The following article reviews literature pertaining to the association between child maltreatment and self-injury and the ways it varies according to maltreatment type. Research supporting various mediators of the relations between different maltreatment types and self-injury is summarized. Informing mediator models, dominant theories of functionality, particularly affect regulation theories, are summarized and granted empirical support. Following from explanations of its functionality, three developmental pathways (regulatory, representational/interpersonal, and reactive/neurobiological) leading from child maltreatment to self-injury are presented within an organizational model of psychopathology. Understanding the deviations in these pathways that perpetuate self-injury helps to inform intervention approaches that forge pathways perpetuating resilience instead. Three psychosocial treatments (i.e., Dialectical Behavior Therapy [DBT], Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT], and Acceptance and Commitment Therapy [ACT]) were chosen for review, based upon their accumulating evidence bases, as well as upon the relevance of their core components in correcting or compensating for trauma-related developmental deviations.

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Objective: Efficacy of trauma-specific cognitive–behavioral therapies (Trauma-Focused CBT; Alternatives for Families CBT) in treating sequelae (posttraumatic stress disorder, PTSD; depression; conduct problems) for affected youth and families is established. Despite the emphasis on emotional and cognitive processes in explanatory models of sequelae and the inclusion of components to address these impairments, this is the first study to examine how emotion dysregulation and attributions of blame mediate or moderate treatment changes. Method: About 118 youth with trauma histories, ages 4–17 years old, and caregivers who completed treatment were included in the analyses, providing self- and/or caregiver-reported assessments that yielded indices of trauma history, behavioral and emotional symptomatology, emotion dysregulation, and self-blame. Results: PTSD symptoms and conduct problems significantly decreased across treatment. Analyses provided support for emotion dysregulation as a moderator of the reduction of PTSD symptoms and conduct behavior problems across treatment. Self-blame was a partial mediator and a moderator of conduct problems. Conclusions: Baseline emotion dysregulation and self-blame influenced trajectories of treatment reductions of PTSD and/or conduct problems, extending emotion and cognitive theories of symptom development to explain treatment-related changes. Patterns of change suggest a framework for selecting components to match clinical presentations.

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