Associations among child maltreatment, non-suicidal self-injury and internet addiction in adolescents: Longitudinal mediation of symptoms of complex posttraumatic stress disorder

Backgrounds: Non-suicidal self-injury (NSSI) and internet addiction are behavioral problems influenced by environmental factors, with child maltreatment emerging as an important risk factor. Complex posttraumatic stress disorder (CPTSD) is closely associated with child maltreatment. Objective: This study aimed to explore the longitudinal associations among child maltreatment, NSSI and internet addiction, focusing on the mediating role of CPTSD symptoms. Participants and setting: This study collected three-wave data from 454 Chinese adolescents with a six-month interval. Child maltreatment was assessed at T1, while CPTSD symptoms, NSSI and internet addiction were assessed at both T2 and T3. Methods: Path analysis was utilized to examine both direct and indirect effects of child maltreatment on NSSI and internet addiction, mediated by two clusters of CPTSD symptoms: posttraumatic stress disorder (PTSD) and disturbance in self-organization (DSO). Results: CPTSD symptoms partially mediated the relationship between child maltreatment and the two behavioral problems, with DSO symptoms being the primary contributors to this mediating effect. Specifically, affective dysregulation and negative self-concept in DSO were key mediators for internet addiction and NSSI respectively. Conclusions: Among adolescents with child maltreatment, CPTSD symptoms, especially DSO symptoms, exert a significant influence on behavioral problems. This study underscores the need to integrate CPTSD symptoms into evidence-based interventions targeting maladaptive behaviors in maltreated youth.