Deliberate self-harm and the nexus of violence, victimization, and mental health problems in the United States

Deliberate self-harm (DSH) is associated with diverse psychiatric diagnoses and broad psychopathology but less is known about its association with other forms of interpersonal violence and crime. Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the current study examined linkages between not only DSH and mental health and substance abuse comorbidity, but also childhood abuse, lifetime victimization, and a variety of violent behaviors. We identified a prevalence of 2.91% for DSH and found that DSH is associated with generalized and severe psychopathology, wide-ranging substance abuse, and adverse childhood experiences. Contrary to other studies, we found significant racial and ethnic differences in DSH. African-American, Latinos, and Asians, were substantially less likely than Whites to report DSH. Our hypothesis that DSH would be associated with a variety of violent behaviors including robbery, intimate partner violence, forced sex, cruelty to animals, and use of a weapon was supported even after adjusting for an array of covariates. We extend previous research on DSH by examining its prevalence in one the largest comorbidity surveys ever conducted and show that DSH is associated with multiple forms of violent behavior toward others, including animals.