Wounds That Speak: Exploring Childhood Trauma and Self-Injury in Patients with Generalized Anxiety Disorder
DOI:
https://doi.org/10.69980/ajpr.v28i5.645Abstract
Anxiety disorders affect up to 20% of adults annually, with Generalized anxiety disorder being among the most prevalent. The defining characteristics of generalized anxiety disorder are persistent feelings of stress and dread, along with exaggerated, irrational and perpetual worry over routine matters. This excessive worry often spans concerns about the future, family, health, or finances, and is difficult to manage, frequently accompanied by vague physical and psychological symptoms.1,2 The weighted prevalence rates observed was 5.8% for GAD in accordance with the Indian research.
References
1. Leonard K, Abramovitch A. Cognitive functions in young adults with generalized anxiety disorder. Eur Psychiatry. 2019 Feb;56:1-7.
2. Grenier S, Desjardins F, Raymond B, Payette MC, Rioux MÈ, Landreville P, Gosselin P, Richer MJ, Gunther B, Fournel M, Vasiliadis HM. Six-month prevalence and correlates of generalized anxiety disorder among primary care patients aged 70 years and above: Results from the ESA-services study. Int J Geriatr Psychiatry. 2019 Feb;34(2):315-323.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013
4. Chandrashekhar CR., Reddy MV. Prevalence of mental and behavioural disorders in India: a meta-analysis. Indian J Psychiatry. 1998;40:149–157.
5. Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008 Mar 29;371(9618):1115–25.
6. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010 Jan;15(1):53–63.
7. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048–60.
8. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2006 Apr;63(4):415–24.
9. Munir S, Takov V. Generalized Anxiety Disorder [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2022 Oct 17; cited 2025 Jun 9].
10. Copeland WE, Shanahan L, Hinesley J, Chan RF, Aberg KA, Fairbank JA, et al. Association of childhood trauma exposure with adult psychiatric disorders and functional outcomes. JAMA Netw Open. 2018;1(7):e184493.
11. World Health Organization. Report of the consultation on child abuse prevention, WHO, Geneva. World Health Organization; 1999.
12. NATIONAL CRIME RECORDS BUREAU . Crime in India – statistics, 2016.
13. Choudhry V, Dayal R, Pillai D, Kalokhe AS, Beier K, Patel V. Child sexual abuse in India: A systematic review. PLoS One. 2018
14. WORLD HEALTH ORGANISATION . Child maltreatment, 2016.
15. Radhika K, Manjula M, Jaisoorya TS. Ethical gaps in conducting research among adult survivors of child sexual abuse: a review. Indian J Med Ethics 2018;3:186–92.
16. Khan M, Ahmed M, Bhatti A, Siddiqui H. Childhood maltreatment and risk of generalized anxiety disorder in adolescents: A cohort study in Karachi. J Child Adolesc Trauma. 2023;16(2):365–74.
17. Lindert J, von Ehrenstein OS, Grashow R, Gal G et al. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health. 2014 Apr;59(2):359-72.
18. Grummitt L, Baldwin JR, Mathews B, et al. Burden of mental disorders and suicide from childhood maltreatment in Australia. JAMA Psychiatry. 2024;81(5):427–38.
19. World Health Organization. International Classification of Diseases for Mortality and Morbidity Statistics (11th Revision). Geneva: World Health Organization; 2019.
20. Nock, M.K.. Why do people hurt themselves? New insights into the nature and functions of self‐injury. Current Directions in Psychological Science. 2009;18 : 78 – 83.
21. Nishizono, M., Yasuoka, H... Wrist cutting syndrome. Japanese Journal of Clinical Psychiatry. 1979; 35 : 257 – 264
22. Paivio, S.C., McCulloch, C.R... Alexithymia as a mediator between childhood trauma and self‐injurious behaviors. Child Abuse & Neglect. 2004; 28 : 339 – 354.
23. Matsumoto, T., Azekawa, T., Yamaguchi, A., Asami, T., Iseki, E.. Habitual self‐mutilation in Japan. Psychiatry and Clinical Neurosciences. 2004; 58 : 191 – 198.
24. Shi Y, et al. Anxiety disorders and non-suicidal self-injury: A meta-analysis. J Anxiety Disord. 2025;85:102543.
25. Martínez M, et al. Childhood maltreatment and non-suicidal self-injury in adolescent population: A systematic review and meta-analysis. Child Abuse Negl. 2024 Nov;157:107048.
26. Guo S, et al. Association of adverse childhood experiences with non-suicidal self-injury and suicidality: Baseline survey of the Chinese Adolescent Health Growth Cohort. Future. 2023;1(3):76–92.
27. Xie X, et al. Relationship between childhood trauma and nonsuicidal self-injury among adolescents with depressive disorder: Mediated by negative life events and coping style. Neuropsychiatr Dis Treat. 2023;19:2271–81.
28. International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021
29. Hamilton, M., Diagnosis and rating of anxiety. British Journal of Psychiatry, 1969. Special Publication No 3.: pp. 76–79.
30. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disorder. 1988 Jan-Feb;14(1):61-8.
31. Tiwari, K. & Ojha, R. A Study on Hamilton Anxiety Rating Scale among College Students. International Journal of Indian Psychology, (2022); 10(3), 1725-1731.
32. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Zule W. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect. 2003;27(2):169–190.
33. Charak R, Koot HM. Abuse and neglect in adolescents of Jammu, India: the role of gender, family structure, and parental education. J Anxiety Disord. 2014 Aug;28(6):590-8.
34. Martin J, Cloutier PF, Levesque C, Bureau J-F, Lafontaine M-F, Nixon, MK. Psychometric properties of the functions and addictive features scales of the Ottawa Self-injury Inventory: A preliminary investigation using a university aged sample. Psychological Assessment. 2013
35. Bhatia MS, Aggarwal NK, Aggarwal BB. Childhood trauma in psychiatric patients: A clinical study from India. Delhi Psychiatry J. 2011;14(1):157–61.
36. Bresin K, Schoenleber M. Gender differences in non-suicidal self-injury: A meta-analysis. Clin Psychol Rev. 2015;38:55–64.
37. Brown RC, Plener PL, Braehler E, Fegert JM, Haeuser W. The association of nonsuicidal self-injury and suicide attempts: A representative population study. BMC Psychiatry. 2018;18:353.
38. Singh A, Thomas AM, Gopalkrishna G. Adverse childhood experiences and anxiety among Indian female adolescents: A cross-sectional study. Indian J Psychol Med. 2021;43(1):12–8.
39. Sharma R, Grover S, Basu D. Association of non-suicidal self-injury and generalized anxiety disorder in Indian married women: A clinical evaluation. Indian J Psychiatry. 2020;62(3):247–53.
40. Verma A, Singh S. Religion and mental health among Indian youth: A sociocultural perspective. Indian J Soc Psychiatry. 2019;35(1):35–41.
41. Wang Y, Zhang Y, Li Q, et al. Adverse childhood experiences and non-suicidal self-injury among Chinese adolescents: A population-based analysis. BMC Public Health. 2024;24(1):305.
42. Zhang L, Wu Y, Li J, et al. Anxiety symptom profiles among trauma-exposed adolescents: Clinical correlates and comorbidities. J Affect Disord. 2022;299:490–8.
43. McLaughlin KA, Sheridan MA, Lambert HK. Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience. Neurosci Biobehav Rev. 2014;47:578–91.
44. Hou F, Wang Y, Liu J, et al. Emotional regulation and its relation to non-suicidal self-injury in trauma-exposed adolescents. Front Psychiatry. 2023;14:1020456.
45. Yan H, Zhang Y, Lu Z, Li M, Ge Y, Mei D, et al. High-risk group and functional subtypes of non-suicidal self-injury in young adults with mental disorders. Front Psychiatry. 2023;14
46. Zhang Y, Lin Y, Wang Y, et al. Alexithymia and rumination as mediators of the relationship between childhood trauma and NSSI in Chinese youth. J Psychiatr Res. 2023;162:188–95.
47. Lindholm T, Waenerlund AK, Elklit A, et al. Psychological mediators of the association between childhood abuse and non-suicidal self-injury in Swedish adolescents. Eur Child Adolesc Psychiatry. 2022;31(8):1235–42.
48. Liu RT, Scopelliti KM, Pittman SK, Zamora AS. Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis. Clin Psychol Rev. 2017;56:1–16.
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