The theme of the ISTSS 2015 Annual Meeting highlights the need to address the effects of childhood trauma across a lifespan. The relation between childhood trauma and suicidality is one particular area requiring further attention. Childhood trauma is associated with increased risk of suicide across one’s lifespan (e.g., Brown, Cohen, Johnson, & Smailes, 1999; Dube et al., 2001), with marked effects of childhood physical abuse and violent sexual abuse on suicidal behaviors (Joiner et al., 2007). Although the relation between childhood trauma and suicidal behaviors has been reported in the literature, it is less often studied from the perspective of the Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005).
From the perspective of Joiner’s (2005) IPTS, both the desire for suicide (which involves thwarted belongingness and perceived burdensomeness) and acquired capability for suicide (which involves fearlessness about death and pain tolerance) are necessary for lethal self-harm. The relation between traumatic experiences and these components of suicide has received some attention.
For example, life events and lifetime traumatic experiences were related to the acquired capability for suicide (Christensen, Batterham, Mackinnon, Donker, & Soubelet, 2014). According to IPTS, childhood abuse and maltreatment are associated with the acquired capability for suicide (Joiner, 2005; Van Orden et al., 2010), such that these experiences habituate individuals to pain and injury. Yet, it is also thought that childhood abuse is associated with components of the desire for suicide as well. Joiner (2005) hypothesizes that, “Childhood physical and sexual abuse may particularly confer risk because they are both painful and imply burdensomeness and disconnection” (p. 65). As such, the relations between different types of childhood abuse (i.e., physical, sexual, and emotional) and the components of IPTS (i.e., perceived burdensomeness, thwarted belongingness, and acquired capability for suicide) warrant further investigation.
To address the complexity of how early life traumatic experiences predict the capability and desire for suicide in adults, we had sixty six participants (recruited from college and community populations; predominantly female 92.5%; mean age 21.62 SD=6.2, range 18-47) complete self-report measures prior to participating in a laboratory session assessing physiological responses to a standardized stress task (trier social stress task; Kirschbaum et al., 1993). Participants completed the Childhood Trauma Questionnaire (Bernstein et al., 2003), which assesses early life traumatic experiences such as sexual abuse, physical abuse and neglect, and emotional abuse and neglect; the abuse variables were chosen for the present study. Participants also completed the Interpersonal Needs Questionnaire (Van Orden et al., 2008), which assesses both thwarted belongingness and perceived burdensomeness on a 7-point Likert scale (1=not at all true for me, 7=very true for me). This measure specifically assesses how people are feeling recently, rather than general attitudes and feelings. Thwarted belongingness is assessed with items such as “These days I feel like I belong” and “These days I feel disconnected from other people” where perceived burdensomeness includes items such as “These days, I think I am a burden on society” and “These days, I think I matter to people in my life.”
Participants also completed the Acquired Capability for Suicide Scale (Van Orden, et al., 2008), which asks individuals to rate the extent to which they feel statements describe them on a 5-point Likert-type scale ranging from 0 (not at all like me) to 4 (very much like me). It includes items such as, “I am not at all afraid to die” and “The pain in dying frightens me (reverse coded).” These components are related to suicidal ideation and number of past attempts (Van Orden, et al., 2008). Linear regression analyses were used to examine whether different types of trauma (physical, sexual, emotional abuse) differentially predicted perceived burdensomeness, thwarted belongingness, and acquired capability for suicide.
Results from our study indicated significant associations between early life trauma and the capability and desire for suicide in adults (Smith, Averill, Trueba, & Meuret, 2014*). Interestingly, different types of trauma (i.e., physical, sexual, emotional abuse) differentially predicted perceived burdensomeness, thwarted belongingness, and acquired capability for suicide. Emotional abuse significantly predicted thwarted belongingness (B = .22, p = .002), and a trend for perceived burdensomeness (B = .14, p = .059), over and above physical and sexual abuse. This finding is in line with IPTS; childhood abuse is thought to be related to thwarted belongingness through the absence of reciprocal care (e.g., receiving support from others and care for others; Van Orden et al., 2010).
Our results indicate that emotional abuse is more closely related to a desire for suicide than physical and sexual abuse. Although emotional abuse is not generally considered to be a traumatic experience, per criterion A of diagnostic criteria for Posttraumatic Stress Disorder (American Psychiatric Association, 2013), it appears to be quite influential in the desire for suicide, specifically thwarted belongingness.
Additionally, physical abuse significantly predicted acquired capability for suicide (B = 4.80, p = .028), over and above sexual and emotional abuse. From the perspective of IPTS, repeated exposure to painful and provocative events, such a physical and sexual abuse, habituates individuals to the fear and pain associated with lethal self-harm.
Our findings provide partial support for this, such that physical abuse, but not sexual abuse, was significantly and positively related to acquired capability for suicide. It is somewhat surprising that emotional and physical abuse were more closely related to components of suicide than sexual abuse; it could be that the sexual abuse assessed in the current study did not capture the violent sexual abuse associated with suicidal behavior (Joiner et al., 2007).
In summary, forms of childhood abuse represent distal risk factors for later suicide (e.g., Brown, et al., 1999; Dube et al., 2001), yet they are also significantly related to proximal factors related to suicidal behavior, such as perceived burdensomness, thwarted belongingness, and acquired capability for suicide. Future studies identifying mechanisms that explain these relations between childhood trauma and components of IPTS, such as PTSD symptoms, perceived social support, emotion dysregulation, etc. could provide areas for targeted intervention.
For example, in a sample of undergraduates who reported exposure to traumatic experiences at some point during their lives, PTSD symptom clusters were related to components of the acquired capability for suicide; numbing symptoms were positively related to pain tolerance, a component of the acquired capability for suicide (Zuromski, Davis, Witte, Weathers, & Blevins, 2014).
Assessment and understanding of the components of IPTS, particularly in individuals with a history of childhood trauma, could be helpful in identifying and addressing factors that are closely related to lethal self-harm and identifying individuals that are most at-risk for suicidal behaviors.
About the Author
Noelle Bassi Smith, MA, is currently a student at Southern Methodist University, completing her Ph.D. in Clinical Psychology. Her dissertation examined physiological responses to pain in individuals that engage in nonsuicidal self-injury. She is completing internship at the VA Connecticut Healthcare System and will begin her postdoctoral fellowship at the National Center for PTSD-Clinical Neurosciences Division, also at the VA Connecticut in September.
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Smith, N.B., Averill, L.A., Trueba, A.F., & Meuret, A.E. (2014, November). Childhood trauma and suicide: Emotional abuse and physical abuse differentially predict the desire and capability for suicide. Poster accepted for presentation at the International Society for Traumatic Stress Studies (ISTSS) Annual Convention, Miami, FL.
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