Seksuelt misbrug i barndommen og selvskadende adfærd: ingen sammenhæng

Man har længe antaget at årsagen til selvskadende adfærd er multi-faktuel, hvor seksuelt misbrug i barndommen er en prominent faktor. En meta-analyse i tidsskriftet British Journal of Psychiatry afviser den antagelse og påviser i stedet at der kun er en lille statistisk sammenhæng på 5 % mellem seksuelt misbrug og selvskadende adfærd. Der er altså ingen evidens for at seksuelt misbrug medfør selvskadende adfærd som cutting (at skære i sig selv), hælde kogende vand over sig, brændemærke sig selv med cigaretter, etc.. I stedet ser det ud til at årsagen til selvskadende adfærd bunder i flere psykiatriske risikofaktorer.

De undersøgelser der hidtil er blevet publiceret om en sammenhæng mellem seksuelt misbrug og selvskadende adfærd har bias i materialet, påviser forskerne altså i denne meta-analyse.

British Journal of Psychiatry: Childhood sexual abuse and non-suicidal self-injury: meta-analysis, (2008) 192: 166-170; E. David Klonsky, PhD and Anne Moyer, PhD,

Abstract

Background

Many theorists posit that childhood sexual abuse has a central role in the aetiology of self-injurious behaviour. Studies that report statistically significant associations between a history of such abuse and self-injury are cited to support this view.

Aims

A meta-analysis was conducted to determine systematically the magnitude of the association between childhood sexual abuse and self-injurious behaviour.

Method

Forty-five analyses of the association were identified. Effect sizes were converted to a standard metric and aggregated.

Results

The relationship between childhood sexual abuse and self-injurious behaviour is relatively small (mean weighted aggregate {varphi}=0.23). This figure may be inflated owing to publication bias. In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Conclusions

Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.

Om risikofaktorer henvises der til:

Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 2001; 158: 848–56.

Om arbejde med selvskadende adfærd:
Sundhedspersonale der arbejder med mennesker der udøver selvskadende adfærd, henvises til denne artikel: E. David Klonsky, Jennifer J. Muehlenkamp, Self-injury: A research review for the practitioner, Journal of Clinical Psychology, November 2007, Volume 63, Issue 11 , Pages 1045 – 1056.

PodCast: Childhood sexual abuse and non-suicidal self-injury: meta-analysis.
Dr. David Klonsky is an associate Professor of Psychology, based at the Department of Psychology, Stony Brook University, New York. Here he talks to Raj Persaud about his paper, co-authored by Anne Moyer and published in the March issue of The British Journal of Psychiatry on childhood sexual abuse and non-suicidal self-injury: meta-analysis.

Hjemmeside: Raj Persaud talks to

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