Cognitive-behavioural therapy for deliberate self-harm Slee, N.

Citation

Slee, N. (2008, April 24). Cognitive-behavioural therapy for deliberate self-harm. Retrieved from https://hdl.handle.net/1887/12835

Version: Not Applicable (or Unknown)

License: Leiden University Non-exclusive license Downloaded from: https://hdl.handle.net/1887/12835

Note: To cite this publication please use the final published version (if applicable).

EhnX]deVi]dad\nVcYIgZVibZci

DjiXdbZ^c9Za^WZgViZHZa["=Vgb

EVi^Zcih

CVY_VHaZZ!E]^a^eHe^c]dkZc!CVY^V<VgcZ[h`^!

:aaV6gZchbVc

BVcjhXg^eihjWb^iiZY[dgejWa^XVi^dc

.-

6WhigVXi

I]Z dW_ZXi^kZ d[ i]Z hijYn lVh id ZmVb^cZ i]Z VhhdX^Vi^dc d[ X]^aY]ddY VWjhZ l^i]

ehnX]deVi]dad\nVcYi]Z^beVXid[X]^aY]ddYVWjhZdcigZVibZcidjiXdbZ^c9Za^WZgViZ

HZa["=Vgb 9H= eVi^Zcih# I]Z hijYn ^ckdakZY .% 9H= eVi^Zcih! V\ZY &*Ä(* nZVgh! l]d

lZgZgVcYdbanVhh^\cZYid&'hZhh^dchd[Xd\c^i^kZ"WZ]Vk^djgVai]ZgVen87I^cVYY^i^dc

idigZVibZciVhjhjVaI6JdgidI6Jdcan#6hhZhhbZcid[X]^aY]ddYVWjhZh]dlZYi]Vi

), d[ i]Z eVi^Zcih ]VY V ]^hidgn d[ e]nh^XVa VWjhZ! )+ ]VY V ]^hidgn d[ hZmjVa VWjhZ

VcY '. ]VY V ]^hidgn d[ XdbW^cZY e]nh^XVa VcY hZmjVa VWjhZ# I]dhZ l^i] V ]^hidgn d[

X]^aY]ddY e]nh^XVa VWjhZ! hZmjVa VWjhZ VcY XdbW^cZY VWjhZ h]dlZY i]Z bdhi hZkZgZ

ehnX]dad\^XVa VcY ehnX]^Vig^X egdWaZbh Vi WVhZa^cZ# 9Zhe^iZ i]Z bdgZ hZkZgZ ^c^i^Va

^beV^gbZci! ^cY^k^YjVah l^i] V ]^hidgn d[ VWjhZ gZhedcYZY ZfjVaan lZaa id i]Z 87I

^ciZgkZci^dc#=dlZkZg!i]ZgZhjaihVahd^cY^XViZi]VieVgi^X^eVcihl^i]hZmjVaVWjhZ^ci]Z^g

eVhigZYjXZYi]Z^g9H=idVh^\c^ÒXVcian\gZViZgZmiZci^ci]Z87IXdcY^i^dcXdbeVgZY

idi]ZI6JdcanXdcY^i^dc#I]ZgZhjaihhj\\Zhii]ZcZZYidVYYgZhhZbdi^dcgZ\jaVi^dc

Y^[ÒXjai^ZhVcYegdWaZbhdak^c\YZÒX^ih[dgi]^hhjW\gdjed[9H=eVi^Zcih#87IhZZbhid

WZi]ZWZhiX]d^XZ[dg9H=eVi^Zcihl^i]ZmiZch^kZVWjhZ]^hidg^Zh#

>cigdYjXi^dc

:VganigVjbVi^XZmeZg^ZcXZhiZcYid]VkZadc\"aVhi^c\cZ\Vi^kZZ[[ZXihdcehnX]dad\^XVa

lZaa"WZ^c\ =ZgbVc! &..'# >c eVgi^XjaVg! i]ZgZ hZZbh id WZ V XaZVg a^c` WZilZZc VWjhZ

^c X]^aY]ddY VcY 9Za^WZgViZ HZa["=Vgb 9H= Yjg^c\ VYdaZhXZcXZ VcY VYjai]ddY hZZ

:kVch! =Vlidc!  GdY]Vb! '%%* [dg V gZk^Zl# I]Z iZgb 9Za^WZgViZ HZa["=Vgb ^cXajYZh

YZa^WZgViZhZa["ed^hdc^c\VcYYZa^WZgViZhZa["^c_jgn=Vlidc!OV]a!LZVi]ZgVaa!'%%(#

8]^aY]ddYe]nh^XVaVcYk^daZcihZmjVaVWjhZhZZbidedhZi]Z\gZViZhig^h`d[[jijgZ9H=

?d^cZgZiVa#!'%%,!VcYeZdeaZl^i]]^hidg^Zhd[XdbW^cZYe]nh^XVaVcYhZmjVaVWjhZ]VkZ

WZZc[djcYidZm]^W^ii]ZbdhihZkZgZhnbeidbVidad\nGnVc!LViVcVWZ!=dni!@^abZg!

 8VjXZ! '%%%# I]Z gZaVi^dch]^e WZilZZc e]nh^XVa VcY hZmjVa VWjhZ VcY 9H= eZgh^hih

l]ZcXdcigdaa^c\[dgdi]ZgVYkZghZX]^aY]ddYZmeZg^ZcXZhNhi\VVgY!=ZhiZijc!AdZW!

BZ]ajb!'%%)VcYi]ZZ[[ZXihd[ehnX]^Vig^XY^hdgYZgh:cchZiVa#!'%%+#I]ZhZÒcY^c\h

hj\\Zhii]ViV]^hidgnd[X]^aY]ddYVWjhZ^hVc^bedgiVciVZi^dad\^XVa[VXidg^c9H=VhlZaa

VhVc^bedgiVciXa^c^XVaX]VgVXiZg^hi^X#

I]ZgZ ^h Vc ZmiZch^kZ WdYn d[ gZhZVgX] dc i]Z edhh^WaZ XdchZfjZcXZh d[ X]^aY]ddY

VWjhZVbdc\9H=eVi^Zcih#8]^aY]ddYVWjhZ^hVhhdX^ViZYl^i]gZeZi^i^dcd[9H=;dgbVc!

7ZX`! 7gdlc! 7Zg`!  =Zcg^fjZh! '%%)! VaXd]da VcY Ygj\ VWjhZ ;VkVgd! ;ZggVgV! 

HVcidcVhiVhd!'%%,!^ci^bViZeVgicZgk^daZcXZHZZYVi!HiZ^c!;dgYZ!'%%*!YZegZhh^dc!

..

]deZaZhhcZhh!Vc\ZgVcYadlhZa["ZhiZZbDhkVi]!KŽgŽh!;Z`ZiZ!'%%)!]^\]aZkZahd[

Y^hhdX^Vi^dcAdl!EdlZg!9j\\Vc!?dcZh!BVXAZdY!'%%%!gZYjXZYbZbdgnheZX^ÒX^in

H^cXaV^g! 8gVcZ! =Vlidc!  L^aa^Vbh! '%%, VcY bVaVYVei^kZ WZa^Z[h 6gcio! 9^ZioZa! 

9gZZhZc!&...#

9Zhe^iZi]Zhigdc\^beVXid[X]^aY]ddYVWjhZVbdc\9H=eVi^Zcih!kZgn[ZlhijY^Zh

]VkZZmVb^cZYl]Zi]Zgi]ZegZhZcXZd[V]^hidgnd[VWjhZa^b^ihVc^cY^k^YjVaÉhgZhedchZ

idigZVibZci#IldhijY^Zh[djcYi]ViVai]dj\]9H=eVi^Zcihl^i]V]^hidgnd[VWjhZ]VY

bdgZ hZkZgZ ^c^i^Va ^beV^gbZci! i]Zn WZcZÒiZY ZfjVaan lZaa [gdb igZVibZci EZii^\gZl

7jgX]Vb!&..,06gcdaYZiVa#!'%%(#6i]^gYhijYn[djcYi]ViV]^hidgnd[hZmjVaVWjhZ

egZY^XiZY eddg igZVibZci djiXdbZ , nZVgh V[iZg i]Z ^cYZm Ze^hdYZ d[ 9H= HŽYZgWZg\!

@jaa\gZc!  HVaVcYZg GZcWZg\! '%%)# =dlZkZg! i]Z gZaVi^dch]^e WZilZZc V ]^hidgn d[

VWjhZVcYigZVibZcidjiXdbZ[dg9H=]VhcZkZgWZZchijY^ZY^cVgVcYdb^oZYXdcigdaaZY

Xa^c^XVaig^Va#6hVXdchZfjZcXZ!^igZbV^chjcXaZVgl]Zi]ZgV]^hidgnd[VWjhZ^hVegZY^Xidg

d[i]ZXdjghZd[9H=^c\ZcZgVadgVegZY^Xidgd[i]ZdjiXdbZd[VheZX^ÒXigZVibZci^c

eVgi^XjaVg#

I]Z egZhZci hijYn [dXjhZY dc i]Z gZaVi^dch]^e WZilZZc VWjhZ ]^hidgn! aZkZa d[

hnbeidbh VcY igZVibZci djiXdbZ Vbdc\ .% 9H= eVi^Zcih l]d ]VY eVgi^X^eViZY ^c V

gVcYdb^oZYXdcigdaaZYig^Vad[8d\c^i^kZ"7Z]Vk^djgVaI]ZgVen87IHaZZ!<VgcZ[h`^!kVc

YZgAZZYZc!6gZchbVc!He^c]dkZc!'%%-#I]ZÒghidW_ZXi^kZd[i]ZhijYnlVhidZmVb^cZ

i]Z[gZfjZcXnd[Y^[[ZgZciineZhd[X]^aY]ddYVWjhZ^ci]ZhijYnedejaVi^dc#I]ZhZXdcY

dW_ZXi^kZ lVh id ZmVb^cZ l]Zi]Zg \gdje Y^[[ZgZcXZh Zm^hiZY WZilZZc eVi^Zcih l^i] V

]^hidgn d[ X]^aY]ddY VWjhZ VcY cdc"VWjhZY eVi^Zcih l^i] gZ\VgY id ehnX]deVi]dad\n!

^cXajY^c\ 9H=! YZegZhh^dc! Vcm^Zin! Y^hhdX^Vi^dc! bVaVYVei^kZ WZa^Z[h VcY ehnX]^Vig^X

Y^V\cdhZh# 6 [jgi]Zg dW_ZXi^kZ lVh id ZmVb^cZ l]Zi]Zg \gdje Y^[[ZgZcXZh Zm^hiZY

WZilZZc eVi^Zcih l^i] Y^[[ZgZci hjWineZh d[ X]^aY]ddY VWjhZ# I]Z i]^gY dW_ZXi^kZ lVh

idZmVb^cZl]Zi]Zg9H=eVi^Zcihl^i]V]^hidgnd[X]^aY]ddYVWjhZgZhedcYZYZfjVaan

lZaaidigZVibZciXdbeVgZYideVi^Zcihl^i]djiVWjhZ]^hidg^Zh#>[^cY^k^YjVahl^i]VWjhZ

]^hidg^Zh ]VkZ jc^fjZ egdWaZbh Vi WVhZa^cZ i]Vi egZY^Xi eddg djiXdbZ dc gZeZi^i^dc d[

9H=!hjX]ÒcY^c\hVgZa^`Zanid]VkZ^bedgiVciXa^c^XVaVcYgZhZVgX]^bea^XVi^dch#

BZi]dY

Patients and procedure

>cdgYZgidWZZa^\^WaZ!eVi^Zcih]VYidbZZii]Z[daadl^c\Xg^iZg^V/]Vk^c\gZXZcianZc\V\ZY

^c9H=VcYWZ^c\V\ZY&*"(*#9H=lVhYZÒcZYVh^cXajY^c\Wdi]YZa^WZgViZhZa["ed^hdc^c\

dkZgYdhZVcYYZa^WZgViZhZa["^c_jgn=Vlidc!OV]a!LZVi]ZgVaa!'%%(#6cdkZgYdhZlVh

YZÒcZYVhi]ZYZa^WZgViZ^c\Zhi^dcd[bdgZi]Vci]ZegZhXg^WZYdggZXdbbZcYZYVbdjci

&%%

d[X]Zb^XVahjWhiVcXZhl^i]i]Z^ciZci^dcd[hZa["]Vgb#9Za^WZgViZhZa["^c_jgnlVhYZÒcZY

Vh ^ciZci^dcVa hZa["^c_jgn! ^ggZheZXi^kZ d[ i]Z VeeVgZci ejgedhZ d[ i]Z VXi Z#\# hj^X^YZ!

gZa^Z[[gdbeV^c!ejc^h]bZcid[hZa[$di]Zgh!VcY^cXajYZYXjii^c\!hXgViX]^c\!ejcX]^c\!

`^X`^c\!VcY]ZVY"WVc\^c\cdigZaViZYidbZciVagZiVgYVi^dc#>ci]^hYZÒc^i^dc!Wdi]i]Z

dg^\^cVa eVgVhj^X^YZ YZÒc^i^dc d[ i]Z L=D$:jgd hijYn VcY i]Z^g XjggZci cdbZcXaVijgZ

d[ [ViVa VcY cdc[ViVa hj^X^YVa WZ]Vk^djg ^h ^cXajYZY! Vh lZaa Vh ]VW^ijVa WZ]Vk^djgh VcY

hZa["^c_jg^Zh l^i] cd ^ciZci id Y^Z# >c a^cZ l^i] i]Z YZÒc^i^dc d[ i]Z L=D$:jgd hijYn!

9H= VhhdX^ViZY l^i] bZciVa gZiVgYVi^dc ^h ZmXajYZY 9Z AZd Zi Va#! '%%)0 HX]b^Yi`Z Zi

Va#! '%%)# I]jh! Vaa WZ]Vk^djg i]Vi lVh hZa["^c^i^ViZY l^i] i]Z ^ciZci id ]Vgb i]Z WdYn

gZ\VgYaZhhd[^ciZciidY^ZlVh^cXajYZY#EVi^ZcihlZgZZmXajYZY^[i]ZngZedgiZYhZkZgZ

ehnX]^Vig^XY^hdgYZghgZfj^g^c\^ciZch^kZ^ceVi^ZciigZVibZci!lZgZjcVWaZidXdckZghZ^c

9jiX]!]VYXd\c^i^kZ^beV^gbZcih!dga^kZYdjih^YZi]ZgZ\^dcd[AZ^YZc#

EVgi^X^eVcih lZgZ gZXgj^iZY [gdb BVgX] '%%( i]gdj\] 6eg^a '%%+ Vi i]Z AZ^YZc

Jc^kZgh^inBZY^XVa8ZcigZVcYi]ZadXVaBZciVa=ZVai]8ZcigZG^k^ZgYj^cZc#9jg^c\i]Z^g

k^h^i id dcZ d[ i]ZhZ XZcigZh i]Zn ]VY gZXZ^kZY V WgdX]jgZ l^i] V XdbeaZiZ YZhXg^ei^dc

d[ i]Z hijYn# >c i]^h WgdX]jgZ ^i lVh VccdjcXZY i]Vi i]Zn ldjaY WZ XdciVXiZY Wn V

bZbWZgd[i]ZgZhZVgX]iZVb!l]dldjaYegdk^YZ[jgi]Zg^c[dgbVi^dcdci]ZhijYnVcY

ldjaY Vh` ^[ i]Zn lZgZ ^ciZgZhiZY id eVgi^X^eViZ# >c[dgbZY XdchZci lVh dWiV^cZY [gdb

Vaa eVgi^X^eVcih! VcY [gdb eVgZcih d[ VYdaZhXZcih WZadl i]Z V\Z d[ &+ nZVgh# 6[iZg i]Zn

]VY\^kZclg^iiZcXdchZci!i]ZnlZgZ^ciZgk^ZlZY^ci]Z^g]dbZdgVii]ZbZY^XVaXZcigZ

Vaa l^i]^c ild lZZ`h [gdb i]Z ^cYZm Ze^hdYZ# I]dhZ l]d V\gZZY id eVgi^X^eViZ VcY

lZgZ[djcYidWZZa^\^WaZ[dgi]ZhijYnc2.%lZgZgVcYdbanVhh^\cZYid&'hZhh^dchd[

87I^cVYY^i^dcidI6Jc2)-!dgidI6Jdcanc2)'#I]ZhZeVgi^X^eVcihlZgZ^ck^iZY[dg

hjWhZfjZci VhhZhhbZcih (! + VcY . bdci]h [daadl^c\ i]Z WVhZa^cZ ^ciZgk^Zl# >c 87I! -

eVi^Zcih YgdeeZY dji _jhi V[iZg i]Z ^c^i^Va ^ciZgk^Zl VcY WZ[dgZ i]Z hiVgi d[ igZVibZci#

=dlZkZg!VaaeVi^Zcihl]dhiVgiZYl^i]i]Z87IXdbeaZiZYVaahZhh^dch#>cI6J!.eVi^Zcih

YgdeeZYdjiYjg^c\i]ZhijYneZg^dYd[.bdci]h#6XdbeaZiZYZhXg^ei^dcd[i]ZÓdld[

eVgi^X^eVcihi]gdj\]i]ZhijYn^h\^kZcZahZl]ZgZHaZZZiVa#!'%%-#DjgVcVanhZhlZgZ

WVhZY Wdi] dc i]Z ^ciZci"id"igZVi hVbeaZ c 2 .% VcY XdbeaZiZgh hVbeaZ c2,(# I]Z

hijYnlVhVeegdkZYWni]ZadXVaZi]^XhXdbb^iiZZ#

Measures

Demographics and psychiatric diagnosis

9jg^c\ V higjXijgZY Xa^c^XVa ^ciZgk^Zl YZbd\gVe]^X ^c[dgbVi^dc lVh dWiV^cZY! Vh lZaa

Vh ^c[dgbVi^dc dc ehnX]^Vig^X Y^V\cdh^h! l]^X] lVh VhhZhhZY jh^c\ V h]dgi higjXijgZY

Y^V\cdhi^X ^ciZgk^Zl l^i] Vc VYb^c^higVi^dc i^bZ d[ Veegdm^bViZan '% id (% b^cjiZh/

i]Z B^c^">ciZgcVi^dcVa CZjgdehnX]^Vig^X >ciZgk^Zl B>C>! H]ZZ]Vc  AZXgjW^Zg! &..'!

&..)!&..-#>ci]^hhijYni]Z9jiX]igVchaVi^dcd[i]ZXa^c^X^VcgViZY8GkZgh^dcd[i]Z

&%&

B>C>kVcKa^Zi!AZgdn!KVcBZ\Zc!'%%%lVhjhZY#KVa^YVi^dcd[i]ZB>C>"8GV\V^chi

i]ZHigjXijgZY8a^c^XVa>ciZgk^Zl9HB">>>"G"eVi^ZcikZgh^dcH8>9"EVcYi]Z8dbedh^iZ

>ciZgcVi^dcVa 9^V\cdhi^X >ciZgk^Zl [dg >89"&% 8>9> h]dlZY \ddY id kZgn \ddY `VeeV

kVajZhH]ZZ]VcAZXgjW^Zg!&..-#

Psychological problems: DSH, depression, anxiety, dissociation and maladaptive beliefs 9H=lVhVhhZhhZYjh^c\VhigjXijgZYXa^c^XVa^ciZgk^Zl#6iZVX]d[i]Z[djgVhhZhhbZcih!

eVi^Zcih lZgZ Vh`ZY l]Zi]Zg i]Zn ]VY Zc\V\ZY ^c 9H= Yjg^c\ i]Z eVhi ( bdci]h#

6hhZhhbZcid[9H=^cXajYZYcdidcani]ZcjbWZgd[Ze^hdYZh^ci]ZeVhi(bdci]h!Wji

Vahdhj^X^YZ^ciZciVcYbdi^kZh!i]ZVciZXZYZciZkZcihdghigZhhdghZ#\#Vg\jbZcil^i]

eVgZcih dg eVgicZg! egZ"VXi WZ]Vk^djg Z#\# Yg^c`^c\ dg jh^c\ Ygj\h! gZh^hi^c\ jg\Zh!

YZ\gZZ d[ eaVcc^c\! lVgc^c\ di]Zgh! VcY edhi"VXi WZ]Vk^djg VcY XdchZfjZcXZh Z#\#

h]VbZ!gZ\gZi!gZa^Z[#;dgi]ZejgedhZd[i]ZegZhZcihijYn!dcani]ZcjbWZgd[Ze^hdYZh

d[9H=^hjhZY#Id^ckZhi^\ViZi]ZgZa^VW^a^ind[i]ZVhhZhhbZcid[i]ZcjbWZgd[Ze^hdYZh

d[ 9H=! i]Z gZigdheZXi^kZ hZa["gZedgih lZgZ XdbeVgZY l^i] ]dhe^iVa gZXdgYh! Vh lZaa Vh

l^i] ^c[dgbVi^dc Xdb^c\ [gdb i]Z igZVibZci hZhh^dch# I]Z XdggZaVi^dch WZilZZc i]Z

i]gZZbZVhjgZhlZgZ]^\]!gVc\^c\[gdb#--id#.%#

9ZegZhh^dclVhVahdVhhZhhZYViZVX]d[i]Z[djgVhhZhhbZcih#>ilVhbZVhjgZYl^i]

i]Z 7ZX` 9ZegZhh^dc >ckZcidgn >> 79>">> 7ZX`! HiZZg  7gdlc! &..+/ V '&"fjZhi^dc

YZegZhh^dchXVaZl^i]ZVX]VchlZggViZY%"(#HXdgZhgVc\Z[gdb%"+(#I]ZiZhi]Vh]^\]

^ciZgcVa Xdch^hiZcXn l^i] Vc Vae]V gZa^VW^a^in d[ #.& 7ZX`! HiZZg!  7gdlc! &..+0 7ZX`!

HiZZg!7Vaa!GVc^Zg^!&..+#>ci]^hhijYnlZ[djcYVcVae]VgZa^VW^a^ind[#.(#

6cm^ZinlVhbZVhjgZYViZVX]d[i]Z[djgVhhZhhbZcihl^i]i]ZHnbeidb8]ZX`a^hi"

.%9Zgd\Vi^h!A^ebVc8dk^!&.,(06g^cYZaa:iiZbV!&.-+!l]^X]^hVhZa["gZedgiXa^c^XVa

gVi^c\hXVaZd[ehnX]^Vig^XhnbeidbVidad\n#>iXdch^hihd[.%^iZbh^cidiVa!l^i]&%^iZbh[dg

i]ZhjWhXVaZVcm^Zin!*"ed^ciA^`Zgi!gVc\^c\[gdbÆcdiViVaaY^higZhh^c\Ç%idÆZmigZbZan

Y^higZhh^c\Ç)#HXdgZhd[i]^hhjWhXVaZgVc\Z[gdb%")%#EgZk^djhhijY^Zh]VkZgZedgiZY

Vae]V"XdZ[ÒX^ZcihgVc\^c\[gdb#,&id#.&[dgi]ZVcm^ZinhjWhXVaZ#>cVYY^i^dc!iZhi"gZiZhi

gZa^VW^a^i^ZhlZgZ[djcYidWZ\ddYVcYi]ZhjWhXVaZh]dlZYhigdc\XdckZg\ZcikVa^Y^in

l^i]di]ZgXdcXZeijVaangZaViZYhXVaZh6gg^cYZaa:iiZbV!&.-+#>ci]^hhijYnlZ[djcY

VcVae]VgZa^VW^a^ind[#.([dgi]ZVcm^ZinhjWhXVaZ#

9^hhdX^Vi^dc lVh bZVhjgZY Vi ZVX] d[ i]Z [djg VhhZhhbZcih jh^c\ i]Z 9^hhdX^Vi^kZ

:meZg^ZcXZhHXVaZIVmdc9:H"I0LVaaZg!EjicVb!8Vgahdc!&..+!l]^X]^hVhZa["gZedgi

fjZhi^dccV^gZ i]Vi Xdch^hih d[ - d[ i]Z '- ^iZbh d[ i]Z dg^\^cVa 9:H hXVaZ 7ZgchiZ^c 

EjicVb!&.-+09jiX]kZgh^dcWn7ddc9gV^_Zg!&..*/(!*!,!-!&'!&(!''VcY',#I]ZhZ

^iZbhVgZi]dj\]iid^YZci^[neVi]dad\^XVaY^hhdX^Vi^dcLVaaZgZiVa#!&..+#;dgZVX]d[i]Z

9:H"I^iZbh!gZhedcYZcihlZgZVh`ZYid^cY^XViZi]ZeZgXZciV\Zd[i]Zi^bZgVc\^c\[gdb

%id&%%i]Vii]ZnZmeZg^ZcXZVheZX^ÒXe]ZcdbZcdcZ#\#!Æ;ZZa^c\Vhi]dj\]dcZÉh

&%'

WdYn^hcdidcZÉhdlcÇ#I]ZgVc\Zd[hXdgZh^h%id-%#I]Z9:H]VhkZgn\ddYkVa^Y^inVcY

gZa^VW^a^in!VcY\ddYdkZgVaaehnX]dbZig^XegdeZgi^Zh8VgahdcEjicVb!&..(08VgahdcZi

Va#!&..(#>ci]^hhVbeaZ!lZ[djcYVcVae]VgZa^VW^a^ind[#-.[dgi]Z9:H"I#

BVaVYVei^kZWZa^Z[hlZgZVhhZhhZYViWVhZa^cZVcYVi."bdci]VhhZhhbZcijh^c\i]Z

EZghdcVa^in 9^hdgYZg 7Za^Z[ FjZhi^dccV^gZ E97F! 9gZZhhZc! 6gcio  LZZgibVc! &..+

i]ViXdciV^ch&'hjWhXVaZhd['%WZa^Z[h!ZVX]]nedi]Zh^oZYidWZine^XVa[dgi]Z&'9HB">K

eZghdcVa^inY^hdgYZgh#I]ZWZa^Z[hVgZeVgian[dgbjaViZYdci]ZWVh^hd[i]Zldg`d[7ZX`Zi

Va#'%%)VcYeVgiandci]ZWVh^hd[i]ZVji]dghÉdlcXa^c^XVaZmeZg^ZcXZl^i]eVi^Zcihl^i]

eZghdcVa^inY^hdgYZgh#I]ZWZa^Z[h]VkZidWZgViZYdcV&%%"bbK^hjVa6cVad\jZHXVaZ^c

iZgbhd[higZc\i]d[WZa^Z[#>iZbgVi^c\hVgZZmegZhhZY^cb^aa^bZigZh!l^i]V]^\]ZghXdgZ

bZVc^c\ higdc\Zg WZa^Z[ ^c i]Z [dgbjaViZY hiViZbZci b^c^bjb hXdgZ 2 %! bVm^bjb

hXdgZ2&%%#7ZXVjhZi]ZVhhZhhbZcii^bZlVha^b^iZY!lZbZVhjgZYdcanh^mhjWhXVaZh

XdggZhedcY^c\idi]Zbdhi[gZfjZcianY^V\cdhZYeZghdcVa^inY^hdgYZgh^ci]^hedejaVi^dc/

7dgYZga^cZZ#\#Æ>ÉaacZkZg\Zil]Vi>lVciÇ!EVgVcd^YZ#\#ÆDi]Zghl^aaignidjhZbZdg

bVc^ejaViZbZ^[>YdcÉilViX]djiÇ!DWhZhh^kZ"8dbejah^kZZ#\#Æ>i^h^bedgiVciidYdV

eZg[ZXi_dWdcZkZgni]^c\Ç!=^hig^dc^XÆ>h]djaYWZi]ZXZciZgd[ViiZci^dcÇ!9ZeZcYZci

Æ>Éb]ZaeaZhhl]Zc>ÉbaZ[idcbndlcÇ!VcY6kd^YVciZ#\#Æ>[eZdeaZ\ZiXadhZidbZ!

i]Zn l^aa Y^hXdkZg i]Z ÆgZVaÇ bZ VcY gZ_ZXi bZÇ# E97F"hjWhXVaZh ]VkZ \ddY ^ciZgcVa

Xdch^hiZcX^Zh!l^i]Vae]VgZa^VW^a^i^ZhgVc\^c\[gdb#-(id#.+LZZgibVc!6gcio!HX]djiZc

9gZZhhZc!'%%*#>cdjghijYnlZ[djcYVcVae]VgZa^VW^a^ind[#.([dg7dgYZga^cZ!d[#.+

[dgEVgVcd^Y!#.([dgDWhZhh^kZ"8dbejah^kZ!#.%[dg=^hig^dc^X!#.([dg9ZeZcYZciVcY#.*

[dg6kd^YVci#

Childhood abuse

8]^aY]ddY VWjhZ lVh VhhZhhZY Vi WVhZa^cZ jh^c\ i]Z HigZhh[ja VcY IgVjbVi^X :kZcih

FjZhi^dccV^gZ HI:F! YZkZadeZY VcY kVa^YViZY Wn @Zg`]d[! 7VgcVhXd! 7^aaZ"7gV]Z! EaVii

VcYHX]b^Yi`Z&.-.VcY6gZchbVc&..,#>ilVhYZh^\cZYVheVgid[i]Z:EH>HL=D$

:JGD Bjai^XZcigZ HijYn# I]Z fjZhi^dccV^gZ ZmVb^cZY Y^[[ZgZci ZmeZg^ZcXZh Yjg^c\

i]gZZ Y^hi^cXi eZg^dYh/ X]^aY]ddY VcY ZVgan VYdaZhXZcXZ 1 &* nZVgh! aViZ VYdaZhXZcXZ

VcY VYjai]ddY 3 &* nZVgh VcY Yjg^c\ i]Z &' bdci]h eg^dg id i]Z Ze^hdYZ d[ 9H=# I]Z

fjZhi^dccV^gZXdch^hihd[.+^iZbhXdcXZgc^c\higZhh[jaVcYigVjbVi^XZkZcihVhlZaaVh

bdgZhjW_ZXi^kZZmeZg^ZcXZh#;dgi]ZejgedhZd[i]^hhijYn!i]Za^hid[^iZbhlVhgZYjXZY

id-igVjbVi^XZkZcih/e]nh^XVaVWjhZ!hZmjVaVWjhZ!Zbdi^dcVaVWjhZ!cZ\aZXi!adhhZhd[

h^\c^ÒXVcidi]Zgh!e]nh^XVaVcYehnX]^Vig^XY^hdgYZghd[[Vb^anbZbWZghVcYdi]ZghigZhh[ja

ZkZcihhjX]eVgZciVaY^kdgXZ#>ci]^hhijYn!i]Z[dXjh^hdci]ZediZci^VabdYZgVi^c\gdaZ

d[ X]^aY]ddY e]nh^XVa! hZmjVa VcY Zbdi^dcVa VWjhZ WZ[dgZ i]Z V\Z d[ &*! Vh lZaa Vh dc

XdbW^cZYe]nh^XVaVcYhZmjVaVWjhZ#L^i]gZ\VgYide]nh^XVaVWjhZ!eVi^ZcihlZgZVh`ZY

Æ^[hdbZdcZ]VYWZViZcndjdgejc^h]ZYndjl^i]V]VgYdW_ZXiÇ#L^i]gZ\VgYidhZmjVa

&%(

VWjhZ!eVi^ZcihlZgZVh`ZYÆ^[hdbZdcZ]VYhZmjVa^ciZgXdjghZl^i]ndjl]ZcndjY^Ycdi

lVciidÇ#L^i]gZ\VgYidZbdi^dcVaVWjhZ!eVi^ZcihlZgZVh`ZYÆ^[hdbZdcZ]VYnZaaZYVi

ndjdghV^Y^chjai^c\dg]jgi[jai]^c\hidndjÇ#;dgVfjZhi^dcidWZ\^kZcVedh^i^kZgVi^c\!

YZiV^aZY^c[dgbVi^dcXdcXZgc^c\i]ZVWjhZ]VYidWZegdk^YZY#

Treatment interventions

Cognitive-Behavioural Therapy Intervention (CBT-condition)

>cVYY^i^dcidjhjVaXVgZZ#\#egZhXg^WZYbZY^XVi^dcdgehnX]di]ZgVen!eVgi^X^eVcih^c

i]Z87IXdcY^i^dclZgZidgZXZ^kZ&'djieVi^Zci87IhZhh^dchheZX^ÒXVaanYZkZadeZY[dg

egZkZci^c\gZeZViZY9H=#IZcdjid[&'hZhh^dchlZgZ\^kZclZZ`an0i]ZaVhiildhZhh^dch

lZgZ [daadl"je hZhh^dch# 6aa id\Zi]Zg! i]Z ^ciZgkZci^dc aVhiZY *#* bdci]h# I]Z XZcigVa

[ZVijgZ d[ i]^h ^ciZgkZci^dc lVh i]Z ^YZci^ÒXVi^dc VcY bdY^ÒXVi^dc d[ i]Z bZX]Vc^hbh

i]VibV^ciV^cZYi]Z^cY^k^YjVaÉhhZa["]Vgb^c\WZ]Vk^djg#I]jh!i]ZigZVibZcihiVgiZYl^i]

i]ZVhhZhhbZcid[i]ZbdhigZXZciZe^hdYZd[9H=Z#\#X^gXjbhiVcXZhVii]Zi^bZd[i]Z

Ze^hdYZ!bdi^kZhVcYgZVhdch[dg9H=!Xd\c^i^dch!Zbdi^dchVcYWZ]Vk^djgeg^dgidVcY

Vi i]Z i^bZ d[ i]Z Ze^hdYZ# I]Z i]ZgVe^hi i]Zc heZX^ÒZY ]dl Zbdi^dcVa! Xd\c^i^kZ VcY

WZ]Vk^djgVa[VXidgheaVnZYVgdaZ^ci]ZbV^ciZcVcXZd[9H=#HeZX^ÒXbV^ciZcVcXZ[VXidgh

i]Vi lZgZ VYYgZhhZY ^cXajYZY Ynh[jcXi^dcVa Xd\c^i^dch! Zbdi^dc gZ\jaVi^dc Y^[ÒXjai^Zh

VcYeddgegdWaZbhdak^c\#IdlVgYhi]ZZcYd[i]ZgVengZaVehZegZkZci^dclVhVYYgZhhZY

VhlZaa#6bVcjValVhlg^iiZcidhiVcYVgY^oZi]Z^ciZgkZci^dcVkV^aVWaZdcgZfjZhi#>c

dgYZg id ^begdkZ igZVibZci Xdbea^VcXZ! i]ZgVe^hih eaVnZY Vc VXi^kZ gdaZ ^c `ZZe^c\

eVi^Zcih^cigZVibZciZ#\#XVaa^c\eVi^ZcihidgZb^cYi]Zbd[Veed^cibZcih#

6aai]ZgVe^hihlZgZZmeZg^ZcXZYegVXi^i^dcZghd[87IVcYlZgZZmeZg^ZcXZY^cldg`^c\

l^i] eVi^Zcih l]d Zc\V\Z ^c 9H=# Eg^dg id iV`^c\ eVgi ^c i]Z gZhZVgX] egd_ZXi! i]Zn

gZXZ^kZYildYVnhd[igV^c^c\^ci]ZhiVcYVgY^oZYegdidXda#IdbV^ciV^ci]Z^ciZ\g^ind[

igZVibZci! i]Z i]ZgVe^hih [daadlZY i]^h igZVibZci bVcjVa# >c VYY^i^dc! X]ZX`a^hih VcY

djia^cZh lZgZ jhZY ^c ZkZgn hZhh^dc id [dhiZg XdggZXi ZmZXji^dc d[ i]Z igZVibZci# 6i

bdci]anbZZi^c\h!i]ZigZVibZcihZhh^dchlZgZgZk^ZlZYVcYi]ZgVe^hihXdjaYh]VgZi]Z^g

ZmeZg^ZcXZhl^i]i]Z^gXdaaZV\jZh#GZXjggZci^hhjZhi]VilZgZY^hXjhhZYlZgZgZVXi^dch

^c i]Z i]ZgVe^hi Za^X^iZY Wn Ze^hdYZh d[ 9H= Z#\# ldggn! VkZgh^dc VcY egdWaZbh l^i]

igZVibZciXdbea^VcXZ#

Treatment As Usual (TAU) Comparison Condition

;dg Zi]^XVa gZVhdch! eVgi^X^eVcih ^c i]^h \gdje lZgZ [gZZ id ejghjZ Vcn igZVibZci i]Zn

YZZbZY lVggVciZY# Bdhi d[ i]Z ^ciZgkZci^dch ^ckdakZY V a^b^iZY cjbWZg WZilZZc^'

VcY (% d[ hZhh^dch d[ ^cY^k^YjVa ehnX]di]ZgVen hjX] Vh Xd\c^i^kZÄWZ]Vk^djgVa^{ }i]ZgVen

VcY ^ciZgeZghdcVa ehnX]di]ZgVen# HdX^Va h`^aah igV^c^c\ lVh Vahd Xdbbdc! ZheZX^Vaan

Vbdc\VYdaZhXZcihVcYndjc\VYjaih#CdigZVibZciheZX^ÒXid9H=lVhgZedgiZY#I]ZhZ

&%)

igZVibZcih[dXjhZYdcheZX^ÒXehnX]^Vig^XegdWaZbhZ#\#YZegZhh^dcdgdcdi]ZgcZZYh

d[ i]Z eVi^Zci Z#\# egdWaZbh l^i] ]djh^c\! ÒcVcXZh! hdX^Va ^hdaVi^dc# >c VYY^i^dc id

ehnX]dhdX^Va^ciZgkZci^dch!i]ZbV_dg^ind[i]ZeVi^ZcihgZXZ^kZYegZhXg^WZYehnX]digde^X

bZY^XVi^dc#I]ZcjbWZgd[ehnX]^Vig^X]dhe^iVa^hVi^dchlVhVahdgZXdgYZY#

Data analysis

IdZmVb^cZi]Z[gZfjZcXnd[X]^aY]ddYZbdi^dcVa!hZmjVa!e]nh^XVa!dgXdbW^cZYe]nh^XVa

VhgZedgiZYViWVhZa^cZ!YZhXg^ei^kZhiVi^hi^XhlZgZjhZY#IdZmVb^cZl]Zi]ZgY^[[ZgZcXZh

Zm^hiZYWZilZZc87IVcYI6J^ci]ZgZedgi^c\d[i]ZhZY^[[ZgZciineZhd[VWjhZ!X]^"hfjVgZ

iZhihlZgZeZg[dgbZY#IdZmVb^cZl]Zi]Zg9H=eVi^Zcihl^i]V]^hidgnd[VWjhZh^\c^ÒXVcian

Y^[[ZgZY [gdb 9H= eVi^Zcih l^i]dji V ]^hidgn d[ VWjhZ dc hZeVgViZ WVhZa^cZ ehnX]^Vig^X

Y^V\cdhZhVcYdcidiVacjbWZgd[ehnX]^Vig^XY^V\cdhZh!gZheZXi^kZanX]^"hfjVgZiZhihVcY

Vi"iZhilZgZeZg[dgbZY#9^[[ZgZcXZhWZilZZci]ZVWjhZVcYcd"VWjhZ\gdjeh87I I6J

^cgZeZi^i^dcd[9H=!YZegZhh^dc!Vcm^Zin!Y^hhdX^Vi^dcdgbVaVYVei^kZWZa^Z[hlZgZiZhiZY

Wn bZVch d[ Bjai^kVg^ViZ 6cVanh^h d[ KVg^VcXZ B6CDK6#  I]Z gZaVi^dch]^e d[ 9H= Vi ."

bdci][daadl"jel^i]X]^aY]ddYVWjhZlVhVcVanhZYl^i]hZeVgViZ]^ZgVgX]^XVabjai^eaZ

gZ\gZhh^dcVcVanhZhWdi]^ci]Z^ciZci"id"igZVic2.%VcYXdbeaZiZghhVbeaZc2,(#

GZhjaih

Demographic characteristics at baseline

I]Z 87I \gdje Xdch^hiZY d[ )- eVi^Zcih .+ [ZbVaZh l^i] V bZVc V\Z d[ '(#& nZVgh

H92+#(!  .'c2)) ]VY i]Z 9jiX] cVi^dcVa^in! +. c2(( a^kZY VadcZ VcY ,% c2()

lZgZjcbVgg^ZY#>cVYY^i^dc!)'c2'%lZciidhX]ddadghijY^ZY!'(c2&&]VYV[jaa"

i^bZdgeVgi"i^bZ_dWVcY(-c2&-a^kZYdchdX^ValZa[VgZWZcZÒih#D[i]ZhZeVi^Zcih!

,. c2(- gZedgiZY &% dg bdgZ egZk^djh Ze^hdYZh d[ 9H= hZa["ed^hdc^c\ VcY$dg hZa["

^c_jgn#L^i]gZ\VgYidi]Z^cYZmZe^hdYZd[9H=!-*c2)&gZedgiZYhZa["ed^hdc^c\VcY

&*c2,gZedgiZYhZa["^c_jgn#

I]ZI6J\gdjeXdch^hiZYd[)'eVi^Zcih.&[ZbVaZh!c2(-l^i]VbZVcV\Zd['*#*

nZVgh H92)#*# .( c2(. ]VY i]Z 9jiX] cVi^dcVa^in! ,)  c2(& a^kZY VadcZ VcY ,-

c2((lZgZjcbVgg^ZY#>cVYY^i^dc!&.c2-lZciidhX]ddadghijY^ZY!',c2&&]VY

V [jaa"i^bZ dg eVgi"i^bZ _dW VcY (+ c2&* a^kZY dc hdX^Va lZa[VgZ WZcZÒih# D[ i]ZhZ

eVi^Zcih!,%c2(%gZedgiZY&%dgbdgZegZk^djhZe^hdYZhd[9H=hZa["ed^hdc^c\VcY$dg

hZa["^c_jgn#L^i]gZ\VgYidi]Z^cYZmZe^hdYZd[9H=!.&c2(-gZedgiZYhZa["ed^hdc^c\

VcY.c2)gZedgiZYhZa["^c_jgn#I]ZgZlZgZcdh^\c^ÒXVciY^[[ZgZcXZhWZilZZci]Z87I

XdcY^i^dcVcYI6JXdcY^i^dcl^i]gZ\VgYidi]ZhZYZbd\gVe]^Xh#

Prevalence of childhood abuse as reported at baseline

&%*

6h XVc WZ hZZc ^c IVWaZ &! V hjWhiVci^Va egdedgi^dc d[ i]Z eVi^Zcih gZedgiZY X]^aY]ddY

VWjhZ 1&* nZVgh/ ), c2 )' d[ i]Z eVi^Zcih hj[[ZgZY [gdb e]nh^XVa VWjhZ! )+ c2)&

hj[[ZgZY [gdb hZmjVa VWjhZ VcY '. c2'+ d[ i]Z eVi^Zcih ]VY V ]^hidgn d[ XdbW^cZY

e]nh^XVaVcYhZmjVaVWjhZ#H^cXZZbdi^dcVaVWjhZlVh[djcYVbdc\VabdhiVaaeVi^Zcih

.+!c2-+!i]^hkVg^VWaZlVhZmXajYZY[gdb[jgi]ZgVcVanh^h#I]ZgZlZgZcdh^\c^ÒXVci

Y^[[ZgZcXZhWZilZZci]Z87IXdcY^i^dcVcYI6JXdcY^i^dcl^i]gZ\VgYidi]ZgZedgi^c\d[

hZmjVa!e]nh^XVadgXdbW^cZYVWjhZ#

IVWaZ&#History of childhood abuse as reported at baseline in CBT and TAU groups:

Chi² tests

Clinical comparisons at baseline for patients with and without childhood abuse

IVWaZ'egZhZcihi]ZWVhZa^cZYViVXdcXZgc^c\ehnX]^Vig^XY^V\cdhZhVcYehnX]^Vig^XXd"

bdgW^Y^ind[9H=eVi^Zcihl^i]V]^hidgnd[hZmjVa!e]nh^XVadgXdbW^cZYVWjhZ87I I6J

VcY 9H= eVi^Zcih l^i]dji V ]^hidgn d[ VWjhZ 87I I6J# ;gZfjZcX^Zh d[ ehnX]^Vig^X

Y^V\cdhZhlZgZbjX]]^\]Zg[dgVWjhZY9H=eVi^Zcihi]Vc[dgcdc"VWjhZY9H=eVi^Zcih#

Add`^c\ViheZX^ÒXhjWineZhd[X]^aY]ddYVWjhZ!X]^"hfjVgZiZhihgZkZVaZYi]VieVi^Zcih

l^i]V]^hidgnd[VWjhZ!l]Zi]Zg^ilVhe]nh^XVaVWjhZ!hZmjVaVWjhZdgXdbW^cZYVWjhZ!

h^\c^ÒXVcianbdgZd[iZc[jaÒaaZYi]ZXg^iZg^V[dgEIH9i]Vccdc"VWjhZYeVi^Zcih#I"iZhih

gZkZVaZY i]Vi eVi^Zcih l^i] hZmjVa VWjhZ! e]nh^XVa VWjhZ VcY XdbW^cZY VWjhZ Vahd ]VY

V h^\c^ÒXVcian ]^\]Zg cjbWZg d[ Y^[[ZgZci ehnX]^Vig^X Y^V\cdhZh i]Vc eVi^Zcih l^i]dji

V ]^hidgn d[ VWjhZ# ;jgi]ZgbdgZ! ^i ^h ^bedgiVci id cdiZ i]Vi i]ZgZ lZgZ cd h^\c^ÒXVci

Y^[[ZgZcXZh WZilZZc eVi^Zcih l^i] V ]^hidgn d[ hZmjVa! e]nh^XVa dg XdbW^cZY VWjhZ# >c

VYY^i^dc!^cY^k^YjVah^c87IVcYI6JY^YcdiY^[[Zgl^i]gZ\VgYidehnX]^Vig^XXd"bdgW^Y^in

dgVcnd[i]ZheZX^ÒXehnX]^Vig^XY^V\cdhZh#

IVWaZ ( egZhZcih i]Z WVhZa^cZ Y^[[ZgZcXZh XdcXZgc^c\ 9H=! YZegZhh^dc! Vcm^Zin!

Y^hhdX^Vi^dcVcYbVaVYVei^kZWZa^Z[hWZilZZc9H=eVi^Zcihl^i] VcYl^i]djiVcVWjhZ

]^hidgn87I I6J#8dch^YZg^c\i]ZFiZhihVcYedhi]dXAH9iZhihVhhdX^ViZYl^i]i]Z

B6CDK6h [dg i]ZhZ kVg^VWaZh! VWjhZY eVi^Zcih ]VY h^\c^ÒXVcian ]^\]Zg WVhZa^cZ hXdgZh

dccjbWZgd[9H=VXihVhgZedgiZYViWVhZa^cZ!YZegZhh^dc!Vcm^ZinVcYY^hhdX^Vi^dcVh

lZaaVhdcbdhid[i]ZbVaVYVei^kZWZa^Z[hXdbeVgZYl^i]cdc"VWjhZYeVi^Zcih#EVi^Zcih

CBT (n=48) TAU (n=42) Chi² p

Childhood Physical Abuse 45.8% (n=22) 47.7% (n=20) .029 .87

Childhood Sexual Abuse 45.8% (n=22) 45.2% (n=19) .003 .96

Combined Abuse 29.2% (n=14) 28.6% (n=12) .004 .95

&%+

l^i]V]^hidgnd[XdbW^cZYe]nh^XVaVcYhZmjVaVWjhZ]VYi]Z]^\]ZhihXdgZhd[Vaa\gdjeh#

=dlZkZg! i]Z edhi"]dX AH9 iZhih gZkZVaZY cd h^\c^ÒXVci Y^[[ZgZcXZh WZilZZc eVi^Zcih

l^i]V]^hidgnd[hZmjVa!e]nh^XVadgXdbW^cZYVWjhZ#;jgi]ZgbdgZ!^i^h^bedgiVciidcdiZ

i]Vi^cY^k^YjVah^c87IVcYI6JY^YcdiY^[[ZgViWVhZa^cZl^i]gZ\VgYid9H=!YZegZhh^dc!

Vcm^Zin!Y^hhdX^Vi^dcVcYbVaVYVei^kZWZa^Z[h!l^i]i]ZZmXZei^dci]Vi^cY^k^YjVah^c87I

gZedgiZYh^\c^ÒXVcianbdgZYZeZcYZciWZa^Z[hi2'#&%&!Y[2-%!e2#%)#

IVWaZ'#Childhood abuse and psychiatric diagnoses: Chi² tests (separate diagnoses) and t-test (total number of diagnoses)

Sexually Abused¹ Physically Abused² Combined Abuse³ No Childhood Abuse

(n=39) (n=39) (n=25) (n=33)

• 64.1% (n=25) PTSD* 59% (n=23) PTSD* 60% (n=15) PTSD* 12.1% (n=4) PTSD

• 35.9% (n=14) Panic Disorder 33.3% (n=13) Panic Disorder 40% (n=10) Panic Disorder* 18.2% (n=6) Panic Disorder

• 15.4% (n=6) Social Phobia 10.3% (n=4) Social Phobia 16% (n=4) Social Phobia 9.1% (n=3) Social Phobia

• 7.7% (n=3) OCD 5.1% (n=2) OCD 4% (n=1) OCD 3% (n=1) OCD

• 7.7% (n=3) GAD 7.7% (n=3) GAD 4.3% (n=1) GAD 3% (n=1) GAD

• 38.5% (n=15) Major Depression 46.2% (n=18) Major Depression 52% (n=13) Major Depression 39.4% (n=13) Major Depression

• 35.9% (n=14) Dysthymia 25.6% (n=10) Dysthymia 28% (n=7) Dysthymia 30.3% (n=10) Dysthymia

• 15.4% (n=6) Hypomania 15.4% (n=6) Hypomania 12% (n=3) Hypomania 3% (n=1) Hypomania

• 2.6% (n=1) Bipolar Disorder 10.3% (n=4) Bipolar Disorder 4% (n=1) Bipolar Disorder 3% (n=1) Bipolar Disorder

• 20.5% (n=8) Bulimia Nervosa 17.9% (n=7) Bulimia Nervosa 24% (n=6) Bulimia Nervosa 12.1% (n=4) Bulimia Nervosa

• 10.5% (n=4) Anorexia Nervosa 22.9% (n=9) Anorexia Nervosa 13% (n=3) Anorexia Nervosa 9.4% (n=4) Anorexia Nervosa

• 23.1% (n=9) Alcohol Dep. 17.9% (n=7) Alcohol Dependence 26.1% (n=7) Alcohol Dependence 9.1% (n=3) Alcohol Dependence

• 5.3% (n=2) Alcohol Abuse 5.1% (n=2) Alcohol Abuse 8.7% (n=2) Alcohol Abuse 6.1% (n=2) Alcohol Abuse

• 10.3% (n=4) Substance Dependence 17.9% (n=7) Substance Dependence 16% (n=4) Substance Dependence 9.1% (n=3) Substance Dependence

• 5.1% (n=2) Substance Abuse 5.1 % (n=2) Substance Abuse 8% (n=2) Substance Abuse No Substance Abuse

• 2.6 (n=1) Psychotic Disorder 5.7% (n=2) Psychotic Disorder 5.3% (n=1) Psychotic Disorder 3% (n=1) Psychotic Disorder

• 7.9% (n=3) Somatoform Disorder 2.9% (n=1) Somatoform Disorder 8 % (n=2) Somatoform Disorder 3% (n=1) Somatoform Disorder

Total number of psychiatric diagnoses

M=3.38 (SD=2.71)** M=3.38 (SD=3.38)* M=3.52 (SD=2.89)** M=1.85 (SD=1.79)

*p<.05, **p<.01;

1 Sexual Abuse versus No Childhood Abuse

2 Physical Abuse versus No Childhood Abuse

3 Combined Abuse versus No Childhood abuse

&%, IVWaZ(#Means and standard deviations of DSH, depression, anxiety and maladaptive beliefs before treatment for individuals with and without a history of childhood abuse

9-month follow-up outcome of repetition of DSH

I]ZgZaVi^dch]^ed[9H=Vi."bdci][daadl"jel^i]X]^aY]ddYVWjhZlVhVcVanhZYl^i]

hZeVgViZ]^ZgVgX]^XVabjai^eaZgZ\gZhh^dcVcVanhZhWdi]^ci]Z^ciZci"id"igZVic2.%VcY

XdbeaZiZghhVbeaZc2,(#>cVaaVcVanhZh9H=ViWVhZa^cZlVh[dgXZY^cidi]ZZfjVi^dc^c

i]ZÒghihiZeVcYigZVibZciXdcY^i^dc^ci]ZhZXdcYhiZe#>ci]Zi]^gYhiZehZmjVaVWjhZ!

e]nh^XVaVWjhZdgXdbW^cZYVWjhZlZgZ[dgXZY^cidi]ZZfjVi^dc!VcY^ci]ZaVhihiZei]Z

^ciZgVXi^dcd[dcZd[i]ZhZ[dgbhd[VWjhZl^i]igZVibZciXdcY^i^dc#>ccdcZd[i]ZVcVanhZh

Zk^YZcXZ [dg bjai^Xdaa^cZVg^in lVh [djcY# >c i]Z ^ciZci"id"igZVi hVbeaZ 9H= Vi WVhZa^cZ

VXXdjciZY[dg&(#*d[i]ZkVg^VcXZ^c9H=Vi[daadl"je;X]Vc\Z&#--2&(#,&!e1#%%&!

l]^aZigZVibZciXdcY^i^dcZmeaV^cZYVcVYY^i^dcVa,#.d[i]ZkVg^VcXZ;X]Vc\Z&#-,2

-#,(!e1#%&#>ccdcZd[i]ZVcVanhZhlZgZhZmjVaVWjhZ!e]nh^XVaVWjhZdgXdbW^cZYVWjhZ

Baseline Baseline Baseline Baseline Sexually abused¹ Physically abused² Combined abuse³ No childhood abuse

(n=39) (n=39) (n=25) (n=33)

M(SD) M(SD) M(SD) M(SD)

DSH 17.13(10.19)** 15.77(10.72)* 17.92(9.72)** 10.15(10.44)

Depression 38.74 (11.46)** 35.38(13.60)** 38.92(12.80)** 26.15 (12.68)

Anxiety 34.15(8.37)** 32.51(9.25)** 34.92(9.38)** 23.09(8.15)

Dissociation 18.56(14.89)** 17.54(16.14)** 22.92(15.04)** 6.36(10.20) Beliefs-total 477.15(182.87)* 450.22(209.77) 492.20(205.78)* 350.36(220.98)

Subscales (range 0-100):

Borderline Beliefs 94.08(38.08)** 89.22(44.38)* 98.68(42.49)** 65.58(41.40) Paranoid Beliefs 80.72(44.17)** 77.35(52.60)* 86.48(51.22)** 49.70(45.37) Obs. Comp. Beliefs 75.92(37.71) 72.16(34.69) 74.48(35.64) 65.55(44.92) Histrionic Beliefs 54.31(29.19)* 51.59(31.42) 56.76(31.67)* 39.27(34.18) Dependent Beliefs 76.26(39.02)* 71.76(37.66) 79.64(39.87) 61.00(45.69) Avoidant Beliefs 95.87(40.31)** 88.14(45.26) 96.16(44.17)* 69.27(46.35)

*p<.05, **p<.01;

1 Sexual Abuse versus No Childhood Abuse

2 Physical Abuse versus No Childhood Abuse

3 Combined Abuse versus No Childhood abuse

&%-

egZY^Xi^kZd[9H=Vi[daadl"jeVWdkZVcY^cYZeZcYZcid[9H=ViWVhZa^cZVcYigZVibZci

XdcY^i^dc ^c i]Z i]^gY hiZe# =dlZkZg! i]Z ^ciZgVXi^dc d[ hZmjVa VWjhZ l^i] igZVibZci

XdcY^i^dc VXXdjciZY [dg )#, d[ i]Z kVg^VcXZ ^c 9H= VWdkZ VcY ^cYZeZcYZci d[ 9H= Vi

WVhZa^cZ/igZVibZciXdcY^i^dcVcYhZmjVaVWjhZ;X]Vc\Z&#-*2*#),!e1#%*#>ci]ZÒcVa

bdYZadcan9H=ViWVhZa^cZWZiV2#(-!e1#%%&VcYi]Z^ciZgVXi^dcd[hZmjVaVWjhZl^i]

igZVibZciXdcY^i^dcWZiV2"#(-!e1#%*lZgZ^cYZeZcYZcih^\c^ÒXVciegZY^Xidghd[9H=

Vi [daadl"je hZZ IVWaZ )# >c i]Z di]Zg bjai^eaZ gZ\gZhh^dc VcVanhZh! i]Z ^ciZgVXi^dc d[

e]nh^XVaVWjhZdgXdbW^cZYVWjhZl^i]igZVibZciXdcY^i^dcY^YcdiegdkZidWZegZY^Xi^kZ

d[9H=Vi."bdci][daadl"je#GZeZVi^c\i]ZhZVcVanhZh^ci]ZXdbeaZiZghhVbeaZn^ZaYZY

Vabdhi^YZci^XVagZhjaih#>ci]ZhZVcVanhZhi]Z^ciZgVXi^dcd[hZmjVaVWjhZl^i]igZVibZci

XdcY^i^dcVXXdjciZY[dg*#'d[i]ZkVg^VcXZ^c9H=hXdgZhVi[daadl"je;X]Vc\Z&#+-2

)#+&!e1#%*^ci]Z[djgi]hiZed[i]ZgZ\gZhh^dcVcVanh^hl^i]9H=ViWVhZa^cZWZiV2#)%!

e1#%%&VcYi]Z^ciZgVXi^dcd[hZmjVaVWjhZl^i]igZVibZciXdcY^i^dcWZiV2"#)&!e1#%*

WZ^c\i]Zdcanh^\c^ÒXVci^cYZeZcYZciegZY^Xidgh^ci]ZÒcVabdYZa#I]ZZ[[ZXih^oZd[i]Z

Y^[[ZgZcXZ ^c gZh^YjVa^oZY X]Vc\Z hXdgZh [dg 9H= WZilZZc hZmjVaan VWjhZY eVgi^X^eVcih

[gdb i]Z 87I VcY I6J XdcY^i^dc lVh kZgn aVg\Z Y 2 &#'! l]^aZ i]Z bV\c^ijYZ d[ i]Z

Y^[[ZgZcXZ^cgZh^YjVa^oZYX]Vc\ZhXdgZhWZilZZccdc"hZmjVaanVWjhZYeVgi^X^eVcih[gdb

Wdi] XdcY^i^dch lVh hbVaa Y 2 #&,# I]ZhZ gZhjaih ^cY^XViZ i]Vi eVgi^X^eVcih l^i] hZmjVa

VWjhZ^ci]Z^geVhi^ceVgi^XjaVggZYjXZYi]Z^g9H=idVh^\c^ÒXVcian\gZViZgZmiZci^ci]Z

87IXdcY^i^dcXdbeVgZYidi]ZI6JdcanXdcY^i^dc#

Variable B t R² F Δ R² F Change

Step 1 13.5 13.71*** 13.5 13.71***

DSH at baseline .38 3.97***

Step 2 21.4 11.82*** 7.9 8.73**

Treatment condition -.08 -.61

Step 3 21.4 7.80*** .00 .04

Sexual abuse .23 1.60

Step 4 26.1 7.52*** 4.7 5.47*

Sexual abuse X -.38 -2.34*

condition

* p < .05; ** p < .01; *** p <.001

IVWaZ)#Summary of hierarchical linear regression analysis predicting deliberate self-harm (DSH) at 9-month follow-up on the basis of DSH at baseline, treatment condition, sexual abuse and the interaction of sexual abuse with treatment condition (n=90)

&%.

9^hXjhh^dc

I]ZgZhjaihd[i]^hhijYn]^\]a^\]iVcjbWZgd[^bedgiVciXa^c^XVaed^cih#8dch^hiZcil^i]

aZVY^c\i]Zdg^Zhd[9H=A^cZ]Vc!&..(!bdhieVi^Zcih^ci]ZhijYnhVbeaZ]VYV]^hidgnd[

X]^aY]ddYVWjhZ!l^i]e]nh^XVaVWjhZVcYhZmjVaVWjhZWZ^c\gZedgiZYWn),VcY)+d[

i]ZeVi^ZcihVcYXdbW^cZYVWjhZWZ^c\gZedgiZYWn'.d[i]ZeVi^Zcih#I]ZhZ[gZfjZcX^Zh

VgZ]^\]Zgi]Vci]dhZ[djcY^cVcZe^YZb^dad\^XVahijYnd[hj^X^YZViiZbeiZghi]VijhZY

i]ZhVbZbZi]dYdad\nDhkVi]ZiVa#!'%%)!WjiadlZgi]Vci]dhZ[djcYVbdc\eVi^Zcih

Y^V\cdhZYl^i]WdgYZga^cZeZghdcVa^inY^hdgYZg6gcioZiVa#!&...#I]Z]^\][gZfjZcXn

d[ X]^aY]ddY Zbdi^dcVa VWjhZ ^h ^c VXXdgYVcXZ l^i] A^cZ]VcÉh i]Zdgn A^cZ]Vc! &..(!

jcYZga^c^c\ i]Z ^beVXi d[ aVX` d[ Zbdi^dcVa kVa^YVi^dc d[ i]Z X]^aY Wn XVgZ\^kZgh ^c i]Z

VZi^dad\nd[WdgYZga^cZeZghdcVa^inY^hdgYZgVcY9H=#

GZhjaih h]dl i]Vi 9H= eVi^Zcih l^i] V ]^hidgn d[ X]^aY]ddY VWjhZ ]VkZ bjai^eaZ

ehnX]dad\^XVa VcY ehnX]^Vig^X egdWaZbh# 8dbeVgZY id cdc"VWjhZY eVi^Zcih! VWjhZY

eVi^Zcih]VYbdgZhZkZgZ9H=add`^c\Vii]ZcjbWZgd[Ze^hdYZh!YZegZhh^dc!Vcm^Zin!

Y^hhdX^Vi^dcVcYbVaVYVei^kZWZa^Z[h!VhlZaaVh]^\]ZgaZkZahd[EIH9VcYehnX]^Vig^XXd"

bdgW^Y^in#I]dhZl^i]V]^hidgnd[XdbW^cZYe]nh^XVaVcYhZmjVaVWjhZ]VYi]Z]^\]Zhi

hXdgZh dc Vaa bZVhjgZh! Vai]dj\] i]Z Y^[[ZgZcXZh WZilZZc i]Z VWjhZ hjWineZh lZgZ

cdi h^\c^ÒXVci# I]ZhZ ÒcY^c\h eVgian XdcÒgb i]Z gZhjaih d[ V egZk^djh hijYn h]dl^c\

i]Vi eVi^Zcih l^i] ]^hidg^Zh d[ Wdi] e]nh^XVa VcY hZmjVa VWjhZ Zm]^W^i i]Z bdhi hZkZgZ

hnbeidbVidad\n! ^cXajY^c\ YZegZhh^dc! Ynhi]nb^V VcY ViiZbeiZY hj^X^YZ GnVc Zi Va#!

'%%%#I]ZXdbbdcVa^ind[i]ZZ[[ZXihd[e]nh^XVaVcYhZmjVaVWjhZ]VhWZZcViig^WjiZYid

i]Zh]VgZYZaZbZcihd[edlZgaZhhcZhh!iZggdg!WZigVnVa!VcYdkZghi^bjaVi^dcZmeZg^ZcXZY

^cVWjh^kZZck^gdcbZcihL^cYH^akZgc!&..'#

9Zhe^iZi]ZbdgZhZkZgZ^c^i^Va^beV^gbZci!i]Z87I^ciZgkZci^dclVh_jhiVhZ[[ZXi^kZ

[dg ^cY^k^YjVah l^i] V ]^hidgn d[ X]^aY]ddY e]nh^XVa! hZmjVa VWjhZ VcY XdbW^cZY VWjhZ

Vh[dg^cY^k^YjVahl^i]djiV]^hidgnd[VWjhZ^&#I]ZhZgZhjaihVgZZcXdjgV\^c\!hj\\Zhi^c\

i]ZgdWjhicZhhd[i]Z^ciZgkZci^dc!l]^X]^hXdch^hiZcil^i]i]ZgZhjaihd[ildegZk^djh

hijY^Zh EZii^\gZl  7jgX]Vb! &..,0 6gcdaY Zi Va#! '%%(# I]Z ÒcY^c\ i]Vi ^cY^k^YjVah

l^i] V ]^hidgn d[ hZmjVa X]^aY]ddY VWjhZ ]VY V eddgZg djiXdbZ dc gZeZi^i^dc d[ 9H=

[daadl^c\jhjVaXVgZbVnhj\\Zhii]Vii]dhZl^i]V]^hidgnd[hZmjVaVWjhZ]VkZheZX^Va

cZZYh#>cYZZY!XdbeVgZYl^i]cdc"VWjhZYeVi^Zcih!i]ZhZeVi^ZcihlZgZ[djcYid]VkZ

h^\c^ÒXVcian bdgZ ehnX]dad\^XVa VcY ehnX]^Vig^X egdWaZbh! ^cXajY^c\ igVjbV"gZaViZY

egdWaZbh hjX] Vh EIH9 VcY Y^hhdX^Vi^dc# >i ]Vh WZZc Vg\jZY i]Vi i]Z bdhi Z[[ZXi^kZ

lVnd[igZVi^c\i]ZhZkZgZVcYX]gdc^XegdWaZbhd[hZmjVaanVWjhZYeVi^Zcih^hWnjh^c\

ZmeZg^Zci^VaiZX]c^fjZhZ#\#^bV\ZgnVcYgdaZeaVnl]^X]VgZi]dj\]iidZcVWaZeVi^Zcih

idZmeZg^ZcXZcZlk^ZlhVcYZbdi^dchdcl]Vi]VeeZcZY^ci]ZeVhi6gcioLZZgibVc!

&...# H^cXZ i]Z 87I ^ciZgkZci^dc ^c i]Z egZhZci hijYn [dXjhZY dc Zbdi^dc gZ\jaVi^dc

&&%

Y^[ÒXjai^Zh VhhdX^ViZY l^i] gZeZi^i^dc d[ 9H= VcY cdi dc Zmeadg^c\ VcY gZ^ciZgegZi^c\

bZbdg^Zhd[ZVganX]^aY]ddY!i]ZgZhjaihd[i]^hhijYnhZZbid^cY^XViZi]ViVigZVibZci

[dXjh^c\dcXjggZciegdWaZbhXVcVahdWZjhZYhjXXZhh[jaan^chZmjVaanVWjhZY9H=eVi^Zcih#

:bdi^dcgZ\jaVi^dcY^[ÒXjai^Zh]VkZWZZcXdcXZeijVa^oZYVhVgZaVi^kZanY^hi^cXi[ZVijgZ^ d[ i]Z XdchZfjZcXZh d[ X]^aY]ddY VWjhZ i]Vi VgZ hjeedhZY id YZg^kZ [gdb i]Z^VWjhZÉh

Y^hgjei^kZ^beVXidci]ZVX]^ZkZbZcid[i]ZYZkZadebZciVa^\dVahd[Zbdi^dcgZ\jaVi^dc

VcY ^ciZgeZghdcVa gZaViZYcZhh KVc YZg @da`! &..+# Id ^cÓjZcXZ i]Z kjacZgVW^a^i^Zh ^c

Zbdi^dc gZ\jaVi^dc! i]Z 87I ^ciZgkZci^dc V^bZY id Zc]VcXZ Zbdi^dcVa VlVgZcZhh!

Y^higZhhidaZgVcXZVcYegdWaZbhdak^c\h`^aah#AZVgc^c\idigjhidcZÉhVW^a^inidXdeZl^i]

Y^[ÒXjai^ZhVcY[ZZa^c\^cXdcigdadkZgdcZÉha^[ZbVnWZeVgi^XjaVgan^bedgiVci[dghZmjVaan

VWjhZYeVi^Zcih!l]d[ZaiedlZgaZhhVii]Zi^bZd[i]ZVWjhZ#7ZiiZgZfj^eeZYidXdeZl^i]

YV^anhigZhh!i]Zncdadc\ZgcZZYidZc\V\Z^cbVaVYVei^kZXde^c\hjX]VhY^hhdX^Vi^dc#6

gZXZcihijYn^cVcdc"Xa^c^XVahVbeaZh]dlhVY^gZXigZaVi^dch]^eWZilZZcVYZXgZVhZ^c

eZgXZ^kZYhigZhhVcYVYZXgZVhZ^cY^hhdX^Vi^kZe]ZcdbZcVYZLVX]iZg!Edjl!HigjWWZ!

AVc\Z!KVcYZga^cYZc!'%%+#=dlZkZg!^i^hhi^aajcXaZVgl]Zi]ZgbZi]dYh[dXjh^c\dc

egZhZci Zbdi^dc gZ\jaVi^dc Y^[ÒXjai^Zh ]VkZ edh^i^kZ adc\"iZgb Z[[ZXih [dg VWjhZY 9H=

eVi^Zcih# ;jijgZ gZhZVgX] bVn ^cY^XViZ l]Zi]Zg bZi]dYh [dXjh^c\ dc i]Z egZhZci VgZ

ZfjVaanZ[[ZXi^kZ[dgVWjhZY9H=eVi^ZcihVhbZi]dYhY^gZXiZYViX]^aY]ddYigVjbV#

I]ZhijYn]VhhZkZgVaa^b^iVi^dch#;^ghi!\^kZci]Vii]^hlVhVXa^c^XVahVbeaZ!i]ZÒcY^c\h

bVn cdi WZ \ZcZgVa^oZY id ^cY^k^YjVah l^i] 9H= ^c i]Z Xdbbjc^in# ;dg ZmVbeaZ! i]Z

egZkVaZcXZd[VWjhZbVnWZ]^\]ZgVcYi]ZaZkZad[ehnX]dad\^XVaegdWaZbhbVnWZ\gZViZg

^cVXa^c^XVahVbeaZ#HZXdcY!YZhe^iZhda^YZbe^g^XVaZk^YZcXZ[dgi]Z^chigjbZcijhZYid

bZVhjgZ X]^aY]ddY VWjhZ! gZigdheZXi^kZ gZedgi^c\ d[ X]^aY]ddY VWjhZ gV^hZh XdcXZgc

VWdji i]Z VXXjgVXn d[ eVgi^X^eVci gZXVaa# >c VYY^i^dc! eVi^Zcih bVn [ZZa jcXdb[dgiVWaZ

Y^hXadh^c\ZmeZg^ZcXZhd[VWjhZ#=dlZkZg!i]Z^ciZgk^ZllVhVYb^c^hiZgZY^ci]ZXdciZmi

d[ V WgdVYZg ^ciZgk^Zl l]^X] VaadlZY gVeedgi id WZ ZhiVWa^h]ZY VcY i]^h b^\]i ]VkZ

[VX^a^iViZYi]ZegdXZhhd[Y^hXadhjgZ#I]^gY!^i^hjcXaZVgl]Zi]Zgi]Zedh^i^kZigZVibZci

Z[[ZXihVgZViig^WjiVWaZidheZX^ÒX^c\gZY^Zcihd[i]Z87Idgidi]ZidiVaeVX`V\Zd[i]Z

87I ^c VYY^i^dc id I6J# ;jijgZ gZhZVgX] ^h cZXZhhVgn id ^YZci^[n kVg^VWaZh i]Vi bZY^ViZ

igZVibZciZ[[ZXihZ#\#heZX^ÒXZbdi^dcgZ\jaVi^dcY^[ÒXjai^ZhVcYidYZiZXii]ZVXi^kZ

^c\gZY^Zcihd[i]Z87IZ#\#Wj^aY^c\Zbdi^dcgZ\jaVi^dch`^aah@gVZbZg!L^ahdc!;V^gWjgc!

6\gVh!'%%'#

KZgn[ZlhijY^Zh]VkZZmVb^cZYl]Zi]Zgi]ZegZhZcXZd[V]^hidgnd[VWjhZa^b^ihVc

^cY^k^YjVaÉhgZhedchZidigZVibZci#9Zhe^iZhdbZa^b^iVi^dch!i]^hhijYn^[djcYZk^YZcXZ

i]ViVi^bZ"a^b^iZY87I^ciZgkZci^dci]ViYdZh^cdiVYYgZhhVWjhZY^gZXian^hcdiVhhdX^ViZY

l^i]bdgZcZ\Vi^kZdjiXdbZ^^cVedejaVi^dcd[9H=eVi^Zcihl^i]V]^hidgnd[X]^aY]ddY

VWjhZ#87IhZZbhidWZi]ZWZhiX]d^XZ[dg9H=eVi^Zcihl^i]ZmiZch^kZVWjhZ]^hidg^Zh#

&&&

&6YY^i^dcVaVcVanhZhVahdh]dlZYi]Vi^cY^k^YjVahY^[[Zg^c\^cYZbd\gVe]^X!ehnX]^Vig^XVcYehnX]d"

ad\^XVaX]VgVXiZg^hi^XhZfjVaanWZcZÒiZY[gdbi]Z87I#