The role of dissociation and abuse among adolescents who self-harm

Abstract

Objectives: Retrospective recall of dissociative symptoms has been found to mediate the association between childhood abuse and deliberate self-harm (DSH) in later life. To disentangle the effect of recall bias, we tested whether dissociation symptoms ascertained during an acute DSH presentation mediates this link. Method: All participants with DSH were recruited during emergency presentation. Seventy-one individuals aged 11–17 years with overdose (OD) and/or self-injury (SI) participated in semi-structured interviews and psychiatric assessment to measure abuse and dissociation. An age- and gender-matched comparison group of 42 non-psychiatric patients admitted to the same service were also assessed. Results: The DSH groups reported significantly higher levels of abuse and dissociation compared to comparison group. Dissociation significantly mediated the association between abuse and DSH. Of the four dissociation subtypes, ‘depersonalisation’ was the primary mediator. Adolescents with chronic patterns of DSH and the ‘OD + SI’ self-harm type reported more severe dissociation. Conclusion: Exposure to abuse significantly increased the risk of DSH in adolescence. This association was mediated by dissociation. Our findings suggest a possible dose–response relationship between dissociation with DSH chronicity and the ‘OD + SI’ self-harm type, implicating the importance of evaluating dissociation and depersonalisation symptoms as well as abuse exposure in DSH management.

Psychoform and somatoform dissociation in anorexia nervosa: A systematic review

“…Dissociation is of clinical relevance not only within the framework of dissociative disorders but also as a transdiagnostic feature across several mental illnesses (Lyssenko et al, 2018). It is well established that dissociation is related to a range of complications such as self‐harm and pain threshold abnormalities that could lead to treatment difficulties (Brodsky, Cloitre, & Dulit, 1995; Hoyos et al, 2019). Moreover, researchers recognize dissociative symptoms in many psychiatric disorders such as schizophrenia, anxiety disorders, obsessive–compulsive disorders and eating disorders (EDs) (Lyssenko et al, 2018).…”

“…Dissociation is of clinical relevance not only within the framework of dissociative disorders but also as a transdiagnostic feature across several mental illnesses (Lyssenko et al, 2018). It is well established that dissociation is related to a range of complications such as selfharm and pain threshold abnormalities that could lead to treatment difficulties (Brodsky, Cloitre, & Dulit, 1995;Hoyos et al, 2019).…”

Kadın Üniversite Öğrencilerinde Çocukluk Çağı Travmaları ile Kendine Zarar Verme Davranışları, Depresyon, Psikoform ve Somatoform Dissosiyasyon Arasındaki İlişkilerin İncelenmesi

“…Another study demonstrates that dissociation serves as a mediator between childhood traumas and selfharming behaviours (Hoyos et al, 2019). Childhood traumas have also been shown to have an intermediary effect for internalized and externalized behaviour problems such as self-harming behaviours (Hébert et al, 2018).…”

“…These studies report that psychiatric disorders such as depression (Bifulco et al, 1991) and anxiety disorder (panic disorder and diffuse anxiety) are frequently encountered in adults exposed to sexual abuse in childhood (Stein et al, 1996). Similarly, traumas experienced in childhood increase the risk of self-harming behaviours (Bennet, Investigation of the Relationship Among Childhood Traumas and Self-Harming Behaviours, Depression, Psychoform and Somatoform Dissociation in Female University Students Ermağan-Çağlar, Öztürk, Derin & Türk-Kurtça (2021), 11(62) Turkish Psychological Counseling and Guidance Journal 2016; Hoyos et al, 2019), eating disorders (Tunç, 2019), internalized and externalized behaviour problems (Hébert, Langevin, & Oussaïd, 2018) in older ages. It is not possible, or even almost impossible, to react appropriately to both childhood traumas and traumatic events experienced after childhood.…”

Associations of childhood trauma experiences with religious and spiritual struggles

“…Consequently, in later life, there is a growing risk of failure in social relationships, adoption of maladaptive behaviour patterns and development of further mental and personality pathologies (Henschel et al, 2019;Maaranen et al, 2005). Among others, dissociative reactions have already been associated with deliberate self-harm (Hoyos et al, 2019;Polskaya and Melnikova, 2020), eating disorder (Pugh et al, 2018) or an increased severity of psychiatric symptoms (Schimmenti, 2018). For these reasons, research pays attention to possible pathways through which CT can lead to maladaptive functioning in later life.…”