Solving the puzzle of deliberate self-harm: The experiential avoidance model

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Abstract

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework—the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.

Section snippets

The puzzle of deliberate self-harm behavior

The act of deliberately injuring oneself is a puzzling behavior to understand, but one that has received increased attention from researchers in recent years (Brown, Comtois, & Linehan, 2002; Chapman, Specht, & Cellucci, in press; Favazza, 1998; Gratz, Conrad, & Roemer, 2002; Nock & Prinstein, 2004). When defined broadly as the deliberate, direct destruction or alteration of body tissue without conscious suicidal intent, self-injurious behavior occurs in various forms among several different

Solving the puzzle of deliberate self-harm: the experiential avoidance model

DSH is a puzzling behavior, precisely because of its seemingly self-defeating, self-destructive nature. Although it is rather difficult to understand why people might intentionally self-inflict tissue damage, there is a striking commonality across many of the leading theories of DSH (see Suyemoto, 1998). Despite differing theoretical perspectives, these theories are bound together by the notion that DSH somehow helps the individual escape, manage, or regulate emotions. For instance, the affect

General tendency to avoid or escape from aversive emotional experiences

As a behavioral model of DSH, the EAM proposes that experiential avoidance represents a functional response class, or a set of behaviors that serve similar functions (Nelson, 1988). The particular response class relevant to DSH and highlighted within the EAM consists of behaviors that function to avoid or escape from unwanted emotional experiences (such as substance use, bingeing, avoidant coping, or thought suppression). Given research suggesting that the specific behaviors that comprise a

The function of DSH: escape or relief from emotions

The EAM conceptualizes DSH as a behavior that leads to the reduction or elimination of unwanted emotional responses, particularly the physiological aspects of the emotional response. Through a vicious cycle, temporary relief from intense emotional responding reinforces and strengthens DSH, making this behavior considerably more likely when the individual experiences similar conditions in the future. Converging findings from a variety of self-report and psychophysiological studies provide

Mechanisms of emotional escape in DSH

If, as we propose in the EAM, DSH is an experiential avoidance strategy, an important question emerges: Why do people experience relief after injuring themselves? Although very few empirical studies have examined the potential mechanisms underlying the emotionally avoidant function of DSH, several theories have been posed. These theories include the opioid hypothesis, the distraction hypothesis, and the self-punishment hypothesis.

The vicious cycle of experiential avoidance and DSH

To recap the EAM, DSH is a behavior that is negatively reinforced through the reduction of unwanted internal experiences, particularly emotional responses. According to the EAM, individuals who engage in DSH have strong experiential avoidance repertoires or response tendencies, possibly stemming from more intense emotional responses, poor distress tolerance, deficits in emotion regulation skills, and/or difficulties implementing alternative coping strategies when emotionally aroused. We propose

General summary and discussion

The EAM is a model that is grounded in research on emotions and DSH, and that may serve as a conceptual guide for further research on DSH and its treatment. The EAM describes the primary function of DSH as the avoidance of, or escape from, unwanted or aversive states of emotional arousal. A growing number of studies provide support for the conceptualization of DSH as an experiential avoidance behavior. Moreover, researchers are beginning to delineate the potential mechanisms by which DSH may

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