Taunton, Kirsty
(2025)
Adverse childhood experiences, self-harm, and aggression: an emotion-regulatory pathway.
DForenPsy thesis, University of Nottingham.
Abstract
The association between childhood adversity and negative outcomes including harm to self and others has been well established. Less is known however about the mechanisms that underlie these relationships. Harm to self and others has significant costs at an individual and societal level. Elucidating the causal pathways between adverse childhood experiences (ACEs) and harm to self and others is vital to informing clinical practice and is the focus of this thesis. Initially, a systematic review synthesises research investigating psychological mechanisms that mediate the relationship between childhood adversity and self-harm in clinical and forensic adult populations. Findings provide preliminary support for an emotion-regulatory pathway connecting childhood adversity to self-harm. Several other psychological mechanisms were also identified, albeit methodological limitations restrict the ability to draw firm inferences regarding causality and mediation effects. Moreover, there was a distinct lack of studies conducted with forensic inpatients, limiting the generalisability of findings to this population. Thereafter, an empirical study investigates the associations between ACEs, and self-harm and aggression, and the mediating role of emotion dysregulation, in a sample of male and female forensic inpatients detained in low- and medium-secure conditions. ACEs were positively correlated with self-harm and aggression, and emotion dysregulation partially mediated these relationships; an effect that remained after controlling for age and gender. Following this, a single case study of a female detained in a medium-secure unit, characterised by ACEs, emotion dysregulation, self-harm, and aggression, is presented. An evaluation of the intervention delivered to target the patient’s difficulties indicated positive outcomes, evidenced by changes in pre- and post-intervention psychometric tests and observed behavioural changes. Lastly, a critical evaluation of the Difficulties in Emotion Regulation Scale (DERS) examines its psychometric properties and clinical utility. The DERS was found to be a sound measure of emotion dysregulation appropriate for use among a range of populations and cultures. However, further research is needed to evaluate its psychometric efficacy and clinical utility amongst more unique populations, such as forensic inpatients. This thesis emphasises the importance of considering developmental perspectives and an emotion-regulatory pathway in the aetiology and maintenance of harmful behaviours, as well as the need for therapeutic interventions targeting the psychological mechanisms underpinning the relationships between childhood adversity, and self-harm and aggression.
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