Deliberate self-harm (DSH) is associated with diverse psychiatric diagnoses and broad psychopathology but less is known about its association with other forms of interpersonal violence and crime. Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the current study examined linkages between not only DSH and mental health and substance abuse comorbidity, but also childhood abuse, lifetime victimization, and a variety of violent behaviors. We identified a prevalence of 2.91% for DSH and found that DSH is associated with generalized and severe psychopathology, wide-ranging substance abuse, and adverse childhood experiences. Contrary to other studies, we found significant racial and ethnic differences in DSH. African-American, Latinos, and Asians, were substantially less likely than Whites to report DSH. Our hypothesis that DSH would be associated with a variety of violent behaviors including robbery, intimate partner violence, forced sex, cruelty to animals, and use of a weapon was supported even after adjusting for an array of covariates. We extend previous research on DSH by examining its prevalence in one the largest comorbidity surveys ever conducted and show that DSH is associated with multiple forms of violent behavior toward others, including animals.
Deliberate self-harm (DSH) is the intentional act of harming oneself typically by means of cutting, scratching, or burning the flesh (Winchel and Stanley, 1991 and Gratz, 2001). DSH is associated with a host of psychiatric disorders including, but not limited to, anxiety and depressive disorders (Klonsky et al., 2003 and Andover et al., 2005), borderline personality disorder (Andover et al., 2005), and post-traumatic stress disorder (Harned et al., 2006), and is thought to be a symptom of severe, yet heterogeneous, psychopathology (Klonsky and Muehlenkamp, 2007). Unsurprisingly, DSH is often tied to suicidal thoughts and behaviors (Canetto, 1997, Brown et al., 2002 and Zahl and Hawton, 2004).
Prior epidemiologic studies of DSH have identified wide-ranging prevalence depending on the research sample employed. Prevalence estimates from population-based surveys, though few in number, range from approximately 2% to 6% (Briere and Gil, 1998 and Klonsky, 2011), while studies from student and clinical psychiatric settings have been found to be substantially higher (e.g., 30%) (Briere and Gil, 1998 and Brunner et al., 2007). DSH is most likely to occur in adolescence and early adulthood (Schmidtke et al., 1996 and Briere and Gil, 1998). With respect to sex differences, studies among adolescents have found that women are more likely to engage in DSH (Hawton et al., 2002, Kirkcaldy et al., 2006 and Brunner et al., 2007), but this does necessarily hold for adults (Klonsky, 2011). Less research has focused on racial and ethnic patterns of DSH; however, findings suggest non-significant results (Klonsky, 2011).
