Childhood Origins of Self-Destructive Behavior
Bessel A. van der Kolk, M.D., J. Christopher Perry,
M.D., M.P.D.,
and Judith Lewis Herman, M.D.
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.
(Am J Psychiatry 1991; 148;1665-1671)
Received Jan. 10, 1991;
revision received May 22, 1991; accepted July 1, 1991. From
the departments of psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston,
and Cambridge Hospital, Cambridge, Mass. Addrees reprint
requests to Dr. van der Kolk The Trauma Clinic, Erich
Lindemann Mental Health Center, 25 Stamford St., Boston, MA
02114.
Supported in part by NIMH grant
MH-34123.
The authors thank Idell Goldenberg,
M.A., Beth Hoke, M.A., Chris Pagano, Ph.D., and Barbara
Matthews, who served as reseach assistants.
Copyright © 1991 American
Psychiatric Association.