The Relation Between Childhood Maltreatment and Self-Injury: A Review of the Literature on Conceptualization and Intervention

Abstract

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.

Direct and indirect forms of childhood maltreatment and nonsuicidal self-injury among clinically-referred children and youth

“…Although research related to the impact of physical and sexual maltreatment on children and youth and its potential relation to the development of NSSI has been widely studied (Ford and Gó-mez, 2015;Moyer, 2008: Lang andSharma-Patel, 2011), there is a paucity of research on the impact of witnessing domestic violence in its relation to NSSI. This is despite widespread evidence that witnessing domestic violence carries with it numerous significant consequences for the adjustment of child, including mental health and behavioral problems, as well as an increased risk for the expression of violence by those same young people (for a comprehensive overview of the literature to date see Artz et al, 2014).…”

“…In contrast, childhood physical abuse has been associated with NSSI in some studies (Heath et al, 2009;Gonçalves et al, 2015;Wan et al, 2015) but not in others (Auerbach et al;Rabinovitch et al, 2015). Even fewer studies have examined the effects of emotional abuse and neglect but what little evidence is available has suggested a significant association with NSSI (for a review see Lang and Sharma-Patel, 2011).…”

The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings

“…Furthermore, Maniglio (2010Maniglio ( , 2012 conducted systematic reviews and found that having a history of childhood sexual abuse was a significant risk factor for developing both depression and anxiety disorder, regardless of gender of the victim and severity of the abuse. With respect to the association between ACEs and NSSI, various systematic reviews and meta-analyses (Ford & Gómez, 2015;Lang & Sharma-Patel, 2011;Maniglio, 2011;Smith, Kouros, & Meuret, 2014) have shown that adolescents with a history of ACEs are more likely to engage in NSSI, even after adjusting for demographic and known mental health factors. Similar results have been found among adolescent inpatients (e.g., Bifulco et al, 2014;Kaess et al, 2013;Thomassin et al, 2016).…”

Young people who cut themselves: can understanding the reasons guide the treatment?

“…In abusive contexts, some young people may selfinjure in an attempt to avoid punishment or abuse (Lang 2011).…”