Profiling Dual Harm in late childhood and adolescence: psychopathology, emotion regulation, and aggression

In clinical practice, one of the most frequent reasons for psychiatric consultation during late childhood and adolescence is aggressive behavior, either directed towards the self or others. In a subset of individuals, these two forms of aggression co-occur, defining a clinical presentation known as “dual harm”. This phenomenon remains poorly characterized in the literature, often described simply as the co-occurrence of self-harm and other-directed aggression. However, a limited body of research suggests that dual harm may constitute a distinct clinical entity, characterized by specific psychosocial and developmental features rather than a simple overlap of two behavioral domains. Despite the relatively high prevalence of self- and other-directed aggression in childhood and adolescence, the dual harm phenomenon remains particularly underexplored within these developmental stages. The aim of the present work was to delineate a specific profile of dual harm in adolescence. Chapter 1 provides an overview of the phenomenon in terms of its clinical manifestations and theoretical models. Chapter 2 focuses on the developmental period—childhood and adolescence—presenting a systematic review of the literature on dual harm and studies examining the co-occurrence of self-harm and externalized aggression during these stages. The review identified three key areas for empirical investigation: the psychopathological profile, emotional regulation difficulties and impulsivity, and the combination of different forms of aggression. Chapter 3 presents Study 1, which investigated the specific psychopathological profile of adolescents with dual harm and their self-reported PhD Thesis difficulties in emotion regulation. Chapters 4 and 5 introduce laboratory-based tasks designed to further explore emotional regulation, focusing on emotional reactivity (Study 2) and affective inhibitory control (Study 3). Finally, Chapter 6 (Study 4) examines the specific combination of different forms of aggression in adolescents with dual harm. Overall, this research project contributes to enhancing our understanding of the dual harm phenomenon, providing a preliminary profile of adolescents who exhibit this complex clinical condition.