Childhood Abuse, PTSD, and Deliberate Self-Injury in Adolescents

Childhood Abuse, PTSD, and Deliberate Self-Injury in Adolescents
By Matthew Tull, PhD, About.com Guide
Updated: April 10, 2009

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

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PTSD and Veterans
Deliberate self-injury (also referred to as deliberate self-harm) basically means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-injurious behaviors may include:

•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting is often considered to be the most common method of self-injury.

How Common is Self-Injury
Self-injury is more common than you may think. Although high rates of self-injury have been found in some groups of people with certain psychiatric disorders (for example, borderline personality disorder and PTSD), high rates of self-injury have also been found in young adults. Specifically, it has been shown that anywhere between 17% to 37% of college students have engaged in self-injury.

There is also some evidence that adolescents may be at high risk for engaging in self-injurious behaviors. Specifically, approximately 14% to 21% of adolescents indicate that they have engaged in some form of self-injury at some point in their lifetime.

What May Place Adolescents at Risk for Self-Injury?
The experience of childhood physical or sexual abuse, as well as the development of PTSD symptoms, have been found to be connected to self-injury.

For example, one study by researchers at the Veterans Affairs Boston Healthcare System, Boston University School of Medicine, and Harvard University looked at the role of childhood sexual abuse, PTSD symptoms, and self-injury among a group of adolescents around the ages of 12 to 19.

They found that having re-experiencing, avoidance, and emotional numbing symptoms of PTSD as a result of childhood sexual abuse may lead to self-injury.

How Might PTSD Symptoms Lead to Self-Injury?
People may use self-injury as a way of attempting to express and manage uncomfortable and upsetting emotional experiences, such as anxiety, sadness, shame, and/or anger. Self-injury may also provide a temporary escape from or be a way of avoiding emotional pain. These emotional experiences commonly stem from experiencing PTSD symptoms, such as intrusive thoughts or memories about a past traumatic event.

Self-injury may also be a way of expressing pain. People struggling with the emotional numbing symptoms of PTSD (where there are difficulties in having certain emotions, especially positive emotions), may use self-injury as a way to feel something or create feelings.

What Can Be Done About Self-Injury?
Self-injury is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterward, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.

If you engage in self-injury or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides information on their nationally recognized treatment program for self-injury, as well as resources on and referrals for people struggling with self-injurious behaviors. The Borderline Personality Disorder Survival Guide also provides excellent tips on how to address and cope with self-injurious behaviors.

Sources:
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.

Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.

Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.

Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.

Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.

Nock, M.K., & Prinstein, M.J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885-890.

Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.

Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.

Ross, S., & Heath, N.(2002). A study of the frequency of self-mutilation in a community sample of adolescents.American Journal of Psychiatry, 152, 1336-1342.

Weierich, M.R., & Nock, M.K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76, 39-44.

Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.