Understanding the relationship between adverse childhood experiences (ACEs) and deliberate self harm (DSH)

Sweeney, Emma (2024). Understanding the relationship between adverse childhood experiences (ACEs) and deliberate self harm (DSH). University of Birmingham. Foren.Psy.D.

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Abstract

There is an empirically established relationship between Adverse Childhood Experiences (ACEs) and deliberate self-harm (DSH) (Lui et al., 2019) and it is widely recognised that those with particular and an increased number of ACEs are at an elevated risk of engaging in self-harm (Russell et al., 2019). However, little is understood about the processes which underlie this relationship. The main purpose of this thesis was to further investigate the nature of the relationship between ACEs and DSH, and to acquire insight into variables which increase the likelihood of individuals with ACEs engaging in DSH.

More specifically, Chapter 2 aimed to review research findings in relation to risk factors for non-suicidal self-injury (NSSI) amongst populations who have ACEs. That is, the review focuses specifically on acts of self-injury, where suicidality is not the function of the behaviour. Potential risk factors which were identified included experiencing post-traumatic stress symptoms (PTSS), emotion dysregulation (ED) and dissociation. Limitations are noted and findings are discussed in relation to the clinical implications of this in terms of the treatment of NSSI.

Chapter 3 consists of a qualitative study which explored the experiences of hospitalised women with a history of childhood abuse, who have a history of repeated self-harm. Using Interpretative Phenomenological Analysis (IPA), the study aimed to gain an in-depth understanding of how six participants made sense of their self-harm. The study also explored factors which may make participants more likely to engage in self-harming behaviours. Three group experiential statements were identified: Journey of self-harm; Reasons why I self-harm, and Relationships and self-harm. Participants spoke about why they self-harm (e.g., to regulate emotions or to “feel something”) and their experiences of factors which made them less likely to self-harm (e.g., positive personal support). Clinical implications of the research were discussed, along with study limitations, and recommendations for future research.

Chapter 4 provides a critique of the Dissociative Experiences Scale (DES; Carlson & Putnam, 1986). Dissociation has been recognised as playing a role in the ACEs and self-harm relationship (Franzke et al., 2015; Gomez, 2019). The DES-II was evaluated in terms of the reliability and validity of the scale, and the critique concluded that the DES (I and II) is a significant and robust tool in quantifying dissociation in a range of clinical populations. However, floor effects and skewed data have been recognised in the use of the DES in non-clinical populations.

Chapter 5 provides a summary of the aims and key findings from each chapter of the thesis. It also highlights overall strengths and limitations of the thesis, as discussed in each distinct chapter. Lastly, the chapter considers how the findings from the thesis have implications for practice, as well as gives suggestions for areas of future research.

Type of Work:

Thesis (Doctorates > Foren.Psy.D.)

Award Type:

Doctorates > Foren.Psy.D.

Supervisor(s):