Affect Regulation as a Mediator of Attachment and Deliberate Self‐Harm

The authors used structural equation modeling to test the mediational role of affect regulation on attachment and deliberate self-harm in 216 undergraduates. Results suggest that affect regulation mediates the relationship between attachment and deliberate self-harm, providing support for the theoretical importance of attachment and affect regulation in the etiology of self-harm behaviors. Accordingly, attachment styles should be considered when providing clinical assistance to college students in an effort to improve affect regulation and to treat deliberate self-harm. ********** Deliberate self-harm has been defined as "the deliberate, direct destruction or alteration of body tissue without conscious suicidal intent" (Favazza, 1998, p. 260). Although skin-cutting is the most common form of deliberate self-harm, other methods include burning and hitting oneself (Favazza & Rosenthal, 1993). Whereas deliberate self-harm may signal severe psychiatric disturbance, there is considerable evidence that members of the general population and mildly debilitated clinical populations use deliberate self-harm to regulate negative affect (Osuch, Nail, & Putnam, 1999; Ross & Heath, 2003). Although deliberate self harm is often perceived by a self-harming individual as helpful in temporarily managing emotional discomfort, it may result in physical disfigurement, social isolation, hospitalization, and even death (Kahan & Pattison, 1984; Suyemoto, 1998). To develop effective treatment interventions for use within the counseling profession, it is important to understand etiological factors related to deliberate self-harm. A preponderance of research investigating deliberate self-harm has been conducted among psychiatric inpatient and incarcerated populations (see, for example, Babus et al., 2000; Haines, Williams, & Brain, 1995). However, a growing body of research has investigated deliberate self-harm in adolescents, college students, and adults in the general population (Favazza, 1998; Gratz, 2001; Ross & Heath, 2002). Among college students, the incidence of deliberate self-harm has been estimated to range from 12% to 38% (Gratz, Conrad, & Roemcr, 2002; Suyemoto, 1998). Furthermore, according to a 2004 national survey of college and university counseling center directors, 54% reported an increase in deliberate self-harm among their clients, indicating that deliberate self-harm is a growing mental health problem on college campuses (Gallagher, 2004). To inform prevention and treatment of deliberate self-harm on college and university campuses, additional research is needed using clinical and community samples drawn from college student populations. Despite the sizeable estimates of deliberate self-harm among college students, this population has rarely been the focus of empirical research. Moreover, research attempting to measure deliberate self-harm among college students has typically included lifetime incidence of self-harming behaviors, making it difficult to discern to what extent college students continue to engage in deliberate self-harm after making the transition to college (Gratz et al., 2002; Paivio & McCulloch, 2004). This distinction is particularly important given the research that suggests that deliberate self-harm among adolescents is often a temporary, rather than a chronic behavior (Ross & Heath, 2002).There is a need for the research conducted with members of college populations to use deliberate self-harm measures that would identify the extent to which self-harm begins in, or continues into, the college years. Whereas there has been some progress in research investigating the functional aspects of deliberate self-harm, there has been less attention devoted to etiological factors associated with the phenomenon and to how these factors might interact (Warm, Murray, & Fox, 2003). Moreover, research analyzing theoretical path models that involve mediated relationships is only beginning to emerge. …