The mediating roles of psychological pain proxies and pain catastrophising in the relationship between childhood trauma and self-harm: A mixed methods investigation

Background: The relationship between childhood trauma (CT) and self-harm (SH) is well documented in the literature, and both are associated with significant negative consequences. This highlights the need to understand mediators that facilitate this relationship. One such mediator is Psychological Pain (PP), a multifaceted construct, encompassing both cognitive and emotional components. This study operationalised PP through proxies of emotional regulation and emotional reactivity, with Pain catastrophising (PC) explored as a potential secondary mediator. Aims: This study aimed to explore the correlational relationships between CT, SH, PP and PC, and to assess the potential mediating roles of PP and PC in this relationship. Additionally, this study aimed to explore the lived experiences of individuals who engaged in SH, specifically exploring themes related to CT and PP. Method: First, a secondary data analysis was conducted, which utilised existing measures including the Childhood Traumatic Events Scale, SH scale, the Emotional Reactivity Scale, the Difficulties in Emotional Regulation Scale and the Pain Catastrophising Scale. Second, a convergent mixed-methods study was conducted, incorporating these measures alongside semi-structured interviews, which were analysed using Reflexive Thematic Analysis. Findings: Both the quantitative and qualitative results indicated that PP proxies mediated the CT-SH relationship. Study one found both frequency and intensity of CT predicted PP, which in turn predicted SH. Study two found the intensity of CT predicted PP, which also predicted SH. The mediating effect of PC varied within and between studies. Qualitative themes revealed that CT contributed to PP and PC, and SH served as a coping mechanism. Conclusions: The findings highlight the central mediating role of PP in the CT-SH relationship. Clinical interventions aimed at resolving PP may be beneficial in reducing SH. Future research should investigate additional mediators and protective factors. Limitations include challenges in conceptualising PP, and the use of measures with limited validation.