The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality

Abstract

Background

Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood.

Objective

This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality.

Participants and setting

We recruited 907 adults from clinical and community settings in Greater London.

Methods

The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model.

Results

The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising.

Conclusions

These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.

Highlights

• •

  Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it.

• •

  We employed structural equation modelling in a large clinical and community sample of 907 adults, consisting largely of individuals with personality disorders and used a novel approach to conceptualise childhood maltreatment as a general factor in a confirmatory bifactor model while studying this relationship.

• •

  We found that insecure attachment and compromised mentalising partially mediate this association and discuss these results within a mentalisation-based framework.