The development of the CTF builds on evidence that measures of childhood sexual and physical abuse and other family adversities are not unitary constructs but rather are interdependent, correlated measures of contextual risk. A study (Green et al. 2010) that used data from the National Comorbidity Survey Replication (NCS‐R) to examine associations of multiple indicators of childhood interpersonal loss and trauma with first onset of psychiatric and substance use disorders offers support for this premise. Descriptive analyses found that measures of parental dysfunction, family violence, and physical and sexual abuse and neglect loaded on a single factor. In predictive analyses, however, individual binary variables were used, and these had a subadditive effect on risk, indicating that each additional adversity increased risk, but to a decreasing extent. Importantly, while childhood adversity increased risk for all classes of disorder, little evidence of specificity of effects was observed (Green et al. 2010). Those findings, in combination with other evidence that childhood adversities do not occur in isolation but tend to cluster (Kessler et al. 1997; Dong et al. 2004; McCutcheon et al. 2010), highlight the importance of considering broader measures of childhood adversity rather than individual events.
