Rossi Rodolfo, Jannini Tommaso B, Socci Valentina, Pacitti Francesca, Rossi Alessandro, Di Lorenzo Giorgio
Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy.
Gen Psychiatr. 2025 Apr 5;38(2):e101277. doi: 10.1136/gpsych-2023-101277. eCollection 2025.
Non-suicidal self-injury (NSSI) is a significant health concern among adolescents and young adults, often resulting from adverse childhood experiences (ACEs). Dissociation, post-traumatic symptoms and attachment style may have a role in shaping such associations.
This study aims to provide a unified model of the impact of ACEs on NSSI, exploring complex post-traumatic stress disorder (cPTSD) symptoms and dissociation as potential mediators and the role of the predominant attachment style in affecting such associations.
1010 young individuals attending the last year of high school participated in this cross-sectional study. ACEs, cPTSD, dissociation and NSSI were evaluated using self-report questionnaires. We fitted a path model of NSSI, with ACEs as exogenous variables and cPTSD and dissociation as sequential mediators. Secure, fearful and preoccupied attachment styles were modelled as grouping variables.
Our findings showed that dissociation mediated the impact of ACEs on NSSI in subjects with a fearful attachment style, as opposed to those with a preoccupied attachment for whom cPTSD symptoms mediated the ACEs-NSSI association.
Attachment styles moderate the relationship between ACEs and NSSI, with either dissociation or post-traumatic symptomatology mediating the impact of ACEs on NSSI, depending on the predominant attachment style. Our results highlight the importance of attachment as a pathway modifier in the relationships between different psychopathology dimensions, providing a useful framework to better conceptualise the ACEs-NSSI association.
非自杀性自伤（NSSI）是青少年和青年中一个重大的健康问题，通常由童年不良经历（ACEs）导致。解离、创伤后症状和依恋风格可能在塑造这种关联中起作用。
本研究旨在提供一个关于ACEs对NSSI影响的统一模型，探讨复杂创伤后应激障碍（cPTSD）症状和解离作为潜在中介变量，以及主要依恋风格在影响这种关联中的作用。
1010名即将高中毕业的年轻人参与了这项横断面研究。使用自我报告问卷评估ACEs、cPTSD、解离和NSSI。我们构建了一个NSSI的路径模型，将ACEs作为外生变量，cPTSD和解离作为顺序中介变量。将安全型、恐惧型和痴迷型依恋风格作为分组变量进行建模。
我们的研究结果表明，在恐惧型依恋风格的个体中，解离介导了ACEs对NSSI的影响，而在痴迷型依恋风格的个体中，cPTSD症状介导了ACEs与NSSI之间的关联。
依恋风格调节了ACEs与NSSI之间的关系，根据主要依恋风格的不同，解离或创伤后症状学介导了ACEs对NSSI的影响。我们的结果强调了依恋作为不同心理病理学维度之间关系的途径调节因素的重要性，为更好地概念化ACEs与NSSI之间的关联提供了一个有用的框架。
