Adolescents who self-harm and commit violent crime: Testing early-life predictors of dual harm in a longitudinal cohort study

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Objective. Self-harm is associated with violent offending. However, little is known about young people who engage in “dual-harm” behavior. We investigated antecedents, clinical features, and life characteristics distinguishing dual-harming adolescents from those who self-harm only.
Method. Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative UK cohort of 2,232 twins born in 1994-1995. Self-harm in adolescence was assessed through interviews at age 18. Violent offending was assessed using a computer questionnaire at age 18 and police records through age 22. Risk factors were assessed between ages 5-12. Adolescent mental health, victimization, personality functioning, and use of support services were measured at age 18.
Results. Self-harm was associated with violent crime (OR=3.50, 95% CI=2.61-4.70), even after accounting for familial risk factors. Dual-harmers had been victims of violence from childhood, and exhibited lower childhood self-control and lower childhood IQ than self-only harmers. Dual-harmers experienced higher rates of concurrent psychotic symptoms and substance dependence. They also exhibited distinct personality styles characterized by resistance to change and by emotional and interpersonal lability. However, dual-harmers were not more likely than self-only harmers to have contact with mental health services.
Conclusions. Dual-harmers have self-control difficulties and are immersed in violence from a young age. A treatment- rather than punishment-oriented approach is indicated to meet these individuals’ needs. Connecting self-harming adolescents with delinquency-reduction programs and transdiagnostic approaches that target self-regulation may reduce harmful behaviors. Preventing childhood maltreatment and implementing strategies to reduce victimization exposure could mitigate risk for both internalized and externalized violence.
Original languageEnglish
Pages (from-to)186-195
Number of pages10
JournalThe American Journal of Psychiatry
Issue number3
Early online date4 Jan 2019
Publication statusPublished - 1 Mar 2019


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