Self-injurious behaviours in youth

Abstract

Non-suicidal self-injury (NSSI) is the “deliberate destruction or alteration of one’s own body tissue without conscious suicidal intent” (p. 225, Favazza, 1996). Significant research has been devoted to exploring the prevalence and function of self-injury. However, the comparability of many studies has been compromised due to disagreement about how to define self-injurious behaviour, and whether it should be separated from self-injury which occurs with suicidal intent. Presented as a thesis by publication, the first chapter of this thesis offers a review of the literature on self-injury, and a discussion of the differences between suicidal and non-suicidal self-injury and its correlates. The second chapter provides a discussion of the rationale and aims of the present thesis. The study presented in Chapter 3 aimed to explore the correlates of NSSI and assessed whether they differed across the continuum of self-injury in community and clinical samples of adolescents. Chapter 4 reports on the development and validation of a measure designed to assess attitudes toward others’ NSSI. Differences in attitudes according to severity of self-injury were also assessed. Chapter 5 provides a general discussion of the key findings contained within this thesis and their broader clinical and research implications. For the study presented in Chapter 3, 393 13-18 year-old students recruited from secondary schools and twenty-seven adolescents recruited from in-patient psychiatric units completed a 40-minute questionnaire battery assessing the variables of interest. Participants from the community were classified into groups according to frequency, recency and severity of NSSI (‘none, ‘mild’, ‘moderate’ and ‘severe’), using data from a continuous measure of NSSI designed for this study. This produced four evenly distributed groups that were relatable by NSSI. The clinical sample was retained separately and formed the fifth group in Chapter 3. The study in Chapter 3 hypothesised that the ‘none, ‘mild’ ‘moderate’, ‘severe’ and ‘clinical’ NSSI groups would differ on coping, emotion regulation and psychopathology and that differences would increase as self-injury became more severe. The results partially supported these hypotheses. Generally, more severe self-injury was related to greater alcohol use, less adaptive coping, emotional suppression and psychological distress. Of note, the more severe self-injurers in the community sample did not differ from the clinical sample on any measures. While these findings suggest that ‘severe’ community and ‘clinical’ self-injurers are qualitatively analogous, the possibility that other factors may explain observed differences are discussed as an alternative explanation. The study described in Chapter 4 utilised the community-based data from the first study, combined with a second group of 18-30 year-old young adults (n=211, 47 males, 164 females). The young adults were recruited from doctors’ surgeries, universities, private counselling centres and other businesses around Melbourne, Australia and completed the same measures for NSSI and Attitudes Towards Self-injury, as the adolescents. The study explored whether any latent factors existed in adolescents’ attitudes and, combined with the young adult data, tested for differences according to acuity of NSSI. Three factors (‘Helpless/hopeless’, ‘Anti-social/avoidant’ and ‘Socially functional’) were established in adolescents’ attitudes towards those who self-injure. Attitudes differed according to acuity of self-injury, with less severe NSSI associated with more negative views. Young adults normalised NSSI more and were less negative in their views of those who engage in NSSI than adolescents. No differences in NSSI, nor attitudes between groups were observed at the extremes of the NSSI spectrum. The role of peer-education programmes and the vulnerability of severe self-injurers in community settings are discussed. The fifth chapter of this thesis provides a synopsis and general discussion of the key findings of the studies presented in Chapters 3 and 4. Clinical and research implications as well as strengths and limitations of the present thesis are discussed, and recommendations for future research are provided.