Psychiatry 64(4) Winter 2001 319 The Contribution of Early Traumatic Events to Schizophrenia in Some Patients: A Traumagenic Neurodevelopmental Model JOHN READ,BRUCE D. PERRY,ANDREW MOSKOWITZ, AND JAN CONNOLLY THE current diathesis-stress model of schizophrenia proposes that a genetic deficit creates a predisposing vulnerability in the form of oversenstivity to stress. This model positions all psychosocial events on the stress side of the diathesis-stress equation. As an example of hypotheses that emerge when consideration is given to repositioning adverse life events as potential contributors to the diathesis, this article examines one possible explanation for the high prevalence of child abuse found in adults diagnosed schizophrenic. A traumagenic neurodevelopmental (TN) model of schizophrenia is presented, documenting the similarities between the effects of traumatic events on the developing brain and the biological abnormalities found in persons diagnosed with schizophrenia, including overreactivity of the hypothalamic–pituitary–adrenal (HPA) axis; dopamine, norepinephrine, and sero- tonin abnormalities; and structural changes to the brain such as hippocampal dam- age, cerebral atrophy, ventricular enlargement, and reversed cerebral asymmetry. The TN model offers potential explanations for other findings in schizophrenia research beyond oversensitivity to stress, including cognitive impairment, pathways to positive and negative symptoms, and the relationship between psychotic and dissociative symptomatology. It is recommended that clinicians and researchers explore the presence of early adverse life events in adults with psychotic symptoms in order to ensure comprehensive formulations and appropriate treatment plans, and to further investigate the hypotheses generated by the TN model. INTRODUCTION tion is often described as less than adequate (Bentall 1990; Boyle 1990; Karon 1999; Rose 2001; Ross and Pam 1995). This article ex- Schizophrenia is considered to be one of the most biologically based of the mental plores the possibility that for some adults diag- nosed as schizophrenic, adverse life events or disorders (Chua and Murray 1996; McGuffin, Asherson, Owen, and Farmer 1994; Walker significant losses and deprivations cannot only “trigger” schizophrenic symptoms but may also, and DiForio 1997). However, the method- ological rigor of the evidence for this proposi- if they occur early enough or are sufficiently John Read, PhD, is Senior Lecturer and Co-Director, Doctorate of Clinical Psychology Programme, Psychology Department, The University of Auckland, New Zealand. Bruce D. Perry, MD, PhD, is Provincial Medical Director, Children’s Mental Health, Alberta Mental Health Board, Canada. Andrew Moskowitz, PhD, is a lecturer, Psychology Department, The University of Auckland, and Jan Connolly, MA, is a psychologist, South Auckland District Health Board. Correspondence may be sent to John Read, Psychology Department, The University of Auckland, Private Bag 92019, Auckland 1, New Zealand; fax: +64-9-373–7450; E-mail: j.read@auckland.ac.nz. We thank Professor Michael Corballis and Associate Professor Jenni Ogden (The University of Auckland) for their critiques of early drafts of this article.