Mapping Childhood Abuse to PTSD: The Role of Regulation and Dissociative Reactivity

Abstract
Purpose
Adverse childhood experiences (ACEs) are established risk factors for both dissociation and posttraumatic stress disorder (PTSD). This study explores a developmental pathway by which childhood abuse may increase vulnerability to peritraumatic dissociation and PTSD symptoms through impaired emotion regulation. We examine how early adversity affects negative mood regulation (NMR), which in turn predicts dissociative responses to later trauma exposure. Findings also highlight roles of cognitive reappraisal and expressive suppression as emotion regulation strategies that shape NMR.

Methods
Secondary data analyses were performed on data collected as part of a larger study examining “Sex differences in fear conditioning in PTSD” (PI: Inslicht) at the San Francisco VA, using a dataset of trauma-exposed veterans and civilians. Analyses were limited to participants (n = 66) who completed the Childhood Trauma Questionnaire (CTQ), Negative Mood Regulation Scale (NMR), Emotion Regulation Questionnaire (ERQ), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV).

ACEs were constructed using proxy variables:

Childhood abuse and neglect were derived from the CTQ.
Household dysfunction was inferred using FHS (parental mental illness, parental substance abuse, parental separation), LSCR (parental incarceration), and PCL-5 narrative responses (violence toward mother).

The PDEQ captured dissociative responses to each participant’s self-identified “worst trauma,” which was not necessarily their childhood adversity. Therefore, the model examined a hypothesized pathway from ACEs to PTSD symptoms via mood regulation and dissociative reactivity. Neglect and household dysfunction were included in the full model but were not significantly associated with the primary pathway.

Results
The final structural model demonstrated good fit (CFI = .945, SRMR = .040, RMSEA = .146), considering the sample size (n = 66). Abuse-related adverse childhood experiences were associated with lower negative mood regulation (NMR; β = –.316, p < .001) and greater peritraumatic dissociation (PDEQ; β = .322, p = .012). Emotion regulation strategies were significant predictors of NMR, with cognitive reappraisal positively associated (β = .648, p < .001) and suppression negatively associated (β = –.263, p = .009). NMR, in turn, negatively predicted PDEQ (β = –.350, p = .045), and PDEQ strongly predicted PTSD symptom severity (CAPS; β = .585, p < .001). Importantly, a significant indirect effect emerged from childhood abuse to PTSD symptoms via PDEQ (β = .188, p = .016), supporting a sequential pathway from childhood abuse to PTSD symptoms mediated by emotion regulation difficulties and
peritraumatic dissociation.

Conclusions
These findings support a developmental model in which childhood abuse increases PTSD risk through disrupted mood regulation and vulnerability to dissociation during later traumatic events. The indirect pathway from childhood abuse to PTSD symptoms via NMR and PDEQ underscores the relevance of early emotion regulation deficits in shaping dissociative trauma responses. Cognitive reappraisal
emerged as a strong positive predictor of mood regulation, suggesting a potential clinical target for intervention. By contrast, expressive suppression was associated with poorer mood regulation, underscoring the importance of addressing maladaptive emotion regulation styles in trauma-exposed individuals.