Abstract
The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2 = 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more depth.
Highlights
Self-harm is conceptualized as a wide range of self-directed harmful behaviors, regardless of their suicidal intent
Non-suicidal selfinjury (NSSI) refers to the direct injury of one’s own bodily tissue without suicidal intent, it can increase the risk for suicide attempts [4, 9]
By crossing these two dimensions, four primary function domains appear: automatic-positive reinforcement, automatic-negative reinforcement, social-positive reinforcement (e.g., NSSI is followed by attention from others), and social-negative reinforcement
Summary
Self-harm is conceptualized as a wide range of self-directed harmful behaviors, regardless of their suicidal intent. Self-injury refers to socially unaccepted direct and deliberate destruction (i.e. direct self-harm) of one’s own body surface (e.g. cutting, burning, scratching, biting) without suicidal intent and does not involve indirect forms of self-damaging behaviors [2, 4, 5]. The first dimension refers to contingencies that are related to the self (autonomous) or to others (social); the second dimension refers to positive (i.e., the presentation of a favorable stimulus) or negative reinforcement (i.e., the removal of an aversive stimulus) By crossing these two dimensions, four primary function domains appear: automatic-positive reinforcement (e.g., engaging in NSSI to feel pain, which is considered as positive), automatic-negative reinforcement (e.g., engaging in NSSI to remove negative feelings), social-positive reinforcement (e.g., NSSI is followed by attention from others), and social-negative reinforcement (e.g., engaging in NSSI to escape from social demands). Automatic-negative reinforcement is the most frequently reported function of NSSI [11]
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