Researchers describe the findings as both unique and alarming.
If children and adolescents grow up in families where they do not learn healthy ways to deal with emotions, they may lack the skills to manage emotions.(Photo: Victoria Chemaeva / Shutterstock / NTB)
More than half of children and adolescents who have experienced violence and abuse have harmed themselves, according to a new Norwegian study.
"These are concerning numbers," says Børge Sivertsen, senior researcher at the Norwegian Institute of Public Health.
He led the study, in which 308 children attending courses at the Stine Sofie Centre answered a series of questions from the researchers. The centre offers stays for children and adolescents with histories of abuse or violence.
Nearly 53 per cent report that they have harmed themselves. This is far higher than in the general youth population, where about 16 per cent of Norwegian adolescents say they have harmed themselves, Sivertsen explains.
"We expected the rate to be somewhat higher, but that it was this high, and that so many do it so frequently, was truly surprising," he says.
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Unique access to an 'invisible' group
The project, known as the Triple-S study, is unique worldwide, according to Sivertsen.
It's carried out in collaboration with the Stine Sofie Foundation, the National Centre for Violence and Traumatic Stress Studies, and the University of Bergen.
Børge Sivertsen at the Norwegian Institute of Public Health has led the study on self-harm among children and adolescents.(Photo: Michael Grasdalsmoen)
"Large population surveys don't capture this group. Either because the young people don't have the energy to participate, or because they aren’t identified. Collaborating with the Stine Sofie Foundation has made it possible for us to get a high response rate among this vulnerable group," says Sivertsen.
A bleak picture
The researchers found no major differences in self-harm among adolescents who had experienced different types of violence, with the exception of a small increase in cases of sexual abuse.
"A striking finding was the degree of overlap. Very few have experienced only one type of abuse. Most have experienced a combination of physical, emotional, and sexual violence," says Sivertsen.
He believes the findings paint a very bleak picture of these adolescents' living conditions.
The most vulnerable
Iselin Solerød Dibaj is a psychologist and researcher at the National Centre for Suicide Research and Prevention. She believes this study is very important.
"It directly reaches the most vulnerable, those often overlooked in population surveys and not always prioritised in clinical research," she says.
According to Dibaj, the results confirm what has long been known: Childhood trauma and trauma in close relationships are linked to higher rates of self-harm.
Iselin Solerød Dibaj has found that one particular treatment is highly effective against self-harm.(Photo: Åsne Rambøl Hillestad)
She notes that high rates of childhood trauma also appear in other studies on self-harm she has been involved in.
Multiple, complex problems
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Dibaj is not surprised that the type of abuse does not matter much for the severity of the trauma.
"Other factors likely play a larger role, such as who committed the abuse and how much support the child has in other relationships," she says, adding:
"This occurs more frequently in families with multiple, complex problems."
Self-harm as a coping mechanism
The researchers behind the Triple-S study point to the link between early trauma and difficulties in regulating emotions.
Many of those who self-harm do so because they lack other ways of managing their emotions, Dibaj explains.
"Childhood trauma can make emotions harder to regulate, making them feel more overwhelming and intense," she says.
If children and adolescents also grow up in families where they're not taught healthy ways to cope with emotions, they may lack the skills needed to handle them.
"They simply don't know what to do with such strong emotions. That makes them especially vulnerable to turning to self-harm," says Dibaj. "It may bring temporary relief, but ultimately worsens things over time, similar to substance use."
Effective treatment is available
In her own research, Dibaj has studied dialectical behaviour therapy (DBT), a treatment method that focuses on regulating emotions. This has proven to be very effective. You can read more about this in this article.
"The great thing about DBT is that it targets self-harm very early in the treatment. The youth are taught to use safe, alternative strategies for regulating their emotions," she says.
These alternatives can include mindfulness, problem-solving, intense physical exercise, or even a cold shower – all of which provide a similar short-term physical regulation effect, she explains.
Over time, DBT teaches individuals to pause, notice what is happening, and choose a different action when the urge to self-harm arises.
Dibaj emphasises the importance of involving parents or other caregivers in the treatment. Adults should also learn these skills and how to support their adolescents through the process.
She has followed adolescents who self-harmed into adulthood.
"Most have stopped harming themselves, but those who received DBT stopped earlier than those treated with other methods. Those who stop earlier also report having better strategies for regulating their emotions as adults," she explains.
Will continue to follow the youth
The Triple-S study will not end here.
Researchers plan to continue tracking the same children and adolescents into adulthood.
"Very few studies follow this group over time. Our main goal is to do exactly that," says Børge Sivertsen.
He explains that the researchers want to examine how these children and adolescents fare in terms of school and education, work, and health.
At the same time, they aim to identify protective factors that may help some cope better than others, such as support from family, friends, or teachers.
"The goal is both to prevent violence and abuse, and to make life easier for those already affected. To achieve this, we need more knowledge," says Sivertsen.
He adds that participants have given feedback saying they are grateful to be asked such highly sensitive questions.
"That makes this study especially important," he says.
