What is the relationship between dissociation and self-harming behaviour in adolescents?

Clin Psychol Psychother. 2019 May;26(3):328-338. doi: 10.1002/cpp.2354. Epub 2019 Mar 5.


Deliberate self-harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self-harm to end the aversive experience of dissociation, others propose that self-harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self-harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross-sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self-harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self-harm.

Keywords: adolescents; dissociation; self-harm; self-injury; teens.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adverse Childhood Experiences
  • Correlation of Data
  • Cross-Sectional Studies
  • Dissociative Disorders / diagnosis*
  • Dissociative Disorders / psychology
  • Female
  • Humans
  • Male
  • Self-Injurious Behavior / diagnosis*
  • Self-Injurious Behavior / psychology