American Journal of Psychiatry, Volume 148: Page 1665-1671, December 1991.
Bessel A. van der Kolk, M.D., J. Christopher Perry, M.D., M.P.D., and Judith Lewis Herman, M.D.
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.
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.
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.
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.
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