The serial mediational role of attachment and emotion regulation in the relationship between early life adverse experiences and self-harm in a group of individuals engaging in self-harm who interact in self-harm focused online platforms

Studies have demonstrated that adverse childhood experiences, attachment and emotion dysregulation are significant predictors of self-harm. Developmental theories of self-harm propose that adverse childhood experiences can influence attachment, which in turn has an impact on emotion dysregulation, leading to self-harm. However, to date no study has investigated this. The aim of this study was to investigate whether the relationship between early life experiences and self-harm is serially mediated by insecure attachment and emotion dysregulation. An observational cross-sectional study design was adopted for this study. A sample of 284 adults (77% females), 64% of whom acknowledged a mental health disorder and 49% of whom have attempted suicide before, was recruited online via specific self-harm groups on social media platforms (e.g. the subreddit r/AdultSelf-Harm on Reddit) and was asked to complete an online survey, consisting of four self-report questionnaires. Conditional process analysis was used to investigate the proposed model (using the PROCESS macro). The findings supported the serial mediation model [Indirect effect = 0.004, SE = 0.002, 95% CI (0.0007, 0.0090)], even after controlling for previous suicide attempts. The findings of the study seem to provide a fruitful start to the development of conceptual models of self-harm. Applications regarding early identification and assessment of self-harm and the development of specific interventions are discussed.