Self-injurious behaviors in posttraumatic stress disorder: An examination of potential moderators

Abstract

Background Despite increasing evidence for a relation between posttraumatic stress disorder (PTSD) and self-injurious behaviors (SIB), limited research has examined the factors that may moderate the associations between PTSD and both nonsuicidal SIB (deliberate self-harm; DSH) and suicidal SIB (suicide attempts). Nonetheless, research suggests that characteristics of the traumatic event, co-occurring borderline personality disorder (BPD), and emotion dysregulation may influence the relations between PTSD and SIB. Methods Thus, the aim of this study was to examine the moderating role of these factors in the association between PTSD and SIB (including history and frequency of DSH and suicide attempts, and DSH versatility) among a sample of substance use disorder inpatients with (n = 116) and without (n = 130) a history of PTSD. Results Results from stepwise regression analyses indicate that sexual assault-related PTSD predicted suicide attempt frequency and DSH versatility among those with PTSD. Furthermore, results from hierarchical linear and logistic regression analyses suggest that co-occurring BPD moderates the relationship between PTSD and both DSH history and versatility and emotion dysregulation moderates the relationship between PTSD and DSH frequency. Specifically, the relations between PTSD and DSH outcomes were stronger among participants with co-occurring BPD and higher levels of emotion dysregulation. Limitations This study is limited by its reliance on cross-sectional, self-report data. Conclusions Despite limitations, findings suggest distinct risk factors for suicide attempts and DSH, and highlight the importance of examining characteristics of the trauma and associated BPD and emotion dysregulation in assessing risk for SIB in PTSD.

Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16

“…The DSHI has demonstrated good internal consistency, adequate test–retest reliability, and adequate construct, discriminant, and convergent validity among undergraduate student, community adult, and patient samples (Fliege et al, 2006; Gratz, 2001; Gratz et al, 2011). Consistent with past research (Dixon-Gordon, Tull, & Gratz, 2014; Gratz & Tull, 2012; Turner, Layden, Butler, & Chapman, 2013), a deliberate self-harm frequency variable was computed by summing the total number of deliberate self-harm episodes reported in the past four months and a deliberate self-harm versatility index was computed by summing the number of different types of deliberate self-harm behaviors in the past four months (Turner et al, 2013). …”

A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury.

“…Self-injuring individuals evidence deficits in self-reported emotion awareness (e.g., Dixon-Gordon, Tull, & Gratz, 2014; Klonsky & Muehlenkamp, 2007; Wupperman, Fickling, Klemanski, Berking, & Whitman, 2013) and high self-reported experiential avoidance (e.g., Howe-Martin, Murrell, & Guarnaccia, 2012; Najmi, Wegner, & Nock, 2007). Individuals with a history of NSSI but none in the past year also report greater acceptance of emotions than those currently engaging in NSSI (Anderson & Crowther, 2012).…”

Differential Impact of Combat on Postdeployment Symptoms in Female and Male Veterans of Iraq and Afghanistan

“…Although we did not clinically assess for any of these disorders nor did we assess suicidal self-injurious behavior, our combined findings on the relationship between combat and aggressive behavior in women supports the need for systematic and comprehensive research to better understand the association and to delineate the role of psychiatric conditions on the impact of combat on aggression, especially nonsuicidal and suicidal self-injurious behavior, in female veterans. 46 This study has several limitations. First, our findings were based on a population of OEF/OIF veterans enrolling for VA health care at a single facility and do not necessarily represent OEF/OIF veterans at other facilities or those who do not seek care at the VA.…”