Although diagnosis acceptance is frequently discussed in psychiatric practice and research, both components – psychiatric diagnoses and the act of accepting them – are inherently unclear.

The present study aimed to evaluate how well existing theoretical concepts of diagnosis acceptance align with patient experiences and to explore themes related to diagnosis acceptance.

An iterative thematic analysis was conducted on 30 illness narratives from (former) psychiatric patients. The analysis proceeded through three phases: (a) review of transcripts for overall narratives and attitudes toward diagnoses, (b) extraction of detailed data using a narrative summary template and (c) refining and comparison of themes across narratives.

Existing acceptance theories insufficiently captured the lived experiences reflected in the narratives. Attitudes toward diagnoses were multidimensional, fluctuated over time and were often described using terms other than ‘acceptance‘. Participants emphasised the importance of sharing their stories without being defined by a diagnosis and conflated DSM-5 classifications with broader diagnostic terms, highlighting challenges in communication of psychiatric constructs. Disagreement with diagnoses did not necessarily hinder therapeutic relationships, emphasising the importance of collaboration over consensus.

Given the limited practical application of existing acceptance theories and our findings on contextual factors relevant to psychiatric diagnosis attitudes, the necessity of diagnosis acceptance as a stand-alone goal for positive outcomes should be questioned. Rather than imposing classifications, creating co-constructed narratives may be more effective. Researchers and clinicians are encouraged to adopt narrative approaches to better understand and support patients, thereby fostering reciprocal, patient-centred mental healthcare.

Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.

Three longitudinal studies of major depressive disorder (MDD, N = 1240), bipolar disorder (BD, N = 1339), and schizophrenia (SCZ, N = 577), each including controls (N = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (N = 143 473).

Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17–5.67) and neglect for BD (OR 2.69, 95% CI 2.09–3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55–3.01) and suicide attempts (OR 2.16, 95% CI 1.55–3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02–1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08–2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVWforward = 0.13, 95% CI 0.01–0.24).

Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies.