The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

Abstract

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.

Intimate partner violence victimization and perpetration as precursors to suicide

“…According to the Cognitive-Emotional Model of Dual-Harm, individuals who engage in both interpersonal and self-directed violence have unique characteristics compared to individuals who engage in only one of those behaviors ( Shafti, Taylor, Forrester, & Pratt, 2021 ). Dual-harm most often occurs among men who are highly impulsive, have poor self-regulation, and use maladaptive coping mechanisms (such as substance use) to deal with interpersonal stress ( Shafti et al, 2021 ). Our examination of the correlates for IPV circumstances among men who die by suicide largely suggest a profile that is consistent with this description.…”

Childhood adversities, history of mental disorders, anxiety-depressive symptoms are associated with dual-harm in violent offenders

“…Finally, according to the theories about dual-harm, depression might lead to aggression towards self [38]. Some researchers proposed that a personality characterized by a predisposition to engage in harmful behaviors might be shaped by biological factors interacting with adverse early environments [39]; they emphasized that the secondary psychopathy characterized by antisocial and unstable lifestyle could be a risk factor for dual-harm [39]. In our study, the dual-harm group scored higher on the antisocial scale than the violence-only group, which supported the previous views.…”

Healthcare presentations with self-harm and the association with COVID-19: an e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016 - March 2021

“…However, they are consistent (albeit smaller) with a recent UK population online survey who reported unadjusted associations, 9 and with the association between self-harm and engagement in risky behaviours that may also increase the risk of COVID-19 infection. 30…”