 18.0 for Windows software. The two-tailed significance level was set at p < 0.05.

Results

All CTQ subscales were significantly correlated at the level of p < 0.01, with coefficients ranging from 0.20 (between
emotional neglect and sexual abuse) to 0.67 (between emotional neglect and emotional abuse). The strongest associations
were found between emotional abuse, emotional neglect and physical neglect (r values between 0.47 and 0.67) and between
emotional and physical abuse (r value = 0.47). Sexual abuse was weakly correlated with all other trauma indicators (r values
between 0.20 and 0.25). These results provide empirical support for the use of a general trauma score.

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
traits. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.10.013
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Fig. 1. Temperament dimensions according to the intensity of childhood trauma. The data for the four temperament dimensions are presented as the
means and 95% confidence intervals (ANCOVA) for emotional abuse (A), physical abuse (B), sexual abuse (C), emotional neglect (D), physical neglect (E)
and total trauma (F).

Regarding temperament, harm avoidance showed a positive and significant association with all childhood trauma meas-
ures, particularly with emotional abuse (Fig. 1A) and emotional neglect (Fig. 1D), but not physical abuse (Fig. 1B). The other
associations with the temperament dimensions were less robust. Novelty seeking scores were higher in relation to abuse
(Fig. 1A–C) but not neglect (Fig. 1D and E). Emotional neglect was significantly negatively associated with reward depend-
ence and persistence (Fig. 1D). The total trauma scores were positively associated with harm avoidance (significant differences
between all severity categories), and mildly associated with the other temperament dimensions, including higher novelty
seeking and lower reward dependence and persistence (Fig. 1F).
Regarding character, self-directedness was significantly negatively associated with childhood trauma (Fig. 2), particularly
emotional abuse and neglect (Fig. 2A and D). A similar but weaker association was observed between cooperativeness and
childhood trauma (Fig. 2A, B, D and E), except for sexual abuse (Fig. 2C). The association between Self-transcendence and
trauma associations was not significant. The total trauma scores were negatively associated with self-directedness, with
significant differences between all severities. A similar pattern was found for cooperativeness (Fig. 2F).
The association between specific facets of the temperament and character dimensions and the trauma parameters
followed the patterns of the corresponding dimension, and no sex effects were observed (data not shown).

Discussion

Traumatic childhood experiences are associated with a range of pathological and maladaptive outcomes (Rademaker
et al., 2008; Toker et al., 2011). In the context of mental health, most studies have focused on the association of child trauma

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
traits. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.10.013
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Fig. 2. Character dimensions according to the intensity of different types of childhood trauma and total trauma. The data for the three character dimensions
are presented as the means and 95% confidence intervals (ANCOVA) for emotional abuse (A), physical abuse (B), sexual abuse (C), physical neglect (D),
emotional neglect (E) and total trauma (F).

events with psychiatric disorders (Afifi et al., 2011; Allen & Lauterbach, 2007; Gilbert et al., 2009) but rarely with personality
traits. The results of our web-based survey demonstrated that specific temperament and character traits were associated
with certain types of childhood trauma in a large general population sample. To the best of our knowledge, this was the
first study to be published evaluating the relationship between different types of trauma and psychological traits using a
web-based survey design.
The personality dimensions of harm avoidance and self-directedness were clearly strongly associated with childhood
trauma and emotional abuse and neglect. High harm avoidance and low self-directedness have also been reported in several
psychiatric disorders, such as major depression (Josefsson, Merjonen, Jokela, Pulkki-Raback, & Keltikangas-Jarvinen, 2011;
Pelissolo & Corruble, 2002; Smith, Duffy, Stewart, Muir, & Blackwood, 2005), eating disorders (Fassino, Amianto, & Abbate-
Daga, 2009; Fassino, Amianto, Gramaglia, Facchini, & Abbate Daga, 2004; Giovanni et al., 2011), personality disorders (Svrakic
et al., 2002; Svrakic, Whitehead, Przybeck, & Cloninger, 1993), and alcoholism (Cloninger, Sigvardsson, Przybeck, & Svrakic,
1995; Evren, Dalbudak, & Cakmak, 2009). Accordingly, childhood adversity is also a well-established risk factor of these
psychiatric disorders (Afifi et al., 2011; Cicchetti & Toth, 2005; Kong & Bernstein, 2009; Sansone et al., 2006; Tucci et al.,
2010; Weiss et al., 1999; Widom et al., 2007; Wingo et al., 2010). Mild but significant associations were found between
emotional neglect and reduced reward dependence and between emotional abuse and neglect and reduced cooperativeness.
Thus, our interpretation is that childhood trauma produces maladaptive effects on temperament and personality traits that
may contribute to the development of psychiatric disorders and that the degree and type of these effects depend on the
characteristics of the adversity (Clark, 2005).
Unexpectedly, dysfunctional personality traits displayed stronger associations with emotional events than with physical
and sexual trauma. This finding is of particular relevance because physical and sexual abuse are typically considered to
be of higher importance and because these types of trauma have been more thoroughly investigated. Furthermore, these

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
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data have implications for public mental health, suggesting the need for additional attention to emotional trauma and its
consequences (Cicchetti & Toth, 2005; Gilbert et al., 2009; Tyrka, Wyche, Kelly, Price, & Carpenter, 2009). An additional
finding refers to the degree of overlap between traumatic experiences: the correlations between the traumatic domains
evaluated in this study were of moderate magnitude overall but varied according to the type of traumatic experience. This
finding is in agreement with other studies demonstrating that the exposure to one type of maltreatment is a fair predictor
of exposure to other types of trauma over time (Dong et al., 2004; Tyrka et al., 2009).
The neurobiological mechanisms underlying the changes in personality in response to childhood trauma have yet to be
completely elucidated, but there are important candidate mechanisms. In rats, pups that receive less maternal care exhibit
increased emotionality, increased behavioural and endocrine responsiveness to stress and impaired cognition compared to
those receiving high-quality maternal care (Caldji et al., 1998; Liu, Diorio, Day, Francis, & Meaney, 2000; Liu et al., 1997).
Additionally, poor maternal care alters GABA(A) receptor subunit expression (Caldji, Diorio, & Meaney, 2003), reduces the
mRNA expression of NMDA subunit and BDNF (Liu et al., 2000) and affects the methylation pattern of the glucocorticoid gene
in the hippocampus in a manner that persists into adulthood (Weaver et al., 2004). Accordingly, humans with a history of
childhood abuse display lower glucocorticoid expression and altered methylation status of the neuron-specific glucocorticoid
receptor promoter, as well as persistent hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity,
presumably due to CRF hypersecretion (Heim et al., 2000). However, these studies did not address the role of different types
of stress, and our results suggest that physical abuse may be less strongly associated with neurobiological alterations than
neglect and other types of abuse. One interpretation of these findings is that in evolutionary terms, physical contact and
distress have always been inherent to species survival, whereas emotional abuse is a recent phenomenon that may have
arisen with the emergence of language. However, distinct coping mechanisms may be activated, as demonstrated by lower
and higher cortisol levels in patients with personality disorders experiencing physical abuse and neglect, respectively (Flory
et al., 2009).
Longitudinal studies are the gold standard for cause-effect assumptions. However, in the context of childhood trauma
studies, some methodological issues that may prevent a successful implementation of longitudinal methodologies must be
emphasized, particularly in regard to emotional trauma. These types of trauma are difficult to quantify due to the lack of
external criteria (e.g., medical records), sub-notification (Cicchetti & Toth, 2005) and the poor reporting of sensitive issues
when anonymity is not guaranteed. In this regard, cross-sectional web-based surveys have methodological advantages, as
they allow anonymous participation without face-to-face contact with the investigator, possibly increasing data reliability
(Couper, 2000; Gosling, Vazire, Srivastava, & John, 2004).
The current study has certain notable positive aspects. Most studies are based on specific and small samples, such as sol-
diers (Rademaker et al., 2008), females (Vranceanu et al., 2007) and clinical samples, whereas our results are based on a large
and diverse community sample. Online data collection, aside from allowing for the gathering of heterogeneous participants,
may be the best paradigm for the collection of stigmatized, individually sensitive experiences with guaranteed anonymity
(Reimers, 2007). Moreover, in our web-based survey, the participants were required to answer approximately 1200 ques-
tions on various topics, and both scales (CTQ and TCI-R) were separated into different sections, preventing the participants
from inferring specific study goals and hypotheses. Finally, the instruments used herein are widely used internationally,
allowing comparisons with other studies, and both the CTQ and the TCI-R were validated in Brazilian samples. Addition-
ally, to our knowledge, this is the first study to investigate childhood trauma and personality traits utilizing Internet-based
research.
Some limitations of this study are also worth noting. First, the CTQ appears to be more sensitive to family environment-
related trauma, does not evaluate the specific age of maltreatment and does not assess other forms of traumatic experiences,
such as parental loss, accidents, exposure to violence, bullying, and natural disasters. Second, the CTQ is a retrospective
instrument, although most items describe objective rather than subjective experiences (e.g., “People in my family called
me things like ‘stupid’, ‘lazy’, or ‘ugly”’ and “My parents were too drunk or high to take care of the family”), which may
minimize memory bias. Third, because the abuse and neglect categories are not conceptually or empirically independent (as
corroborated by correlational analysis), some heterogeneity is expected within each severity group; therefore, the conclu-
sions drawn from our results should consider that these groups are limited by the degree (approximately 2% of the sample
reported experiencing all types of trauma to a moderate to severe degree) to which they represent overlapping groups.
Fourth, although our sample was community-based and was composed of volunteers from all Brazilian regions, it is not
representative of the general Brazilian population, especially in regard to its educational level (54% of participants with a
college education) and sex distribution (75.7% females). Furthermore, the participants who failed to respond correctly to
the validity assessments were less educated and reported a higher prevalence of traumatic experiences, which may have
selected a sample with a limited power of generalization.
In conclusion, the primary relevance of this study was the finding of strong associations between emotional abuse and
neglect but not physical abuse and maladaptive temperament and character traits. Further studies are necessary to replicate
these findings and to investigate the biological and psychological responses to different types of trauma.

Contributors

LWB, GLO and DRL designed the study and wrote the protocol. RP, JF, LWB, and HWC managed the literature searches,
summaries of previous related work, and manuscript development. HWC and DRL prepared the revised version of the

Please cite this article in press as: de Carvalho, H. W., et al. Childhood trauma is associated with maladaptive personality
traits. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.10.013
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paper. All authors participated in the statistical analysis, contributed to the final version, and have approved the final
manuscript.

Conflicts of interest

None.

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