The Impact of Adverse Childhood Experiences on Therapy Outcome in Adolescents Engaging in Nonsuicidal Self-Injury.

Alexandra Edinger,Romuald Brunner,Peter Parzer,Franz Resch,Michael Kaess,Gloria Fischer-Waldschmidt

doi:10.3389/fpsyt.2020.505661

Abstract

Objective: Nonsuicidal self-injury (NSSI) is a prevalent and clinically significant behavior. There is a substantial association between adverse childhood experiences (ACEs) and NSSI. However, there are no studies investigating the impact of ACEs on NSSI treatment (psychotherapy) outcome. The aim of this secondary analysis of a randomized controlled trial (RCT) on psychotherapy of NSSI was to investigate the relationship between ACEs and treatment outcome in adolescents engaging in NSSI.Method: A sample of 74 adolescent outpatients engaging in repetitive NSSI (incidents on ≥ 5 days within the last 6 months) was recruited for a RCT. ACEs were assessed by the Childhood Experience of Care and Abuse (CECA) interview before treatment onset. Based on the CECA, participants were divided in two groups: with a history of ACEs (n = 30) and without a history of ACEs (n = 44). Frequencies of NSSI, depression, and suicide attempts as well as quality of life were measured at three points in time: before treatment onset (baseline; T0), 4 (T1), and 10 months (T2) after treatment onset.Results: Both participants with and without ACEs were able to reduce the frequency of NSSI significantly [χ2(1) = 26.72; p < 0.001]. Surprisingly, participants with ACEs reached a significantly greater reduction in NSSI frequency within the past 6 months compared to participants without ACEs [χ2(1) = 5.08; p = 0.024]. There were also substantial and similar improvements regarding depressive symptoms, suicide attempts and quality of life in both groups.Conclusion: ACEs seem to positively predict treatment response in psychotherapy for adolescent NSSI. This is contrary to prior research suggesting ACE as an unfavorable prognostic factor in the treatment of mental disorders.Clinical Trial Registration: Short term therapy in adolescents with self-destructive and risk-taking behaviors; http://www.drks.de; DRKS00003605.

Highlights

Nonsuicidal self-injury (NSSI) is defined “as the deliberate, selfinflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned” (International Society for the Study of Self-Injury, ISSS)
NSSI is associated with a variety of psychiatric disorders, including posttraumatic stress disorder (PTSD) [8] and borderline personality disorder (BPD), it occurs without any comorbid diagnoses [9]
It should be taken into account that the potential risk of a recall bias may still have influenced the present findings. With these reservations in mind, this study suggests that participants with adverse childhood experiences (ACEs) showed similar, and in terms of NSSI even greater improvements during psychotherapeutic treatment compared to participants without a history of ACEs

Summary

Introduction

Nonsuicidal self-injury (NSSI) is defined “as the deliberate, selfinflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned” (International Society for the Study of Self-Injury, ISSS). NSSI is categorized as an independent disorder in need of further study in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. It is a highly recurrent behavior and peaks in adolescence [2, 3]. The prevalence rate for repetitive NSSI using the criteria of the DSM-5 ranges between 1.5 and 6.7% in a recent community study [6]. NSSI is exhibited by 50–60% of adolescents [7]. NSSI is associated with a variety of psychiatric disorders, including posttraumatic stress disorder (PTSD) [8] and borderline personality disorder (BPD), it occurs without any comorbid diagnoses [9]

Methods

Results

Discussion

Conclusion