Personality functioning as a pathway from childhood trauma to substance use in clinical and community samples

Background Traumatic childhood experiences are associated with an increased risk of substance abuse. It remains unclear to what extent this association is mediated by personality organization and mentalization ability across different populations. Method A structural equation model (SEM) with bootstrap estimates was calculated in a community sample ( N = 498), and Bayesian path analysis with informed priors was calculated in an inpatient sample of individuals diagnosed with substance use disorder (SUD sample) ( N = 68) to examine direct and indirect relationships between childhood trauma, personality organization, mentalization ability, and addictive behavior. Results In the community sample, structural personality impairments partially mediated the effect of childhood trauma on addictive behavior (indirect: β = 0.14, p < 0.001; direct: β = 0.19, p = 0.002), whereas mentalization showed no independent effect. In the SUD sample, childhood trauma was associated with structural impairments ( β = 0.24), which, in turn, were associated with addictive behavior ( β = 0.22). Conclusion These findings highlight the central role of structural personality impairments in the association between childhood trauma and addictive behavior. While structural deficits act as a partial mediator in the general population, they emerge as the strongest and most consistent correlate of addictive behavior in clinical SUD model.