Early child abuse is, like other early life adversities, an important risk factor for the development of later mental health problems and plays a central role in the development of psychological disorders (Caplan et al., 2016; Hart, & Rubia, 2012).
The general term ‘child abuse’ can be divided into four subcategories: neglect, physical abuse, emotional abuse and sexual abuse. Neglect can be described as the failure of the caregiver to meet the nutritional needs of the child, as well as failure to provide for the safety, shelter, and supervision of the child. Neglect can be both physical and emotional (Hart, & Rubia, 2012). Physical abuse implies that the child is injured by the caregiver. This can be done via different non-accidental means, for example punching, hitting and kicking (Hart, & Rubia, 2012). Emotional abuse is another form of hurting children; it implies that a child is rejected, isolated, terrorized and corrupted by his or her caregiver. Verbal abuse is also a part of emotional abuse (Hart, & Rubia, 2012). Finally, sexual abuse can be described as “any sexual act with a child performed by an adult or older child” (Hart, & Rubia, 2012, p. 1). Unfortunately, most children experience more types of abuse at the same time. In their research, Kuo, Khoury, Metcalfe, Fitzpatrick and Goodwill (2015) mention that the different types of abuse usually do not occur in isolation. For example, children who experience sexual abuse, also tend to report emotional abuse (Kuo et al., 2015).
Child abuse can have devastating effects on the development of children (Paivio, & Laurent, 2001), and also on the way children deal with their emotions. The way children handle their emotions is called ‘emotion regulation’, which can be defined as the psychological and physiological processes that allow people to modulate feelings, behaviours, and physiological responses so they are able to respond in an appropriate manner to demands of the environments, especially when emotional distress is present. (Mandavia, Robinson, Bradley, Ressler, & Powers, 2016; Hiraoka, Crouch, Reo, Wagner, Milner, & Skowronski, 2016). Emotion regulation involves that one is able to understand emotions, to accept them, to inhibit impulsive behaviour, and to use different emotion regulation strategies to meet the situational demands (Stevens et al., 2013).
It is suggested that children adjust the way in which they handle emotions to their specific situations (Stevens et al., 1013). Children who are emotionally abused, live in environments in which they are punished for their emotions, or are told that their emotional reactions are wrong and need to be ignored (Stevens et al., 2013). For children who experience sexual abuse, it might be helpful to suppress emotions and to dissociate from the abuse, in order to be able to survive the abuse (Stevens et al., 2013). In a healthy situation, children need their parents in order to acquire emotion regulation skills. But given the fact that parents or other caregivers are often the perpetrators of child abuse, abused children might lack those skills (Kuo et al., 2015). As a result, abused children need to find out their own strategies to deal with their distress, which can lead to difficulties in emotion regulation, which are theorized to play an important role in the development of maladaptive behavioural responses (Hiraoka et al., 2016). It may also affect one’s ability to understand others and to be accepted by others, and most important, the ability to enjoy oneself (Mandavia et al., 2016).
As mentioned before, emotion regulation problems can lead to maladaptive behavioural responses and externalizing behavioural problems, for example poor impulse control an aggression (Hart, & Rubia, 2012). It is hypothesized that poor impulse control might be linked to non-suicidal self-injury in adolescents (Auerbach et al., 2014; Mossige, Huang, Straiton, & Roen, 2016). It seems that there is an association between child abuse and self-injury, but the specific pathways are unclear (Auerbach et al., 2014). It might be the case that certain types of abuse might lead to self-injury, whereas other types of abuse might not. Mossige and colleagues (2016) suggest that sexual abuse might be specifically related to self-injury, because those children are very familiar with feelings of shame and also tend to blame themselves for the abuse, which in turn leads to the self-harming behaviour.
Based on previous research, several questions arise. Is there a relationship between child abuse and self-harm? And since emotion regulation plays such an important role in determining how children respond to child abuse, is emotion regulation style related to self-injury? Does emotion regulation mediate the potential relationship between child abuse and self-injury?
In line with past research, I hypothesize that there is a positive relationship between child abuse and self-injury and that the way children regulate their emotions is also related to self-injury. Finally, considering the important role emotion regulation seems to play in determining behavioural responses of children and adolescents, I expect that emotion regulation at least partially mediates the potential relationship between child abuse and self-injury.
2. Methods
2.1 Participants
This study is part of a larger study about the associations between childhood trauma, borderline personality features, and intimate partner violence.
Respondents will be recruited via the SONA system of the Leiden University and via social media and online forums for people with Borderline features, childhood trauma experiences and/or intimate partner violence, in order to be able to reach a mixed population (clinical and non-clinical sample). Both males and females will be included in the study. In order to be able to participate, respondents should be aged above 18. The estimated number of respondents is between 150 and 400.
Since the study is in English, a sufficient level of English is required. This will be checked by asking for level of English explicitly in the beginning of the study. When respondents indicate that they have difficulties with understanding English, this will lead to termination of the survey. At the end of the survey, respondents can indicate if they have had any trouble with understanding the questions due to lack of English proficiency. If respondents indicate this was the case, they will be excluded from the study.
2.2 Procedure
Childhood trauma, emotion regulation strategies and self-harm will assessed using self-report scales, which are described below. The online survey software Qualtrics will be used for the data collection. Respondents will receive a link which gives them access to the survey, and after they have read and signed the informed consent, the survey will begin. Before moving on to the questionnaires below, respondents will complete a short questionnaire about their demographics; age, nationality, relationship status, highest completed level of education, gender, employment and possible medication and/or psychological treatment.
The Childhood Trauma Questionnaire, the Cognitive Emotion Regulation Strategies Inventory and the Self-Harm Inventory will be presented to the respondents in a randomized order. After completion of the survey, respondents can leave their e-mail address if they are willing to participate in a lottery. Also, respondents will be debriefed about the constructs and hypotheses of this study and they can indicate whether they would like to be informed about the outcomes of the study.
Respondents who sign up for the survey via the SONA system, receive one credit for their participation. The total survey will take approximately 35 minutes.
2.3 Measures
Child abuse
Child abuse will be assessed using the Childhood Trauma Questionnaire (CTQ) (Bernstein & Fink, 1998). The 28-item questionnaire consists of five subscales, assessing emotional, physical and sexual abuse and emotional and physical neglect. Respondents are asked to rate items on a scale: (1) never true, (2) rarely true, (3) sometimes true, (4) often true, and (5) very often true. According to Paivio & Cramer (2004), the abuse subscales show high internal consistencies ( = .84 to .92) and strong reliability ( = .87 to .96).
Self-injury
Respondents will complete the Self-Harm Inventory (SHI) (Sansone, Sansone & Wiederman, 1995) to assess self-injury. This questionnaire consists of 22 yes/no items. Each item starts with the following phrase: ‘Have you ever intentionally, or on purpose…’ (Sansone, Sansone, & Wiederman, 1995). Three of the questions are related to eating disorders (e.g. ‘…starved yourself to hurt yourself’), two items are related to high-lethal behaviour (e.g. ‘…attempted suicide’) and three questions relate to medical issues (e.g. ‘…prevented wounds from healing’) (Sansone, Sansone & Wiederman, 1995). Other individual items include for example self-mutilation, and self-hitting. It takes 5 minutes to complete the inventory.
Sansone et al. (2006) report that internal consistency of the inventory is good; between .80 and .90.
Emotion regulation
Emotion regulation will be assessed using the Cognitive Emotion Regulation Inventory (CERQ) (Garnefski, Kraaij, & Spinhoven, 2001). This self-report questionnaire measures the cognitive emotion regulation strategies of the respondent after he or she experienced a negative event or situation. In this study, the short version of the CERQ will be used, which consists of 18 items. Those items measure 9 different coping strategies: self-blame, other-blame, rumination, catastrophizing, positive refocusing, planning, positive reappraisal, putting into perspective and acceptance (Garnefski, Kraaij, & Spinhoven, 2001).
For each item, respondents will indicate whether the item applies to them on a five point Likert scale from 1 (almost never) to 5 (almost always). Garnefski and Kraaij (2007) found that all the subscales had good internal consistencies ranging from .68 to .86.
2.4 Analyses
The data that will be obtained, will be analysed in SPSS. First, I will do a multiple regression analyses, to see whether child abuse and self-harm and emotion regulation style are related with each other, followed by a mediation analyses to find out whether emotion regulation can mediate the possible relationship between child abuse and self-harm.