Childhood origins of self-destructive behavior.
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.


METHODS
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.
van der Kolk
B A
BA
Department of Psychiatry, Harvard Medical School, Boston, Mass.
Perry
J C
JC
Herman
J L
JL
D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000150:complications*; D002650:Child Abuse, Sexual / Q000150:complications; D002657:Child Development; D002675:Child, Preschool; D004213:Dissociative Disorders / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007837:Latency Period, Psychological; D008297:Male; D016728:Self-Injurious Behavior / Q000209:etiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology