Adverse childhood experiences, attachment, and daily-life self-harm in adolescents: an Experience Sampling study

Purpose: Self-harm is a leading cause of death and injury worldwide and is especially common amongst adolescents. Adverse childhood experiences (ACEs) are characterized as a risk factor for self-harm within the Integrated-Motivational Volitional (IMV) model. However, it is unclear how ACEs relate to self-harm as it unfolds in daily-life, and research investigating potential protective factors in the association between ACEs and self-harm is scarce. Here, we investigated whether ACEs were associated with lifetime and daily-life self-harm using Experience Sampling Methodology (ESM), and whether parent-child or peer attachment relationship quality influenced this association. Additionally, we explored whether specific types of ACEs were differentially associated with self-harm. Methods: A cross-sectional study using retrospective questionnaires to assess ACEs, lifetime self-harm thoughts and behaviours, and paternal, maternal, and peer attachment relationship quality, and ESM to assess daily-life self-harm thoughts and behaviours, 10x/day for 6 days. N=1014 adolescents (Age, Mean (SD) = 14.05 years (1.91), 66.66% female) were recruited from the general population via schools across Flanders (Belgium). Results: Multilevel analyses demonstrated associations between ACEs and lifetime and daily-life self-harm thoughts and behaviours, that were attenuated by a high-quality maternal attachment relationship. Specific types of ACEs (e.g., sexual victimization) were more strongly associated with lifetime and daily-life self-harm thoughts and behaviours.Conclusion: The study provides evidence for ACEs as a pre-motivational phase variable within the IMV model. Clinicians are encouraged to consider exposure to ACEs and the potential of maternal relationships to buffer their impact in the prevention and management of adolescent self-harm.