What is the relationship between dissociation and self-harming behaviour in adolescents?

Abstract

Deliberate self‐harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self‐harm to end the aversive experience of dissociation, others propose that self‐harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self‐harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross‐sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self‐harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self‐harm.