Letters to the Editor

Is Childhood Sexual Abuse Related to Self-Injurious Behavior?


Am Fam Physician. 2011 Dec 1;84(11):1195.

Original Article: Self-Injurious Behavior in an Adolescent [Curbside Consultation]

Issue Date: March 1, 2011

Available at: https://www.aafp.org/afp/2011/0301/p609.html

to the editor: In this informative Curbside Consultation, Drs. Bode and Roberts state that “In addition to high-risk sexual behaviors, higher rates of sexual abuse are found in patients with nonsuicidal self-injury.” I assume they mean that patients with nonsuicidal self-injury are more likely to have a history of sexual abuse. This would not appear to be the case, based on a review article and meta-analysis that found the relationship to be relatively small.1 The meta-analysis concludes that “Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.”

Would the authors agree, in light of this information, that childhood sexual abuse does not have a causative and central role in nonsuicidal self-injury?

Author disclosure: No relevant financial affiliations to disclose.


1. Klonsky ED, Moyer A. Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry. 2008;192(3):166–170.

in reply: Thank you to Dr. Ewald for your contribution to the discussion of this difficult subject. Although we agree that the evidence may not support a causal relationship between a history of sexual abuse and nonsuicidal self-injury, there is a statistically significant and clinically relevant association.1 The prevalence of childhood sexual abuse in the general population is high (approximately 17 and 8 percent for adult women and men, respectively), and it is associated with other nonsuicidal self-injurious comorbidities (e.g., depression, eating disorders, substance abuse).2 We encourage routine questioning about a history of sexual abuse in patients with nonsuicidal self-injury, because knowledge of abuse can help physicians manage patient safety and can influence future therapy. A biopsychosocial approach such as HEADSS (home life, education, activities, drugs, suicide, sex) provides a simple, commonly used framework to evaluate patients with nonsuicidal self-injury for associated comorbidities, including a history of sexual abuse.

Author disclosure: No relevant financial affiliations to disclose.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army or Navy Medical Departments, or the U.S. Army or Navy Services at large.


1. Klonsky ED, Moyer A. Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry. 2008;192(3):166–170.

2. Putnam FW. Ten-year research update review: child sexual abuse. J Am Acad Child Adolesc Psychiatry. 2003;42(3):269–278.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 2011 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


May 15, 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article