ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Mood Disorders
The Effect of Childhood Maltreatment on Non-Suicidal Self-Injury in Adolescents with Bipolar Disorder: The Mediating Role of Dysfunctional Attitudes and the Moderating Role of Social Support
Provisionally accepted
- Renmin Hospital of Wuhan University, Wuhan, China
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Background: Childhood maltreatment has been consistently associated with nonsuicidal self-injury (NSSI). Patients with bipolar disorder (BD) are especially vulnerable to early adversity and self-injurious behaviors; however, the mechanisms underlying this association remain unclear. Among Chinese patients with BD, this study tested whether dysfunctional attitudes mediate the association between childhood maltreatment and NSSI and whether social support moderates this association. Methods: A cross-sectional study was conducted with 838 clinically diagnosed bipolar disorder patients (68.1% female; median age = 16 years). Measures included the Childhood Trauma Questionnaire–Short Form (CTQ-SF), Dysfunctional Attitudes Scale (DAS-A), Social Support Rating Scale (SSRS), Ottawa Self-Injury Inventory–Chinese Revised Edition (OSIC), and Hamilton Depression Rating Scale (HAMD-24). Descriptive analyses, correlations, mediation, and moderated mediation models were tested using SPSS 26.0 and Mplus 8.3, with robust maximum likelihood estimation (MLR) and 5,000 bootstrap resamples. Results: In our clinical sample of patients with bipolar disorder, 68.5% reported nonsuicidal self-injury (NSSI). Childhood maltreatment was positively associated with both dysfunctional attitudes and NSSI. Mediation analysis demonstrated that dysfunctional attitudes partially mediated the association between childhood maltreatment and NSSI (indirect effect β = 0.040, 95% CI [0.017, 0.061], p < 0.01), accounting for 18.2% of the total effect. Moderation analysis further indicated that social support significantly attenuated the association between dysfunctional attitudes and NSSI (interaction β = –0.082, 95% CI [–0.162, –0.015], p < 0 .05), but did not moderate the associations of childhood maltreatment with either dysfunctional attitudes or NSSI. Conclusion: Childhood maltreatment increases the risk of NSSI in patients with BD both directly and indirectly through dysfunctional attitudes, while social support mitigates the behavioral impact of dysfunctional attitudes on NSSI. These findings highlight dysfunctional attitudes as a cognitive mechanism and social support as a conditional protective factor, underscoring the importance of childhood maltreatment screening, cognitive restructuring, and support-enhancing interventions in reducing NSSI risk among Chinese patients with bipolar disorder.
Keywords: childhood maltreatment, nonsuicidal self-injury, Bipolar Disorder, Dysfunctional Attitudes, social support
Received: 03 Sep 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Tan, Zhao, Cao, Huang, Yi, Zhang and Wan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Fan Zhang
Zhihui Wan
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