The Duality of Harm: The Co-occurrence and Risk Factors of Self-directed and Other-directed Harm in a Subclinical Sample

Dual-harm, the co-occurrence of self-directed and other-directed harm, has received increasing attention due to its compounded public health impact. This study aimed to (1) identify latent profiles of harmful behaviors in a subclinical sample and (2) to examine between-profile differences in distal and proximal risk factors, guided by the Cognitive-Emotional Model for dual-harm (CEM-DH). A convenience sample of 378 subclinical participants who engaged in self- and/or other-harm (Mage = 24.0, SD = 8.9; 71.2% female) completed self-report questionnaires. First, Latent Profile Analysis identified four harm-based profiles: low-harm, self-harm, other-harm, and dual-harm. While self-harm and other-harm co-occurred to some degree across all profiles, the dual-harm group was distinguished by frequent and clinically severe behaviors, including more lethal self-harm and more criminally offensive other-harm. Second, Bayesian ANOVAs revealed that dual-harm was associated with elevated maladaptive personality traits and greater exposure to childhood physical trauma. The self-harm profile showed higher internal distress, marked by negative affectivity and emotion dysregulation. Impulsivity appeared to serve as a shared vulnerability factor rather than a profile-specific marker. Overall, our findings imply that mere co-occurrence of self- and other-harm is relatively common and might be insufficient to define dual-harm. Instead, dual-harm may be best characterized by the interchangeable use of self- and other-directed behaviors at elevated levels of frequency and severity, reflecting broader psychopathological vulnerability. These results underscore the importance of assessing behavioral severity, functional overlap, and underlying risk factors to better understand and intervene in dual-harm.Keywords: non-suicidal self-injury, aggression, self-harm, other-harm, dual-harm, latent profile analysis, childhood trauma, maladaptive personality, impulsivity, emotion dysregulation