Compensatory self-injury: Posttraumatic stress, depression, and the role of dissociation

Despite a number of studies, the reasons for self-injurious behavior (SIB) have yet to be clearly specified. Using path analysis, we sought to test the hypothesis that exposure to adverse events produces depression and posttraumatic stress, which in turn motivate dissociation that, when at high levels, supports the use of SIB.

A sample of 679 adults (54% female, mean age = 53 years) were recruited from the general population by a national survey company, and administered measures evaluating posttraumatic stress, depression, dissociation, and SIB.

A total of 4.3% of participants reported some level of SIB within the prior 6 months. Younger age, exposure to adverse events, posttraumatic stress, depression, and dissociation were all related to SIB by univariate analyses. Path analyses revealed that although adverse events predicted posttraumatic stress and depression, which were then associated with SIB, these paths to SIB were no longer significant once dissociation was entered into the model, indicating full mediation.

Rather than arising directly from posttraumatic stress or depression, SIB may occur most proximally in response to dissociation, with the pain associated with SIB potentially serving to interrupt or titrate unwanted hypoarousal and numbing. Clinicians should consider specifically targeting dissociation and its adversity-related antecedents when treating SIB. (PsycINFO Database Record