Sex as a Form of Self-Injury in the Aftermath of Sexual Assault: The Role of Trauma-Related Shame and Social Support

Abstract

The behavior of using sex as a form of self-injury (SASI) is under-acknowledged and under-researched. Preliminary studies with adolescents suggest that SASI behaviors are associated with traumatic experiences and several deleterious mental health outcomes. The present study proposes a novel scale with which SASI could be measured, as no scale currently exists. Correlates of SASI behavior were also examined among adults with no history of self-harm (n=100), a history of only non-sexual self-harm (n=100) and a history of sexual self-injury (n=100) in the US. Between group comparisons revealed that sexual assault was significantly more prevalent among individuals who use SASI. Over half of the SASI group also reported that they were reacting to or replaying traumatic memories through SASI. Additionally, those who use SASI reported higher levels of trauma-related shame. Self-esteem levels were lower, on average, among those with a history of SASI, compared with those with no self-injury history. Levels of social support did not significantly differ with SASI use but did have a negative correlation with trauma-related shame. 96% of individuals in the SASI group reported a history of non-suicidal self-injury (NSSI) and the most common functional motivators of SASI behavior were intrapersonal, similar to patterns seen in NSSI. Exploratory path analyses indicated that sexual assault was associated with engagement in SASI both directly and indirectly through trauma-related shame. These findings underscore the importance of screening for SASI alongside other forms of self-injury, and the need for trauma-informed interventions.