Functions Of Nonsuicidal Self-injury Research Articles

Behavioral functions underlying NSSI and eating disorder behaviors.

This study examined whether the psychological functions motivating eating disorder (ED) and nonsuicidal self-injury (NSSI) behaviors are similar, thereby representing shared mechanisms accounting for their high co-occurrence. Self-report data assessing NSSI, ED symptoms, and behavioral functions were collected from 676 adults with recent NSSI (past 6 months; n = 333) or disordered eating ( n = 343). Measurement invariance analyses revealed the same function-factor structure for ED and NSSI behaviors for 8 out of 13 scales. Comparisons of scalar latent means showed that some functions, while relevant to both behaviors, were rated as subjectively more salient to engaging in either ED or NSSI behavior. Similar functions have relevance to understanding engagement in NSSI and ED, but important differences exist in the subjective salience of each function. Treatments focusing on the shared functions of NSSI and ED may have greater success in simultaneously decreasing engagement in these behaviors.

Starting from scratch: prevalence, methods, and functions of non-suicidal self-injury among refugee minors in Belgium

BackgroundAs many refugee minors have gone/go through stressful life experiences and uncertainty, one might expect mental health issues, including self-injury. However, literature on non-suicidal self-injury (NSSI) in refugee minors is scarce. This study explores the prevalence, methods, and functions of NSSI in refugee minors in Belgium, and compares research results to the existing literature on NSSI in Western adolescents.MethodsData were obtained from 121 refugee minors (mean age = 16.12, SD = 1.23; range 14–18 years) through schools located in the Flemish and Brussels-Capital regions of Belgium. The sample consists of 39.7% girls and 60.3% boys. Self-report questionnaires were used to explore socio-economic data, NSSI behaviour (e.g. The Brief Non-Suicidal Self-injury Assessment Tool; BNNSI-AT) and emotional and behavioural difficulties (The Strengths and Difficulties Questionnaire; SDQ). Non-parametric Chi square tests were used for statistical comparisons of the obtained data as well as independent-sample t-tests and Fisher’s exact tests.ResultsResults show a lifetime NSSI prevalence rate of 17.4%. Being accompanied or not, having both parents around, or living in an asylum centre did not influence NSSI prevalence. An average of 2.65 methods of NSSI was applied (SD = 2.50; range 1–9). The mean number of functions per person was six (SD = 4.97, range 0–16), with automatic functions reported the most. The data do point towards a greater psychological strain, with 68.4% reporting more than five acts of NSSI. Results of the SDQ’s Total Difficulties Scale and, more specifically, of the Emotional Problems, Conduct Problems, Peer Problems and Impact Scales indicate a substantial risk of clinically significant problems within the NSSI group. The Peer Problems and Impact Scales also point towards a high risk for suicidality amongst self-injuring refugees.ConclusionsPrevalence rates, methods and functions are comparable to Western samples. However, the higher incidence of the NSSI and the results on the SDQ also emphasise the vulnerability of refugee minors.

Non-suicidal Self-injury Differentiates Suicide Ideators and Attempters and Predicts Future Suicide Attempts in Patients with Eating Disorders.

We aimed first to identificate psychopathological variables differentiating between suicide ideators, suicide attempters and patients without suicide ideation or attempts, and second to identificate better predictors of suicide attempts longitudinally. We compared suicide ideation, hopelessness, borderline symptoms, frequency, types, number of different non-suicidal self-injury (NSSI) methods, intrapersonal and interpersonal functionality of NSSI in a sample of 238 patients with Eating Disorders (1) with no history of suicide ideation or suicide attempts (n=150); (2) with recent suicide ideation (n=65); and (3) with suicide attempts in the previous year (n=23). In addition, we analyzed the predictive power of the mentioned variables over the number of suicide attempts 7 months after the first assessment. The group of suicide attempters showed a major number of different methods of NSSI, higher frequency of NSSI, cutting, and more NSSI intra and interpersonal functions than the group of ideators. Unlike in previous studies, hopelessness did not differentiate between patients with ideation and suicide attempts. In addition, the best predictor of suicide attempts 7 months later was frequency of NSSI at T1 (N=123). Cutting, frequency and different methods of NSSI, intra and interpersonal functions were risk factors that differentiated ideators from attempters, being frequency of NSSI the best predictor of suicide attempts longitudinally. Thus, patients with ED with NSSI should be the focus of preventive interventions for suicidal behavior.

Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury

Non-Suicidal Self-Injury (NSSI) is the deliberate damage to one's bodily tissue without suicidal intent. The Emotional Cascade Model proposes NSSI functions as a distraction from ‘cascades’ of intense affect and rumination. Low distress tolerance is one factor thought to potentially amplify these cascades but has yet to be empirically tested. Using the Emotional Cascade Model as a framework, we investigated the moderating roles of rumination and distress tolerance in the relationship between affect intensity and NSSI. A sample of 400 university students between the ages of 17 and 62 years (M = 21.02, SD = 5.32) completed well-validated measures of NSSI, affect intensity, rumination, and distress tolerance. As expected, rumination was associated with history of NSSI but only among individuals who reported high levels of distress tolerance. Further, affect intensity was positively associated with NSSI frequency, but only at low levels of rumination and distress tolerance. These results provide promising insight into potential prevention and intervention initiatives that may target rumination and distress tolerance to reduce the likelihood and frequency of self-injury.

Functions of non-suicidal self-injury in prisoners with mental health diagnoses

Functions of non-suicidal self-injury in prisoners with mental health diagnoses

The Non‐Suicidal Self‐Injury Expectancy Questionnaire: Factor structure and initial validation

BackgroundModels of non‐suicidal self‐injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI‐related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire.MethodsA total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students.ResultsPrincipal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self‐Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self‐efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity.ConclusionsThe questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.

Non-Suicidal Self-Injury Among Male Adjudicated Adolescents: Psychosocial Concerns, Coping Responses, Diagnoses, and Functions

Non-suicidal self-injury (NSSI) refers to self-inflicted physical injury without suicidal intent. NSSI is particularly common in forensic settings and associated with several psychosocial concerns, coping responses, diagnoses, and functions, but little information is available regarding NSSI in adjudicated male adolescents. The present study examined the frequency and types of NSSI among adjudicated male adolescents (n = 103) and assessed the relationships between NSSI history, psychosocial concerns, coping responses, diagnoses, and functions within this population. Approximately two-thirds (66%) reported NSSI history. Participants with NSSI history reported poorer social adaptation and greater alienation and boredom, aggression, and emotional lability than controls. Youth with high-frequency NSSI were also more likely to utilize emotional discharge as an unhealthy coping response than controls. In addition, participants with high-frequency NSSI were more likely than controls to meet criteria for a mood or anxiety disorder. Function of NSSI primarily surrounded anxiety reduction/affect regulation, punishment, dissociation reduction, and social/sensation-seeking. NSSI appears to be prevalent among male adjudicated youths, and the findings suggest that the relationship between NSSI history, psychosocial concerns, coping responses, and functions is nuanced and could inform more calibrated assessment and treatment strategies.

The functions and addictive features of non-suicidal self-injury: A confirmatory factor analysis of the Ottawa self-injury inventory in a university sample

The Ottawa Self-Injury Inventory (OSI) is a comprehensive self-report measure of non-suicidal self-injury (NSSI). In an effort to build on past research and further validate the OSI, this study presents a confirmatory factor analysis of the OSI's subscales measuring the functions and addictive features of NSSI using a university sample. Participants were 316 university students aged 17–25 years (84.8% female) who had engaged in NSSI at least once in their lifetime. Consistent with past research, results confirmed the four-factor structure of the Functions items (Internal Emotion Regulation, Social Influence, External Emotion Regulation, Sensation Seeking), as well as the single-factor structure of Addictive Features items. Correlations calculated between the obtained factors and indicators of NSSI severity revealed that higher endorsement of NSSI's Internal Emotion Regulation functions, External Emotion Regulation functions, and Addictive Features were associated with more frequent lifetime NSSI, recent (past 6 months) NSSI, and greater distress regarding NSSI urges; greater endorsement of NSSI's Sensation Seeking functions was also linked with more frequent lifetime NSSI. Results provide further support for the OSI's psychometric properties in a university sample, and offer additional evidence for links between specific NSSI functions and addictive features and more severe manifestations of the behavior.

Association between Non-Suicidal Self-Injury, Parents and Peers Related Loneliness, and Attitude Towards Aloneness in Flemish Adolescents: An Empirical Note.

Loneliness and attitude towards aloneness have been shown to be associated to depression, anxiety, and other psychiatric disorders in adolescents and they may also increase the vulnerability to Non-Suicidal Self-Injury (NSSI). Therefore, the present study investigated the association between lifetime prevalence and functions of NSSI, parent- and peer-related loneliness, and attitude towards aloneness (positive and negative). Data regarding NSSI, loneliness, and attitude towards aloneness were collected from a sample of 401 high school students from three different high schools located in the Dutch-speaking part of Belgium. Lifetime prevalence of NSSI was found to be 16.5%. Females reported a higher lifetime prevalence of NSSI than males. Higher mean scores for parent-, peer-related loneliness, and positive attitude (i.e., affinity) towards aloneness was observed in adolescents with lifetime NSSI as compared to adolescents without a history of NSSI. Finally, a positive correlation between self-related (i.e., automatic) functions of NSSI and parent- and peer-related loneliness and a positive attitude towards aloneness was also observed.

Identifying the relative importance of non-suicidal self-injury features in classifying suicidal ideation, plans, and behavior using exploratory data mining

Individuals with a history of non-suicidal self-injury (NSSI) are at alarmingly high risk for suicidal ideation (SI), planning (SP), and attempts (SA). Given these findings, research has begun to evaluate the features of this multi-faceted behavior that may be most important to assess when quantifying risk for SI, SP, and SA. However, no studies have examined the wide range of NSSI characteristics simultaneously when determining which NSSI features are most salient to suicide risk. The current study utilized three exploratory data mining techniques (elastic net regression, decision trees, random forests) to address these gaps in the literature. Undergraduates with a history of NSSI (N = 359) were administered measures assessing demographic variables, depression, and 58 NSSI characteristics (e.g., methods, frequency, functions, locations, scarring) as well as current SI, current SP, and SA history. Results suggested that depressive symptoms and the anti-suicide function of NSSI were the most important features for predicting SI and SP. The most important features in predicting SA were the anti-suicide function of NSSI, NSSI-related medical treatment, and NSSI scarring. Overall, results suggest that NSSI functions, scarring, and medical lethality may be more important to assess than commonly regarded NSSI severity indices when ascertaining suicide risk.

Nonsuicidal Self-injury: A Systematic Review.

Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors.Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles.Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder.Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.

Shame Proneness, Shame Coping, and Functions of Nonsuicidal Self-Injury (NSSI) Among Emerging Adults

Shame proneness (i.e., experiencing shame in a trait-like manner) and internalizing shame coping styles (e.g., withdrawing/attacking one’s self when feeling shame) predict distress, psychopathology, and nonsuicidal self-injury (NSSI) among emerging adults. Parental invalidation is instrumental in the development of both maladaptive shame and NSSI. In this study, we proposed that shame proneness and internalized shame coping would link perceived parental invalidation and psychological distress to NSSI functions among emerging adults. A sample of 384 Australian emerging adults with a history of NSSI (M age = 20.7 years, SD = 2.25; 81.3% female, 61.2% Caucasian) completed online self-reports assessing the relevant constructs. Hypothesized indirect effects through shame proneness and internalized shame coping were supported when participants reported using NSSI for intrapersonal (e.g., self-punishment), but not interpersonal (e.g., signaling autonomy), functions. Findings advance theories on why some young pe...

Exploring the relationship between non suicidal self-injury and borderline personality traits in young adults

Non-suicidal self-injury (NSSI) is highly prevalent during late adolescence and young adulthood. There is some evidence of a link between NSSI and Borderline Personality Disorder (BPD), but little is known about the association between BPD traits and the various functions that maintain NSSI. The main purpose of this study was to explore the association between borderline personality traits and NSSI functions in a sample of college students. We also compared NSSI functions in college students who engaged in NSSI to those in an age-matched sample of BPD patients. This study included a total of 238 college students and 36 BPD patients. Participants were asked to complete a number of clinical measures. In the non-clinical sample, BPD features were more pronounced in the presence of NSSI, and we observed a differential relationship between NSSI functions and psychopathological BPD-traits. The NSSI clinical variables most strongly associated with BPD were frequency, variety of methods and severity, but not age of onset. Our results provide new information on the relationship between BPD and NSSI in young adults, and could be used to improve the early detection of vulnerable BPD-individuals and in planning NSSI treatment.

The relationship between interpersonal trauma history and the functions of non-suicidal self-injury in young adults: An experience sampling study

ABSTRACTNon-suicidal self-injury (NSSI) has been reported to serve a range of functions for individuals who engage in it. Despite considerable variation in NSSI functions between individuals, limited attention has been paid to exploring relationships between NSSI functions and other characteristics of self-injuring individuals, such as trauma history. This is despite allusion to trauma history in the suggested etiology of some NSSI functions (e.g., anti-dissociation, self-punishment). The present study used a 21-day online daily diary to explore possible relationships between common NSSI functions and past interpersonal trauma in community young adults (n = 38). The interpersonal boundaries and anti-dissociation functions significantly related to interpersonal trauma severity in multiple regression analyses; the interpersonal boundaries function continued to significantly relate to interpersonal trauma severity when controlling for the number of NSSI functions endorsed.

Methods and Functions of non-Suicidal Self-Injury among Adolescents Seeking Emergency Psychiatric Services

Non-suicidal self-injury (NSSI) has been associated with an array of difficulties such as childhood abuse, interpersonal conflict, and mental health concerns ranging from emotional distress to suicidal thoughts and urges. To improve our understanding of NSSI and its relation to suicide risk, this study assessed the demographic (age, sex) and clinical (anxiety, depression, suicidal ideation, suicide attempt history) characteristics associated with NSSI methods (“how”) and functions (“why”). The study sample (N = 193) included youth and young adults, ages 13 to 25, who were seeking emergency psychiatric services and endorsed a lifetime history of NSSI. Study participants completed questionnaires assessing depression, anxiety, suicidal ideation, history of suicide attempt, and characteristics of NSSI engagement. Data were analyzed using Pearson, Spearman, and point-biserial correlation, Mann-Whitney U test, chi-square, t-test, and regression analyses (Poisson, binary-logistic, and ordinal). Female sex, the most prominent correlate in this study, was associated with number of lifetime NSSI incidents, quantity of NSSI methods used, and frequency of NSSI function engagement. Lifetime history of suicide attempt and suicidal ideation were positively associated with numbers of NSSI methods and functions, respectively. Regression analysis indicated that number of NSSI methods was associated with suicide attempt history, whereas total number of NSSI incidents was not. A greater understanding of the demographic and clinical factors associated with NSSI may ultimately advance the assessment and treatment of this behavior, especially in relation to suicide risk.

Functions of nonsuicidal self-injury in Singapore adolescents: Implications for intervention.

The functions of nonsuicidal self-injury (NSSI) and DSM-IV-TR diagnoses were examined in a sample of thirty ethnic adolescents followed up in a local child and adolescent psychiatric clinic in Singapore. The most commonly endorsed function of NSSI on the Functional Assessment of Self-Mutilation scale was Automatic Negative Reinforcement (A-NR) and the least being Social Negative Reinforcement (S-NR). Participants were more likely to be diagnosed as having Major Depression Disorder. Depressed adolescents did not differ from non-depressed counterparts in their endorsement of social reinforcement functions. The results suggest that specific psychosocial interventions may help address both automatic and social functions of NSSI in Singapore adolescents.

Examining Nock and Prinstein's four-function model with offenders who self-injure.

Nonsuicidal self-injury (NSSI) is the deliberate bodily harm or disfigurement without suicidal intent and for purposes not socially sanctioned (e.g., cutting, burning, head banging). Nock and Prinstein (2004) proposed a 4-function model (FFM) of NSSI, in which the functions of NSSI are categorized by two dichotomous factors: (a) positive (i.e., involves the addition of a favorable stimulus) or negative (i.e., involves the removal of an aversive stimulus; and (b) automatic (i.e., intrapersonal) or social (i.e., interpersonal). This study examined the validity of this model with incarcerated populations. In-depth semistructured interviews with 201 incarcerated offenders were analyzed and categorized based on the FFM. Participants' descriptions of functions of NSSI were most commonly categorized as automatic negative reinforcement (25.0%; e.g., coping with negative emotions), followed by automatic positive reinforcement (31.3%; e.g., self-punishment), social positive reinforcement (31.3%; e.g., to communicate with others), and social negative reinforcement (12.5%; e.g., to avoid hurting someone else). While the uniqueness of the correctional environment affects some of the specific functions evident in offenders, FFM can be used to adequately organize the functions of NSSI in offenders, providing a useful tool for explaining this complex behavior. Clinically, NSSI in offenders can be viewed has having the same underlying motivations, although automatic positive reinforcement is more prevalent in offenders and social positive reinforcement is more prevalence in nonoffenders. Given that the motivations underlying nonsuicidal self-injury are similar for offender and nonoffender populations, similar treatment approaches may be effective with both populations. (PsycINFO Database Record

Sociotropy, autonomy, and non-suicidal self-injury: The mediating role of identity confusion

In the present study, we integrated the cognitive personality model (sociotropy/autonomy) and Erikson's identity model to investigate the influence of these two constructs on the vulnerability to non-suicidal self-injury (NSSI). We collected data regarding sociotropy/autonomy, identity synthesis/confusion, and NSSI functions using self-report questionnaires in 401 high school students (Mean age=16.6years; SD=0.96; 51.1% female). The lifetime prevalence of NSSI was 16.5%. Our findings suggested that the automatic function (self-reinforced) of NSSI (e.g., decrease of negative affect) was positively associated with the personality trait autonomy. This function of NSSI was also found to be negatively associated with identity synthesis and positively associated with identity confusion. Finally, the association between sociotropy/autonomy and NSSI was fully mediated by identity confusion. Clinical implications of these findings are discussed.

Functions of nonsuicidal self-injury (NSSI): Cross-sectional associations with NSSI duration and longitudinal changes over time and following treatment

In this study, we sought to clarify if and how the functions of nonsuicidal self-injury (NSSI) relate to duration of NSSI or change over time. To accomplish this aim, we analyzed data obtained from routine clinical evaluations completed within a specialized acute-care treatment program for NSSI. Specifically, we examined how functions of NSSI vary between patients by duration of NSSI, how functions changed within patients over time, and how changes in NSSI functions related to treatment outcomes. Neither internal nor social functions were associated with NSSI duration between patients after controlling for relevant covariates. For patients completing two admissions assessments, internal and social functions decreased similarly over time, although the decrease in internal functions was no longer significant after controlling for decreases in NSSI urges. For patients who completed admissions and discharge assessments, internal and social functions decreased over the course of treatment, with larger decreases in internal functions. Decreases in both types of functions related to improved treatment outcomes. In conclusion, our results suggest that NSSI functions are generally stable across time, although decreases in NSSI functions may relate to clinical improvement.

Reconsidering Criterion A for the Diagnosis of Non-Suicidal Self-Injury Disorder

Empirical research is needed to verify that the DSM-5 proposed diagnostic criteria for non-suicidal self-injury (NSSI) disorder provide a valid and clinically meaningful symptom set. The current study used data-driven methods to examine the diagnostic validity of the frequency and recency thresholds (i.e., Criterion A) for NSSI disorder. Data were collected from a random sample (n = 2206) of undergraduates. Participants completed counter-balanced questionnaires assessing the frequency, recency, and functions of NSSI, psychopathology symptoms, and indicators of distress and functional impairment. Discriminant functional analyses identified a significant differentiation for frequency between 10 or more acts of NSSI and 1–9 acts. Groups were also differentiated with a split on recency between less than 12-months ago and more than 12-months ago. After re-grouping the sample into categories based on the new frequency and 12-month recency threshold, the 10+ NSSI group reported significantly more functions for NSSI, including higher scores on affect regulation, self-punishment, and sensation seeking, than the subthreshold NSSI group. The 10+ NSSI group also reported significantly worse psychopathology, greater distress, and more impairment than both the subthreshold group and controls (no NSSI history). These findings indicate the current DSM-5 diagnostic criteria for NSSI disorder may be too liberal, and offer support for increasing the frequency thresholds for the diagnosis to ensure clinical validity and utility.