Department of Psychiatry Columbia University, New York, NY 10032, USA.
Compr Psychiatry. 2010 Mar-Apr;51(2):121-9. doi: 10.1016/j.comppsych.2009.05.003. Epub 2009 Aug 29.
Childhood abuse and neglect are known to affect psychological states through behavioral, emotional, and cognitive pathways. They increase the risk of having psychiatric diseases in adulthood and have been considered risk factors for suicidal behavior in all diagnostic categories. Early, prolonged, and severe trauma is also known to increase impulsivity, diminishing the capacity of the brain to inhibit negative actions and to control and modulate emotions. Many neurobiological studies hold that childhood maltreatment may lead to a persistent failure of the inhibitory processes ruled mainly by the frontal cortex over a fear-motivated hyperresponsive limbic system. Multiple neurotransmitters and hormones are involved in the stress response, but, to our knowledge, the two major biological consequences of the chronic exposure to trauma are the hypofunction of the serotonergic system and changes in the hypothalamic-pituitary-adrenal axis function. Some of these findings overlap with the neurobiological features of impulsivity and of suicidal behavior. Impulsivity has also been said to be both a consequence of trauma and a risk factor for the development of a pathological response to trauma. Thus, we suggest that impulsivity could be one of the links between childhood trauma and suicidal behavior. Prevention of childhood abuse could significantly reduce suicidal behavior in adolescents and adults, in part, through a decrease in the frequency of impulsive behaviors in the future.
儿童期虐待和忽视已知会通过行为、情感和认知途径影响心理状态。它们增加了成年后患精神疾病的风险，并被认为是所有诊断类别的自杀行为的危险因素。早期、长期和严重的创伤也已知会增加冲动性，降低大脑抑制负面行为以及控制和调节情绪的能力。许多神经生物学研究认为，儿童虐待可能导致主要由额叶皮层控制的抑制过程持续失效，而恐惧驱动的边缘系统过度反应。多种神经递质和激素参与应激反应，但据我们所知，慢性暴露于创伤的两个主要生物学后果是 5-羟色胺能系统功能低下和下丘脑-垂体-肾上腺轴功能改变。这些发现中的一些与冲动性和自杀行为的神经生物学特征重叠。冲动性也被认为既是创伤的后果，也是对创伤产生病理性反应的风险因素。因此，我们认为冲动性可能是儿童期创伤与自杀行为之间的联系之一。预防儿童期虐待可以显著降低青少年和成年人的自杀行为，部分原因是减少未来冲动行为的发生频率。
