Mechanistic Links Between Early Adversity and Suicide: A Neuropsychoanalytic Model

This article employs a holistic, mechanistic model explaining how early life adversity (ELA) leads to increased suicide risk. It maps the internalization and introjection processes from psychoanalytic object relations theory with circuits involving the amygdala, hippocampus, and medial prefrontal cortex ( mPFC ) within the framework of memory engrams and system consolidation. The model emphasizes neuroplastic and epigenetic reprogramming mediated by the serotonergic apparatus (specifically 5-HT1A and 5-HT2A receptors) and the HPA axis as the biological foundation. Using a dual-aspect monism approach and theoretical integration based on Gundersen’s six criteria, it suggests that ELAs strengthen negative internal objects through norepinephrine-glucocorticoid-mediated synaptic traces, site-specific DNA methylation, PFC regulatory attenuation, and amygdala hyperreactivity. These changes disrupt social homeostasis, lead to the generalization of autobiographical memory, affect pain processing, and increase feelings of loneliness, which contribute to the schemas of “Thwarted Belongingness” and “Perceived Burdensomeness” in Joiner’s interpersonal theory of suicide. Over time, repeated stress raises allostatic load, resulting in permanent set-point shifts and an increased capacity for “deliberate/lethal” behaviors. This comprehensive framework supports a shift from descriptive to mechanistic psychiatry, offering a theoretical and practical guide to understanding the neurobiological development of suicide.