Associations between adverse childhood experiences and their implications for patients with diabetes in adulthood

This dissertation addresses the associations between ACEs, diabetes, and psychological burden in the form of anxiety, depressive, somatic, and suicidal symptoms, diabetes-related distress, and psychosocial phenomena such as loneliness. The transdiagnostic construct of impairments in personality functioning according to OPD was considered as the underlying mechanism, as well as the closely related concept of the epistemic stance (epistemic trust, mistrust, and credulity). In addition to the high prevalence of ACEs among people with diabetes compared to the general population, the results show that diabetes occurs more frequently after ACEs and that people with diabetes who have experienced ACEs compared to those without show greater psychological burden, diabetes-related distress, and loneliness. These associations are largely conveyed by impairments in personality functioning. Epistemic mistrust and credulity are closely associated with impairments in personality functioning.
Based on these results it can therefore be concluded that psychological burden should play a central role in the treatment of people with diabetes, alongside somatic aspects. The present findings show that psychological burden in people with diabetes encompasses much more than just depressive and anxiety symptoms, highlighting the importance of somatic symptoms, suicidal ideation, and broader phenomena such as loneliness (which is closely linked to psychopathology). Given the transdiagnostic characteristics of personality functioning, screening for impairments in personality functioning could provide early indications of general psychological burden and initiate further treatment approaches. Impairments in personality functioning could pose a novel treatment approach for people with diabetes and psychological burden. Psychodynamic interventions or mentalization-based treatments that promote personality functioning as well as epistemic trust could positively influence the multitude of psychological and psychosocial complaints of people with diabetes, enhance the patient-doctor-relationship, and ultimately have a beneficial effect on associated diabetes self-management and, not least, the health-related quality of life of people with diabetes.