Abstract
The aims of this study were to investigate the rates of deliberate self-harm (DSH) behavior among an Italian adolescent sample, as well as to explore its clinical correlates. On a sample of 234 adolescents in Italian secondary schools (Mean age = 16.47; SD = 1.7) were assessed the DSH as well as externalizing symptoms (including both conduct disorder [CD] and oppositional defiant disorder [ODD] symptoms), borderline personality disorder [BPD] symptoms, dissociative symptoms, and the incidence of life-stressors. Consistent with past research on DSH in youth, 42% of the adolescents in this sample engaged in DSH. Results indicate a positive association between DSH and all psychopathological correlates, including BPD, dissociative, and ODD and CD symptoms. Further, findings revealed an association between DSH and specific life-stressors (i.e., psychological and sexual abuse, natural disasters and serious accidents, the loss of someone important, and the witnessing of family violence or a serious accident).
Conclusion
The present study focused on DSH among community adolescents, examining the rates of this behavior, the most common methods, and the associations between this behavior and both psychopathology and stressful life experiences. It is interesting to note that adolescents reported high rates of DSH, with 42% reporting a lifetime history of this behavior. Further, consistent with past research, results revealed few gender differences in DSH, with comparable rates, methods, and age of onset reported across female and male adolescents and negligible changes in the strength of the associations between DSH and the clinical correlates when controlling for gender. The findings from this study highlight the relevance of DSH among adolescents and suggest the importance of continuing to examine DSH as a behavior of interest in its own right (rather than as simply a symptom of psychiatric disorders within clinical populations).
Several important limitations warrant consideration. First, because this study used correlational data and a cross-sectional design, it is impossible to determine the precise nature and direction of the relationship between DSH and the psychopathological correlates of interest. In particular, it remains unclear if these psychopathological symptoms preceded (and predicted) DSH, or are a consequence of DSH. Moreover, the reliance on self-report measures of stressful life events and DSH provides no way to substantiate the actual occurrence of these phenomena and introduces the possibility of retrospective bias. A related limitation is the exclusive reliance on self-report measures of psychopathology, which may be influenced by an individual’s willingness and/or ability to report accurately on their experiences. Finally, although the focus on the correlates of DSH within a mixed-gender sample of community adolescents is a strength of the study, it is unclear if the observed associations would be found within clinical adolescent samples.
Future research would benefit from the use of structured clinical interviews to assess psychopathology, as well as a prospective longitudinal design. Moreover, future research should examine other clinical correlates and putative risk factors for DSH within this population, including other forms of personality pathology and more basic mechanisms such as emotion dysregulation and impulsivity. Further, future research should examine the extent to which these findings generalize to clinical or at-risk community populations of adolescents.
Despite limitations, the results of this study extend extant research on the factors associated with DSH among community adolescents, providing preliminary evidence that various forms of psychopathology and negative life events are associated with DSH within this nonclinical sample, including symptoms of borderline personality, oppositional defiant and conduct disorders, and dissociation, as well as a range of stressful life events (from witnessing potentially traumatic events to experiencing them directly). In addition to highlighting the importance of continuing to examine clinical and psychopathological correlates of, and risk factors for, DSH among nonclinical samples of youth, the findings from this study have potential clinical implications. In particular, findings suggest the importance of conducting a complete assessment of Axis I and II psychopathology when intervening with self-harming adolescents in nonclinical settings, such as schools. Indeed, despite examining the correlates of this behavior within a community sample, findings revealed significant associations with personality pathology and externalizing disorders, as well as pathological dissociation. Thus, even when providing targeted interventions in nonclinical settings, a comprehensive assessment of co-occurring psychopathology would be warranted. Further, findings of an association between DSH and externalizing psychopathology in particular highlight the importance of assessing for the presence of DSH even among adolescents who appear to be directing anger outward. Although externalizing behaviors may be more likely to capture the attention of teachers and counselors, the findings from this study suggest that they may co-occur with more self-destructive behaviors, such as DSH. Findings also highlight the potential utility of targeting borderline personality and/or externalizing symptoms in prevention programs for DSH, or, alternatively, developing targeted interventions for DSH that focus on addressing the shared mechanisms underlying these forms of psychopathology (e.g., emotion dysregulation or impulsivity). Finally, findings of an association between DSH and both dissociation and a variety of negative life events suggest the potential utility of teaching self-harming adolescents grounding skills and other coping strategies for managing trauma-related symptoms.
