Abstract about the Origins of Cutting/Self-Mutilation

ABSTRACT:  Childhood origins of self-destructive behavior

AUTHORS:  BA van der Kolk, JC Perry and JL Herman
Department of Psychiatry, Harvard Medical School, Boston, Mass.

OBJECTIVE: Clinical reports suggest that many adults who engage in self-destructive behavior have childhood histories of trauma and disrupted parental care. This study explored the relations between childhood trauma, disrupted attachment, and self-destruction, using both historical and prospective data.

METHOD: Seventy-four subjects with personality disorders or bipolar II disorder were followed for an average of 4 years and monitored for self-destructive behavior such as suicide attempts, self-injury, and eating disorders. These behaviors were then correlated with independently obtained self-reports of childhood trauma, disruptions of parental care, and dissociative phenomena.

RESULTS: Histories of childhood sexual and physical abuse were highly significant predictors of self-cutting and suicide attempts. During follow-up, the subjects with the most severe histories of separation and neglect and those with past sexual abuse continued being self-destructive. The nature of the trauma and the subjects' age at the time of the trauma affected the character and the severity of the self-destructive behavior. Cutting was also specifically related to dissociation.

CONCLUSIONS: Childhood trauma contributes to the initiation of self-destructive behavior, but lack of secure attachments helps maintain it. Patients who repetitively attempt suicide or engage in chronic self-cutting are prone to react to current stresses as a return of childhood trauma, neglect, and abandonment. Experiences related to interpersonal safety, anger, and emotional needs may precipitate dissociative episodes and self-destructive behavior. 

It all seems to begin and end with relationships. How do we spread the message of attachment security?  What is it?  How do we ensure it?  Do we understand what is at stake?  It is preventative and healing.  Attachment security mediates and moderates the development of PTSD - for victims of childhood abuse, for veterans, for holocaust survivors.  Regardless of the trauma, it is relationship that soothes our distress.