Difficulties with emotion regulation moderate the relationship between child maltreatment and emotion recognition

Abstract

Background

Emotion regulation (ER) and emotion recognition (ERC) deficits are frequently observed in the sequelae of child maltreatment (CM). Despite a wealth of research on emotional functioning, these emotional processes are often presented as independent but related functions. As such, there is currently no theoretical framework on how different components of emotional competence, such as ER and ERC, may be related to one another.

Objective

The present study aims to empirically assess the relationship between ER and ERC by examining the moderating role of ER in the relationship between CM and ERC. A secondary objective is to explore whether unique CM subtypes, recognition of specific emotions, and ER dimensions are driving this relationship.

Methods

A sample of 413 emerging adults (18–25 years) completed an online survey (CM history, ER difficulties) and an ERC task.

Results

Moderation analysis indicated that in emerging adults with ER difficulties, as CM increased, the accuracy for negative emotions decreased (B = −0.02, SE = 0.01, t = −2.50, p = .01). Exploratory analyses revealed that most CM subtypes (sexual abuse, emotional maltreatment, and exposure to domestic violence) significantly interacted with two ER dimensions (difficulty with impulsivity and limited access to ER strategies) and was associated with disgust, but not sadness, fear, nor anger recognition.

Conclusions

These results provide evidence for ERC impairment in emerging adults with more CM experiences and ER difficulties. The interplay between ER and ERC is important to consider in the study and treatment of CM.

Introduction

Child maltreatment (CM) is robustly associated with impairments in emotion regulation (ER) and emotion recognition (ERC), with negative effects persisting into adulthood (McCrory et al., 2017; McLaughlin et al., 2020). While ER is the ability to appropriately and flexibly modulate one's affect based upon situational demands (Gratz & Roemer, 2004), ERC is the ability to accurately perceive and interpret emotional states expressed by others (Scherer & Scherer, 2011). Despite a wealth of research on ER and ERC and their relevance as primary domains of emotional competence (Saarni, 2000), there remains a lack of a unifying theory of emotional functioning explaining how different domains of emotional competence relate to one another (Milojevich et al., 2021). Considering the abundance of research on ER and ERC, there is a surprising dearth of empirical research investigating the relationship between these two domains of emotional competence, least of all in people with a history of CM. The primary objective of the current study was to empirically examine if ER moderates the association between CM and ERC, in emerging adults. The secondary objective was more exploratory in nature and sought to investigate whether unique CM subtypes, recognition of specific emotions, and ER dimensions were driving this relationship.

Emerging adulthood, a lengthy period of transition marked by the exploration of identity and instability (Arnett, 2007), is a period during which emotional competence improves (Parker et al., 2005) and is aligned with the maturation of the prefrontal cortex, central to executive functioning and emotion regulation (Smolker et al., 2018). Additionally, emerging adults with a history of child maltreatment are especially vulnerable to the development of psychopathology (Widom et al., 2007). As such, it is important to understand the nature of the relationship between ER and ERC in emerging adults with a history of CM since both ER and ERC are implicated in the development of psychopathology (e.g., Milojevich et al., 2019; Tognin et al., 2020) and revictimization (e.g., Lilly et al., 2014), and are thus essential for well-being. Further, research demonstrating differential relationships between CM and ERC (Turgeon et al., 2020) and CM and ER (Cheng & Langevin, 2022) urges scholars to examine more closely the unique associations between CM subtypes and emotional competence during this transitional period. With such great variance and diversity within the CM population, emerging adulthood is a sensitive period in the continued development of emotional competence which has potential for intervention and a positive lasting impact.

ERC is central to monitoring the environment for threats; both the ability to recognize and regulate emotions facilitates social interactions (Lopes et al., 2011; Miller et al., 2005). Robust neuroimaging evidence for impairments in brain activity during ERC tasks show that people with a CM history, relative to those without, have a heightened amygdala response towards fearful and angry faces (see Hein & Monk, 2017 for a review), indicative of sensitivity towards negative emotions (Dannlowski et al., 2012). This attentional bias in CM survivors is present irrespective of psychopathology (Letkiewicz et al., 2020). Nevertheless, the behavioral evidence is inconsistent with some studies indicating greater accuracy in recognizing negative facial expressions and others demonstrating the reverse (see Bérubé et al., 2021 for a review). Despite extensive research on ER and ERC, there is a dearth of studies on the relationship between ER and ERC in people with a history of CM.

Considering effective ER is characterized by the ability to flexibly and successfully apply strategies under various conditions (Aldao et al., 2009), ERC may be moderated by ER abilities. Since threatening stimuli triggers automatic emotional reactivity, engagement with the stimuli requires an individual to be able to manage this automatic response. As such, the ability to effectively regulate emotional reactivity likely affects how well someone is able to re-engage with the threatening stimuli after the initial reactivity. In fact, two studies have demonstrated ER as a moderator in relation to ERC (Aldinger et al., 2013; England-Mason et al., 2018). In the first study, women with more severe depression were generally worse at identifying angry facial expressions but not any other basic emotions, however, expressive suppression - an ER strategy - moderated this relationship such that women who were more severely depressed and less likely to use that strategy were less accurate in recognizing angry facial expressions (Aldinger et al., 2013). In contrast, in participants with high expressive suppression, depression severity did not affect the accuracy of anger recognition.

The second study demonstrated a similar trend of results with attentional bias as the outcome. England-Mason et al. (2018) found that post-partum women with a CM history and less ER difficulties were less inclined to avoid emotional stimuli. These findings suggest that participants with a CM history and greater ER abilities were better able to engage with and process emotional stimuli compared with those with poorer ER abilities. This improved performance may be due to a greater capacity to tolerate discomfort, enabling the individual to address, rather than avoid, the experienced distress. In summary, both studies demonstrated that the ability to accurately process emotion information depended on ER abilities.

CM is frequently studied as a general category or as an individual subtype, however, there are also differential associations between CM subtypes and various outcomes (e.g., psychopathology, internalizing and externalizing behaviours, ERC, ER; Cheng & Langevin, 2022; Cecil et al., 2017; de Oliveira et al., 2018). Given the frequent co-occurrence of CM subtypes (Kim et al., 2017), Cecil et al. (2017) demonstrated the importance of accounting for the effects of CM subtypes to differentiate between unique and shared associations. They showed that while CM subtypes were individually associated with mental health outcomes, emotional abuse emerged as a primary predictor of mental health outcomes when all CM subtypes were included in the analysis (Cecil et al., 2017). Consequently, the current study sought to examine whether specific CM subtypes, taking into account other CM subtypes, uniquely interacted with ER.

An emergent model, the dimensional model of adversity and psychopathology (DMAP), provides a guiding theory on how threat and deprivation differentially impact developmental cognitive and emotional functioning (Mclaughlin & Sheridan, 2016). DMAP stipulates that repeated exposure to threat in early childhood, such as childhood physical and sexual abuse, and exposure to domestic violence, disrupts fear and reward-learning processes which is associated with emotion dysregulation (Milojevich et al., 2019; Weissman et al., 2019), heightened emotion reactivity (Pollak & Sinha, 2002), and difficulty discriminating between threatening and safety cues (Mclaughlin & Sheridan, 2016). Conversely, early deprivation, such as in cases of neglect, where there is a deficit of social and cognitive input, is associated with a detrimental impact on executive functioning (Mclaughlin & Sheridan, 2016). While emotional maltreatment is not explicitly discussed within DMAP, this maltreatment subtype consists of both emotional abuse and neglect which falls along the continuum of both threat and deprivation. As such, emotional maltreatment will be categorized as threat in the present study since it has strong associations with emotional processes (Burns et al., 2012; Christ et al., 2019).

Similar to the study of CM, ER is typically studied as a broad construct involving multiple dimensions. Maladaptive ER strategies include persistent and inflexible avoidance or control of emotions, and adaptive strategies include those that flexibly enhance the awareness, understanding, and acceptance of emotions and emotional states (Gratz & Roemer, 2004). Gratz and Roemer (2004) identified six dimensions of difficulties with ER: nonacceptance of emotional responses, difficulties engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to ER strategies, and lack of emotional clarity. Correlations between these dimensions ranged from weak to moderate (e.g., r = 0.08–0.44; Greene et al., 2021) demonstrating that individuals may have difficulty with one dimension but not with another. In fact, emotional maltreatment is more strongly correlated with ER difficulties relative to other CM subtypes (Burns et al., 2010; Greene et al., 2021; Rosenstein et al., 2018), and specifically, emotional maltreatment was most strongly associated with limited access to ER strategies (Burns et al., 2010; Greene et al., 2021; Rosenstein et al., 2018). Additionally, emotional maltreatment was a stronger predictor of ER difficulties than sexual abuse and physical abuse (Burns et al., 2010; Christ et al., 2019), though these results are inconsistent (Kim & Cicchetti, 2010). As such, there is empirical support for differential relationships between CM subtypes and specific ER dimensions.

Along with differential relationships between CM subtypes and ER, CM subtypes have also been associated with the recognition of specific emotions. While CM has generally been associated with impairments in the recognition of negative emotions as a whole (Bérubé et al., 2020; Catalana et al., 2020), there is also some evidence for specific associations. Although there are inconsistencies between studies, physical abuse was associated with reduced accuracy in recognizing fearful, angry, sad, and happy expressions; neglect, sexual abuse, and emotional maltreatment were all associated with reduced accuracy for anger (Cheng & Langevin, 2022; Turgeon et al., 2020; Wagner et al., 2015). There is also support for emotional maltreatment and increased accuracy for anger and fear (Turgeon et al., 2020). Like ER, there is empirical support for differential relationships between CM subtypes and negative ERC. Given the lack of research on that topic, we did not make any specific hypotheses regarding the specific ER dimensions or recognition of emotions and decided to take a more exploratory approach for these dimensions.

The extant empirical research is currently limited in providing a sense of how ERC and ER are jointly impacted by CM. Some research suggests that ER may be a moderator (Aldinger et al., 2013; England-Mason et al., 2018). As such, the primary objective of the current study was to clarify the relationship between ER and ERC and examine whether ER moderates the relationship between CM and ERC. We hypothesized that ER moderates the association between CM and ERC such that difficulties with ER are expected to worsen ERC outcomes in emerging adults with a CM history. Alternatively, our null hypothesis is that impairments in ERC and ER are co-morbid conditions independently associated with CM. Given the robust association between CM and the recognition of negative emotional expressions (Bérubé et al., 2021), the current study focused on negative emotions (anger, fear, sadness, and disgust). Our secondary objective was to explore whether specific CM subtypes and ER dimensions predict the recognition of specific emotions. Based on DMAP, we hypothesize that physical abuse, sexual abuse, emotional maltreatment, and exposure to domestic violence will have stronger associations in the moderation model compared with neglect since both ER and ERC are emotional processes. By identifying the unique effects of CM subtypes on ERC and specific ER dimensions, and exploring how both constructs relate to one another in the context of CM, the fine-grained analyses conducted as part of the current study will contribute to a better understanding of emotional competence in survivors of CM.