Self-Harm and Trauma: Research Findings
Self-Harm and Trauma: Research Findings
What is self-harm?
Self-harm refers to the deliberate, direct destruction of body tissue. Other terms for self-harm include "parasuicide," "self-mutilation," "self-injury," "self-abuse," "cutting," or "self-inflicted violence." When someone engages in self-harm, they may have a variety of intentions; these are discussed below. However, the person's intention is not to kill himself or herself.
Self-harm tends to begin in adolescence or early adulthood. While some people may engage in self-harm a few times and then stop, others engage in it frequently and have great difficulty stopping the behavior (1). Self-harm is related to trauma in that those who engage in self-harm are likely to have experienced abuse in childhood (2-6).
How common is self-harm?
The rates of self-harm revealed through research vary tremendously, depending on how researchers pose their questions about this behavior. Estimates of lifetime self-harm prevalence in the general population range from 2.2% to 6% (2). In samples of students, the rates are higher, ranging from 13% to 35% (2).
In studies that have compared general population samples to clinical samples, the rates of self-harm were higher in the clinical samples (2-3). Within clinical samples, those with a diagnosis of PTSD report higher rates of self-harm than do those without PTSD (7). In one sample of psychiatric outpatients, as many as 60% of those with a diagnosis of PTSD reported harming themselves in the previous three months (7).
Characteristics of self-harmers
A systematic review of the literature on correlates of self-harm found that self-harmers, as compared to others, have more frequent and more negative emotions such as anxiety, depression, and aggressiveness. Links between self-harm and dissociation, low emotional expressivity, and low self-esteem have also been found (2). The evidence on whether self-harm is more common in females or males is mixed (2-3, 7).
Individuals who self-harm appear to have higher rates of PTSD and other psychological problems (1, 4-6). Self-harm may be most often related to trauma exposure in childhood rather than adulthood (2-3). A number of studies (2-6) have found that individuals who engage in self-harm report unusually high rates of histories of:
Childhood sexual abuse appears especially frequently in the histories of those who self-harm (2). In one sample of individuals who self-harmed, 93% reported a history of childhood sexual abuse (3). Some research has looked at whether particular characteristics of childhood sexual abuse place individuals at greater risk for engaging in self-harm as adults. More severe, more frequent, or a longer duration of sexual abuse was associated with an increased risk of engaging in self-harm in one's adult years (8-9).
Why do people engage in self-harm?
While there are many theories about why individuals harm themselves, the answer to this question may vary from individual to individual (10-11). One study specifically examined the reasons given for the behavior in a sample of self-harmers (3). The top two reasons were "To distract yourself from painful feelings" and "To punish yourself." When factor analysis was applied the responses, nine factors were found:
How is self-harm treated?
Self-harm is a problem that many people are embarrassed or ashamed to discuss. Often, individuals try to hide their self-harm behaviors and are very reluctant to seek needed psychological or even medical treatment.
Because self-harm is often associated with other psychological problems, it tends to be treated under the umbrella of a co-occurring disorder like PTSD, substance abuse, or borderline personality disorder. There is evidence, however, suggesting more improvement when the self-harming behavior is the primary focus of treatment. A randomized controlled trial looked at the effects of adding a short cognitive behavioral therapy (CBT) intervention focused on self-harm to treatment as usual in a sample of self-harmers. Treatment as usual included medications or psychotherapy not specific to self-harm. The group that received the self-harm CBT showed a significant reduction in self-harming behaviors, as compared to the group receiving only treatment as usual (12).
It is possible that psychopharmacological treatments would be helpful in reducing self-harm behaviors, but this has not yet been rigorously studied. As yet, there is no consensus regarding whether or not psychiatric medications should be used in relation to self-harm behaviors. This is a complicated issue to study because self-harm can occur in many different populations and co-occur with many different kinds of psychological problems.
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