Non-suicidal Self Injury: Relationship with Attachment, Childhood Trauma and Dissociation

OBJECTIVE:This study aimed to investigate the relationship between non-suicidal self injury (NSSI), dissociative experiences, types of childhood traumas, and attachment styles in adolescents. METHOD:Adolescents aged 14-18 with a diagnosis of NSSI and a psychiatric disorder (NSSI, n=40), a clinical comparison group which have any psychiatric disorder without NSSI (CCG, n=40) and a healthy control group (HC, n=40) were included. The diagnosis of NSSI were confirmed with the research criteria of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition. All participants were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version. Childhood Trauma Questionnaire (CTQ), the short form of the Inventory of Parent and Peer Attachment (IPPA), and the Adolescent Dissociative Experiences Scale (ADES) were used. RESULTS:The dissociation scores were higher in the NSSI group compared to the CCG group (4.8±2.0 and 2.9±2.2, p<0.001). NSSI group also had higher trauma levels but the difference was not statistically significant (48.0±14.2 and 41.4±5.0, p=0.062). Similarly, the NSSI group yielded higher scores of CTQ (48.0±14.2 and 33.8±6.8, p<0.001) and ADES (4.8±2.0 and 1.8±1.6, p<0.001) compared to HC group. Also, compared to the HC group, the NSSI group had more impaired attachment to father (42.0±19.7 vs. 53.0±21.7, p=0.056) and more frequently reported physical and emotional abuse. Finally, there were negative correlations between attachment levels to mother and CTQ total scores (r=-0.70, p<0.001) and between father attachment subscale and ADES scores (r=-0.33, p=0.047). CONCLUSION:Our study supports the notion that dissociation, trauma and insecure attachment are more common in individuals with NSSI. Psychotherapeutic approaches based on current findings will provide more benefits to patients.