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Self-Injurious Behavior in a Community Sample of Young Women: Relationship With Childhood Abuse and Other Types of Self-Damaging Behaviors

Angela Favaro, M.D., Ph.D., M.Sc.; Silvia Ferrara, Ph.D.; and Paolo Santonastaso, M.D. 


Objective: The prevalence of self-injurious behavior (SIB) in the general population is unknown. The present study aims to assess the prevalence and dimensionality of a large spectrum of SIBs in a community sample of young women.

Method: A cohort of female subjects aged 18 through 25 years resident in 2 areas of a large city was involved in the study, which was conducted from December 1996 to August 1998. Subjects (N = 934) underwent a clinical interview to assess the presence of SIBs, childhood sexual and physical abuse, suicidality, use of illicit drugs, alcohol abuse, and DSM-IV lifetime eating disorder diagnosis.

Results: About 24% of the sample reported some type of SIB. The factor analysis revealed that the different types of SIBs tend to group into 4 dimensions: 2 characterized by impulsive features and the other 2 by compulsive features. Body image disturbance (p < .01), emotional distress (p < .001), alcohol/substance misuse (p < .05), and suicide attempts (p < .01) were significantly associated with both compulsive and impulsive SIBs. In addition, the presence of impulsive SIBs was significantly predicted by a lower level of education (p < .05), lifetime eating disorders (p < .01), and childhood abuse (p < .05), whereas skin picking/self-biting was predicted by childhood sexual molestation (p < .04) and childhood rape (p < .005).

Conclusion: Self-injurious behaviors are common among young women. There is a significant association between SIBs and other forms of direct and indirect self-damaging behaviors, including alcohol abuse, use of illicit substances, suicidality, and eating disorders. Further research is needed to better understand the nosology of this spectrum of behaviors.

(J Clin Psychiatry 2007;68:122-131)


Received March 5, 2006; accepted July 17, 2006. From the Department of Neurosciences, University of Padua, Padua, Italy.

The study was performed without any external financial help.

A preliminary version of this article was presented at the 9th annual meeting of the Eating Disorders Research Society, October 1-4, 2003, Ravello, Italy.

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Drs. Favaro, Ferrara, and Santonastaso have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services consumed by, or used on, patients to disclose relative to the article.

Corresponding author and reprints: Paolo Santonastaso, M.D., Clinica Psichiatrica, Dipartimento di Neuroscienze, via Giustiniani 3, 35128 Padova, Italy (e-mail: paolo.santonastaso@unipd.it).