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Child maltreatment

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Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticismIntroductionMethodParticipantsAssessmentChildhood maltreatmentSelf-criticismPerceived criticismNon-suicidal self-injuryDepressionData analysesResultsChildhood maltreatment and NSSIPotential mediators of the relation between childhood maltreatment and NSSIDiscussionAcknowledgmentsReferencesBehaviour Research and Therapy ] (]]]]) ]]]–]]]Shorter communicationChild maltreatment, non-suicidal self-injury, and the mediatingrole of self-criticismLisa H. Glassmana, Mariann R. Weierichb, Jill M. Hooleya,Tara L. Delibertoa, Matthew K. Nocka,aDepartment of Psychology, Harvard University, 33 Kirkland Street, 1280, Cambridge, MA 02138, USAbBoston University School of Medicine, Boston, MA, USAReceived 12 November 2006; received in revised form 6 April 2007; accepted 11 April 2007AbstractWe examined the relation between child maltreatment and non-suicidal self-injury (NSSI). Participants were 86adolescents who completed measures of child maltreatment, self-criticism, perceived criticism, depression, and NSSI.Analyses revealed significant, small-to-medium associations between specific 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 thestrongest relations with NSSI, and the data supported a theoretical model in which self-criticism mediates the relationbetween emotional abuse and engagement in NSSI. Specificity for the mediating role of self-criticism was demonstrated byruling out alternative mediation models. Taken together, these results indicate that several different forms of childhoodmaltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associatedwith NSSI. Future research is needed to test the temporal relation between maltreatment and NSSI and should aim toidentify additional pathways to engagement in NSSI.r 2007 Elsevier Ltd. All rights reserved.Keywords: Self-injury; Child abuse; Criticism; Self-harm; Self-mutilation; SuicideIntroductionNon-suicidal self-in jury (NSSI), which refers to direct and deliberate harm of bodily tissue in the absence ofsuicidal intent, is a major public health problem in the US and around the world. Data suggest thatapproximately 4% of adults in the US popul ation exhibit NSSI (Briere & Gil, 1998; Klonsky, Oltmanns, &Turkheimer, 2003), and that adolescents are at even higher risk, with approximately 12–21% reporting alifetime 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 wellunderstood. One consistently reported relation is that between a history of child maltreatment, defined here asARTICLE IN PRESSwww.elsevier.com/locate/brat0005-7967/$ - see front matter r 2007 Elsevier Ltd. All rights reserved.doi:10.1016/j.brat.2007.04.002Corresponding author. Tel.: +1 617 496 4484; fax: +1 617 496 9462.E-mail address: [email protected] (M.K. Nock).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.2007.04.002neglect or abuse during childhood, and the development of NSSI. For instance, sexual abuse has shown astrong 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 beenassociated 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 betweendifferent forms of child maltreatment and NSSI remains unclear, as most studies examine only one type ofneglect or abuse. This makes it difficult to compare results across studies. Examining the relations betweenspecific forms of child maltreatment and NSSI within a singl e study provides more detailed information aboutthe relative magnitude of these associations and may facilitate greater understanding of how and why theseconstructs are related. Second, beyond knowing that child maltreatment is related to NSSI, it is importantscientifically and clinically to better understan d the factors that mediate or explain this relation. The potentialmechanisms involved may vary depending on the type of neglect or abuse in question and variability amongindividual cases also is likely. Careful study and delineation of the mediators of these relations is an importantand necessary step in understanding how NSSI might develop, and in informing prevention and interventionprograms in the future.Prior work suggests that people most often engage in NSSI for the purposes of emotion regulation or socialcommunication (Brown et al., 2002; Nock & Prinstein, 2004, 2005). However, what has not been explained iswhy some individuals choose NSSI to achieve these ends rather than other behaviors that might serve similarfunctions, such as alcohol/drug use or bingeing/purging. One possibility is that some people select NSSI due tothe directly self-injurious nature of this behavior, and that they learn to do so via modeling of earlier abuse byothers. In other words, individuals who are excessively criticized and verbally or emotionally abused may, overtime, 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 themselvesover tim e through modeling the behavior of those who criticized and abused them. This could lead to thedevelopment of a self-critical cognitive style, and may ultimately manifest in the engagement in NSSI as anextreme form of self-punishment or self-abuse whenever they disapprove of their own behavior. NSSI isundoubtedly 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 understandthis dangerous behavior.According to this


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