Derealisation and self-harm strategies are used to regulate disgust, fear and sadness in adult survivors of childhood sexual abuse

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of posttraumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma-related emotions (anger, sadness, disgust and fear) on PTSD severity via two mediators; derealisation and self-harm. In particular, we tested if the two hypothetical mediators operate sequentially, derealisation precedes self-harm and/or self-harm precedes derealisation. A predominately female clinical sample (N=109) of CSA survivors completed measures of experience of emotions, emotion regulation and post-traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma-related emotions on PTSD severity. Serial mediation analyses indicated there were significant total effects of all trauma-related emotions on PTSD severity. Three trauma-related emotions (sadness, disgust and fear) were indirectly associated to PTSD severity via derealisation and self-harm and via self-harm and derealisation. Results indicate that difficulties in regulating the emotions of sadness, disgust and fear may result in more severe derealisation and self-harm as coping strategies which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealisation and self-harm might enable the reduction of PTSD among CSA survivors