Cognitive insight in adults with posttraumatic stress disorder and childhood maltreatment

Cognitive insight includes the assessment of experiences and beliefs, review of misinterpretations, and awareness of more helpful alternate conclusions. Although there are suggestions that cognitive insight may play a role in posttraumatic stress disorder (PTSD), this relationship has not been directly investigated. Childhood maltreatment exposure may influence cognitive insight and be a pathway to impaired cognitive insight in PTSD. Our aim was to investigate cognitive insight in PTSD and childhood maltreatment exposure. This was a case-control study (SHARED ROOTS) amongst PTSD cases and trauma exposed controls (TEC) from South Africa. PTSD diagnoses were determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and childhood maltreatment with the Childhood Trauma Questionnaire (CTQ-SF). We compared cognitive insight scores determined with the Beck Cognitive Insight Scale (BCIS) between PTSD cases and TEC using multivariate hierarchical logistic regression. Multivariate linear regression was used to determine the association between CTQ severity and cognitive insight scores. Higher self-reflectiveness was associated with greater CTQ total severity ( β = 0.09, p = 0.039) and all abuse subtypes. Higher self-reflectiveness was associated with PTSD (diagnosis and severity), but not once we controlled for trauma-related factors. Childhood maltreatment severity mediated the association between self-reflectiveness and PTSD (diagnosis and severity). Higher self-certainty was associated with greater emotional abuse ( β = 0.11, p = 0.028), but not with PTSD nor childhood maltreatment severity. These results highlight the interplay between cognitive insight and the manifestation and severity of PTSD in the context of childhood maltreatment.