Attitudes, cognition, and functional disability in individuals with self-harm and psychiatric disorders

Abstract: Title: Attitudes, cognition, and functional disability in individuals with self-harm and psychiatric disorders.Background: Self-harm is common and is associated with stigma and an increased risk for suicide attempts. There is a lack of knowledge about this behaviour, especially in clinical samples. Executive functions might be associated with self-harm, and there is also evidence that adverse childhood experiences and self-hatred are of relevance. However, there is a lack of studies in clinical samples. Similarily, there are few studies that explore the impact of self-harm on functional disability. Finally, tolerance towards self-harm could be of importance, but there’s currently no available measure that assesses tolerance towards self-harm in the general population.Aim: The current study aimed to develop a scale to measure tolerance towards self-harm, as well as to explore executive functions, functional disability, tolerance towards self-harm, self-hatred, and adverse childhood experience in a clinical group of individuals with self-harm, as compared to a clinical and a healthy control group. Method: A questionnaire on tolerance towards self-harm was constructed and validated against other instruments in a community sample of 336 respondents and a psychiatry staff sample of 582 respondents. Furthermore, 65 individuals with psychiatric conditions, with and without self-harm, and 29 healthy controls were interviewed and assessed with relevant instruments. Results: The questionnaire, named Lund Tolerance towards Self-harm Scale (LUTOSH), proved to have acceptable statistical characteristics. As compared to clinical and healthy controls, individuals with psychiatric conditions and self-harm exhibited deficits in one aspect of executive functions. They also reported significantly higher functional disability as compared to clinical controls. In addition, individuals with self-harm reported more childhood emotional abuse. Self-hatred mediated the impact of emotional abuse on self-harm. Discussion: Despite some limitations, the results have expanded our understanding of self-harm in clinical samples. The results, as well as the developed instrument, can be used for further studies as well as for developing new interventions.