Childhood emotional maltreatment and adult psychopathology: Evidence for emotion regulation as a mediating mechanism

BACKGROUND: Childhood emotional abuse (CEA) and childhood emotional neglect (CEN) are major risk factors for adult psychopathology. They may alter long-term emotion processing by reducing adaptive strategies such as cognitive reappraisal and increasing maladaptive strategies such as expressive suppression. Such regulatory changes are considered central mechanisms increasing risk for mental disorders. OBJECTIVE: The aim of this study was to examine both the direct and indirect associations between childhood emotional maltreatment (CEM)-a composite of CEA and CEN-as well as the two subdimensions separately, and the presence of a psychiatric diagnosis in adulthood. Cognitive reappraisal and expressive suppression were tested as parallel mediating mechanisms. PARTICIPANTS AND SETTING: Analyses were based on data from N = 2484 adults drawn from a nationally representative German population sample (data collection: October 2024 to February 2025). CEA and CEN were assessed using the corresponding subscales of the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 2003). Emotion regulation was measured with the German version of the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003), with cognitive reappraisal and expressive suppression as subscales. METHODS: In the main analysis, a composite predictor for emotional maltreatment (sum of CEA and CEN scores) was created. The binary criterion variable (Y) was the self-reported presence of a current or past psychiatric diagnosis. Reappraisal and suppression were specified as parallel mediators. Covariates included age, gender, education level, physical abuse, sexual abuse, and physical neglect. Statistical analyses were conducted using PROCESS v4.2 (Hayes, 2022), Model 4, with 5000 bootstrap samples. For the binary outcome, logistic regression was applied. RESULTS: In the main CEM model (CEA + CEN), higher self-reported CEM was associated with an increased likelihood of having a psychiatric diagnosis (OR ≈ 1.09; p < .001), partially mediated by lower reappraisal (b = 0.0040; 95% CI [0.0013; 0.0076]); suppression was not a significant mediator. The CEN model showed a similar pattern (OR ≈ 1.06; p = .0002; indirect effect via reappraisal: b = 0.0051; 95% CI [0.0017; 0.0098]). In the CEA model, only the direct association remained significant (OR ≈ 1.15; p < .001), with no indirect effects. CONCLUSIONS: CEA and CEN represent substantial risk markers for mental health problems. The present findings indicate that deficits in emotion regulation-particularly reduced cognitive reappraisal-partially mediate this risk. Differences between CEA and CEN suggest divergent underlying processes, which is important for tailoring interventions. The results highlight the central role of emotion regulation as a target for reducing the long-term mental health consequences of CEM and enhancing resilience. Although direct comparisons with physical forms of maltreatment are beyond the scope of this study, the robust and independent effects of emotional maltreatment suggest that psychological violence should be considered at least as relevant for prevention and clinical care as physical abuse.