Child abuse and negative explicit and automatic self-associations: The cognitive scars of emotional maltreatment Anne-Laura van Harmelen a, * , Peter J. de Jong b , Klaske A. Glashouwer b , Philip Spinhoven a, d , Brenda W.J.H. Penninx c, d, e , Bernet M. Elzinga a a Department of Clinical, Health and Neuropsychology, Leiden University, Pieter de la Court Building, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands b Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands c Department of Psychiatry, VU University Amsterdam, A.J. Ernststraat 887, 1081 HL Amsterdam, The Netherlands d Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands e Department of Psychiatry, University Medical Center Groningen, Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands article info Article history: Received 25 June 2009 Received in revised form 26 January 2010 Accepted 19 February 2010 Keywords: Childhood abuse Emotional maltreatment Automatic self-associations Depression Anxiety abstract Individuals reporting Childhood Abuse (CA) (i.e., emotional neglect, emotional-, physical- and sexual- abuse) are marked by increased explicit (i.e. self-reported) negative self-associations, and an increased risk to develop depression or anxiety disorders. Automatic self-associations might play an important role in the development and maintenance of affective disorders after exposure to CA, since automatic associations are assumed to be involved in uncontrolled (spontaneous) affective behavior. This study examined whether individuals reporting a history of CA show stronger automatic (and explicit) self- depression and/or self-anxiety associations than individuals who report no CA in a large cohort study (Netherlands Study of Depression and Anxiety (NESDA), n ¼ 2981). The Implicit Association Test (IAT) was utilized to assess automatic self-depression and self-anxiety associations. We found that CA was associated with enhanced automatic (and explicit) self-depression and self-anxiety associations. Addi- tionally, when compared to physical- and sexual-abuse, Childhood Emotional Maltreatment (CEM; emotional abuse and emotional neglect) had the strongest link with enhanced automatic (and explicit) self-depression and self-anxiety associations. In addition, automatic and explicit negative self- associations partially mediated the association between CEM and depressive or anxious symptomatology. Implications regarding the importance of CA, and CEM in particular will be discussed. Ó 2010 Elsevier Ltd. All rights reserved. Childhood abuse (CA) (e.g. emotional neglect and emotional, physical or sexual abuse) is a widespread phenomenon with inci- dence rates between 3 and 32% in the general population (Briere & Elliott, 2003; Brown, Cohen, Johnson, & Salzinger, 1998). Converging evidence in children, adolescents and adults indicates that CA can have a chronic impact on emotional functioning (Alloy, Abramson, Smith, Gibb, & Neeren, 2006; Silverman, Reinherz, & Giaconia, 1996). This is supported by associations between self- reported CA and the enhanced risk to develop both depressive (Agid et al., 1999; Kessler, Avenevoli, & Ries Merikangas, 2001; Weiss, Longhurst, & Mazure, 1999) and/or anxiety disorders in later life (Gibb, Chelminski, & Zimmerman, 2007; Hovens et al., in press; Kendler et al., 2000; Kessler, Davis, & Kendler, 1997; Levitan, Rector, Sheldon, & Goering, 2003; Safren, Gershuny, Marzol, Otto, & Pollack, 2002; Spinhoven et al., in press). Experiences of CA have been suggested to lead to (an increase in) negative self-associations such as negative (self-)inferential styles, dysfunctional (self-)attitudes, and low self-worth (Beck, 1967, 2008). This is corroborated by numerous studies linking CA to enhanced negative self-associations (Alloy et al., 2006; Gibb, 2002; Jacobs, Reinecke, Gollan, & Kane, 2008; Rose & Abramson, 1992). Furthermore, these increased negative self-associations, in itself, are hypothesized to enhance (negative) bias and recall when engaged in new situations, and when retrieving memories. Abused individuals, therefore, may get caught in a negative loop, where CA may enhance negative biases, which may result in more frequent and more intense negative experiences, which in turn may enhance negative self-associations, etc. Due to this process, abused indi- viduals may be more vulnerable to develop and/or maintain a mood and/or anxiety disorder (Beck, 2008). * Corresponding author. Tel.: þ31 715273886. E-mail addresses: harmelenavan@fsw.leidenuniv.nl (A.-L. van Harmelen), p.j.de.jong@rug.nl (P.J. de Jong), k.a.glashouwer@rug.nl (K.A. Glashouwer), spinhoven@fsw.leidenuniv.nl (P. Spinhoven), brendap@ggzba.nl (B.M. Penninx), elzinga@fsw.leidenuniv.nl (B.M. Elzinga). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat ARTICLE IN PRESS 0005-7967/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2010.02.003 Behaviour Research and Therapy xxx (2010) 1e9 Please cite this article in press as: van Harmelen, A.-L., et al., Child abuse and negative explicit and automatic self-associations: The cognitive scars of..., Behaviour Research and Therapy (2010), doi:10.1016/j.brat.2010.02.003