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Am J Psychiatry 1991; 148:1665-1671
Copyright © 1991 by American Psychiatric Association
Childhood origins of self-destructive behavior
BA van der Kolk, JC Perry and JL Herman
Department of Psychiatry, Harvard Medical School, Boston, Mass.
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.
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