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Childhood sexual abuse and non-suicidal self-injury: meta-analysis

  • E. David Klonsky (a1) and Anne Moyer (a1)
Abstract
Background

Many theorists posit that childhood sexual abuse has a central role in the aetiology of self-injurious behaviour. Studies that report statistically significant associations between a history of such abuse and self-injury are cited to support this view.

Aims

A meta-analysis was conducted to determine systematically the magnitude of the association between childhood sexual abuse and self-injurious behaviour.

Method

Forty-five analyses of the association were identified. Effect sizes were converted to a standard metric and aggregated.

Results

The relationship between childhood sexual abuse and self-injurious behaviour is relatively small (mean weighted aggregate ϕ=0.23). This figure may be inflated owing to publication bias. In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Conclusions

Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.

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Copyright
Corresponding author
Dr E. David Klonsky, Department of Psychology, Stony Brook University, Stony Brook, New York 11794-2500, USA. Tel: +1 631 632 7801; fax: +1 631 632 7876; email: E.David.Klonsky@stonybrook.edu
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Pattison, EM, Kahan, J. The deliberate self-harm syndrome. Am J Psychiatry 1983; 140: 867–72.
2 Favazza, AR, Conterio, K. Female habitual self-mutilators. Acta Psychiatr Scand 1989; 79: 283–9.
3 Langbehn, DR, Pfohl, B. Clinical correlates of self-mutilation among psychiatric inpatients. Ann Clin Psychiatry 1993; 5: 4551.
4 Herpertz, S. Self-injurious behavior: psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand 1995; 91: 5768.
5 Nijman, HLI, Dautzenberg, M, Merckelbach, HLGJ, Jung, P, Wessel, I, del Campo, JA. Self-mutilating behavior in psychiatric inpatients. Eur Psychiatry 1999; 14: 410.
6 Tantam, D & Whittaker, J. Personality disorder and self-wounding. Br J Psychiatry 1992; 161: 451–64.
7 Skegg, S. Self-Harm. Lancet 2005; 366, 1471–83.
8 Feldman, MD. The challenge of self-mutilation: a review. Compr Psychiatry 1988; 29: 252–69.
9 Favazza, AR. Repetitive self-mutilation. Psychiatr Ann 1992; 22: 60–3.
10 Scheel, KR. The empirical basis of Dialectical Behavior Therapy: summary, critique, and implications. Clin Psychol: Sci Pract 2000; 7: 6896.
11 Kapur, N. Management of self-harm in adults: which way now? Br J Psychiatry 2005; 187: 497–9.
12 Gratz, KL. Risk factors for and functions of deliberate self-harm: an empirical and conceptual review. Clin Psychol Sci Pract 2003; 10, 192205.
13 Klonsky, ED, Oltmanns, TF, Turkheimer, E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 2003; 160: 1501–8.
14 Nock, MK, Prinstein, MJ. Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol 2005; 114: 140–6.
15 Klonsky, ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2007; 27: 226–39.
16 van der Kolk, BA, Perry, JC, Herman, JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991; 148: 1665–72.
17 Wonderlich, S, Donaldson, MA, Carson, DK, Staton, D, Gertz, L, Leach, LR, Johnson, M. Eating disturbance and incest. J Interpers Violence 1996; 11: 195207.
18 Noll, JG, Horowitz, LA, Bonanno, GA, Trickett, PK, Putnam, FW. Revictimization and self-harm in females who experienced childhood sexual abuse. J Interpers Violence 2003; 18: 1452–71.
19 Cavanaugh, RM. Self-mutilation as a manifestation of sexual abuse in adolescent girls. J Pediatr Adolesc Gynecol 2002; 15, 97100.
20 Stone, MH. A psychodynamic approach: some thoughts on the dynamics and therapy of self-mutilating borderline patients. J Personal Disord 1987; 1: 347–9.
21 Yates, TM. The developmental psychopathology of self-injurious behavior: compensatory regulation in posttraumatic adaptation. Clin Psychol Rev 2004; 24: 3574.
22 Mina, EES, Gallop, RM. Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review. Can J Psychiatry 1998; 43: 793800.
23 Romans, SE, Martin, JL, Anderson, JC, Herbison, GP, Mullen, PE. Sexual abuse in childhood and deliberate self-harm. Am J Psychiatry 1995; 152: 1336–42.
24 Sansone, RA, Gaither, GA & Barclay, J. Childhood trauma and somatic preoccupation in adulthood among a sample of psychiatric inpatients. Psychosomatics 2002; 43: 86.
25 Brown, LK, Houck, CD, Hadley, WS. Self-cutting and sexual risk among adolescents in intensive psychiatric treatment. Psychiatr Serv 2005; 56: 216–18.
26 Brodsky, BS, Cloitre, M, Dulit, RA. Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. Am J Psychiatry 1995; 152: 1788–92.
27 Carroll, J, Schaffer, D, Spensley, J, Abramowitz, SI. Family experiences of self-mutilating patients. Am J Psychiatry 1980; 137: 852–3.
28 Craine, LS, Henson, CE, Colliver, JA, MacLean, DG. Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system. Hosp Community Psychiatry 1988; 39: 300–4.
29 Schwartz, RH, Cohen, P, Hoffman, NG, Meeks, KE. Self-harm behaviors (carving) in female adolescent drug abusers. Clin Pediatr 1989; 28: 340–6.
30 Wonderlich, SA, Crosby, RD, Mitchell, JE, Thompson, KM, Redlin, J, Demuth, G, Smyth, J, Haseltine, B. Eating disturbance and sexual trauma in childhood and adulthood. Int J Eat Disord 2001; 30: 401–21.
31 Swanston, HY, Nunn, KP, Oates, RK, Tabbutt, JS, O'Toole, BI. Hoping and coping in young people who have been sexually abused. Eur Child Adolesc Psychiatry 1999; 8: 134–42.
32 Tyler, KA, Whitback, LB, Hoyt, VR, Johnson, KD. Sell-mutilation and homeless youth: the role of family abuse, street experiences and mental disorders. J Res Adolesc 2003; 13: 457–71.
33 Bierer, LM, Yehuda, R, Schmeidler, J, Mitropoulou, V, New, AS, Silverman, JM, Seiver, LJ. Abuse and neglect in childhood: Relationship to personality disorder diagnoses. CNS Spectr 2003; 8: 737–54.
34 Boudewyn, AC, Liem, JH. Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. J Trauma Stress 1995; 8: 445–59.
35 Briere, J, Gil, E. Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 1998; 68: 609–20.
36 Briere, J, Zaidi, LY. Sexual abuse histories and sequelae in female psychiatric emergency room patients. Am J Psychiatry 1989; 146: 1602–6.
37 Brown, L, Russell, J, Thornton, C, Dunn, S. Dissociation, abuse, and the eating disorders: evidence from an Australian population. Aust NZ J Psychiatry 1999; 33: 521–8.
38 Darche, MA. Psychological factors differentiating self-mutilating and non-self-mutilating adolescent inpatient females. Psychiatr Hosp 1990; 21: 31–5.
39 Evren, C, Evren, B. Self-mutilation in substance-dependent patients and relationship with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality. Drug Alcohol Depend 2005; 80: 1522.
40 Favaro, A, Santonastaso, P. Different types of self-injurious behavior in bulimia nervosa. Compr Psychiatry 1999; 40: 5760.
41 Gladstone, GL, Parker, GB, Wilhelm, K, Malhi, GS, Wilhelm, K, Austin, MP. Characteristics of depressed patients who report childhood sexual abuse. Am J Psychiatry 1999; 156: 431–7.
42 Gladstone, GL, Parker, GB, Mitchell, PB, Malhi, GS, Wilhelm, K, Austin, MP. Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization. Am J Psychiatry 2004; 161: 1417–25.
43 Gleaves, DH, Eberenz, KP. Eating disorders and additional psychopathology in women: the role of prior sexual abuse. J Child Sex Abus 1993; 2: 7180.
44 Gratz, KL. Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. Am J Orthopsychiatry 2006; 76: 238–50.
45 Gratz, KL, Conrad, SD & Roemer, L. Risk factor for deliberate self-harm among college students. American Journal of Orthopsychiatry 2002; 72: 128–40.
46 Jarvis, TJ, Copeland, J. Child sexual abuse as a predictor of psychiatric comorbidity and its implications for drug and alcohol treatment. Drug Alcohol Depend 1997; 49: 61–9.
47 Joyce, PR, McKensie, JM, Mulder, RT, Luty, SE, Sullivan, PF, Miller, AL, Kennedy, MA. Genetic, developmental, and personality correlates of self-mutilation in depressed patients. Aust NZ J Psychiatry 2006; 40: 225–9.
48 Kroll, J, Fiszdon, J, Crosby, RD. Childhood abuse and three measures of altered states of consciousness (dissociation, absorption, and mysticism) in a female outpatient sample. J Personal Disord; 1996; 10: 345–54.
49 Lipschitz, DS, Winegar, RK, Nicolau, AL, Hartnick, E, Wolfson, M, Southwick, SM. Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients. J Nerv Ment Dis 1999; 187: 32–9.
50 Low, G, Jones, D, MacLeod, A, Power, M, Duggan, C. Childhood trauma, dissociation, and self-harming behaviour: a pilot study. Br J Med Psychol 2000; 73: 269–78.
51 Martin, G, Bergen, HA, Richardson, AS, Roeger, L, Allison, S. Sexual abuse and suicidality: Gender differences in a large community sample of adolescents. Child Abuse Neg 2004; 28: 491593.
52 Matsumoto, T, Azekawa, T, Yamaguchi, A, Asami, T, Isaki, E. Habitual self-mutilation in Japan. Psychiatry Clin Neurosci 2004; 58: 191–8.
53 Paivio, SC, McCulloch, CR. Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse Negl 2004; 28: 339–54.
54 Parker, G, Malhi, G, Mitchell, P, Kotze, B, Wilhelm, K, Parker, K. Self-harming in depressed patients: pattern analysis. Aust NZJ Psychiatry 2005; 39: 899906.
55 Pettigrew, J, Burcham, J. Effects of childhood sexual abuse in adult female psychiatric patients. Aust NZ J Psychiatry 1997; 31: 208–13.
56 Rodriguez-Srednicki, O. Childhood sexual abuse, dissociation, and adult self-destructive behavior. J Child Sex Abus 2001; 10: 7590.
57 Rose, SM, Peabody, CG, Stratigeas, B. Undetected abuse among intensive case management clients. Hosp Community Psychiatry 1991; 42: 499503.
58 Sar, V, Akyuz, G, Kundakci, T, Kiziltan, E, Dogan, O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004; 161: 2271–6.
59 Tobin, DL, Griffing, AS. Coping, sexual abuse, and compensatory behavior. Int J Eat Disord 1996; 20: 143–8.
60 Whitlock, J, Eckenrode, J, Silverman, D. Self-injurious behaviors in a college population. Pediatrics 2006; 117: 1939–48.
61 Wright, J, Friedrich, W, Cinq-Mars, C, Cyr, M, McDuff, F. Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples. Violence and Vict 2004; 19: 627–43.
62 Ystgaard, M, Hestetun, I, Loeb, M, Mehlum, L. Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? Child Abuse Negl 2004; 28: 863–75.
63 Zanarini, MC, Yong, LMA, Frankenburg, FR, Hennen, J, Reich, DB, Marino, MF, Vjuanovic, AA. Severity of reported childhood sexual abuse and its relation to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis 2002; 190: 381–7.
64 Zlotnick, C, Shea, MT, Pearlstein, T, Simpson, E, Costello, E, Begin, A. The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Compr Psychiatry 1996; 37: 1216.
65 Zoroglu, SS, Tuzun, U, Sar, V, Tutkun, H, Savas, HA, Ozturk, M, Alyanak, B, Kora, ME. Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect, and dissociation. Psychiatry Clin Neurosci 2003; 57: 119–26.
66 Zweig-Frank, H, Paris, J, Guzder, J. Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder. Can J Psychiatry 1994; 39: 259–64.
67 Kraemer, HC, Stice, E, Kazdin, A, Offord, D, Kupfer, D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 2001; 158: 848–56.
68 Rind, B, Tromovitch, P, Bauserman, R. A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychol Bull 1998; 124: 2253.
69 Klonsky, ED, Muehlenkamp, JJ. Self-injury: a research review for the practitioner. J Clin Psychol 2007; 63: 1045–56.
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Childhood sexual abuse and non-suicidal self-injury: meta-analysis

  • E. David Klonsky (a1) and Anne Moyer (a1)
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