Psychiatry Research 258 (2017) 130–135

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Do serum BDNF levels vary in self-harm behavior among adolescents and are MARK
they correlated with traumatic experiences?
⁎
Canem Kavurmaa,1, Fatma Varol Tasa, Burcu Serim Demirgorena, , Ferhat Demircib,2,
Pınar Akanb, Damla Eyuboglua,3, Taner Guvenira
a
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
b
MD, Department of Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: The aim of this study was to compare serum brain-derived neurotrophic factor (BDNF) levels between adoles-
BDNF cents that harm themselves, those that receive psychiatric treatment but do not harm themselves, healthy
Self-harm adolescents, and childhood traumas and to investigate the relationship between traumatic experiences and
Neuroplasticity serum BDNF levels. The cases were divided into two groups of 40 adolescents exhibiting self-harm behavior (self-
Childhood trauma
harm/diagnosed group) and 30 adolescents receiving psychiatric treatment but not exhibiting self-harm beha-
viors (non self-harm/diagnosed group). The control group (healthy control group) consisted of 35 healthy
adolescents with no psychiatric disorders or self-harm behaviors. The adolescents were asked to fill in the
Inventory of Statements About Self Injury (ISAS) and Childhood Trauma Questionnaire (CTQ). For BDNF
measurement, blood samples were taken from the cases and controls. The serum BDNF level of self-harming
adolescents who used the self-cutting method was significantly lower than that of other groups, and serum BDNF
levels decreased with the increase in the emotional neglect and abuse severity of self-harming adolescents during
childhood. In our study, serum BDNF levels decreased with the increase in emotional abuse in self-harming
adolescents. This finding may indicate that neuroplasticity can be affected by a negative emotional environment
during the early period.

1. Introduction
Adolescent self-harm which includes suicidality behavior and non-
suicidal self-harm, is a worldwide public health concern. The hetero-
geneity of self-harm is strongly associated with psychopathologies,
environment interaction and other social threats such as sexual abuse
(Lundh et al., 2011). Previous researches on self-harm is mostly focused
on the classification, prevalence, gender differences or underlying
motivations in adolescent. Nevertheless the exact explanation and
molecular mechanism still remains uncertain (Laye-Gindhu and
Schonert-Reichl, 2005).
The brain-derived neurotrophic factor (BDNF) is a well-known
neurotrophin in the brain which particularly associated with depres-
sion, anxiety, bipolar disorders and stress (Althoff et al., 2005). It was
shown that BDNF supports the development and survival of cholinergic,
dopaminergic, serotonergic neurons and protects against neurotoxicity
(Mamounas et al., 1995). Decreased level of BDNF in patients with
major depressive disorder and increase of BDNF mRNA in the brain
with utilization of antidepressants as well as negative correlation with
depression severity and serum BDNF levels were documented in pub-
lished data. Moreover numerous studies have reported lower BDNF
levels in suicide victims (Deveci et al., 2007). Furthermore BDNF plays
a prominent role in the regulation of serotonin [5-hydroxytryptamine
(HT)] neurons during childhood which are later related to suicidal
behavior by possible inhibition by low BDNF levels (Perroud et al.,
2008)). Although some researches showed no genetic association of
BDNF single nucleotide polymorphisms with completed suicide (Pregelj
et al., 2011; Zarrilli et al., 2009), the relationship between BDNF and
suicidal behavior is so obvious that today researchers discussing the
diagnostic value of BDNF as possible predictors of suicidal behavior in
genetic studies (Schenkel et al., 2010).
In a study examining the BDNF messenger ribonucleic acid (mRNA)
expression in peripheral mononuclear blood cells of depression patients
with and without suicide attempt, the BDNF mRNA expression in

⁎
Corresponding author.
E-mail address: burcuserim@hotmail.com (B. Serim Demirgoren).
1
Department of Child and Adolescent Psychiatry, Manisa Mental Health Hospital, Manisa, Turkey.
2
Department of Biochemistry, Dr. Suat Seren Chest Disease and Thoracic Surgery Teaching and Research Hospital, Izmir, Turkey.
3
Department of Child and Adolescent Psychiatry, Mardin State Hospital, Mardin, Turkey.

http://dx.doi.org/10.1016/j.psychres.2017.09.069
Received 27 April 2017; Received in revised form 5 September 2017; Accepted 24 September 2017
Available online 28 September 2017
0165-1781/ © 2017 Elsevier B.V. All rights reserved.
C. Kavurma et al.
peripheral mononuclear cells of depression patients was found to be
low when compared to healthy controls, and it was shown that the
BDNF mRNA expression of those depression patients who attempted
suicide was lower (Lee and Kim, 2010). In post-mortem studies, sig-
nificantly low BDNF levels were indicated in the hippocampus and
prefrontal cortexes of suicide cases, independently of the psychiatric
diagnosis (Karege et al., 2005a, b; Dwivedi et al., 2003). It was in-
dicated that BDNF dysfunction has a more significant and bigger role in
psychiatric disorders and suicide behaviors among adolescents when
compared to adults (Kim et al., 2007).
The adolescents who exhibiting non-suicidal self-harm are certainly
at the risk of completed suicide, therefore it is important to evaluate
non-suicidal self-harm in every detailed aspect. In addition, to our
knowledge, no published data is available such as evaluation of serum
BDNF levels and non-suicidal self-harm independently of the psychia-
tric disorder and suicide behavior in adolescents. Considering that this
study may contribute to enlightening the neurobiological factors of the
self-harm behavior, therefore it was aimed to compare the serum BDNF
levels of adolescents who were either exhibiting non-suicidal self-harm
behaviors or not exhibiting non-suicidal self-harm behaviors but re-
ceiving psychiatric treatment, to healthy adolescents in comparison
between childhood traumas and traumatic experiences.
2. Material and method
This study was approved by the Dokuz Eylul University Medical
Sciences Research Ethics Committee. Informed written consent forms
were obtained from all participants.
2.1. Sample
The study included total number of 105 adolescents aged between
12 and 18 years old. The case group was consisted of 70 adolescents and
the control group was consisted of 35 healthy adolescent. The cases
were divided into two groups as exhibiting non-suicidal self-harm be-
haviors (Self-harm/diagnosed group, n = 40) and not exhibiting non-
suicidal self-harm behaviors but receiving psychiatric treatment (Non
self-harm/diagnosed group, n = 30). The healthy control group
(Healthy control group, n = 35) was not exhibiting either psychiatric
disorder or non-suicidal self-harm behavior. Those with chronic dis-
eases and acute infection, mainly psychotic disorder, bipolar disorder,
substance abuse, clinically mental retardation, those with autistic dis-
order, chronic neurological disorder history and diabetes, hypertension,
and asthma, were excluded from this study.
2.2. Measures
2.2.1. Socio-demographic questionnaire
Includes socio-demographic data such as age, gender, educational
state, socio-economical level, substance abuse, history of physical dis-
orders as well as information related with our study goal.
2.2.2. Schedule for affective disorders and schizophrenia for school aged
children –present and lifetime version (K-SADS-PL-Turkish Version)
An interview form that created by Chambers et al. in order to detect
past and current psychopathologies in children and adolescents ac-
cording to Diagnostic and Statistical Manual of Mental Disorders 3rd
ed., rev.; DSM-III-R; American Psychiatric Association (1987) and DSM-
IV 4th ed.; American Psychiatric Association (1994) diagnostic criteria.
The form has three sections as “introduction”, “diagnosis” and “general
evaluation”. Severity of symptoms is rated as “absent”, “subthreshold”
and “threshold” (Chambers et al., 1985). The Recurrent Thoughts of
Death, Suicidal Ideation, Suicidal Acts–Seriousness, Suicidal Acts-
Medical Lethality, Non-Suicidal Physical Self-Damaging Acts was
evaluated via the 'Depressive Disorders' section of the interview in
present study.
131
Psychiatry Research 258 (2017) 130–135
2.2.3. Inventory of Statements About Self Injury (ISAS)
The ISAS is a scale that consists of 2 sections, developed in order to
investigate the self-harm behavior. The first section (Section 1: Beha-
viors) questions the life-long frequency of 12 self-harm behaviors ex-
hibited intentionally and without the intention of suicide. The function
of 13 different self-harm behaviors is questioned with a total of 39
questions in the second section (Section 2: Functions) (Klonsky and
Glenn, 2009).
2.2.4. Childhood Trauma Questionnaire (CTQ)
The CTQ is a 5-point Likert-type scale consisting of 40 items de-
veloped by Bernstein et al. (1994) in order to scan traumatic experi-
ences (emotional abuse and emotional neglect, physical abuse and
sexual abuse) before the age of 18.
All three instruments have been shown to be valid and reliable for
the Turkish population (Gökler et al., 2004; Bildik et al., 2012; Aslan
and Alparslan, 1999).
2.3. BDNF sampling
For the measurement of BDNF, blood samples were taken from the
cases and controls on an empty stomach between 9:00 and 10:00 A.M.
to 10 mL tubes not containing anticoagulants. After keeping the blood
samples for clotting, they were centrifuged for 20 min at 1000 g, and
their serums were divided into Eppendorf tubes in 2–3 parts and kept at
−80 °C until being analyzed. The BDNF analysis was performed with an
ELISA (Enzyme-linked Immunosorbent Assay) method at sensitivity of
0.057 ng/mL or below.
2.4. Statistical analysis
All data were analyzed with SPSS (Statistical Package for the Social
Sciences) software for Windows (v21.0; IBM, Armonk, NY, USA).
Individual and aggregate data were summarized using descriptive sta-
tistics including mean, standard deviations, medians (min-max), fre-
quency distributions and percentages. The Pearson's Chi-square test
(Fisher's Exact test) was used in the comparison of classified categorical
variables. Evaluation of categorical variables performed by Chi-Square
test. Comparison of the variables with normal distribution was made
with Student t-test and ANOVA (Post Hoc Tukey analysis in multiple
group comparisons). For the continuous variables that were not nor-
mally distributed, the Mann Whitney and the Kruskal-Wallis test was
conducted to compare between groups. Presence of correlation was
analyzed with Spearman's Rho and Pearson tests. P-values of < 0.05
were considered statistically significant.
3. Results
3.1. Sociodemographic results
Self-harm/diagnosed group included 40 adolescents, non self-harm/
diagnosed group included 30 adolescents, and the healthy control
group, included 35 adolescents. The mean age of the adolescents in self-
harm/diagnosed group was 15.29 ± 1.5 years, and it was observed that
80% were female. While the mean age of the adolescents in non self-
harm/diagnosed was 15.50 ± 1.1 years and 70% were female, the
mean age of the adolescents in healthy control group was found to be
14.65 ± 1.7 years and 68.6% were determined to be female. No sig-
nificant difference was found according to the age and gender between
the groups (p = 0.093; p = 0.47 respectively).
3.2. Results on self-harm behavior and ISAS
The mean onset age of the non-suicidal self-injury behaviors was
found to be 12.80 ± 1.9 years in self-harm group. 85% (n = 34) of the
adolescents with non-suicidal self-injury behaviors reported cutting to
C. Kavurma et al. Psychiatry Research 258 (2017) 130–135

Table 1 Table 2
The frequency of self-injury functions scaled by ISAS in Self-harm/diagnosed group. Distribution of psychiatric diagnoses of adolescents in self-harm/diagnosed group and
non self-harm/diagnosed group.
Functions ‘Very relevant/somewhat relevant’ N
(%) Psychiatric diagnosis Self-harm/ Non self-harm/
diagnosed group diagnosed group
Affect regulation 33 (82.5%) N (%) N (%)
Self-punishment 29 (72.5%)
Anti-suicide 25 (62.5%) Affective Disorders
Self-care 26 (65.0%) Depressive disorder 24 (60.0%) 12 (40.0%)
Revenge 24 (60.0%) Attention-Deficit and
Anti-dissociation/feeling-generation 24 (60.0%) Disruptive Behavior
Marking distress 24 (60.0%) Disorders
Toughness 23 (57.5%) ADHD 6 (15.0%) 8 (26.7%)
Interpersonal influence 21 (52.5%) ODD 2 (5.0%) 0
Interpersonal boundaries 20 (50.0%) CD 6 (15.0%) 0
Autonomy 16 (40.0%) Anxiety Disorders
Sensation-seeking 16 (40.0%) GAD 1 (2.5%) 8 (26.7%)
Peer-bonding 8 (20.0%) PTSB 1 (2.5%) 1 (3.3%)
TOTAL 40 (100.0%) 30 (100.0%)
* On the scale, the adolescents can mark the "Very relevant/Somewhat relevant" option
for multiple self-harming functions. *ADHD: Attention-Deficit Hyperactivity Disorder, ODD: Oppositional Defiant Disorder,
ISAS: Inventory of statements about self-injury. CD: Conduct Disorder, GAD: Generalized Anxiety Disorder, PTSB: Posttraumatic Stress
Disorder.
be the method that they used most frequently. While the second most
frequent method (62.5%) was interfering wound healing (such as re- statistically significant difference was found between the groups (p =
moving scabs off), it was determined that carving was the third (55%) 0.024). In the advanced statistical assessment, it was determined that
most frequent method. In terms of the functions of the behavior, affect the average scores of non self-harm/diagnosed group (p = 0.012) and
regulation was found to be the most frequently used function with self-harm/diagnosed group (p = 0.008) were statistically higher when
82.5% (n = 33). Self-punishment (72.5%) and anti-suicide (62.5%) compared to healthy control group. However, no difference was found
were found to be the second and third most frequent functions, re- between the average scores of self-harm/diagnosed and non self-harm/
spectively (Table 1). diagnosed group (p = 0.956) (Table 3).
The physical abuse and neglect subscale score average was calcu-
lated as 31.80 ± 11.71 for self-harm/diagnosed group, 26.63 ± 9.94
3.3. Results on the suicide thought/behavior for non self-harm/diagnosed group, and 20.82 ± 4.69 for healthy
control group. A statistically significant difference was found between
When an assessment was made in relation to suicide, suicide at- the groups (p = 0.000). A paired group comparison was made using the
tempt was reported at the rate of 65% (n = 26) in self-harm group, Bonferroni-corrected Mann-Whitney U test in order to determine the
suicide plan was reported in 27.5% (n = 11) and suicide thought (at groups causing this difference. Self-harm/diagnosed group was found to
least once during lifetime) was 82.5% (n = 33). While it was observed be significantly higher than healthy control group (p = 0.000) and non
that 16.7% (n = 5) of the patients in psychiatric group made suicide self-harm/diagnosed group (p = 0.033), and non self-harm/diagnosed
attempts, 6.7% (n = 2) had suicide plans, and 66.7% (n = 20) had group was found to be statistically significantly higher than controls (p
suicide thoughts (at least once during lifetime); no suicide attempt and = 0.004) (Table 3).
plan were reported in the adolescents in control group. Suicide thought The average of the total scores of the scale was calculated as
(at least once during lifetime) was determined in only 17.1% (n = 6) of 79.97 ± 26.96 for self-harm/diagnosed group, 65.43 ± 19.55 for non
controls. When compared to the adolescents in control group, suicide self-harm/diagnosed group, and 54.00 ± 17.45 for healthy control
thought, plan and attempts were statistically significantly higher among group. A statistically significant difference was found between all
the adolescents in self-harm group and psychiatric group (p < 0.0005; groups (p = 0.000). A paired group comparison was made using the
p = 0.001; p < 0.0005, respectively). The psychiatric diagnosis dis- Bonferroni-corrected Mann-Whitney U test in order to determine the
tributions of the adolescents in self-harm and psychiatric group are groups causing this difference. Self-harm/diagnosed group was found to
shown in Table 2. In addition there was a statistically significant dif- be significantly higher than control group (p = 0.000) and non self-
ference among groups according to the psychiatric diagnosis (p = harm/diagnosed group (p = 0.020), and non self-harm/diagnosed
0000). group was found to be statistically significantly higher than control
group (p = 0.027) (Table 3).
3.4. Childhood Trauma Questionnaire results
3.5. Results of serum BDNF levels
The emotional abuse and neglect subscale score average was cal-
culated as 42.27 ± 16.05 for self-harm/diagnosed group, The mean serum BDNF level of self-harm/diagnosed group
32.93 ± 10.45 for non self-harm/diagnosed group, and 28.08 ± 7.88 (42.70 ± 23.01), was found to be low when compared to non self-
for healthy control group. A statistically significant difference was harm/diagnosed group (47.27 ± 18.48) and healthy control group
found between the groups (p = 0.000). In the advanced statistical as- (45.86 ± 19.82) in present study. Accordingly, no statistically sig-
sessment, it was determined that the average scores of non self-harm/ nificant difference was determined between groups (p = 0.636).
diagnosed group (p = 0.018) and healthy control group (p = 0.000) Although no statistically significant results have found, the lower serum
were statistically significantly lower when compared to the self-harm/ BDNF levels in self-harm/diagnosed group and highest serum BDNF
diagnosed group. However, no difference was found between the levels in non self-harm/diagnosed group which receiving treatment, is
average scores of non self-harm/diagnosed group and healthy control remarkable.
group (p = 0.81) (Table 3). The relationship between the self-harm methods of the adolescents
The sexual abuse subscale score average was calculated as harming themselves and their serum BDNF levels was also examined.
5.90 ± 2.14 for self-harm/diagnosed group, 5.86 ± 1.79 for non self- Moreover the mean serum BDNF levels of self-harm/diagnosed group
harm/diagnosed group, and 5.08 ± 0.51 for healthy control group. A were presented in the Table 4 according to the gender differences. The

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serum BDNF level was found to be statistically significantly lower in

Non self-harm/diagnosed group > Healthy control group p = 0.004

Non self-harm/diagnosed group > Healthy control group p = 0.012

Non self-harm/diagnosed group > Healthy control group p = 0.020

Self-harm/diagnosed group > Non self-harm/diagnosed group; p =

Self-harm/diagnosed group > Non self-harm/diagnosed group p =

Self-harm/diagnosed group > Non self-harm/diagnosed group p =

those using the self-cutting method as a self-harm method (p = 0.047).

Self-harm/diagnosed group > Healthy control group; p = 0.000

Self-harm/diagnosed group > Healthy control group p = 0.000

Self-harm/diagnosed group > Healthy control group p = 0.008

Self-harm/diagnosed group > Healthy control group p = 0.000

Upon examining the correlation between the serum BDNF levels and
CTQ subscale scores of the self-harming and healthy adolescents, a
medium-level negative statistically significant relationship was found
between emotional abuse and neglect (p = 0.044) weighted total scores
(p = 0.038) and serum BDNF levels in self-harming adolescents. No
significant relationship was found between the serum BDNF levels and
CTQ subscale scores of the adolescents receiving psychiatric treatment
but not harming themselves and healthy adolescents (Table 5).
The comparison of the BDNF levels according to the suicidality also
performed in this study (Table 6). Although there was no statistically
significant difference was found between groups, the lowest BDNF le-
vels were obtained from suicide attempt positive group (40.40 ± 22.3).
Binary comparisona

Furthermore the serum BDNF level of 43.74 ± 21.07 was obtained from
group that exhibit at least one relation with suicidality (suicide attempt,
plans or thoughts) and the serum BDNF level of 50.14 ± 22.04 was
obtained from group that had no relation with suicidality. The lower
0.018

0.033

0.027

serum BDNF levels of group that related with suicidality also remark-
able.
17.41

24.80

23.22
7.42

We have also evaluated the patients diagnosed with depressive

x2

disorder in both self-harm/diagnosed and non self-harm/diagnosed

0.000

0.000

0.024

0.000

group. Accordingly the mean levels of BDNF was 36.26 ± 22.53 in self-
P*

harm/diagnosed group patients who were diagnosed with depressive

disorder (n = 21), similarly the mean levels of BDNF was
Healthy control group (N = 35)

42.76 ± 16.00 in non self-harm/diagnosed group patients who were

diagnosed with depressive disorder (n = 12). Although the BDNF levels
of self-harm/diagnosed group patients with depressive disorder were
lower than non self-harm/diagnosed group, the decrease of BDNF was
not statistically significant. Moreover when we evaluated the BDNF
54.00 ± 17.45
28.08 ± 7.88

20.82 ± 4.69

5.08 ± 0.51

levels to inspect for significant predictors, the findings obtained from

M ± SD

conduct disorder (p = 0.013, p = 0.013, R square = 0.058 square =

0.058) and depressive disorder (p = 0.017, p = 0.017, R square =
0.054 square = 0.054) were statistically significant as predictors.
Non self-harm/diagnosed group (N =

4. Discussion

As a result of the data obtained from our study, the serum BDNF
levels of self-harming adolescents were found to be low when compared
to other groups, despite not being significant. Furthermore, the serum
BDNF level of those self-harming adolescents who used the self-cutting
32.93 ± 10.45

65.43 ± 19.55

method was found to be statistically significantly lower, and it was

26.63 ± 9.94
Comparison of the results of Childhood Trauma Questionnaire (CTQ) among the groups.

5.86 ± 1.79

determined that serum BDNF levels decreased with the increase in the
Mann Whitney U Test, Bonferroni correction was applied in binary comparisons.
M ± SD

emotional neglect and abuse severity of self-harming adolescents

during childhood.
30)

* Kruskal Wallis test, p < 0.05, bold values mean a statistical significance.

BDNF is a neurotrophin with a very important role in neuroplasti-

Self-harm/diagnosed group (N = 40)

city (Givre, 2002). In the recent ten years, the role of BDNF in the
pathophysiology of suicide behavior has attracted the attention of re-
searchers. In a study carried out by Kim et al. (2007), the plasma BDNF
levels of patients diagnosed with depression that attempted and did not
attempt suicide and healthy controls were compared, and it was found
out that plasma BDNF level is related to the suicide behavior in de-
pression. According to the findings obtained from the results of the
42.27 ± 16.05

31.80 ± 11.71

79.97 ± 26.96
5.90 ± 2.14

same study, it was put forth that BDNF level can be a biological in-
M ± SD

dicator in depression with suicide thoughts.

The low level of BDNF in suicide-related patients is explained by
decreasing the BDNF expression by the low serotonin function causing
Emotional abuse and neglect

suicide thoughts and attempts. BDNF and serotonin are held responsible
Physical abuse and neglect

for synaptic plasticity, neurogenesis and neuronal survival. These two

Weighted total score

signals regulate each other (Zetterström et al., 1999; Mattson et al.,

2004). Whether BDNF can be a biological marker for suicidal behavior
in adolescents keeps on being an issue of concern.
Sexual abuse

In a study in the literature carried out on BDNF Val66Met poly-

morphism in two groups with self-harm behavior and suicide attempts,
Table 3

CTQ

it was indicated that the co-existence of negative environmental factors

a

during childhood and BDNF homozygote Val allele is a possible risk

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Table 4
Evaluation of BDNF levels in comparison with gender and the self-injury methods in Self-Harm/diagnosed group.

Methods of self-injury Boys (n = 8) Control (31) Patients (Total) Girls (n = 32) Total BDNF

BDNF Mean ± Sd N (%) BDNF Mean ± Sd N (%)

Cutting 42.40 ± 28.9 6 (%75.0) 39.39 ± 22.1 28 (%87.5) 39.91 ± 22.9

Interfering w/wound healing (e.g., picking scabs) 52.26 ± 26.9 5 (%62.5) 37.11 ± 19.7 20 (%62.5) 40.14 ± 21.6
Carving 32.23 ± 30.9 4 (%50.0) 43.21 ± 21.8 18 (%56.3) 41.30 ± 23.2
Banging or hitting self 66.21 ± 2.5 2 (%25.0) 43.68 ± 23.2 19 (%59.4) 45.82 ± 23.0
Severe Scratching 35.94 ± 27.7 3 (%37.5) 40.6 ± 23.1 15 (%46.9) 39.86 ± 23.1
Swallowing dangerous substances 6.8 ± 3.08 2 (%25.0) 42.66 ± 25.1 10 (%31.3) 37.14 ± 26.6
Burning 4.6 1 (%12.5) 39.04 ± 22.9 11 (%34.4) 36.17 ± 24.0
Pinching 4.6 1 (%12.5) 38.06 ± 20.07 10 (%31.3) 35.02 ± 21.5
Biting 65.22 1 (%12.5) 40.51 ± 21.6 9 (%28.1) 42.75 ± 21.8
Sticking self w/needles 4.6 1 (%12.5) 36.85 ± 25.8 9 (%28.1) 33.63 ± 26.4
Rubbing skin against rough surface 59.92 ± 12.54 3 (%37.5) 37.92 ± 24.9 4 (%12.5) 47.35 ± 22.4
Pulling hair – 0 (%0.0) 42.19 ± 18.2 7 (%21.9) 42.19 ± 18.2

Table 5 history in self-harming adolescents was found to be statistically sig-

Correlation of Childhood Trauma Questionnaire (CTQ) scores with serum BDNF levels. nificantly higher when compared to healthy adolescents, and it was
determined that serum BDNF levels decrease at a statistically significant
CTQ Self-harm/diagnosed Non self-harm/ Healthy control
group (N = 40) diagnosed group (N group (N = 35)
rate with the increase in the emotional abuse and neglect during
= 30) childhood. In the studies on the relation between self-harm and child-
hood traumas, it was stated that being exposed to physical and sexual
r p r p r p traumas during childhood causes personality disorders and self-harm
Emotional −0.320 0.044* 0.167 0.338 0.181 0.297
behavior in advancing ages (van der Kolk et al., 1991). In their studies
abuse and examining the relation between sexual and physical abuse and self-
neglect harm behavior, Muehlenkamp et al. (2010) found a stronger relation
Physical abuse −0.281 0.079 0.213 0.218 0.153 0.381 between physical abuse and self-harm behavior when compared to
and
sexual abuse and emphasized the disruption of emotional regulation in
neglect
Sexual abuse −0.205 0.204 0.050 0.774 0.034 0.846 the relation between abuse and self-harm behavior. Also in another
Weighted total −0.329 0.038* 0.204 0.239 0.184 0.290 study early trauma were found negatively associated with BDNF serum
score levels (Benedetti et al., 2017). The results of the low number of studies
investigating the relation between emotional abuse that occurs during
* P < 0.05 a statistical significance.
childhood and self-harm behaviors do not support one another
(Mandelli et al., 2011). One of its possible reasons is that individuals
Table 6
respond differently to the effects from the environment due to various
Comparison of the BDNF levels according to the suicidality.
factors such as genes. While genes may regulate the effect of environ-
Suicidality BDNF Levels (Mean ± SD) Control Patients p-value mental factors in self-harm behavior, environmental factors may also
change the expression of the genes (Moffitt et al., 2006). One of the
Positive (n) Negative (n) results that we achieved in our study, which is the relation between
Suicide 40.40 ± 22.3 31 48.04 ± 19.8 39 0.135
emotional abuse and neglect and serum BDNF levels, can be an im-
Attempt portant finding in terms of showing the interaction between environ-
Suicide Plans 48.46 ± 20.7 13 43.79 ± 21.3 57 0.477 mental and neurobiological factors.
Suicide 42.72 ± 19.7 53 50.71 ± 24.8 17 0.178 In a study that examines the self-harm behavior and suicide attempt
Thoughts
together, it was stated that childhood emotional abuse is a possible risk
Any Relation 43.74 ± 21.07 60 50.14 ± 22.04 10 0.381
with factor for the self-harm behavior in individuals with homozygote Val
Suicidality allele (Nock et al., 2006). Again, in the same study, it was shown that
while childhood sexual abuse is correlated to a suicide attempt, it is not
correlated to self-harm behavior. In our study, it was shown that serum
factor for the formation of both suicide and self-harm behavior (Bresin BDNF levels decrease with the increase in emotional abuse in adoles-
et al., 2013). In our study, low BDNF levels in adolescents with self- cents harming themselves. This may show that neuroplasticity can be
harm behavior that we determined have made us think that there is a affected by the early period negative emotional environment in ac-
similarity with the results of these studies. cordance with the literature.
It is reported that the self-cutting behavior among children and Our study also has certain limitations. The low number of cases and
adolescents is the most frequent self-harm behavior, and it is the most controls in the sample, the fact that the cases include different psy-
correlated method to psychopathology among other self-harm beha- chiatric diagnoses, some have suicide attempt, and self-harm behavior
viors (Briere and Gil, 1998; Nock et al., 2006). In our study, the serum is not grouped in terms of being episodic or recurrent are important
BDNF level of the users of the “self-cutting” method among the ado- limitations. The fact that BDNF levels were only examined in the serum
lescents harming themselves was found to be statistically significantly is also another limitation of the study. Karege et al. (2005a, b) have
lower. This result may show that the change in neurobiological factors shown that BDNF levels examined in the full blood, serum and plasma
such as BDNF is more in the forefront in actions that are more asso- vary between different laboratories (32). The use of different ELISA
ciated with psychopathology. methods and sample tubes may cause this difference. More studies are
The relationship between childhood traumas that can affect neu- required in order to determine the most accurate and reliable mea-
robiology and self-harm was also attributed importance in the literature surement method and the source (full blood, serum, plasma, throm-
(Ray, 2007). In our study, the physical, sexual and emotional abuse bocytes) of the most reliable biological indicator of BDNF. In the light of

134
C. Kavurma et al.
these findings, samples with a higher number of cases, longer follow-up
period and more homogenous grouping and multi-centered studies are
required in order to assess the significance of the data obtained.
5. Conclusion
In this study, it is important to obtain certain significant findings as
a result of assessing serum BDNF levels, considered to play an important
part in the etiology of self-harm behavior. As far as we determined as a
result of our literature research, our study is the first clinical study on
understanding the etiologic importance of serum BDNF level and en-
vironmental factors in self-harm behaviors among adolescents. The
findings obtained from present study showed that BDNF can be a sig-
nificant molecule. However, many comprehensive animal studies and
clinical studies are required, in which more homogenous grouping is
performed and which aim to reveal the effect of BDNF and the me-
chanisms that ensure this effect. It was considered that these studies on
BDNF will enable us to understand both the etiology of self-harm be-
havior and the relations between complex neurotransmitter systems
and will contribute to the formation of suitable treatment options in the
future.
Acknowledgements
The authors would like to thank all the participants of this study.
Funding sources
This study was supported by the Department of Scientific Research
Projects of Dokuz Eylul University (2013.KB.SAG.005).
Conflict of interest
All authors declare that there are no conflicts of interest.
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