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ARTICLE IN PRESS Behaviour Research and Therapy www elsevier com locate brat Shorter communication Child maltreatment non suicidal self injury and the mediating role of self criticism Lisa H Glassmana Mariann R Weierichb Jill M Hooleya Tara L Delibertoa Matthew K Nocka a Department of Psychology Harvard University 33 Kirkland Street 1280 Cambridge MA 02138 USA b Boston University School of Medicine Boston MA USA Received 12 November 2006 received in revised form 6 April 2007 accepted 11 April 2007 Abstract We examined the relation between child maltreatment and non suicidal self injury NSSI Participants were 86 adolescents who completed measures of child maltreatment self criticism perceived criticism depression and NSSI Analyses revealed signi cant small to medium associations between speci c forms of child maltreatment physical neglect emotional abuse and sexual abuse and the presence of a recent history of NSSI Emotional and sexual abuse had the strongest relations with NSSI and the data supported a theoretical model in which self criticism mediates the relation between emotional abuse and engagement in NSSI Speci city for the mediating role of self criticism was demonstrated by ruling out alternative mediation models Taken together these results indicate that several different forms of childhood maltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associated with NSSI Future research is needed to test the temporal relation between maltreatment and NSSI and should aim to identify additional pathways to engagement in NSSI r 2007 Elsevier Ltd All rights reserved Keywords Self injury Child abuse Criticism Self harm Self mutilation Suicide Introduction Non suicidal self injury NSSI which refers to direct and deliberate harm of bodily tissue in the absence of suicidal intent is a major public health problem in the US and around the world Data suggest that approximately 4 of adults in the US population exhibit NSSI Briere Gil 1998 Klonsky Oltmanns Turkheimer 2003 and that adolescents are at even higher risk with approximately 12 21 reporting a lifetime history of NSSI Ross Heath 2002 Whitlock Eckenrode Silverman 2006 Zoroglu et al 2003 Recent research has begun to systematically describe the form and function of NSSI Brown Comtois Linehan 2002 Nock Prinstein 2004 2005 however the potential pathways to this behavior are not well understood One consistently reported relation is that between a history of child maltreatment de ned here as Corresponding author Tel 1 617 496 4484 fax 1 617 496 9462 E mail address nock wjh harvard edu M K Nock 0005 7967 see front matter r 2007 Elsevier Ltd All rights reserved doi 10 1016 j brat 2007 04 002 Please cite this article as Glassman L H et al Child maltreatment non suicidal self injury and the mediating role of self criticism Behaviour Research and Therapy 2007 doi 10 1016 j brat 2007 04 002 ARTICLE IN PRESS 2 L H Glassman et al Behaviour Research and Therapy neglect or abuse during childhood and the development of NSSI For instance sexual abuse has shown a strong association with different forms of self injury including NSSI Bergen Martin Richardson Allison Roeger 2003 Nock Kessler 2006 Peters Range 1995 Yates 2004 while physical abuse has been associated with such outcomes in some studies e g Joiner et al 2007 but not others e g Nock Kessler 2006 There are at least two important limitations of prior research in this area First the relation between different forms of child maltreatment and NSSI remains unclear as most studies examine only one type of neglect or abuse This makes it dif cult to compare results across studies Examining the relations between speci c forms of child maltreatment and NSSI within a single study provides more detailed information about the relative magnitude of these associations and may facilitate greater understanding of how and why these constructs are related Second beyond knowing that child maltreatment is related to NSSI it is important scienti cally and clinically to better understand the factors that mediate or explain this relation The potential mechanisms involved may vary depending on the type of neglect or abuse in question and variability among individual cases also is likely Careful study and delineation of the mediators of these relations is an important and necessary step in understanding how NSSI might develop and in informing prevention and intervention programs in the future Prior work suggests that people most often engage in NSSI for the purposes of emotion regulation or social communication Brown et al 2002 Nock Prinstein 2004 2005 However what has not been explained is why some individuals choose NSSI to achieve these ends rather than other behaviors that might serve similar functions such as alcohol drug use or bingeing purging One possibility is that some people select NSSI due to the directly self injurious nature of this behavior and that they learn to do so via modeling of earlier abuse by others In other words individuals who are excessively criticized and verbally or emotionally abused may over time learn to engage in excessive self criticism and use NSSI as a form of direct self abuse For instance people who experience maltreatment during childhood in the form of repeated insults excessive criticism or some form of physical abuse may come to adopt a similarly critical view of themselves over time through modeling the behavior of those who criticized and abused them This could lead to the development of a self critical cognitive style and may ultimately manifest in the engagement in NSSI as an extreme form of self punishment or self abuse whenever they disapprove of their own behavior NSSI is undoubtedly a multi determined behavior that cannot be explained through one simple pathway such as this but the examination of multiple pathways such as the one proposed here is necessary to begin to understand this dangerous behavior According to this model the presence of child maltreatment is related to later engagement in NSSI during adolescence and this relation is mediated by the presence of a self critical cognitive style We are proposing that it is self criticism speci cally that would mediate this relation given the directly self abusive nature of NSSI Beyond demonstrating mediation the case for self criticism as a mechanism through which maltreatment is associated with NSSI would be strengthened considerably if we were able to demonstrate

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