Adverse childhood experiences, including emotional, physical, and sexual abuse, have been consistently linked to mental health problems in children and adults ^[1][2][1,2]. A review of 52 studies on in-patient care [3] found that more than 50% of the men and over 60% of the women were exposed to sexual or physical abuse in their childhood. Rates of reported childhood abuse in clinical populations vary for different types of abuse, with studies showing the highest prevalence for emotional abuse (25–54%) ^[4][5][4,5], followed by physical abuse (21–30%) [6] and sexual abuse (4.3–28%) ^[4][7][4,7].

Studies have consistently documented the association between childhood abuse and mental health problems in adulthood, including depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, eating disorders, personality disorders, and dissociative disorders ^[8][9][8,9]. Additionally, psychiatric patients who have been exposed to sexual or physical childhood abuse were found to have an earlier first admission, longer hospitalizations, received more medication, a higher likelihood to commit suicide and self-mutilate, and a higher symptomatology ^[10][11][10,11]. Maladaptive processes of the emotional-processing system and general physiological reactivity have been assumed to contribute the vulnerability of deleterious sequelae of exposure to childhood traumatic experiences ^[12][13][12,13].

Despite this robust body of literature, the information regarding childhood abuse in research to date has frequently relied on a sole source such as previous documentation (e.g., social services charts) or participants’ self-reports.

Ample research has examined the association between exposure to neglect and abuse during childhood and adult diagnoses of personality disorders (PDs) ^[14][15][14,15]. Research most frequently based the investigation on a sample of patients in community mental health clinics or a representative community sample [16]. Studies that have included patients in mental health clinics frequently relied on a sole source to collect information on childhood abuse, including patients’ self-reports and interviews or clinical records ^[17][18][17,18]. Findings show that childhood adverse experiences are particularly prevalent among persons diagnosed with PDs, specifically, borderline PD (BPD), and they are associated with greater symptom severity, as well as with worse psychopathology ^[19][20][19,20]. For example, a study conducted among adults seeking mental health care diagnosed with PDs, relying on self-reported history of abuse, showed that individuals diagnosed with PDs reported increased rates of childhood abuse (73%) and neglect (82%). BPD was, in particular, marked as being associated with childhood abuse and neglect [19]. A study among patients from different mental health care settings (outpatient, inpatient, and forensic) documented associations between specific types of childhood maltreatment and adult PDs. Sexual abuse was associated with symptoms of borderline, paranoid, schizoid, and avoidant PDs; physical abuse was associated with antisocial PD; emotional abuse was associated with paranoid, borderline, and schizotypal PDs; and neglect was associated with borderline and histrionic PDs [20]. Importantly, studies that used multiple sources of information pointed to potential gaps in reports of childhood experiences of abuse. For example, a study by Rossiter et al. [6] among adult patients in community and hospital-based clinics compared information from self-reports and clinical notes. Authors documented that 93–100% of patients with antisocial, passive-aggressive, paranoid, and borderline PDs self-reported childhood-abuse experiences, while only 40–69% of clinical notes included similar information for these patients [6].

Studies that have examined PD symptoms and childhood adversities in the general population (non-clinical samples) have used mainly structured interviews for assessing psychiatric diagnosis (SCID I and II) and self-reports for collecting information on histories of trauma. These assessments have shown similar results. For example, Johnson et al. [21], using psychosocial and psychiatric interviews, found that an exposure to abuse and neglect during childhood was associated with greater PD symptomatology, and that persons that were abused or neglected during childhood were up to four times more likely to be diagnosed with PDs in adulthood compared to those who did not experience maltreatment in childhood. Another study, conducted by Tyrka et al. [22], applying methods of psychiatric diagnostic interviews and self-report questionnaires assessing exposure to abuse during childhood have shown similar results. Childhood maltreatment, including emotional, physical, and sexual abuse, as well as neglect, was associated with elevated symptoms of PDs, specifically of borderline, paranoid, avoidant, obsessive-compulsive, and dependent PDs. A different study also used structured diagnostic interviews, as well as self-reports, to document that childhood adversities, including emotional, physical, and sexual abuse, were highly prevalent among persons with PDs [23]. Indeed, a recent review of 44 studies regarding early-life stress has confirmed the robust connection between emotional abuse and neglect with PDs [24].

Similar to the literature on adult PDs and childhood abuse, research has documented the association between exposure to abuse during childhood and symptoms of mood and anxiety disorders in adulthood. A meta-analysis, conducted by Mandelli et al. [25], documented that, regardless of research method, childhood experiences of emotional neglect were highly correlated with adult symptoms of depression [25]. Another meta-analysis showed similar results, indicating that childhood exposure to physical and sexual abuse, as well as neglect, was associated with common adult mental disorders [24]. It is noteworthy that all studies to date have used diagnostic information and information regarding childhood abuse from either one (participants or interviewers) or two sources (participants and independent interviewers), with diagnostic assessment mostly based on structured clinical interviews (e.g., SCID) or self-report questionnaires, and childhood abuse information gathered mostly through self-reports or semi-structured interviews ^[25][26][27][25,26,27].

Using data from self-report measures, Kounou et al. [26] found that compared to individuals without psychiatric history, patients with major depression reported higher rates of childhood maltreatment, including emotional, physical, and sexual abuse, as well as neglect. Similarly, Mall et al. [28] showed that childhood exposure to emotional abuse and/or neglect predicted adult depression during the preceding year. As for studies using interviews, Hovens et al. [29] reported that childhood exposure to emotional and physical abuse, as well as emotional neglect, was correlated with adult depressive and anxiety disorders. Surprisingly, exposure to childhood sexual abuse was not associated with depression during adulthood. Another study relying on interviews showed that sexual abuse during childhood was related to lifetime mood and anxiety disorders, while physical abuse during childhood was associated with lifetime anxiety disorders [30].