Functions Of Nonsuicidal Self-injury Research Articles

Clinical Correlates of Non-Suicidal Self-Injury (NSSI) in an Outpatient Sample of Adolescents

Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior.

Functions, lifetime frequency, and variety of methods of non-suicidal self-injury among college students

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.

Shame-related functions of and motivations for self-injurious behavior.

Drawing on the self-injury and self-conscious emotion literatures, this study examined the functions of and motivations for self-injury in 67 women, 25 of whom had a history of nonsuicidal self-injury (NSSI). Specifically, the present study tested whether women with a history of NSSI engaged in such behavior in order to reduce shame, in particular, and whether shame-related constructs represent important motivational factors for NSSI. To do so, participants completed (a) self-reports of NSSI functions and relevant personality dimensions (e.g., shame-proneness; shame aversion); and (b) a pain-inducing laboratory task with assessments of state emotions pre- and post-task. Elevations in aversion to general negative affect were associated with presence (vs. absence) of an NSSI history. However, consistent with a role for shame in NSSI, among women with an NSSI history, endorsement of shame regulation functions was positively associated with the frequency of NSSI. Moreover, elevations in shame-proneness were associated with more frequent NSSI, even after taking relevant, broader personality dimensions (e.g., proneness to general negative affect) into account. Finally, following the laboratory task, women with and without an NSSI history experienced reductions in state shame. Future directions for and clinical implications of the present research are discussed.

Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms

Rates of deliberate non-suicidal self-injury (NSSI) increase during adolescence and young adulthood, particularly in clinical samples, making these important developmental stages for understanding the functions of NSSI. Borderline Personality Disorder (BPD) symptoms also begin to emerge in adolescence, though little research has examined relationships between BPD symptoms and the functions of NSSI in youth, the primary goal of the present study. Adolescents and young adults recruited from an outpatient psychotherapy clinic (N=36) endorsed a range of NSSI functions on the Inventory of Statements about Self-Injury (Klonsky and Glenn, 2009). Participants engaged in NSSI to serve intrapersonal functions (e.g., regulate affect, punish oneself) more frequently than interpersonal functions (e.g., bond with peers, establish autonomy). As predicted, linear regression analyses indicated that BPD affective dysregulation symptoms were associated with the intrapersonal but not the interpersonal functions of NSSI. In contrast, BPD interpersonal dysfunction symptoms were differentially associated with the interpersonal rather than intrapersonal functions of NSSI. These preliminary data indicate that clusters of BPD symptoms show unique relationships with functions of NSSI in treatment-seeking adolescents and young adults, relationships that can be used to target specific functions of NSSI in treatment planning.

A cross-sectional study of adolescent non-suicidal self-injury: support for a specific distress-function relationship.

BackgroundThis study has investigated the specific relationship between childhood adversities, individual trauma symptoms and the functions of non-suicidal self-injury (NSSI). The aim was to examine whether different self-reported adverse experiences and trauma symptoms predict the need to engage in NSSI, either to regulate emotions or to communicate with and influence others.MethodThe participants were a community sample of 816 adolescents aged 15–17 years with NSSI. Hierarchical multiple regression was used, controlling for NSSI frequency and gender. The dependent variables were the automatic and social functions of NSSI, respectively. The predictors entered in the model were several different maltreatment and adversity experiences as well as individual trauma symptoms. Mediation analyses were also performed using the bootstrapping method with bias-corrected confidence estimates.ResultsFrequency of NSSI, gender (female), emotional abuse, prolonged illness or handicap during upbringing and symptoms of depression uniquely predicted the automatic functions of NSSI in the final regression model, but not the social functions. Symptoms of anxiety uniquely predicted social but not automatic functions. Having experienced physical abuse, having made a suicide attempt and symptoms of dissociation were significant predictors in both final models. The model for automatic functions explained more of the variance (62%) than the social model (28%). The relationship between childhood emotional, physical and sexual abuse and performing NSSI for automatic reasons was mediated by symptoms of depression and dissociation. The relationship between physical abuse and the social functions of NSSI was mediated by symptoms of anxiety and dissociation.ConclusionsIt is important to understand the specific context in which NSSI has developed and is maintained. Experiences of emotional abuse and symptoms of depression could guide clinical work in the direction of emotion regulation skills since in this study these variables were uniquely associated with the need to engage in NSSI to regulate emotions, to self-punish or to generate feelings. The presence of physical abuse, a suicide attempt and symptoms of dissociation could alert clinicians to a broad treatment approach since they were associated with performing NSSI to regulate both social and automatic experiences.

Differences in Features of Non-Suicidal Self-Injury According to Borderline Personality Disorder Screening Status

Given that non-suicidal self-injury (NSSI) disorder is being considered for the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is important to consider how NSSI occurs with and without borderline personality disorder (BPD). Participants were 480 undergraduates who completed online questionnaires and were assigned to 4 groups based on NSSI and BPD status. Analyses revealed BPD-positive self-injurers had higher self-punishment, anti-suicide, and anti-dissociation functions of NSSI and higher rates of cutting and burning than BPD-negative self-injurers. Furthermore, difficulty in emotion regulation, not distress tolerance, was most critical in distinguishing between groups. Differences between BPD-positive and BPD-negative self-injurers provide preliminary support for NSSI as a distinct disorder. However, more research in this area is needed.

Daily Emotion in Non-Suicidal Self-Injury

While major theories of non-suicidal self-injury (NSSI) emphasize the behavior's role in emotion regulation, little is known about the daily emotional experiences of self-injurers. This study investigated the specific emotions that are characteristic of those who engage in NSSI. University students (n = 84) with either no history or a recent history of NSSI completed daily diary and retrospective measures of emotional experience. To evaluate generalizability of findings, the retrospective measure was also administered to a diverse sample of U.S. adults (n = 92) with and without histories of NSSI. Results indicate that self-injurers experience greater negative emotionality, particularly self-dissatisfaction, compared to individuals with no NSSI history. Self-injurers also reported less positive emotion, but these effects were smaller. The pattern of results was similar when controlling for Axis I psychopathology and borderline personality disorder symptoms. Individuals who engage in NSSI experience more negative emotions, generally, and more self-dissatisfaction, specifically. Findings contribute to the growing literature on the role of emotion in the etiology and functions of NSSI.

Psychometric properties of the functions and addictive features scales of the Ottawa Self-Injury Inventory: A preliminary investigation using a university sample.

Nonsuicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Thus far, no single NSSI self-report measure offers a fully comprehensive assessment of NSSI, particularly including measurement of both its functions and potential addictive features. The Ottawa Self-Injury Inventory (OSI) permits simultaneous assessment of both these characteristics; the current study examined the psychometric properties of this measure in a sample of 149 young adults in a university student sample (82.6% girls, Mage = 19.43 years). Exploratory factor analyses revealed 4 functions factors (internal emotion regulation, social influence, external emotion regulation, and sensation seeking) and a single addictive features factor. Convergent evidence for the functions factor scores was demonstrated through significant correlations with an existing measure of NSSI functions and indicators of psychological well-being, risky behaviors, and context and frequency of NSSI behaviors. Convergent evidence was also shown for the addictive features scores, through associations with NSSI frequency, feeling relieved following NSSI, and inability to resist NSSI urges. Additional comment is made regarding the potential for addictive features of NSSI to be both negatively and positively reinforcing. Results show preliminary psychometric support for the OSI as a valid and reliable assessment tool to be used in both research and clinical contexts. The OSI can provide important information for case formulation and treatment planning, given the comprehensive and all-inclusive nature of its assessment capacities.

Non-Suicidal Self-Injury from the Observer's Perspective: A Vignette Study

The goal of this study was to understand how friends and family members view and respond to non-suicidal self-injury (NSSI). A sample of college undergraduates read fictional vignettes and indicated why they thought the person engaged in NSSI and how they would respond to the situation. Participants were able to differentiate NSSI from accidental injury and suicide attempts. However, beyond this, there was little differentiation among functions. In terms of responses, participants indicated that they would attempt to maintain the safety of the individual if they observed NSSI directly and would provide emotional support if told about it later. These results suggest that observers may lack understanding of the functions of NSSI, but respond with support.

Functions of nonsuicidal self-injury among Chinese community adolescents

This study examined functions of nonsuicidal self-injury (NSSI) among a large sample of Chinese high school students over a six-month period. Among Chinese adolescents, we identified three factors of NSSI functions, namely, Affect Regulation, Social Influence, and Social Avoidance. Affect Regulation was the most frequently endorsed function of NSSI, followed by Social Influence and Social Avoidance. Adolescent male self-injurers were more likely to endorse the Social Influence function than their female counterparts. Moderate/Severe Self-injurers did not differ from Minor Self-injurers on the endorsement of various NSSI functions. All functions of NSSI exhibited small to moderate stability over the six-month assessment period. Findings suggest that Chinese adolescents engaged in NSSI for multiple reasons. These reasons also varied considerably over time within individuals. Assessment of NSSI should thus regularly assess functions of the behavior.

Prevalence and Function of Non-Suicidal Self-Injury (NSSI) in a Community Sample of Adolescents, Using Suggested DSM-5 Criteria for a Potential NSSI Disorder

Previous prevalence rates of non-suicidal self-injury (NSSI) in adolescents have varied considerably. In the present cross-sectional study, prevalence rates, characteristics and functions of NSSI were assessed in a large randomized community sample consisting of 3,060 (50.5% female) Swedish adolescents aged 15-17years. The suggested criteria for NSSI disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5) were used to assess prevalence rates with the aim of arriving at a more precise estimate. Out of the whole sample, 1,088 (35.6%) adolescents (56.2% female) reported at least one episode of NSSI during the last year, of which 205 (6.7%) met suggested DSM-5 criteria for a potential NSSI disorder diagnosis. The NSSI disorder diagnosis was significantly more common in girls (11.1% vs. 2.3%, χ (2) (1, N = 3046) = 94.08, p < 0.001, cOR = 5.43, 95% CI [3.73, 7.90]). The NSSI disorder group consisted of significantly more smokers and drug users compared to adolescents with NSSI that did not meet DSM-5 criteria for NSSI disorder, and also differed concerning demographic variables. A confirmatory factor analysis (CFA) was conducted on reported functions of NSSI, with the aim of validating Nock and Prinstein's (Journal of Consulting and Clinical Psychology 72:885-890, 2004, Journal of Abnormal Psychology 114:140-146, 2005) four-factor model on a Swedish community sample, resulting in a close to acceptable fit. A two-factor model (social and automatic reinforcement) resulted in a slightly better fit. The most frequently reported factors were positive and negative automatic reinforcement. A majority of functions were significantly more often reported by girls than boys. The implications of the suggested DSM-5 criteria and reported functions are discussed.

Variety of Self-Injury: Is the Number of Different Methods of Non-Suicidal Self-Injury Related to Personality, Psychopathology, or Functions of Self-Injury?

This study explored the association between number of methods of Nonsuicidal Self-Injury (NSSI) and personality, psychopathology, and functions of NSSI. Two combined undergraduate samples reporting a history of NSSI (n = 149) completed measures of personality, psychopathology, and NSSI. A series of regression analyses indicated that Conscientiousness, Openness, and two functions of NSSI (i.e., Automatic Negative Reinforcement and Social Negative Reinforcement) shared significant relationships with the number of NSSI methods participants engaged in. These findings demonstrate that, after accounting for NSSI frequency, a relationship exists among specific personality factors, NSSI functions, and engagement in additional methods of NSSI.

Nonsuicidal self-injury in an adolescent population in Singapore

This mixed methods study examined the phenomenon of nonsuicidal self-injury (NSSI) of adolescents in Singapore. The researchers analyzed quantitative data to understand the functions of NSSI, the relationship of parental invalidation to NSSI, and the association between academic stress and parental invalidation. In addition, the researchers employed semi-structured qualitative interviews to provide supportive qualitative data. The participants were outpatients at the Child Guidance Clinic, Singapore, between the ages of 13 to 19 years old. Researchers compared 30 participants who engage in NSSI with 30 participants who do not engage in NSSI. The emotional regulation function was the most commonly endorsed function for NSSI. Adolescents who engage in NSSI have statistically significant (p < .01) higher mean parental invalidation scores than those who do not engage in NSSI. There is also a moderate, positive correlation between the level of parental invalidation and the level of academic stress for Singaporean adolescents. The researchers discuss the implications of this study for mental health professionals.

Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth

This study aimed to investigate a specific relationship between nonsuicidal self-injury (NSSI) and a variety of adverse childhood experiences (ACEs) over and above childhood abuse and their impact on frequency, severity, and functions of NSSI. A sample of 125 inpatients (aged 13 to 26) was consecutively recruited within a psychiatric university hospital. Frequency, methods and functions of NSSI were assessed by the Functional Assessment of Self-Mutilation (FASM), ACEs were assessed by the Childhood Experiences of Care and Abuse Questionnaire (CECA.Q). The 12month prevalence of NSSI in this representative, clinical sample was 60.0%. Engagement in NSSI was significantly related to ACEs with highest associations for maternal antipathy and neglect. Whilst ACEs were not associated with frequency or severity of NSSI, some ACEs were significantly related to the automatic functions of NSSI (e.g., affect regulation, anti-dissociative function or self-punishment) as well as to a peer identification function. NSSI represents a frequent phenomenon among young clinical populations and seems to be specifically related to ACEs with maternal antipathy or neglect commonly featured over and above experiences of abuse. Since ACEs also influence the functions of NSSI such factors need to be examined as part of clinical care planning.

Interpersonal Features and Functions of Nonsuicidal Self‐injury

Etiological models of nonsuicidal self-injury (NSSI) suggest interpersonal features may be important to understand this behavior, but social functions and correlates have not been extensively studied. This study addresses existing limitations by examining interpersonal correlates and functions of NSSI within a stratified random sample of 1,243 predominantly Caucasian college students (mean age = 21.52, SD = 4.15 years). Participants completed an anonymous online survey assessing NSSI features, perceived social support, and disclosure experiences. Approximately 15% of the students endorsed NSSI. Interpersonal reasons were endorsed proportionally more often for initiating rather than repeating the behavior. Individuals with repetitive NSSI reported significantly lower perceived social support from family members and fewer individuals to seek advice from than single-act and control participants. Fifty-nine percent had disclosed their NSSI, but rarely to mental health professionals. Conversations with others about NSSI were rated as being mostly unhelpful. These results emphasize the importance of interpersonal features and functions of NSSI, suggesting treatments should focus on strengthening interpersonal bonds alongside emotion regulation. Improving responses to disclosures of NSSI is needed to promote communication about this behavior and perceived helpfulness of such conversations.

Intrapersonal and Interpersonal Functions of Non suicidal Self‐Injury: Associations with Emotional and Social Functioning

Understanding the functions of nonsuicidal self-injury (NSSI) has important implications for the development and refinement of theoretical models and treatments of NSSI. Emotional and social vulnerabilities associated with five common functions of NSSI-emotion relief (ER), feeling generation (FG), self-punishment (SP), interpersonal influence (II), and interpersonal communication (IC)-were investigated to clarify why individuals use this behavior in the service of different purposes. Female participants (n = 162) with a history of NSSI completed online measures of self-injury, emotion regulation strategies and abilities, trait affectivity, social problem-solving styles, and interpersonal problems. ER functions were associated with more intense affectivity, expressive suppression, and limited access to emotion regulation strategies. FG functions were associated with a lack of emotional clarity. Similar to ER functions, SP functions were associated with greater affective intensity and expressive suppression. II functions were negatively associated with expressive suppression and positively associated with domineering/controlling and intrusive/needy interpersonal styles. IC functions were negatively associated with expressive suppression and positively associated with a vindictive or self-centered interpersonal style. These findings highlight the specific affective traits, emotional and social skill deficits, and interpersonal styles that may render a person more likely to engage in NSSI to achieve specific goals.

What Is the Role of Dissociation and Emptiness in the Occurrence of Nonsuicidal Self-Injury?

Many episodes of nonsuicidal self-injury (NSSI) are reportedly performed for the purpose of feeling generation; however, little is known about the pathways through which such behavior emerges. To address this knowledge gap, we examined the relations among childhood abuse, self-reported feelings of dissociation and emptiness, and the occurrence of NSSI. Eighty-six adolescents were included in this study and completed self-report measures of each construct. The results support a model in which dissociation and emptiness separately mediate the relation between childhood emotional abuse and the occurrence of NSSI. Moreover, as hypothesized, emotional abuse, dissociation, and emptiness all are significantly associated with the intrapersonal positive reinforcement function of NSSI (i.e., NSSI for feeling generation) but are not associated with the other 3 previously identified functions of NSSI. These results provide preliminary information about how NSSI may arise in some cases and suggest that treatment components aimed at teaching noninjurious strategies for generating positive feelings/affect may decrease the occurrence of NSSI.

Non-Suicidal Self-Injury Within Offender Populations: A Systematic Review

Non-suicidal self-injury (NSSI), defined as deliberate self-directed tissue damage, presents a serious health concern for offender populations. Approximately one-third of offenders report a history of NSSI, and it is the most common reason for mental health treatment within correctional settings. To date, no review exists with a specific focus on NSSI in criminal justice contexts. Therefore, the primary aim of this article is to review research on NSSI within correctional settings. Specifically, we explore the role of risk factors for NSSI. We also examine the functions of NSSI within correctional contexts. In addition, we evaluate the evidence for potential assessment tools and treatments for NSSI. Taken together, our review suggests that risk factors for NSSI must be considered differently in correctional settings, due to the high base rates of these vulnerabilities. Further, although environmental control is a more salient function of NSSI within correctional settings, the primary motive for engaging in this behavior remains emotion regulation. Finally, despite the emergence of several promising treatments for NSSI within correctional settings, larger scale studies are necessary to determine the efficacy of these interventions.

The Validity and Reliability of the Turkish Version of the Inventory of Statements About Self-injury

Non-suicidal self-injury (NSSI) is defined as the repetitive deliberate destruction of one's body tissue without suicidal intent and is frequently repetitive. The aim of this study was to examine the psychometric properties of the Inventory of Statements About Self-injury (ISAS), a measure designed to comprehensively assess non-suicidal self-injury (NSSI). The ISAS assesses 13 functions of NSSI, as well as the frequency of 12 NSSI behaviors. The ISAS was administered to 529 high school students who had performed at least one NSSI behavior. The internal consistency and test-retest reliability of the scale were examined; for construct validity, the relationship between the Turkish form of the ISAS and various criteria scales was examined, and confirmatory factor analysis (CFA) was conducted. Consistent with previous research, factor analysis of the functions scale confirmed the good-fit of the original's 2-dimension model (c²=243; s.d. = 59; NCI (c²/sd) = 4; RMSEA = 0.08 (.07-.09); CFI=0.97; NFI=0.97). In order to test the scale for construct validity, the Brief Symptom Inventory and Suicide Probability Scale were administered to participants, in addition to the ISAS, and the correlations with clinical constructs (e.g., suicidality, depression, anxiety) were in the expected direction. Also the reliability analysis revealed that the ISAS subscales demonstrated high internal consistency. In the light of the findings, it was concluded that the Turkish version of ISAS could be used as a reliable and valid tool in assessing non-suicidal self-injury in research and treatment contexts.

Male Eating Disorder Patients With and Without Non‐suicidal Self‐injury: A Comparison of Psychopathological and Personality Features

In the present study, we investigated the prevalence and comorbidity of non-suicidal self-injury (NSSI) in male eating disorder (ED) patients. In total, 130 male ED patients completed a list of 10 impulse-control problems (including NSSI), the Eating Disorder Inventory-2, the Symptom Checklist-90-Revised and the Temperament and Character Inventory. Overall, 21% of the male ED patients (n = 27) engaged in at least one type of NSSI, and we did not find significant differences between the ED subtypes. Self-injurious male ED patients showed significantly more severe ED symptoms and more affective, interpersonal and impulse-control problems than ED patients without NSSI. As previously described in female ED, our data confirm the affect regulation and impulse regulation functions of NSSI in male ED patients.