Auditory hallucinations, childhood sexual abuse, and limbic gray matter volume in a transdiagnostic sample of people with psychosis

Childhood sexual abuse (CSA) is a potentially unique risk factor for auditory hallucinations (AH). In a transdiagnostic sample of people with psychotic disorders, patients reported higher levels of all maltreatment types than healthy controls, but those with AH (n=41) reported greater CSA than patients without AH (NAH; n=37; t=2.21, p=.03) and controls (n=37; t=3.90, p<.001). Elevated CSA among patients was most pronounced in females with AH (sex × AH status: F=4.91, p=.009), remained significant when controlling for diagnosis, medications, and other maltreatment (F=3.88, p=.02), and correlated with current AH severity (r=.26, p=.03) but not other symptoms (p>.16). Greater CSA related to larger left amygdala gray matter volume (GMV) after accounting for AH status, diagnosis, medications, and other maltreatment (t=2.12, p=.04). Findings suggest females with AH may represent a subgroup with greater CSA, and that CSA may be linked to amygdala alterations and AH. Prospective high-risk studies integrating maltreatment and brain measures are needed to elucidate mechanisms.