Are People Who Self-Harm More Likely to Be Violent to Others?
A new study published in The American Journal of Psychiatry found what at first may seem alarming to mental health advocates: Adolescents who self-harm are three times more likely to commit a violent crime than those who do not self-harm. However, what we really learn from this research, which was conducted by the Center for Child and Family Policy at Duke University, is just how harmful childhood trauma can be.
While researchers identified a correlation between self-harm and violence toward others, the main goal was to identify risk factors that led to both types of injurious behaviors. The study looked at more than 2,000 U.K. twins who were assessed for self-harm through age 18 and then violence or crime through age 22. As a result, 4.7 percent of study participants were identified as “dual harmers,” those who engaged in both self-harm and harm to others.
By looking at twins, Duke University researchers were able to determine that self-harm rather than family dynamics was a stronger predictor of future violence. The connection directly correlates to risk factors. Of the study participants with a history of both self-harm and outward violence, they had higher rates of multiple childhood traumas and were diagnosed with more than one mental health condition, especially psychotic symptoms and substance use.
For example, 33.3 percent of “dual harmers” experienced three or more types of victimization in childhood compared to 21.5 percent of those with a history of self-harm only and 2.4 percent of those without a history of any harm. Notably, 55.7 percent of “dual harmers” were exposed to conventional crime in childhood.
Researchers also concluded that those who self-harm and have violence in their history experienced difficulty in regulating their emotions, especially as young people. From this perspective, the connection between self-harm and violence has a similar underlying mechanism.
“Self-harm is often used to regulate negative emotions,” Leah Richmond-Rakerd, Ph.D., lead author of the study, told The Mighty. “It is possible that some individuals who self-harm also harm other people as another means by which to try and ‘solve the problem’ of distressing emotional experiences.”
While of course, not everyone who self-harms or experiences trauma is violent, a history of significant childhood trauma means you don’t always get the skills you need to navigate overwhelming emotions and relationships. When you learn to self-regulate through self-harm (and your body), it may seem like the best resource in other situations too.
“There’s underlying acceptance of engaging with the body in terms of expressing emotion,” explained Janis Whitlock, Ph.D., MPH, director of the Cornell Research Program on Self-Injurious Behaviors and co-author of the book “Healing Self-Injury.” “Acting out on the body is an expression of an emotional state. Whether it’s my body or somebody else’s body is probably not such a great leap.”
However, there’s a crucial distinction missing in this study. Richmond-Rakerd and her team don’t distinguish between non-suicidal self-injury and suicidal self-injury methods of harm. Non-suicidal self-injury includes generally less lethal behaviors that are used to regulate emotions so you feel better, not to attempt suicide. Suicidal self-harm has a much different — and often more violent — intent.
“While non-suicidal self-injury is physical and it looks violent and of course that is true, it doesn’t require the same psychological capacity as it requires to conceive of [suicidal behaviors]. That’s a different psychological step,” Whitlock told The Mighty. “Even people who are self-injurious who use non-suicidal self-injury to feel better and who are or become suicidal will almost always use another method.”
Indeed Duke University’s study found a difference in the self-harm methods between those who only reported self-harm and those who both self-harmed and had a violent history. The implications of this distinction and potential intervention differences are unclear, but it could be a critical area of further investigation on the connection between self-harm, violence and childhood trauma.
“We observed that dual harmers tended to engage in self-harm behaviors that were more potentially lethal,” Richmond-Rakerd said. “However, because many of the self-harm methods were reported by a relatively small number of adolescents, we did not statistically test whether the dual and self-only harm groups differed in the types of methods they used.”
If you self-harm, it might be discouraging to see the results of this study. Keep in mind most people who self-harm or live with a mental health condition are not violent. An estimated 3 to 5 percent of those with mental illness have a history of violence, but those with severe mental health conditions are 10 times more likely to be the victim of a violent crime than commit one.
These research findings are still important because it gives us the opportunity to find better ways to support and treat those who survive childhood trauma as opposed to resorting just to punishment.
“Our research shows that dual harmers experience self-control difficulties and are victims of violence from a young age,” Richmond-Rakerd said. “A treatment-oriented rather than a punishment-oriented approach is needed to support dual harmers’ mental health and reduce their risk for harmful behaviors.”
Rather than add to the stigma of self-harm, this study advocates for a more compassionate approach to self-harm, violence, trauma and mental health. Because, as Whitlock said, what Richmond-Rakerd and her research team have really shown is just how devastating trauma can be. And we need better ways to heal.
“We’re getting a snapshot of what happens when human tolerances are exceeded. We don’t do well,” Whitlock said. “Humans need support. We need to feel cared for and we need to not be hurt. And if we’re hurt, we need extra resources and ways to heal. When those are not possible, then we act out and we act in.”
Header image via Benjavisa/Getty Images.