Childhood Maltreatment and Anxiety in Adulthood: Disentangling the Role of Personality Functioning

Childhood maltreatment (CM), particularly emotional neglect and abuse, has been associated with an increased risk of anxiety and less favorable psychotherapy outcomes in adulthood. Impairments in personality functioning are a significant mechanism mediating this relation. This naturalistic cross-sectional study examined the mediating role of personality functioning in the relation between CM and anxiety symptoms in a clinical adult sample. A total of 335 adult patients starting individual psychotherapy completed intake self-report questionnaires about CM experiences, personality functioning, and anxiety symptoms. We assessed the two dimensions of personality functioning described in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), specifically, self-functioning and interpersonal functioning. Bootstrapped mediation analyses were conducted to evaluate the mediating role of personality functioning in the association between each CM type and anxiety symptoms. 64.2% of the sample reported at least one type of CM. Personality functioning explained 73% of the total effect of CM on anxiety symptoms. Only emotional abuse and emotional neglect showed significant total effects. Emotional abuse retained a direct effect, while emotional neglect was fully mediated by personality functioning. Both personality functioning dimensions were significant mediators, yet self-functioning had a larger impact. Psychotherapeutic interventions targeting impairments in personality functioning are essential for treating anxiety symptoms in adults with CM. Findings emphasize the importance of trauma-informed, personalized interventions, and CM prevention strategies.