Self-compassion and Fear of Self-compassion: Mechanisms Underlying the Link between Child Maltreatment Severity and Psychological Distress in College WomenTerri L. Messman-Moore1 & Prachi H. Bhuptani1
Published online: 17 April 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives Women are at increased risk for depression and anxiety associated with child maltreatment, given higher rates of exposure to childhood maltreatment and a greater sensitivity resulting in maltreatment-related distress. Thus, there is a need to identify mechanisms of resilience among female survivors of child maltreatment. Self-compassion may promote resilience, whereas fear of self-compassion may diminish this protective effect. Moreover, distinct facets of self-compassion (e.g., self- kindness) versus self-coldness (e.g., self-judgment) may differentially explain risk or resilience for child maltreatment outcomes. Methods College women (N = 586) completed anonymous online surveys assessing the severity of different types of child maltreatment, self-compassion, fear of self-compassion, depression, anxiety, and stress. Results Severity of sexual, physical, and emotional abuse, and emotional and physical neglect, was positively associated with elevated fear of self-compassion and the absence of self-compassion (i.e., self-coldness). In contrast, emotional abuse and neglect severity were the only maltreatment variables negatively associated with self-compassion. Models indicated an indirect relation between increased maltreatment severity and heightened psychological distress via fear of self-compassion and self-coldness (i.e., isolation, overidentification). Statistical patterns indicative of suppression among the positive facets of self-compassion occurred. Conclusions The centrality of emotional maltreatment, along with fear of self-compassion, isolation, and overidentification, emerged across analyses. Findings suggest the absence of self-compassion (i.e., self-coldness) is associated with specific forms of distress. Additional research with child maltreatment survivors should examine self-compassion components rather than a unidimensional construct.
Keywords Child abuse . Child neglect . Self-compassion . Depression . Anxiety . Stress
A meta-analysis of longitudinal studies demonstrated that experiencing child maltreatment is associated with increased risk of depression and anxiety in adulthood, with the magnitude of risk varying by maltreatment type (e.g., odds ratios ranged from 1.7 for neglect to 2.7 for sexual abuse) (Li et al. 2016). Maltreated individuals diagnosed with depressive or anxiety disorders have an earlier age of onset, greater symptom severity, more comorbidity, greater risk for suicide, and poorer treatment response than non-maltreated individuals with the same
diagnoses (Teicher and Samson 2013). Exposure to childhood maltreatment and negative outcomes associated with it differ according to the victim’s gender. In the NESARC study of 34,653 US adults, women had significantly higher rates of childhood physical, sexual, and emotional abuse compared with men (Hartford et al. 2014). Research considering the co- existence of different types of childhood maltreatment indicates women experience higher rates of child emotional abuse, emo- tional neglect, and sexual abuse, and higher rates of physical abuse in the context of emotional or sexual abuse compared with men (Rehan et al. 2017; Scher et al. 2004; Taillieu et al. 2016). Thus, women are more likely than men to experience multiple types of child maltreatment, and also experience higher rates of most forms of child maltreatment in isolation.
Psychiatric correlates of child maltreatment also vary by gender, with women more sensitive to the negative impact
* Terri L. Messman-Moore messmat@miamioh.edu
1 Department of Psychology, Miami University, Oxford, OH 45056, USA
Mindfulness (2020) 11:1446–1459 https://doi.org/10.1007/s12671-020-01361-2
High levels of self-compassion are associated with lower rates of depression, anxiety, and general stress (MacBeth and Gumley 2012). Initial longitudinal studies suggest a buffering effect of self-compassion on depression, with improvement in self-compassion leading to decreases in depression (Krieger et al. 2016). Diminished self-compassion as well as elevations in shame and self-criticism explains higher rates of depres- sion, anxiety, and stress associated with child maltreatment (Naismith et al. 2019; Ross et al. 2019). Self-compassion may be one mechanism that underlies resilience following exposure to child maltreatment because it promotes effective emotion regulation among female survivors of interpersonal violence (Scoglio et al. 2018), and mediates the link between child maltreatment and emotion dysregulation (Reffi et al. 2019). Moreover, lack of self-compassion explains the signif- icant association between child maltreatment and heightened internalized shame (Ross et al. 2019). Self-compassion is as- sociated with transdiagnostic mechanisms such as shame and self-criticism (MacBeth and Gumley 2012), which underlie risk for numerous psychiatric outcomes. Importantly, self- compassion is amenable to change (Fritz et al. 2018; Wilson et al. 2019).
Self-compassion involves treating oneself with kindness and encouragement, and the tendency to be warm, caring, and understanding in the face of personal difficulties (López et al. 2018; Muris and Petrocchi 2017; Neff 2003). One of the most widely adopted definitions of self-compassion in the research literature was developed by Neff (2003), who con- ceptualized self-compassion as consisting of two core dimen- sions. These two dimensions reflect opposite poles that signify either the presence of self-compassion or its absence (e.g., self-coldness). These opposite poles do not coexist within an
individual’s experience at any one point in time; rather self- compassion is experienced in the absence of self-coldness or vice versa, from moment to moment. For assessment, Neff operationalized these bipolar dimensions into six separate facets of self-compassion, three of which assess a compassion- ate approach to one’s suffering (i.e., self-kindness, common humanity, and mindfulness) and three of which assess a harsh and critical attitude towards oneself (i.e., self-judgment, isola- tion, and overidentification). Self-kindness involves the ten- dency to be caring and understanding in the context of diffi- culties or failure, in contrast to self-criticism, self-condemna- tion, blaming, and rumination, which are associated with de- pression and other forms of psychopathology (Van Dam et al. 2011). Common humanity reflects our ability to recognize our struggles as an inherently universal aspect of the human ex- perience, in contrast to feelings of isolation upon perceiving one’s struggles as unusual, abnormal, or uncommon. Finally, mindfulness is one aspect of self-compassion which involves a stance of equanimity towards difficult and uncomfortable experiences, rather than overidentifying with, or fixating up- on, such difficulties (Van Dam et al. 2011).
The buffering impact of self-compassion is argued to occur because its components (e.g., self-kindness) shift cognitive factors associated with stress and anxiety, such as self-blame and rumination (Van Dam et al. 2011). Yet, research to date primarily focuses on an overarching self-compassion con- struct. The overarching concept of self-compassion is com- prised of the presence of positive self-compassion facets (e.g., self-kindness) and the absence of the negative facets (i.e., self-coldness). However, the measurement of self- compassion with the Self-Compassion Scale, an instrument developed by Neff (2003), uses reverse-scored self-coldness items, which may artificially inflate the negative association between self-compassion and psychological distress. More research is needed to determine whether facets of self- compassion show this buffering effect. This is especially per- tinent given that self-coldness (i.e., self-judgment, isolation, and overidentification) shows stronger relations with distress than positive self-compassion facets (e.g., self-kindness), which show weak or negligible associations with psychopa- thology (Körner et al. 2015; López et al. 2018).
The seeds of self-compassion are planted in early child relationships with caregivers and attachment figures (Gilbert and Procter 2006; Ross et al. 2019). Because of this, self- compassion may be compromised among children who grew up in environments lacking adequate warmth and compassion. Indeed, diminished self-compassion is associated with critical parents, familial dysfunction, and child maltreatment (Naismith et al. 2019; Vettese et al. 2011; Wu et al. 2018). Children who experience verbal or emotional abuse by par- ents, including being called names such as “stupid” or “bad,” appear especially vulnerable to developing self-criticism (Naismith et al. 2019; Sachs-Ericsson et al. 2006). Yet few
Mindfulness (2020) 11:1446–1459 1447
studies focus specifically on the association between child maltreatment (abuse or neglect) and self-compassion. Most studies that do examine this connection demonstrate that child maltreatment is associated with decreased self-compassion (Miron et al. 2016; Ross et al. 2019; Tanaka et al. 2011; Vettese et al. 2011; Wu et al. 2018), and that such relations are particularly pronounced for emotional abuse and emotion- al neglect. For example, in a study of 117 youth in foster care (Tanaka et al. 2011), self-compassion was significantly lower among survivors of child physical and emotional abuse (and physical and emotional neglect), although emotional abuse was the only type of maltreatment associated with self- compassion in multivariate models. In a sample of Chinese college students, only emotional maltreatment (abuse and ne- glect) was associated with self-compassion in a model that included all forms of child maltreatment (Wu et al. 2018). Similarly, among female US college students, childhood emo- tional abuse, but not sexual or physical abuse, was associated with self-compassion (Miron et al. 2014). Together, these studies suggest emotional maltreatment has a more significant role in development of self-compassion (or lack thereof) than other types of maltreatment.
Several studies documenting an association between child maltreatment and self-compassion focus on female college students (Boykin et al. 2018; Miron et al. 2014; Miron et al. 2016), linking child maltreatment, lower self-compassion, and negative outcomes such as problematic alcohol use, posttrau- matic stress symptoms, and depression. Such findings suggest self-compassion may be a particularly appropriate target for women. Additional research is needed to focus on self- compassion among women, especially considering that fe- males (adolescents and women) report lower levels of self- compassion than males (Bluth et al. 2017; Yarnell et al. 2015). Moreover, women are more likely to employ negative cognitive emotion strategies, such as self-blame, suppression, rumination, and catastrophizing (Nolen-Hoeksema and Aldao 2011), that can be ameliorated by increasing self-compassion.
Fear of self-compassion is also relevant to distress among child maltreatment survivors. Even if survivors of maltreat- ment understand how to engage in self-compassion, there are barriers to doing so. Collectively referred to as fear of self- compassion, such beliefs include thinking that self- compassion would make one weak or vulnerable to others, or that it would lower one’s standards and reveal one’s flaws or inadequacies, or that one is underserving of self-compas- sion. Experiences of child abuse and neglect contribute to such belief systems that interfere with the capacity for self- compassion, culminating in a fear of self-compassion (Gilbert et al. 2011). Factors that contribute to fear of self-compassion include increased sensitivity to threat, critical self-beliefs, and extensive shame (Gilbert and Procter 2006; Ross et al. 2019). Early interpersonal trauma (e.g., child abuse and neglect, pa- rental criticism, or peer bullying) is highly salient to
development of fears of rejection and internalized harsh criti- cism, as well as a feeling of being underserving of compassion (from others and the self). Such experiences may cultivate fear and a lack of perceived safety in abuse survivors, and compassionate acts from others or towards the self may trigger this sense of vulnerability. Gilbert and Procter (2006) noted, “…such individuals often come from neglectful or trau- matic backgrounds and have rarely felt safe or reassured. Indeed, we have found that feelings of warmth or gentle reas- surance were often frightening for them” (p. 355).
Importantly, fear of self-compassion is not synonymous with self-coldness (e.g., self-criticism) or a lack of skill in self-compassion; it is a fearful reaction or avoidance of the provision of self-compassion, due to the negative associations described earlier. Fear of self-compassion explains the associ- ation between child maltreatment and posttraumatic stress dis- order (PTSD) as well as depression (Boykin et al. 2018;Miron et al. 2016). Moreover, in models examining both self- compassion and fear of self-compassion, only fear of self- compassion was directly associated with child sexual abuse, and mediated the association between sexual abuse and dis- tress (depression and PTSD symptoms). Although both self- compassion and fear of self-compassion are associated with child maltreatment, fear of self-compassion may show a stron- ger connection to psychopathology outcomes.
There is evidence that self-compassion is a mechanism that explains child maltreatment outcomes. Low levels of self- compassion explain the association of child maltreatment and negative outcomes, including the link between juvenile victimization (e.g., exposure to community violence and crime, bullying, and child maltreatment) and psychological distress (Játiva and Cerezo 2014), as well as between child maltreatment and emotion dysregulation (Reffi et al. 2019; Vettese et al. 2011). More specifically, low self-compassion mediates the association between child emotional maltreat- ment (emotional abuse or neglect) and depressive symptoms in Chinese college students and adult community members in the Southwestern United States (Ross et al. 2019; Wu et al. 2018). Only two studies have examined the severity of child maltreatment in relation to self-compassion (Tanaka et al. 2011; Wu et al. 2018). However, a focus on severity is impor- tant given that abuse severity (versus presence) is one of the single best predictors of psychological distress such as PTSD and depression (Bifulco et al. 2002; Evans et al. 2013).
The overarching purpose of the current investigation was to expand our understanding of self-compassion in relation to child maltreatment. Assessment of maltreatment severity, rather than the presence of abuse, allows for a more nuanced understanding of the association between child maltreatment and self-compassion. We hypothesized self-compassion, self- coldness, and fear of self-compassion would mediate the rela- tion between child maltreatment severity and distress. Specifically, we expected that increased severity of all types
1448 Mindfulness (2020) 11:1446–1459
of child maltreatment would be significantly associated with lower self-compassion, but that the strongest relations would emerge for emotional maltreatment (emotional abuse and ne- glect). We hypothesized that child maltreatment severity would be positively associated with self-coldness (i.e., nega- tive components of self-compassion: self-judgment, isolation, and overidentification) and fear of self-compassion.
Method
Participants
Participants were 586 female undergraduates at a mid-sized public university in the Midwestern United States, ages 17–26 (mean age = 18.71, SD = 0.97). The vast majority were Caucasian (85.5%), with an additional 10.4% Asian, 4.9% Black, 1.9% biracial, and 0.9% Pacific Islander; 5.5% identi- fied as Latina/Hispanic. The majority were from upper-middle class households based upon reported family household in- comes. We recruited female college students for the study for several reasons. First, women are more likely than men to be exposed to multiple forms of child maltreatment (Rehan et al. 2017; Taillieu et al. 2016), as well as specific forms of maltreatment previously correlated with self-compassion (e.g., Tanaka et al. 2011; Wu et al. 2018), such as emotional and sexual abuse (Hagborg et al. 2017; Rehan et al. 2019). Second, women and female adolescents show an increased risk for anxiety and depression, including major depressive disorder, compared with males (Merikangas et al. 2010), and report lower levels of self-compassion than males (Bluth et al. 2017; Yarnell et al. 2015).
Procedures
Participants were recruited from a research participant pool (for Introduction to Psychology), and earned research credit for study completion. Informed consent was obtained from all participants included in the study. All participants met in the laboratory for informed consent/study instructions, but com- pleted the online surveys outside the laboratory. Participant data were tracked with a unique identification number. No adverse effects were reported.
Measures
Child Maltreatment The Childhood Trauma Questionnaire (CTQ), a 28-item questionnaire, was used to assess five types of child maltreatment severity: sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect (Bernstein and Fink 1998). Each subscale is comprised of five items with responses ranging from 1 (never true) to 5 (very often true); severity was measured with the continuous sum
score. Example items include the following: “Someone tried to touch me in a sexual way, or tried to make me touch them” (sexual abuse), “People in my family called me things like “stupid,” “lazy” or “ugly”” (emotional abuse), “People in my family hit me so hard that it left me with bruises or marks” (physical abuse), “There was someone in my family who helped me feel important or special” (emotional neglect, re- verse scored), and “I had to wear dirty clothes” (physical ne- glect). The CTQ is a widely used screener for child maltreat- ment, but does not specifically assess abusive acts. Comparisons of the CTQ and behaviorally derived assessment showed high levels of agreement (92.4% for sexual abuse and 80% for physical abuse), although the CTQ identified higher rates of sexual abuse and lower rates of physical abuse com- pared with a computer-administered interview that assessed child maltreatment (DiLillo et al. 2010). In the current study, subscales generally demonstrated good internal consistency; Cronbach’s alpha ranged from .80 to .92, with the exception of physical neglect (Cronbach’s alpha = .56), similar to that re- ported byWu et al. (2018). Three items, not used in the current study, may assess response styles reflecting minimization.
Self-compassion Self-compassion was assessed with the Self- Compassion Scale, a 28-item questionnaire with six subscales which assesses self-compassion (self-kindness, common humanity, and mindfulness) and self-coldness (self- judgment, isolation, and overidentification) (Neff 2003). Example items include “I try to be loving towards myself when I’m feeling emotional pain” (self-kindness), or “When I’m feeling down I tend to obsess and fixate on everything that’s wrong” (overidentification). Response options on Likert scale range from 1 (almost never) to 5 (almost always). Subscale scores were computed by calculating the mean of subscale item responses. The SCS has good reliability and validity (Neff 2003). In the current sample, internal consisten- cy Cronbach’s alpha for subscales were good, and ranged from .82 to .87.
Fear of Self-compassion Fear of self-compassion was assessed with the Fear of Compassion Scales-Self-Compassion (FSC- SC), a 15-item questionnaire (Gilbert et al. 2011). Example items include “I feel that I don’t deserve to be kind and for- giving to myself,” or “I fear that if I am more self- compassionate I will become a weak person.” Responses are on a Likert scale, indicating degree of agreement with each statement on a scale ranging from 0 (“do not agree at all”) to 4 (“completely agree”). Higher scores indicate greater fear of self-compassion. Internal consistency in the current sample was good (Cronbach’s alpha = .95).
Psychological Distress Depression, anxiety, and stress were assessed with three subscales of the DASS-21, a 21-item sur- vey (Lovibond and Lovibond 1995). Example items include
Mindfulness (2020) 11:1446–1459 1449
“I felt that I had nothing to look forward to” (depression), “I felt scared without any good reason” (anxiety), and “I tended to overreact to situations” (stress). Each subscale is comprised of seven items, with responses rated on a 4-point Likert scale ranging from 0 (“did not apply all”) to 3 (“applied to me very much, ormost of the time”) with a focus on the previousweek. Higher scores are indicative of greater distress. In the current study, internal consistency was good for each of the subscales, with Cronbach’s alpha ranging from .83 (anxiety) to .90 (de- pression). Above-threshold scores on the DASS-21 are asso- ciated with corresponding DSM-5 diagnostic conditions in college students (Bravo et al. 2018).
Results
Data were examined for normality, completeness, and the presence of outliers or impossible values. Bivariate correla- tions were computed to examine general patterns of associ- ation. Path analysis using the maximum likelihood estima- tion method in MPlus version 7.3 tested five distinct paral- lel mediation models, one for each childhood maltreatment type. Given the overlap between the distinct forms of psy- chological distress, error variances for the three dependent variables (depression, anxiety, and stress) were correlated. Similarly, the error variances for the mediators were corre- lated as they shared overlap. We tested the hypothesized indirect effect of facets of self-compassion, self-coldness, and fear of self-compassion, in addition to focusing on
individual pathways, consistent with current recommenda- tions (e.g., Hayes 2013). Specifically, we tested the overall indirect effect for each model (e.g., child emotional abuse severity → facets of self-compassion, self-coldness, and fear of self-compassion → depression, anxiety, and stress) and used bootstrapping techniques to construct confidence inter- vals around the indirect effects (Hayes 2013; Preacher and Hayes 2004) (see Fig. 1). Path analysis in MPlus allows for multiple simultaneous parallel mediators in the same model and provides magnitude as well as significance of the indi- rect effect via each mediator. Missing Value Analysis (MVA) in SPSS revealed missing values ranging from 0.2 to 1% across key study variables. Little’s MCAR test (Little 1988) indicated that data were not significantly different from the missing completely at random pattern (χ2 (11) = 6.05, p = .53). Based on guidelines to manage less than 2% missing data, single imputation was used (Widaman 2006).
Bivariate Associations
As hypothesized, all forms of child maltreatment severity were associated positively with psychological distress (i.e., depression, anxiety, stress) and fear of self-compassion (see Table 1). Only certain types of maltreatment severity were associated with self-compassion. Child emotional maltreat- ment severity (emotional abuse and emotional neglect) showed the strongest correlations to SCS subscales. Emotional abuse and neglect severity and physical abuse se- verity were positively associated with self-coldness (e.g.,
Fig. 1 Overarching model to test indirect effects of self-compassion facets and fear of self-compassion as mediators of the link between child maltreatment severity and psychological distress. Five independent models were were conducted, one for each type of maltreatment
1450 Mindfulness (2020) 11:1446–1459
Ta bl e 1
B iv ar ia te co rr el at io ns
E A
E N
A nx ie ty
S tr es s
< .0 01 .E
se ve ri ty ,E
N em
ot io na ln eg le ct se ve ri ty ,P A ph ys ic al ab us e se ve ri ty ,P
N ph ys ic al ne gl ec ts ev er ity , S A se xu al ab us e se ve ri ty ,S K se lf -k in dn es s, C H
co m m on
hu m an ity ,M
D m in df ul ne ss ,S J se lf -j ud gm
en t, IS
is ol at io n, O I ov er id en tif ic at io n, F SC
fe ar
pa ss io n, D ep
D A SS
D A SS
-A nx ie ty ,S tr es s D A S S -S tr es s, %
pr ev al en ce
(p re se nc e/ ab se nc e)
of m al tr ea tm
en t( m ild
se ve re
Mindfulness (2020) 11:1446–1459 1451
isolation), and emotional neglect severity was negatively as- sociated with self-compassion (self-kindness, common hu- manity, and mindfulness). Sexual abuse and physical neglect severity showed little to no association with self-compassion.
Suppression
We noted potential multicollinearity due to high correlations among some facets of self-compassion (see Table 1). In initial mediation models, there was evidence of suppression, with the direction of correlations switching in the multivar- iate model compared with bivariate correlations. Specifically, common humanity and self-kindness were cor- related negatively with psychological outcomes at the bivar- iate level, yet showed a positive relation with these out- comes (b paths) in the presence of other variables. To ad- dress this issue, we conducted an additional set of analyses with models that excluded mindfulness given its high cor- relations with the other two positive subscales, and com- pared the patterns to determine the impact of suppression on the models based upon recommendations by Beckstead (2012). Both sets of results are presented below.
The Role of Self-compassion
Three facets of self-compassion were examined: self-kind- ness, common humanity, and mindfulness. Self-kindness was a significant mediator of the relationship between (a) emotional abuse and anxiety, (b) emotional neglect and anxi- ety, and (c) emotional neglect and stress (see Table 2). In all these models, increased severity of childhood emotional abuse and emotional neglect was associated with lower self-kind- ness. However, higher self-kindness was associated with higher anxiety and stress. To address suppression effects, mindfulness was removed from the models, after which self- kindness was no longer a significant mediator. Common hu- manity was a significant mediator of the relationship between (a) emotional neglect and anxiety and (b) emotional neglect and stress (see Table 2). In these models increased severity of emotional neglect was associated with lower common human- ity. Further, higher levels of common humanity were associ- ated with increased anxiety and stress. After mindfulness was removed from the models, common humanity was no longer a significant mediator. Mindfulness was a significant mediator of the relationship between (a) emotional neglect and depres- sion, (b) emotional neglect and anxiety, and (c) emotional neglect and stress (see Table 2). In all models greater severity of emotional neglect was associated with decreased mindful- ness, which in turn was associated with higher depression, anxiety, and stress.
The Role of Self-coldness
Three facets of self-coldness were examined: self-judgment, isolation, and overidentification. Self-judgment was a signifi- cant mediator of the relationship between (a) emotional abuse and anxiety, (b) emotional neglect and anxiety, and (c) phys- ical abuse and anxiety (see Table 2). In all these models, in- creased childhood abuse and neglect severity were associated with higher self-judgment, which in turn was associated with higher anxiety. After mindfulness was removed from the me- diation models, self-judgment was no longer a significant me- diator. Isolation was a significant mediator of the relationship between (a) emotional abuse and depression, (b) emotional neglect and depression, (c) emotional neglect and stress, (d) physical abuse and depression, (e) physical abuse and stress, (f) physical neglect and depression, and (g) physical neglect and stress (see Table 2). In all these models, increased child- hood abuse and neglect severity were associated with higher isolation, which in turn was associated with higher depression and stress. After mindfulness was removed from the models, these results remained unchanged, except isolation emerged as a significant mediator of the relationship between emotional abuse severity and stress. Overidentification was a significant mediator of the relationship between (a) emotional abuse and anxiety, (b) emotional abuse and stress, (c) emotional neglect and anxiety, (d) emotional neglect and stress, (e) physical abuse and anxiety, and (f) physical abuse and stress (see Table 2). In all these models, increased childhood abuse and neglect severity were associated with increased overidentifi- cation, which in turn was associated with increased anxiety and stress. After mindfulness was removed from the models, results remained largely unchanged, except overidentification emerged as a significant mediator of the relationship between physical neglect and anxiety.
The Role of Fear of Self-compassion
Fear of self-compassion mediated the relationship between (a) emotional abuse and depression, (b) emotional abuse and anxiety, (c) emotional abuse and stress, (d) emotional neglect and depression, (e) emotional neglect and anxiety, (f) emotional neglect and stress, (g) physical abuse and depression, (h) physical abuse and anxiety, (i) physical abuse and stress, (j) physical neglect and depression, (k) physical neglect and anxiety, (l) physical neglect and stress, (m) sexual abuse and depression, (n) sexual abuse and anx- iety, and (o) sexual abuse and stress (see Table 2). In all these models, increased severity of childhood maltreatment was associated with increased fear of self-compassion, which in turn was associated with higher depression, anxi- ety, and stress. After mindfulness was removed from the models, results remained unchanged.
1452 Mindfulness (2020) 11:1446–1459
Table 2 Mediation models for childhood maltreatment severity
Model without mindfulness
c path b (S.E.)
Emotional abuse
Depression − .03 (.01)** SK .63 (.63) .86 (.09)*** .39 (.10)*** − .23 (.51)
− .01 (.01) CH .30 (.48) − .27 (.47)
− .01 (.01) MD − 1.64 (.58)** .08 (.01)*** SJ .43 (.55) 08 (.53)
.08 (.01)*** IS 2.19 (.48)*** .18 (.10 to .27) 2.25 (.49)*** .18 (.10 to .28)
.07 (.01)*** OI .24 (.62) .57 (.60)
1.31 (.19)*** FSC .19 (.04)*** .24 (.14 to .38) .19 (.03)*** .24 (.14 to .38)
Anxiety − .03 (.01)** SK 1.16 (.52)* .73 (.08)*** .38 (.08)*** − .03 (− .09 to − 01) .28 (.42)
− .01 (.01) CH .65 (.41) .07 (.40)
− .01 (.01) MD − 1.66 (.50)** .08 (.01)*** SJ 1.09 (.54)* .08 (.006 to .19) .74 (.52)
.08 (.01)*** IS .01 (.46) .06 (.46)
.07 (.01)*** OI 1.2 (.58)* .09 (.009 to .18) 1.5 (.56)** .11 (.03 to .21)
1.31 (.19)*** FSC .15 (.03)*** .20 (.19 to .32) .15 (.02)*** .20 (.11 to .33)
Stress − .03 (.01)** SK 1.00 (.57) .86 (.09)*** .44 (.09)*** − .16 (.53)
− .01 (.01) CH 1.02 (.53) .24 (.47)
− .01 (.01) MD − 2.21 (.56)*** .08 (.01)*** SJ .56 (.53) .09 (.52)
.08 (.01)*** IS .91 (.49) .99 (.49)* .08 (.004 to .17)
.07 (.01)*** OI 2.11 (.58)*** .15 (.07 to .26) 2.57 (.57)*** .18 (.10 to .30)
1.31 (.19)*** FSC .12 (.03)*** .16 (.07 to .27) .12 (.03)*** .16 (.07 to .26)
Emotional neglect
Depression − .05 (.01)*** SK .70 (.62) .80 (.09)*** .37 (.11)** − .19 (.50)
− .03 (.01)** CH .43 (.49) − .16 (.47)
− .03 (.01)** MD − 1.68 (.58)** .05 (.01 to .13)
.05 (.01)*** SJ .53 (57) .18 (.54)
.06 (.01)*** IS 2.21 (.48)*** .13 (.07 to .22) 2.27 (.49)*** .13 (.07 to .22)
.04 (.01)*** OI .35 (.62) .69 (.60)
1.42 (.17)*** FSC .18 (.03)*** .26 (.14 to .40) .18 (.04)*** .26 (.14 to .40)
Anxiety − .05 (.01)*** SK 1.21 (.53)* .62 (.07)*** .32 (.11)** − .06 (− .14 to − .01) .32 (.43)
− .03 (.01)** CH .77 (.42) − .03 (− .07 to − .001) .17 (.40)
− .03 (.01)** MD − 1.6 (.51)** .05 (.01 to .12)
.05 (.01)*** SJ 1.19 (.57)* .06 (.008 to .15) .83 (.54)
.06 (.01)*** IS .04 (.45) .10 (.47)
.04 (.01)*** OI 1.30 (.59)* .06 (.01 to .13) 1.64 (.57)** .07 (.02 to .15)
1.42 (.17)*** FSC .15 (.04)*** .21 (.11 to .35) .15 (.04)*** .21 (.11 to .36)
Stress − .05 (.01)*** SK 1.01 (.58) .61 (.26)*** .25 (.09)** − .05 (− .12 to − .002) − .14 (.54)
− .03 (.01)** CH 1.11 (.54)* − .04 (− .10 to − .004) .34 (.48)
− .03 (.01)** MD − 2.19 (.57)*** .07 (.02 to .15)
.05 (.01)*** SJ .64 (.57) .17 (.57)
.06 (.01)*** IS 1.00 (.51) .06 (.004 to .14) 1.08 (.52)* .06 (.008 to .14)
.04 (.01)*** OI 2.21 (.60)*** .10 (.04 to .19) 2.66 (.59)*** .06 (.05 to .22)
1.42 (.17)*** FSC .13 (.03)*** .19 (.10 to .31) .14 (.03)*** .19 (.10 to .32)
Mindfulness (2020) 11:1446–1459 1453
Table 2 (continued)
Model without mindfulness
c path b (S.E.)
Physical abuse
Depression − .005 (.02) SK .50 (.61) .85 (.23)*** .46 (.20)*** − .26 (.50)
.01 (.02) CH .20 (.49) − .31 (.47)
− .007 (.02) MD − 1.45 (.57)* .04 (.02)* SJ .53 (.57) .22 (.54)
.05 (.02)* IS 2.26 (.48)*** .12 (.04 to .23) 2.30 (.49)*** .12 (.04 to .24)
.04 (.02)* OI .29 (.63) .59 (.61)
1.10 (.23)*** FSC .20 (.03)*** .23 (.10 to .40) .20 (.03)*** .23 (.10 to .40)
Anxiety − .005 (.02) SK 1.04 (.51)* .78 (.13)*** .49 (.12)*** .26 (.42)
.01 (.02) CH .55 (.42) .03 (.40)
− .007 (.02) MD − 1.48 (.50)* .04 (.02)* SJ 1.19 (.56)* .04 (.002 to .15) .89 (.54)
.05 (.02)* IS .07 (.46) .11 (.46)
.04 (.02)* OI 1.24 (.59)* .05 (.001 to .15) 1.54 (.57)** .06 (.006 to .17)
1.10 (.23)*** FSC .17 (.03)*** .19 (.08 to .34) .17 (.03)*** .19 (.08 to .34)
Stress − .005 (.02) SK .89 (.59) .62 (.17)*** .25 (.12)*** − .19 (.54)
.01 (.02) CH .97 (.50) .25 (.48)
− .007 (.02) MD − 2.04 (.57)*** .04 (.02)* SJ .62 (.57) .19 (.56)
.05 (.02)* IS 1.04 (.51)* .06 (.007 to .14) 1.10 (.52)* .06 (.009 to .15)
.04 (.02)* OI 2.17 (.60)*** .09 (.01 to .21) 2.59 (.59)*** .11 (.01 to .24)
1.10 (.23)*** FSC .15 (.03)*** .17 (.07 to .31) .15 (.03)*** .17 (.07 to .31)
Physical neglect
Depression − .03 (.01) SK .56 (.63) .71 (.14)*** .27 (.16) SK − .24 (.51)
− .01 (.02) CH .28 (.49) CH − .25 (.48)
− .02 (.02) MD − 1.52 (.57)** MD
.03 (.02) SJ .50 (.57) SJ .18 (.55)
.04 (.02) IS 2.38 (.50)*** .08 (.003 to .20) IL 2.43 (.50)*** .09 (.003 to .20)
.03 (.02) OI .26 (.63) OI .57 (.61)
1.51 (.25)*** FSC .20 (.03)*** .31 (.17 to .49) FC .20 (.03)*** .31 (.18 to .49)
Anxiety − .03 (.01) SK 1.10 (.53)* .64 (.14)*** .30 (.15) SK .29 (.43)
− .01 (.02) CH .63 (.42) CH .09 (.41)
− .02 (.02) MD − 1.54 (.52)** MD
.03 (.02) SJ 1.18 (.58)* SJ .85 (.55)
.04 (.02) IS .19 (.48) IL .24 (.49)
.03 (.02) OI 1.21 (.60)* OI 1.53 (.58)** .05 (.001 to .15)
1.51 (.25)*** FSC .17 (.03)*** .26 (.14 to .42) FC .17 (.03)*** 26 (.14 to .42)
Stress − .03 (.01) SK .92 (.59) .57 (.15)*** .20 (.12) SK − .17 (.55)
− .01 (.02) CH 1.01 (.54) CH .27 (.48)
− .02 (.02) MD − 2.08 (.56)*** MD
.03 (.02) SJ .62 (.58) SJ .18 (.56)
.04 (.02) IS 1.12 (.51)* .04 (.001 to .12) IL 1.18 (.52)* .04 (.002 to .12)
.03 (.02) OI 2.15 (.60)*** OI 2.57 (.59)***
1.51 (.25)*** FSC .15 (.03)*** .23 (.12 to .38) FS .15 (.03)*** .22 (.12 to .38)
1454 Mindfulness (2020) 11:1446–1459
Discussion
In the current study, the association between child maltreat- ment severity and distress was explained by self-compassion and related variables (e.g., self-coldness, fear of self-compas- sion). As hypothesized, greater severity of maltreatment was associated with lower self-compassion. Our findings are con- sistent with earlier studies showing the strongest association between emotional maltreatment (emotional abuse and ne- glect) and diminished self-compassion (Tanaka et al. 2011; Wu et al. 2018). Distinct patterns emerged for different self- compassion subscales, supporting recommendations to utilize subscales of the SCS to measure self-compassion and self- coldness rather than a total score (López et al. 2018). Child maltreatment severity (with the exception of emotional ne- glect) was not associated with self-compassion (e.g., self- kindness, common humanity, and mindfulness). The strongest and most consistent correlations occurred between emotional abuse and neglect severity and self-coldness.
Self-coldness, otherwise known as the negative aspects of self-compassion, including self-judgment, isolation, and
overidentification, was positively associated with depression, anxiety, and stress. In particular, isolation and overidentifica- tion were significant mediators of the link between child mal- treatment severity and distress, consistent with earlier studies focused on depression, anxiety, or negative affect (Körner et al. 2015; López et al. 2018; Van Dam et al. 2011). Thus, earlier studies documenting that self-compassion (measured with the SCS total score) mediates the link between child maltreatment and distress may instead be demonstrating that child maltreatment is a risk factor for greater self-coldness, which promotes psychological distress, rather than self- compassion serving a buffering or protective effect. Future studies should continue to examine the precise relations among different types of child maltreatment and different components of self-compassion, to determine the extent to which child maltreatment is inversely related to self- compassion rather than positively related to self-coldness.
Examination of particular facets of self-compassion and self-coldness revealed distinct patterns, further supporting our suggestion to examine specific subscales of the SCS. Mindfulness was the only self-compassion subscale
Table 2 (continued)
Model without mindfulness
c path b (S.E.)
Sexual abuse
Depression − .02 (.02) SK .57 (.63) .49 (.12)** .15 (.19) − .26 (.51)
.01 (.02) CH .30 (.49) − .24 (.48)
.01 (.02) MD − 1.57 (.58)*
.03 (.03) SJ .44 (.57) .10 (.54)
.02 (.02) IS 2.38 (.50)*** 2.43 (.51)***
.02 (.03) OI .29 (.63) .61 (.61)
1.32 (.34)*** FSC .22 (.03)*** .28 (.13 to .49) .22 (.03)*** .28 (.13 to .49)
Anxiety − .02 (.02) SK 1.11 (.53)* .48 (.16)** .20 (.18) .26 (.43)
.01 (.02) CH .65 (.42) .09 (.40)
.01 (.02) MD − 1.60 (.52)**
.03 (.03) SJ 1.10 (.57) .76 (.54)
.02 (.02) IS .20 (.49) .24 (.48)
.02 (.03) OI 1.24 (.60)* 1.57 (.58)**
1.32 (.34)*** FSC .18 (.03)*** .24 (.11 to .42) .18 (.03)*** .24 (.11 to .42)
Stress − .02 (.02) SK .91 (.60) .31 (.18) .04 (.17) − .19 (.55)
.01 (.02) CH 1.03 (.54) .30 (.48)
.01 (.02) MD − 2.1 (.57)***
.03 (.03) SJ .57 (.57) .13 (.55)
.02 (.02) IS 1.10 (.51)* 1.17 (.52)*
.02 (.03) OI 2.16 (.60)*** 2.59 (.59)***
1.32 (.34)*** FSC .16 (.03)*** .21 (.10 to .38) .16 (.03)*** 21 (.10 to .38)
*p < .05, **p < .01, and ***p < .001. Unstarred coefficients are non-significant paths. Unstandardized coefficients and standard errors are presented. Only significant indirect effects are reported. SK self-kindness, CH common humanity, MD mindfulness, SJ self-judgment, IS isolation, OI overiden- tification, FSC fear of self-compassion, Depress depression
Mindfulness (2020) 11:1446–1459 1455
associated with depression, anxiety, and stress. However, the high degree of relatedness of self-compassion subscales, par- ticularly betweenmindfulness and self-kindness (and to a less- er degree, common humanity), likely affected multivariate models via statistical suppression. Thus, the hallmark compo- nents of self-compassion, such as self-kindness and common humanity, did not predict distress in multivariate models. In contrast, mediation effects for self-coldness (e.g., negative facets of self-compassion) revealed a specific pattern based upon type of distress: depression was related only to isolation, anxiety was related only to overidentification, and stress was related to both overidentification and isolation. Previous stud- ies support this pattern, suggesting a significant association between overidentification (a negative facet of self- compassion) and increased fear of negative and positive eval- uation among individuals diagnosed with social anxiety dis- order (Werner et al. 2012). Overidentification may be a par- ticularly pernicious and potentially transdiagnostic thought process that mediates the links between multiple types of child maltreatment severity and multiple outcomes (e.g., anxiety, stress). Notably, self-judgment, a variable potentially related to the self-esteem criterion of chronic depression (e.g., dys- thymia), was not a significant mediator. Instead, isolation and overidentification, alongside fear of self-compassion, explain the link between maltreatment severity and distress, but only for particular forms of child maltreatment.
Our findings suggest that the type of child maltreatment matters, at least in terms of associations with self- compassion and self-coldness. Self-compassion is strongly and negatively associated with emotional maltreatment (par- ticularly emotional abuse). Although the negative self- compassion components (i.e., self-coldness) were linked to physical abuse severity as well, the magnitude was weaker, and there were no links to child sexual abuse severity, consis- tent with earlier research that examined different forms of maltreatment (Miron et al. 2014; Ross et al. 2019; Tanaka et al. 2011; Wu et al. 2018). Severity of emotional abuse and emotional neglect was correlated in this and other samples, and the two types of maltreatment have been conceptualized as a composite variable in other studies (e.g., emotional maltreatment, see Wu et al. 2018). Emotional maltreatment experiences may bemore likely to involve particular elements, such as harsh criticism or name-calling, detrimental to devel- opment of self-compassion (Gilbert and Procter 2006). In ad- dition, emotional maltreatment frequently co-occurs with oth- er forms of child abuse, and thus carries a potential cumulative impact (Edwards et al. 2003). Finally, emotional or psycho- logical abuse has been posited to be a fundamental and poten- tially inseparable component of all forms of abuse and neglect (Edwards et al. 2003; Ross et al. 2019); thus, this form of maltreatment may be the most robust predictor of abuse- related outcomes because it pervades almost all types of child maltreatment. This may speak to the complexity of emotional
maltreatment, especially that emotional abuse may coexist alongside more positive and caring parental interactions. In contrast, emotional neglect is defined by the absence of pos- itive emotional interactions with a caregiver; therefore, this type of maltreatment may be especially detrimental to devel- opment of self-compassion skills such as self-kindness and mindfulness. Indeed, emerging longitudinal research indicates that risk for depression is associated with specific symptoms, such as anhedonia, that varies as a function of abuse versus neglect (Cohen et al. 2019).
Fear of self-compassion mediated the link between child maltreatment severity and distress. This pattern held for all types of child maltreatment and across types of distress (e.g., depression, anxiety, and stress). Our findings are consistent with another study that reported child abuse (emotional, phys- ical, and sexual measured together as one construct) was as- sociated with greater fear of self-compassion, and that fear of self-compassion predicted posttraumatic stress symptoms (Boykin et al. 2018). Earlier studies did not examine specific types of child maltreatment and fear of self-compassion. Our findings suggest that regardless of type, as child maltreatment severity increases, there is also an increase in fear of being compassionate towards oneself. However, emotional abuse and emotional neglect severity show the strongest associations with fear of self-compassion. Empirical investigations are just emerging on this topic; thus, the field needs more studies to examine fear of self-compassion among survivors of different types of child abuse and neglect. However, our findings are consistent with theoretical arguments regarding child abuse and neglect as a pathway to fear of self-compassion (Gilbert and Procter 2006).
Limitations and Future Research
Our findings contribute to an emerging empirical consensus regarding the deleterious impact of child maltreatment on self- compassion. Several methodological strengths bolster our confidence in the current findings, including a large sample, inclusion of widely used and psychometrically sound mea- sures that facilitate direct comparisons across studies, and, most importantly, the investigation of a comprehensive model that examines components of self-compassion, self-coldness, and fear of self-compassion to identify specific predictors of distress. However, our results should be considered in the context of several limitations, including the focus on predom- inantly Caucasian female college students, which limits gen- eralization to non-college students, women of other ages, races, and ethnicities, and to men. The pattern of findings reported here may also differ in other samples, particularly among community or clinical populations where the range of distress levels may be wider and absolute levels of distress more severe. Research must continue to examine racial and ethnic minority groups and intersectionality, factors which
1456 Mindfulness (2020) 11:1446–1459
have been commonly overlooked in research on the effects of trauma and its treatment (Bryant-Davis 2019). One study found that female African American college students had higher levels, and female EuropeanAmerican college students lower levels, of self-compassion (Miron et al. 2014). We may find that self-compassion operates differently among diverse populations, interacting with strength and resilience factors such as religion and spirituality, as well as social support and adherence to communal values. Age is another factor that may moderate patterns reported here. In a study of depression among individuals living with AIDS in the USA and Puerto Rico, age was negatively associated with self-judgment and positively associated with self-kindness (Eller et al. 2014). Studies of adolescents also indicate that age and gender are differentially associated with self-compassion and depression. Older adolescent females report the lowest levels of self- compassion compared with younger adolescents and all males (Bluth et al. 2017). Continued studies, on all individuals, are needed to clarify the patterns found here. The interaction of race, age, and gender may be particularly important to exam- ine. A recent report from a nationally representative sample of over 600,000 adolescents and adults in the USA suggests a significant and steady rise in mood disorder and suicide- related outcomes (suicidal ideation, plans, attempts, and deaths by suicide) among White, upper-middle class, college-aged women (Twenge et al. 2019).
We utilized a retrospective questionnaire to assess child maltreatment that may be susceptible to memory bias, mini- mization, or poor recall. Although the CTQ includes a mini- mization and denial subscale, we did not compute such scores, consistent with earlier studies that utilized the same measure (Boykin et al. 2018; Miron et al. 2014, 2016; Tanaka et al. 2011; Vettese et al. 2011; Wu et al. 2018). There is evidence the CTQ may underestimate the incidence and impact of child maltreatment when minimization is not taken into account (MacDonald et al. 2016). However, another study of the CTQ found few individuals minimized responses on the CTQ, but those with high minimization/denial scores were unlikely to completely deny histories of abuse (Schmidt et al. 2018). Therefore, the pattern of findings reported here may be a more conservative estimate of the true association between child maltreatment and self-compassion. The CTQ may identify milder cases of sexual abuse or actual non- abusive experiences. In one study, comparison with a behav- iorally specific computerized interview showed significant agreement, but higher rates of sexual abuse on the CTQ (DiLillo et al. 2010). More detailed behaviorally specific as- sessment of child sexual abuse may reveal nuanced associa- tions with self-compassion based upon abuse characteristics including nature of the abusive acts, frequency and duration, and relationship to the perpetrator (e.g., family member, trusted adult). The use of survey methods to assess all vari- ables and use of multiple subscales in several instruments
(e.g., CTQ, SCS) may lead to common method bias, which could produce spurious correlations among some variables (Podsakoff et al. 2003). Most importantly, the retrospective, cross-sectional design limits conclusions regarding the direc- tionality of effects as well as the causal and proximal nature of relations found. It is unclear whether the presence of distress affects reports of fear of self-compassion, self-compassion, and child maltreatment severity rather than vice versa.
Child maltreatment predicts elevated risk of recurrent and persistent depressive episodes resistant to treatment (Nanni et al. 2012); thus, we must continue to explore factors that cultivate recovery and resilience among child maltreatment survivors. Although fear of self-compassion is associated with child maltreatment, we cannot assume that all survivors of child maltreatment will report difficulties described here. Continued research exploring child maltreatment and other forms of interpersonal trauma is critical to expanding our un- derstanding of self-compassion and potential unique implica- tions for traumatized populations.
Acknowledgments Terri Messman-Moore would like to acknowledge general professional support for this and all scholarly activities from an endowed professor position, The O’Toole, Family Professor, at Miami University.
Author Contributions Terri Messman-Moore and Prachi Bhuptani jointly designed the study. Prachi Bhuptani conducted data analyses and wrote part of the results. Terri Messman-Moore wrote the introduction, methods, part of the results, and the discussion. All authors approved the final version of the manuscript for submission.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of interest.
Ethical Approval All procedures were approved by the Committee for Use of Human Subjects in Research at Miami University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee atMiami University and with the 1964 Helsinki declaration and its later amend- ments or comparable ethical standards.
Informed Consent Informed consent was obtained from all individual participants in the study.
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