Self-mutilative behaviors in male veterans with posttraumatic stress disorder

Abstract

Self-mutilative behaviors (SMB) were examined in a sample of male veterans with posttraumatic stress disorder (PTSD). The primary objective was to determine the prevalence of SMB and any physical, cognitive, or affective antecedents and correlates for these behaviors. Participants included 509 male veterans with PTSD and levels of PTSD, depression, alcohol use, hostility, and impulsivity were evaluated to determine if these variables were related to SMB. Antecedents and sequelae of SMB were also examined to generate hypotheses regarding the functions of these behaviors. A second type of habit behavior, body-focused repetitive behaviors (BFRB), was also examined as part of the study. Findings indicated that veterans who engaged in either type of habit behavior were younger than those who did not engage in SMB or BFRB. Veterans reporting SMB also reported higher levels of PTSD, depression, hostility, and impulsivity compared to the BFRB and no-habit groups. Examination of habit antecedents and sequelae showed support for the automatic-positive reinforcement function of SMB. These findings are discussed in the context of research and treatment involving male veterans with PTSD who engage in SMB. Keywordsself-mutilation; self-injury; posttraumatic stress disorder; male veterans Self-mutilative behaviors (SMB) include the direct and deliberate destruction or alteration of one's own body tissue without suicidal intent (Gratz, 2001;Nock and Prinstein, 2005). SMB typically refers to cutting, burning, or otherwise marking of one's own flesh, with self-cutting being the most frequently endorsed type of SMB (Suyemoto, 1998;van der Kolk et al., 1991). Rates of SMB are approximately 4% in the general adult population (Briere, 1998), between 14% to 35% in college students (Favazza et al., 1989;Gratz, 2001), and approximately 21% in adult clinical populations (Briere, 1998;Klonsky et al., 2003). Self-mutilative behaviors have been linked to negative outcomes, including increased risk for successful suicide (Cooper

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

“…There were no differences between individuals who engaged in NSSI and individuals who did not engage in NSSI, however, on lab-based measures of impulsivity (Glenn & Klonsky, 2010;Janis & Nock, 2009;McCloskey et al, 2012). Moreover, the link between impulsivity and NSSI found for self-report measures was eliminated in some studies when researchers controlled for other risk factors for NSSI Carli et al, 2010;Evren et al, 2012;Rodav et al, 2014;Sacks et al, 2008). Longitudinal research on the link between impulsivity and NSSI also was limited and findings were mixed (Chapman et al, 2009;Glenn & Klonsky, 2011;.…”

“…It is important to note, however, that participants in these studies were overwhelmingly identified as Caucasian. There were only a few studies that included an examination of the link between impulsivity and NSSI among minority samples (e.g., African, Bornovalova et al, 2011;Lynam et al, 2011;Sacks et al, 2008); thus, the results of the review may not be generalizable to more diverse racial/ethnic populations.…”

“…Recall that findings on the link between impulsivity and NSSI were mixed when researchers controlled for possible third variables in their models. Some researchers reported a robust association between negative urgency and NSSI controlling for multiple risk factors (e.g., negative affect, depression, alcohol use; child maltreatment; Arens et al, 2012;Glenn & Klonsky, 2010), and other researchers found that impulsivity was not associated with NSSI when controlling for other risk factors (e.g., BPD, PTSD; depressive symptoms, suicidal ideation; Bornovalova et al, 2011;Rodav et al, 2014;Sacks et al, 2008). To disentangle associations among risk factors for NSSI engagement, studies involving the assessment of multiple risk factors are needed.…”

“…Carli et al (2010) found that impulsive males (i.e., who scored above the 75th percentile) were more likely than non-impulsive males (i.e., who scored below the 25th percentile) to engage in NSSI; however, the link between impulsivity and NSSI was eliminated when controlling for depression, childhood trauma, depression, and aggression. Similarly, Sacks, Flood, Dennis, Hertzberg, and Beckham (2008) found that individuals who engaged in NSSI reported greater impulsivity than individuals who did not engage in NSSI, but that impulsivity was not a multivariate predictor of NSSI status (controlling for age, PTSD, depressive symptoms, alcohol use and severity). Controlling for multiple factors that are highly related to NSSI engagement, therefore, may reduce the predictive value of impulsivity on NSSI.…”

Mental Health and Self-directed Violence Among Student Service Members/Veterans in Postsecondary Education

“…Among a clinical sample of over 500 veteran men who met criteria for PTSD, Sacks and colleagues found over half of the respondents indicated self-mutilating behavior in the last two weeks, and those who reported self-harm had significantly worse mental health profiles, including depression and more severe PTSD. 30 It is unclear whether there are differences among deliberate self-harm among nonclinical samples of service members/veterans compared with those without military service experience. Since self-harm behaviors are prevalent among young adults, 17,20,21 college attending samples may constitute a particularly useful population in which to investigate differences in self-harm behaviors by military experience.…”