The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Reducing Suicide: A National Imperative
recent population-based studies that redress long-standing methodological limitations that have hitherto cast doubt on the veracity of early trauma as a causative factor in suicidality (for review, see Wagner, 1997). It also describes the biological, cognitive, behavioral, and emotional responses to trauma that may lead to psychopathology and later suicidality. These responses occur against the backdrop of development, which is marked by dramatic changes and emergent functions. Trauma during childhood can disrupt psychological and biological development, as manifested by developmental delays or enduring changes in the anatomy and physiology of the brain (Cicchetti and Toth, 1995; De Bellis, 2001; Glaser, 2000; Heim and Nemeroff, 2001). The impact of trauma on the brain’s stress response systems can make children more vulnerable to later stressful events and to the onset of psychopathology. Childhood trauma can also cause earlier onset of psychopathology and suicidality and lead to a cascade of other life events, each of which increase the risk for suicidality.
The relatively new field of developmental traumatology attempts to integrate knowledge from disparate fields of developmental psychopathology, developmental neuroscience, and stress and trauma research (De Bellis, 2001). Developmental traumatology benefits from a solid base of biological, behavioral, and psychological research on the effects of trauma. The integration of many disciplines, involving both human and animal evidence, holds enormous potential for tracing the developmental pathways culminating in mental illness or suicidal behavior.
This chapter begins with the range of childhood traumas and their prevalence. It then presents the evidence for childhood trauma as a risk factor for later suicidality. Childhood sexual abuse emerges as such a strong risk factor that the next section covers its quantitative contribution to the extent of suicide nationwide. From there, the chapter deals with the more immediate effects of childhood trauma on children’s biological, psychological, and social functioning. It then covers the relationship between trauma and psychopathology. Finally, the chapter covers possible pathways from childhood trauma to suicidality and how they can be interrupted through prevention and treatment.
SCOPE AND DEFINITIONS
This chapter covers many types of childhood traumas. The list in Table 5-1 includes the more extreme forms of trauma that have traditionally been grouped together under the term “maltreatment”: physical abuse, sexual abuse,1 neglect, and psychological maltreatment (NRC,
Unless specified further, child sexual abuse refers to a range of behaviors from genital touching and fondling to penetration.