Dissociation, Trauma and Self-Harm



The presented analytical preview considers the main approaches to the relationship between dissociation, trauma and self-harm. This relationship is functionally complex and depends on many variables. In regards to trauma dissociation and self-harm are (1) defense mechanisms, activating to traumatic cues; (2) destructive pathological self-regulatory modes. Meantime functional links between dissociation and self-harm reveal two tendencies: anti-dissociation (regaining control) and dissociation-inducing (rejecting one’s feelings). Dissociation is widely considered a mediator between trauma and self-harm. At the same time psychological mechanisms, such as emotion regulation and body rejection, exert significant influence on pathological post-traumatic development. We discuss the psychopathological aspects of the links between trauma, dissociation and self-harm in borderline personality and eating disorders. We also take note of the gender- and age-related peculiarities of these issues.

General Information

Keywords: dissociation, trauma, self-harm, borderline personality disorder, eating disorders, emotion dysregulation, body rejection

Journal rubric: Research Reviews

Article type: scientific article

DOI: https://doi.org/10.17759/cpp.2020280103

Funding. This paper was prepared with the financial support of the Russian Foundation for Basic Research (RFBR), project № 19-113-50577.

For citation: Polskaya N.A., Melnikova M.A. Dissociation, Trauma and Self-Harm. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2020. Vol. 28, no. 1, pp. 25–48. DOI: 10.17759/cpp.2020280103.


  1. Agarkov V.A. Dissotsiatsiya i pogranichnoe rasstroistvo lichnosti [Dissociation and borderline personality disorder]. Konsul’tativnaya psikhologiya i psikhoterapiya [Counseling Psychology and Psychotherapy], 2014. Vol. 22 (2), pp. 10—37. (In Russ., аbstr. in Engl.).
  2. Van der Hart O., Nijenhuis E.R.S., Steele K. Prizraki proshlogo. Strukturnaya teoriya dissotsiatsii i terapiya posledstvii khronicheskoi psikhicheskoi travmy [The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization]. Moscow: Kogito-Tsentr, 2013. 496 p. (In Russ.).
  3. Gorchakova V.A., Kholmogorova A.B., Palin A.V., et al. Travmaticheskii stress u patsientov s khronicheskim suitsidal’nym povedeniem i chertami pogranichnogo lichnostnogo rasstroistva [Traumatic stress in patients with chronic suicidal behavior and characteristics of borderline personality disorder]. Konsul’tativnaya psikhologiya i psikhoterapiya [Counseling Psychology and Psychotherapy], 2014. Vol. 22 (2), pp. 119—139. (In Russ., аbstr. in Engl.).
  4. Polskaya N.A. Psikhologiya samopovrezhdayushchego povedeniya [The psychology of self-injurious behavior]. Moscow: LENAND, 2017. 320 p.
  5. Polskaya N.A. Emotsional’naya disregulyatsiya v strukture samopovrezhdayushchego povedeniya [Emotion Dysregulation in the Structure of Self-Injurious Behavior]. Konsul’tativnaya psikhologiya i psikhoterapiya [Counseling Psychology and Psychotherapy], 2018. Vol. 26 (4), pp. 65—82. doi:10.17759/cpp.2018260405. (In Russ., аbstr. in Engl.).
  6. Tarabrina N.V. Psikhologiya posttravmaticheskogo stressa: Teoriya i praktika [Psychology of posttraumatic stress. Theory and practice]. Moscow: Institut psikhologii RAN Publ., 2009. 304 p.
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing, 2013. 992 р.
  8. Ataria Y. Body disownership in complex posttraumatic stress disorder. New York: Palgrave Macmillan, 2018. 189 p.
  9. Ataria Y., Gallagher S. Somatic apathy: Body disownership in the context of torture. Journal of Phenomenological Psychology, 2015. Vol. 46 (1), pp. 105—122. doi:10.1163/15691624-12341286
  10. Bernier M.J., Hébert M., Collin-Vézina D. Dissociative Symptoms Over a Year in a Sample of Sexually Abused Children. Journal of Trauma & Dissociation, 2013. Vol. 14 (4), pp. 455—472. doi:10.1080/15299732.2013.769478
  11. Briere J. Dissociative symptoms and trauma exposure: Specificity, affect dysregulation, and posttraumatic stress. The Journal of Nervous and Mental Disease, 2006. Vol. 194 (2), pp. 78—82. doi:10.1097/01.nmd.0000198139.47371.54
  12. Burns E.E., Fischer S., Jackson J.L., et al. Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse & Neglect, 2012. Vol. 36, pp. 32—39. doi:10.1016/j. chiabu.2011.08.005
  13. Calati R., Bensassi I., Courtet P. The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses. Psychiatry Research, 2017. Vol. 251, pp. 103—114. doi:10.1016/j.psychres.2017.01.035
  14. Caslini M., Bartoli F., Crocamo C., et al. Disentangling the association between child abuse and eating disorders: a systematic review and meta-analysis. Psychosomatic Medicine, 2016. Vol. 78 (1), pp. 79—90. doi:10.1097/PSY.0000000000000233
  15. Černis E. Improving the clinical understanding and measurement of dissociation. Dr. Sci. (Clinical Psychology) Thesis. University of Oxford, 2017. 180 p.
  16. Černis E., Chan C., Cooper M. What is the relationship between dissociation and self-harming behaviour in adolescents? Clinical Psychology & Psychotherapy, 2019. Vol. 26 (3), pp. 328—338. doi:10.1002/cpp.2354
  17. Chaplo S.D., Kerig P.K., Bennett D.C., et al. The roles of emotion dysregulation and dissociation in the association between sexual abuse and self-injury among juvenile justice—involved youth. Journal of Trauma & Dissociation, 2015. Vol. 16 (3), pp. 272—285. doi:10.1080/15299732.2015.989647
  18. Connors R. Self-injury in trauma survivors: 1. Functions and meanings. American Journal of Orthopsychiatry. 1996. Vol. 66 (2), pp. 197—206. doi:10,1037 / h0080171
  19. Cucchi A., Ryan D., Konstantakopoulos G., et al. Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis. Psychological Medicine, 2016. Vol. 46 (7), pp. 1345—1358. doi:10.1017/ s0033291716000027
  20. Cyr M., McDuff P., Wright J., et al. Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse. Journal of Child Sexual Abuse, 2005. Vol. 14 (2), pp. 49—68.
  21. Edmondson A.J., Brennan C.A., House A.O. Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. Journal of Affective Disorders, 2016. Vol. 191, pp. 109—117. doi:10.1016/j.jad.2015.11.043
  22. Ford J.D., Gómez J.M. The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review. Journal of Trauma & Dissociation, 2015. Vol. 16 (3), pp. 232—271, doi:10 .1080/15299732.2015.989563
  23. Franzke I., Wabnitz P., Catani C. Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: A path analytic approach. Journal of Trauma & Dissociation, 2015. Vol. 16 (3), pp. 286—302. doi:10 .1080/15299732.2015.989646
  24. Hagan M.J., Gentry M., Ippen C.G., et al. PTSD with and without dissociation in young children exposed to interpersonal trauma. Journal of Affective Disorders, 2018. Vol. 227, pp. 536—541. doi:10.1016/j.jad.2017.11.070
  25. Horowitz S., Stermac L. The relationship between interpersonal trauma history and the functions of non-suicidal self-injury in young adults: an experience sampling study. Journal of Trauma & Dissociation, 2018. Vol. 19 (2), pp. 232—246. doi:10.108 0/15299732.2017.1330228
  26. Klonsky E.D., Glenn C.R., Styer D.M., et al. The functions of nonsuicidal self-injury: converging evidence for a two-factor structure [Elektronnyi resurs]. Child and Adolescent Psychiatry and Mental Health, 2015. Vol. 9 (1). Available at: https:// capmh.biomedcentral.com/articles/10.1186/s13034-015-0073-4 (Accessed 10.02.2020). doi:10.1186/s13034-015-0073-4
  27. Lang C.M., Sharma-Patel K. The relation between childhood maltreatment and self-injury: A review of the literature on conceptualization and intervention. Trauma, Violence, & Abuse, 2011. Vol. 12 (1), pp. 23—37. doi:10.1177/1524838010386975
  28. Laukkanen E., Rissanen, M.L., Tolmunen T., et al. Adolescent self-cutting elsewhere than on the arms reveals more serious psychiatric symptoms. European Child & Adolescent Psychiatry, 2013. Vol. 22 (8), pp. 501—510. doi:10.1007/s00787- 013-0390-1
  29. Lewis J., Binion G., Rogers M., et al. The Associations of Maternal Emotion Dysregulation and Early Child Dissociative Behaviors. Journal of Trauma & Dissociation, 2020. Vol. 21 (2), pp. 203—216. doi:10.1080/15299732.2019.1678211
  30. Löffler A., Kleindienst N., Cackowski S., et al. Reductions in Whole-body Ownership in Borderline Personality Disorder—A Phenomenological Manifestation of Dissociation. Journal of Trauma & Dissociation, 2020. Vol. 21 (2), pp. 264—277. doi:10.1080/15299732.2019.1678213
  31. Lyons-Ruth K., Bureau J.F., Holmes, B., et al. Borderline symptoms and suicidality/ self-injury in late adolescence: prospectively observed relationship correlates in infancy and childhood. Psychiatry Research, 2013. Vol. 206 (2—3), pp. 273—281.
  32. Lyssenko L., Schmahl C., Bockhacker L., et al. Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 2018. Vol. 175 (1), pp. 37—46. doi:10.1176/appi.ajp.2017.17010025
  33. McFetridge M.A., Milner R., Gavin V., et al. Borderline personality disorder: patterns of self-harm, reported childhood trauma and clinical outcome. BJPsych Open, 2015. Vol. 1 (1), pp. 18—20. doi:10.1192/bjpo.bp.115.000117
  34. Muehlenkamp J.J., Claes L., Smits D., et al. Non-suicidal self-injury in eating disordered patients: A test of a conceptual model. Psychiatry Research, 2011. Vol. 188 (1), pp. 102—108. doi:10.1016/j.psychres.2010.12.023
  35. Muehlenkamp J.J., Kerr P.L., Bradley A.R., et al. Abuse Subtypes and Nonsuicidal Self-Injury. The Journal of Nervous and Mental Disease, 2010. Vol. 198 (4), pp. 258— 263. doi:10.1097/nmd.0b013e3181d612ab
  36. Navarro-Haro M.V., Wessman I., Botella C., et al. The role of emotion regulation strategies and dissociation in non-suicidal self-injury for women with borderline personality disorder and comorbid eating disorder. Comprehensive Psychiatry, 2015. Vol. 63, pp. 123—130. doi:10.1016/j.comppsych.2015.09.001
  37. Nock M.K. Future directions for the study of suicide and self-injury. Journal of Clinical Child and Adolescent Psychology, 2012. Vol. 41 (2), pp. 255—259. doi:10.10 80/15374416.2012.652001
  38. Nock M.K. Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 2009. Vol. 18 (2), pp. 78—83.
  39. Oldershaw A., Lavender T., Sallis H. et al. Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clinical Psychology Review, 2015. Vol. 39, pp. 83—95. doi:10.1016/j.cpr.2015.04.005
  40. Palmisano G.L., Innamorati M., Sarracino D., et al. Trauma and dissociation in obese patients with and without binge eating disorder: A case—control study [Elektronnyi resurs]. Cogent Psychology, 2018. Vol. 5 (1). Available at: https://www. tandfonline.com/doi/full/10.1080/23311908.2018.1470483 (Accessed 15.01.2020). doi:10.1080/23311908.2018.1470483
  41. Palmisano G.L., Innamorati M., Susca G., et al. Childhood traumatic experiences and dissociative phenomena in eating disorders: Level and association with the severity of binge eating symptoms. Journal of Trauma & Dissociation, 2018. Vol. 19 (1), pp. 88—107. doi:10.1080/15299732.2017.1304490
  42. Perez S., Lorca F., Marco J.H. Dissociation, posttraumatic stress symptoms, emotional dysregulation, and invalidating environments as correlates of NSSI in borderline personality disorder patients [Elektronnyi resurs]. Journal of Trauma & Dissociation, 2020. Availble at: https://www.tandfonline.com/doi/full/10.1080/152 99732.2020.1719262 (Accesed 29.02.2020). doi:10.1080/15299732.2020.1719262
  43. Pérez S., Marco J.H., Cañabate M. Non-suicidal self-injury in patients with eating disorders: prevalence, forms, functions, and body image correlates. Comprehensive Psychiatry, 2018. Vol. 84, pp. 32—38. doi:10.1016/j.comppsych.2018.04.003
  44. Pignatelli A. M., Wampers M., Loriedo C., et al. Childhood neglect in eating disorders: A systematic review and meta-analysis. Journal of Trauma & Dissociation, 2016. Vol. 18 (1), pp. 100—115. doi:10.1080/15299732.2016.1198951
  45. Rallis B.A., Deming C.A., Glenn J.J., et al. What is the role of dissociation and emptiness in the occurrence of nonsuicidal self-injury? Journal of Cognitive Psychotherapy, 2012. Vol. 26, pp. 287—298. doi:10.1891/0889-8391.26.4.287
  46. Sadeh N., Londahl-Shaller E.A., Piatigorsky A., et al. Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms. Psychiatry Research, 2014. Vol. 216 (2), pp. 217—222. doi:10.1016/j. psychres.2014.02.018
  47. Scalabrini A., Cavicchioli M., Fossati A., et al. The extent of dissociation in borderline personality disorder: a meta-analytic review. Journal of Trauma & Dissociation, 2017. Vol. 18 (4), pp. 522—543. doi:10.1080/15299732.2016.1240738
  48. Schauer E., Elbert T. The psychological impact of child soldiering. In Martz E. (ed.). Trauma rehabilitation after war and conflict. New York, NY: Springer, 2010, рp. 311—360.
  49. Schauer M., Elbert T. Dissociation following traumatic stress. Zeitschrift für Psychologie, 2010. Vol. 218 (2), pp. 109—127. doi:10.1027/0044-3409/a000018
  50. Shenk C.E., Noll J.G., Cassarly J.A. A multiple mediational test of the relationship between childhood maltreatment and non-suicidal self-injury. Journal of Youth and Adolescence, 2010. Vol. 39 (4), pp. 335—342. doi:10.1007/s10964-009-9456-2
  51. Swannell S., Martin G., Page A., et al. Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame. Child Abuse & Neglect, 2012. Vol. 36 (7—8), pp. 572—584. doi:10.1016/j. chiabu.2012.05.005
  52. Trickett P.K., Noll J.G., Putnam F.W. The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology, 2011. Vol. 23 (2), pp. 453—476.
  53. Van der Kolk B.A., Pelcovitz D., Roth S., et al. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. The American Journal of Psychiatry, 1996. Vol. 153 (7), рр. 83—93.
  54. Van der Kolk B.A., Perry J.C., Herman J.L. Childhood origins of self-destructive behavior. American Journal of Psychiatry. 1991, Vol. 148 (12), рр. 1665—1671.
  55. Van Dijke A., Hopman J.A., Ford J.D. Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder [Elektronnyi resurs]. European Journal of Psychotraumatology, 2018. Vol. 9 (1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5795767/ (Accessed 15.01.2020). doi:10.1080/20008198.2017.1400878
  56. Van Dijke A., van der Hart O., Ford J.D., et al. Affect Dysregulation and Dissociation in Borderline Personality Disorder and Somatoform Disorder: Differentiating Inhibitory and Excitatory Experiencing States. Journal of Trauma & Dissociation, 2010. Vol. 11 (4), pp. 424—443. doi:10.1080/15299732.2010.496140
  57. Vanderlinden J., Palmisano G. Trauma and Eating Disorders: The State of the Art. In Seubert A.J., Virdi P. (eds.). Trauma-Informed Approaches to Eating Disorders. New York: Springer Publishing Company, 2018, pp. 15—32.
  58. Vermetten E., Spiegel D. Trauma and dissociation: Implications for borderline personality disorder. Current Psychiatry Reports, 2014. Vol. 16 (2), pp. 1—10. doi:10.1007/s11920-013-0434-8
  59. Yates T.M. The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 2004. Vol. 24 (1), pp. 35—74. doi:10.1016/j.cpr.2003.10.001
  60. Zetterqvist M., Lundh L., Göran Svedin C. A cross-sectional study of adolescent non-suicidal self-injury: Support for a specific distress-function relationship. Child and Adolescent Psychiatry and Mental Health, 2014. Vol. 8, pp. 23—37. doi:10.1186/1753-2000-8-23

Information About the Authors

Natalia A. Polskaya, Doctor of Psychology, Associate Professor, Professor of the Clinical Psychology and Psychotherapy Department, Faculty of Counseling and Clinical Psychology, Moscow State University of Psychology & Education, Leading Researcher, Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva of the Moscow Department of Public Health, Moscow, Russia, ORCID: https://orcid.org/0000-0002-7305-5577, e-mail: polskayana@yandex.ru

Mariya A. Melnikova, post-graduate student of the Councelling and Clinical Psychology Department, Moscow State University of Psychology & Education, Moscow, Russia, ORCID: https://orcid.org/0000-0003-2729-9877, e-mail: melnikova-ma@mail.ru



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