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Licensed Unlicensed Requires Authentication Published by De Gruyter July 10, 2013

Child sexual abuse and the pathophysiology of suicide in adolescents and adults

  • Betsy S. O’Brien EMAIL logo and Leo Sher


Background: Child sexual abuse (CSA) is widespread and is associated with various psychopathologies, including Axis I and II disorders, maladaptive and impulsive behaviors, and suicidal behavior in adolescence and adults. The pathophysiology of this association is not well understood; however, it is clear that suicidal behavior in individuals with a history of CSA is a significant social and medical problem that warrants further investigation.

Methods: An electronic search of the major behavioral science databases (limited to the most recent studies in the last 20 years) was conducted to retrieve studies detailing the social, epidemiological, and clinical characteristics of child sexual trauma and their relation to suicidal behavior in adolescents and adults.

Results: Studies indicate that CSA is related to an increase in Axis I and II diagnoses, including depression, post-traumatic stress disorder, conduct disorders, eating disorders, alcohol and drug abuse, panic disorders, and borderline personality disorder. CSA not just related to an increase in impulsivity and risky behaviors, it has also been linked to an increase in suicidality as well.

Conclusion: CSA makes both direct and indirect contributions to suicidal behavior. It is a complex process involving multiple variables, which include psychopathology, maladaptive personality features and the direct contribution of CSA itself. Psychopathologies, such as impulsivity and mood and personality disorders, may modulate the relationship between CSA and suicidal behavior. Some preventive measures for decreasing the prevalence of CSA and suicidality may include education as well as increased access to mental health services.

Corresponding author: Betsy S. O’Brien, MD, Mount Sinai School of Medicine, Department of Psychiatry, Box 1230, One Gustave L. Levy Place, New York, NY 10029, USA


1. Vogeltanz ND, Wilsnack SC, Harris TR, Wilsnack RW, Wonderlich SA, et al. Prevalence and risk factors for childhood sexual abuse in women: national survey findings. Child Abuse Negl 1999;23:579–92.10.1016/S0145-2134(99)00026-5Search in Google Scholar

2. Gorey KM, Leslie DR. The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases. Child Abuse Negl 197;21:391–8.10.1016/S0145-2134(96)00180-9Search in Google Scholar

3. Wilsnack SC, Vogeltanz ND, Klassen AD, Harris TR. Childhood sexual abuse and women’s substance abuse: national survey findings. J Stud Alcohol 1997;58:264–71.10.15288/jsa.1997.58.264Search in Google Scholar PubMed

4. Laaksonen T, Sariola H, Johansson A, Jern P, Varjonen M, et al. Changes in the prevalence of child sexual abuse, its risk factors, and their associations as a function of age cohort in a Finnish population sample. Child Abuse Negl 2011;35: 480–90.10.1016/j.chiabu.2011.03.004Search in Google Scholar PubMed

5. Renner LM, Whitney SD. Risk factors for unidirectional and bidirectional intimate partner violence among young adults. Child Abuse Negl 2012;36:40–52.10.1016/j.chiabu.2011.07.007Search in Google Scholar PubMed

6. DiLillo D, Damashek A. Parenting characteristics of women reporting a history of childhood sexual abuse. Child Maltreat 2003;8:319–33.10.1177/1077559503257104Search in Google Scholar PubMed

7. Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010;85:618–29.10.4065/mcp.2009.0583Search in Google Scholar PubMed PubMed Central

8. Gunderson JG, Chu JA. Treatment implications of past trauma in borderline personality disorder. Harv Rev Psychiatry 1993;1:75–81.10.3109/10673229309017062Search in Google Scholar PubMed

9. Green BL, Krupnick JL, Stockton P, Goodman L, Corcoran C, et al. Effects of adolescent trauma exposure on risky behavior in college women. Psychiatry 2005;68:363–78.10.1521/psyc.2005.68.4.363Search in Google Scholar PubMed

10. Molnar BE, Berkman LF, Buka SL. Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behavior in the US. Psychol Med 2001;31:965–77.10.1017/S0033291701004329Search in Google Scholar PubMed

11. Dinwiddie S, Heath AC, Dunne MP, Bucholz KK, Madden PAF, et al. Early sexual abuse and lifetime psychopathology: a co-twin-control study. Psychol Med 2000;30:41–52.10.1017/S0033291799001373Search in Google Scholar

12. Burns EE, Fischer S, Jackson JL, Haring HG. Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse Negl 2012;336:32–9.10.1016/j.chiabu.2011.08.005Search in Google Scholar PubMed

13. Brodsky BS, Malone KM, Ellis SP, Dulie RA, Mann JJ. Characteristics of borderline personality disorder associated with suicidal behavior. Am J Psychiatry 1997;154:1715–9.10.1176/ajp.154.12.1715Search in Google Scholar PubMed

14. Braquehais MD, Oquendo MA, Baca-Garcia E, Sher L. Is impulsivity a link between childhood abuse and suicide? Compr Psychiatry 2010;51:121–9.10.1016/j.comppsych.2009.05.003Search in Google Scholar PubMed

15. Holmberg LI, Hellberg D. Sexually abused children. Characterization of these girls when adolescents. Int J Adolesc Med Health 2010;22:291–300.Search in Google Scholar

16. Zanarini MC, Yong LM, Franeknburg FR, Hennen J, Reich D, et al. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis 2002;190:318–87.10.1097/00005053-200206000-00006Search in Google Scholar PubMed

17. Sansone RA, Wiederman MW, Sansone LA. Borderline personality symptomatology, experience of multiple types of trauma, and health care utilization among women in primary care setting. J Clin Psychiatry 1998;59:108–11.10.4088/JCP.v59n0303Search in Google Scholar

18. Brodsky BS, Stanley B. Adverse childhood experiences and suicidal behavior. Psychiatr Clin North Am 2008;31:223–35.10.1016/j.psc.2008.02.002Search in Google Scholar PubMed

19. Roy A. Childhood trauma and impulsivity. Possible relevance to suicidal behavior. Arch Suicide Res 2005;9:147–51.10.1080/13811110590903990Search in Google Scholar PubMed

20. Bursztein C, Apter A. Adolescent suicide. Curr Opin Psychiatry 2008;22:1–6.10.1097/YCO.0b013e3283155508Search in Google Scholar PubMed

21. Roberts AL, McLaughlin KA, Conron KJ, Koenen KC. Adulthood stressors, history of childhood adversity, and risk of perpetration of intimate partner violence. Am J Prev Med 2011;40:128–38.10.1016/j.amepre.2010.10.016Search in Google Scholar PubMed PubMed Central

22. Goldstone DB, Daniel SS, Reboussin DM, Reboussin BA, Frazier PH, et al. Suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study of risk during the first 5 years after discharge. J Am Acad Child Adolesc Psychiatry 1999;38:660–71.10.1097/00004583-199906000-00012Search in Google Scholar PubMed

23. Ystgaard M, Hestetun I, Loeb M, Mehlum L. Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? Child Abuse Negl 2004; 28:863–75.10.1016/j.chiabu.2004.01.009Search in Google Scholar PubMed

24. McReynolds LS, Wasserman GA. Self-injury in incarcerated juvenile females: contributions of mental health and traumatic experiences. J Trauma Stress 2011;24:752–5.10.1002/jts.20699Search in Google Scholar PubMed

25. Enns MW, Cox BJ, Afifi TO, De Graaf R, Ten Have M, et al. Childhood adversities and risk for suicide ideation and attempts: a longitudinal population-based study. Psychol Med 2006;36:1769–78.10.1017/S0033291706008646Search in Google Scholar PubMed

26. Hamza CA, Stewart SL, Willoughby T. Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model. Clin Psychol Rev 2012;32:482–95.10.1016/j.cpr.2012.05.003Search in Google Scholar PubMed

27. Fergusson DM, Beautrais AL, Horwood LJ. Vulnerability and resilency to suicidal behaviours in young people. Psychol Med 2003;33:61–73.10.1017/S0033291702006748Search in Google Scholar PubMed

28. Carballo JJ, Harkavy-Friedman J, Burke AK, Sher L, Baca-Garcia E, et al. Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness. J Affect Disord 2008;109:57–63.10.1016/j.jad.2007.12.225Search in Google Scholar PubMed PubMed Central

29. Bedi S, Nelso EC, Lynskey MT, McCutcheon VV, Heath AC, et al. Risk for suicidal thoughts and behavior after childhood sexual abuse in women and men. Suicide Life Threat Behav 2011;41:405–15.10.1111/j.1943-278X.2011.00040.xSearch in Google Scholar PubMed PubMed Central

30. Evans E, Hawton K, Rodham K. Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. Clin Psychol Rev 2004;24:957–79.10.1016/j.cpr.2004.04.005Search in Google Scholar PubMed

31. Evans E, Hawton K, Rodham K. Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse Negl 2005;29:45–8.10.1016/j.chiabu.2004.06.014Search in Google Scholar PubMed

32. Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, et al. Childhood adversities as risk factors for onset and persistence of suicidal behavior. Br J Psychiatry 2010;197:20–7.10.1192/bjp.bp.109.074716Search in Google Scholar PubMed PubMed Central

33. Modestin J, Oberson B, Erni T. Possible correlates of DSM-III-R personality disorders. Acta Psychiatr Scand 1997;96:424–30.10.1111/j.1600-0447.1997.tb09943.xSearch in Google Scholar PubMed

34. May AM, Konsky ED, Klein DN. Predicting future suicide attempts among depressed suicide ideators: a 10-year longitudinal study. J Psychiatr Res 2012;46:946–52.10.1016/j.jpsychires.2012.04.009Search in Google Scholar PubMed PubMed Central

35. Li N, Ahmed S, Zabin LS. Association between childhood sexual abuse and adverse psychological outcomes amoung youth in Taipei. J Adolesc Health 2012;5:S45–51.10.1016/j.jadohealth.2011.12.003Search in Google Scholar PubMed PubMed Central

36. Yen S, Shea MT, Sanislow CA, Grilo CM, Skodol AE, et al. Borderline personality disorder criteria associated with prospectively observed suicidal behavior. Am J Psychiatry 2004;161:1296–8.10.1176/appi.ajp.161.7.1296Search in Google Scholar PubMed

37. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, et al. Suicide prevention strategies. A systematic review. J Am Med Assoc 2005;294:2064–71.10.1001/jama.294.16.2064Search in Google Scholar PubMed

38. Christoffel KK, Barlow B, Bell C, Dowd D, Godbold LT, et al. Task Force on Adolescent Assault Victim Needs. Adolescent assault victim needs: a review of issues and a model protocol. Pediatrics 1996;98:991–1001.Search in Google Scholar

39. Hogberg G, Hallstrom T. Active multimodal psychotherapy in children and adolescents with suicidality: description, evaluation, and clinical profile. Clin Child Psychol Psychiatry 2008;13:435–48.10.1177/1359104507088348Search in Google Scholar PubMed

Received: 2012-7-2
Accepted: 2012-8-15
Published Online: 2013-07-10
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

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