TABLE 5-1 Types of Childhood Trauma

Physical abuse by adults or peers

Sexual abuse by adults or peers

Neglect

Psychological maltreatment

Witnessing violence, especially against the mother

Family members with substance use, mental disorders, suicidality

Family members who have been incarcerated

Loss or separation from parentsa

Childhood socio-economic disadvantagea

aNot covered by Felitti et al., 1998, but found significant other studies of suicide attempts or completion (Cheng et al., 2000; Fergusson et al., 2000b).

1993). The list also includes other types of trauma, such as witnessing family violence, parental loss, or other serious family adversities. In keeping with the epidemiological literature, childhood traumas do not include “stressful life events,” which are generally defined as the breakdown of a close relationship, interpersonal conflict with parents or friends, school-or work-related difficulties, and legal or disciplinary crises.

Sexual and physical abuse have the strongest relationship to suicidality, but there are several reasons for this chapter’s broad focus on many types of childhood trauma. (1) They are similar in violating the child’s home environment as a safe haven and in compromising parents’ roles as physical and emotional care takers (Margolin and Gordis, 2000). (2) Children are often exposed to more than one type of trauma (Felitti et al., 1998; McGee et al., 1995). For example, one-third to one-half of neglected children witness domestic violence (De Bellis, 2001), and child neglect frequently occurs in association with maternal depression (Glaser, 2000). Furthermore, about one-third of abused adults report both physical and sexual abuse as children (McCauley et al., 1997). (3) Despite the range of trauma types, there are finite ways for biological stress systems to respond, and finite categories of mental disorders associated with trauma (anxiety, mood, and personality disorders, see later section) (De Bellis, 2001). (4) Recent epidemiological research indicates that the adverse, long-term health impact of trauma may be cumulative, irrespective of trauma category. The greater the number of past traumas, the greater the health problems (Felitti et al., 1998; see later section).



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