Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents

• Published in: Child abuse & neglect 2017-05, Vol.67, p.383-390
• Main Authors: Peh, Chao Xu, Shahwan, Shazana, Fauziana, Restria, Mahesh, Mithila V, Sambasivam, Rajeswari, Zhang, YunJue, Ong, Say How, Chong, Siow Ann, Subramaniam, Mythily
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Child Abuse; Child abuse & neglect; Child Abuse - psychology; Child maltreatment; Childhood; Children; Children & youth; Confidence intervals; Cross-Sectional Studies; Depression; Emotion dysregulation; Emotional disorders; Emotional regulation; Emotions; Female; Function; Functional assessment; Functional Behavioral Assessment; Hospitalization; Hospitals, Psychiatric; Humans; Indirect effects; Male; Mental depression; Mental disorders; Mutilation; Path analysis; Patients; Pediatrics; Psychiatric hospitals; Psychiatry; Questionnaires; Risk assessment; Risk Factors; Self destructive behavior; Self injury; Self-harm; Self-Injurious Behavior - psychology; Severity; Singapore; Sociodemographics; Surveys and Questionnaires; Symptoms; Teenagers; Trauma; Youth
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2017.03.013

Abstract Although child maltreatment exposure is a recognized risk factor for self-harm, mechanisms underlying this relationship remain unclear. Self-harm may function as a compensatory strategy to regulate distressing emotions. This cross-sectional study examines if emotion dysregulation mediates between the severity of maltreatment exposure and self-harm, adjusting for demographic variables and depressive symptoms. Participants were 108 adolescent patients recruited from a psychiatric hospital in Singapore (mean age 17.0 years, SD = 1.65; 59.3% female). Study measures included the Childhood Trauma Questionnaire (CTQ-SF), Functional Assessment of Self-Mutilation (FASM), Difficulties in Emotion Regulation Scale (DERS), and the Patient Health Questionnaire (PHQ-8). Path analysis was conducted to examine the direct and indirect effects of maltreatment exposure on self-harm via emotion dysregulation, controlling for demographic variables and depressive symptoms. Indirect effects were tested using bootstrapped confidence intervals (CI). Results showed that self-harm was highly prevalent in our sample (75.9%). Emotion dysregulation and depressive symptoms were found to be associated with higher self-harm frequency. In addition, results from path analysis showed that the association between the severity of maltreatment exposure and self-harm frequency was significantly mediated by emotion dysregulation B = 0.07, p < 0.05, 95% CI [0.02, 0.16]. Thus, emotion dysregulation may be a proximal mechanism linking maltreatment exposure and adolescent self-harm. Notably, self-harm may represent maladaptive attempts to manage emotion dysregulation that may have resulted from maltreatment. Findings from the study have implications for the prevention and treatment of self-harm in maltreated youth.