A preliminary examination of the specificity of the functions of nonsuicidal self-injury among a sample of university students

doi:10.1016/j.psychres.2012.08.036

Psychiatry Research

Volume 205, Issues 1–2, 30 January 2013, Pages 172-175

https://doi.org/10.1016/j.psychres.2012.08.036 Get rights and content

Abstract

To examine whether individuals who engage in NSSI report different coping behaviors and regulatory needs compared to a non-injuring comparison group, we surveyed 1107 undergraduates using a Functions Index. Individuals who engaged in NSSI indicated greater use of coping behaviors for anti-dissociation, interpersonal influence, and self-punishment than the non-NSSI group.

Introduction

Nonsuicidal self-injury (NSSI), which refers to the direct and deliberate destruction or alteration of bodily tissue without lethal intent (e.g., cutting, burning), is a serious health concern (Nock and Favazza, 2009). Among clinical inpatient samples, as many as 21% of adults (Briere and Gil, 1998) and 30–40 % of adolescents engage in NSSI (Darche, 1990, Jacobson et al., 2008). NSSI is also prevalent among community-based samples, and recent estimates indicate that 13–38 % of adolescents and young adults in the community report lifetime histories of NSSI (Gratz et al., 2002, Ross and Heath, 2002, Klonsky and Glenn, 2009, Heath et al., 2008). In addition to reporting higher levels of depression and anxiety (Gratz et al., 2002, Ross and Heath, 2002), individuals who engage in NSSI also report greater engagement in other health-risk behaviors (e.g., smoking, drinking alcohol) as compared to individuals who do not engage in NSSI (Hilt et al., 2008, Serras et al., 2010). In his integrated model of the development of self-injury, Nock suggests that NSSI may be associated with other problem behaviors, such as cigarette smoking, because these behaviors serve similar functions (Nock, 2009). More specifically, researchers have consistently found that individuals engage in NSSI to regulate intrapersonal (e.g., to reduce stress or anxiety) and interpersonal functions (i.e., to elicit help from others) (Nock and Prinstein, 2004, Klonsky and Glenn, 2009), but many other problem behaviors could similarly serve to regulate these needs (Nock, 2009). Researchers have yet to examine, however, whether individuals who engage in NSSI also engage in other coping behaviors to regulate similar affective and social experiences. Moreover, it is unclear whether individuals who engage in NSSI experience different regulatory needs and engage in different coping behaviors as compared to individuals who do not engage in NSSI. To address these gaps in the literature, we surveyed young adults about which coping behaviors they used when they wanted to regulate commonly endorsed NSSI functions (e.g., affect regulation, self-punishment) (Klonsky and Glenn, 2009).

Section snippets

Participants

The current sample consisted of 1107 (70.3% female) first-year undergraduate students between the ages of 17 and 24 years (mean age=19.11, S.D.=1.05) from a mid-sized Canadian university who were part of a larger scale project on stress and coping in university. In total, 87.5% of the participants were born in Canada, and the most common ethnic backgrounds reported other than Canadian were British (19%), Italian (16.8%), French (9.5%) and German (9%), which is consistent with the broader

Results

Of the total sample, 39.5% indicated having engaged in NSSI at least once. Of those individuals who engaged in NSSI, 5.9% engaged in the behavior once, 15.8% engaged in the behavior 2–4 times, 24% engaged in the behavior 5–10 times, 33.0% engaged in the behavior 11–50 times, 7.1% engaged in the behavior 51–100 times and 14.2% engaged in the behavior more than 100 times. The most commonly endorsed types of self-injury were self-hitting and head banging (21.9%), hair pulling and pinching (24%),

Discussion

In total, 39.5% of the sample reported having engaged in NSSI at least once and many individuals reported multiple incidents. Although our prevalence of NSSI may seem high, our estimate is comparable to other studies with community samples that have employed checklist measures of NSSI behaviors, as well as studies involving first-year undergraduate students (Gratz et al., 2002, Klonsky and Olino, 2008, Klonsky and Glenn, 2009).

Consistent with Nock's (2009) prediction, both groups endorsed a

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Psychiatric impairment among adolescents engaging in different types of deliberate self-harm
Journal of Clinical Child & Adolescent Psychology
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Support for a Transdiagnostic Motivational Model of Self-Damaging Behaviors: Comparing the Salience of Motives for Binge Drinking, Disordered Eating, and Nonsuicidal Self-Injury
2022, Behavior Therapy
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That said, individuals who engage in alcohol misuse and disordered eating tend to have high levels of self-criticism (Skinner & Veilleux, 2016; Zelkowitz & Cole, 2020), a robust correlate of self-punishment motives (Glassman et al., 2007). Moreover, among first-year university students, roughly 14% said they would engage in NSSI to punish themselves, followed by 10% and 3% who said they would engage in binge eating/fasting and alcohol use for this reason, respectively (Hamza et al., 2013). Thus, self-punishment may be a salient motive for a variety of SDBs.
Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, M_age = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.
Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders
2021, Comprehensive Psychiatry
Citation Excerpt :
Therefore, we decided to focus on a clinically well-defined group of NSSID according to the DSM-5 criteria as emphasized by a broader movement in clinical NSSI research [3] to make our results comparable to other findings in that field. Therefore, we classified our sample into two groups of NSSID (presence vs. absence of NSSI disorder) based on the DSM-5 criteria which is also common in other research studies [38–40]. The following DSM-IV axis I disorders were assessed using the SCID-I interview (SCID-I, German translation see [41]: affective disorders, psychotic disorders, eating disorders, anxiety disorders, adjustment disorders, somatoform disorders and substance-related disorders.
This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, M_age = 15.09, SD = 1.44; 27% male, M_age = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.
A lab-based study exploring the associations among nonsuicidal self-injury, pain, and emotion among university students
2018, Psychiatry Research
Citation Excerpt :
Despite emerging evidence that the administration of pain may be emotionally reinforcing, it is less clear whether there is heterogeneity in emotional response to pain among individuals who engage in NSSI. Although research and theory on NSSI have long underscored the role of NSSI in the regulation of affect (Chapman et al., 2006; Klonsky and Glenn, 2009; Nock and Prinstein, 2004), another commonly endorsed motivation for engaging in NSSI is to self-punish (Hamza et al., 2013; Klonsky and Glenn, 2009; Taylor et al., 2017). In their new conceptual model on NSSI (i.e., the Benefits and Barriers Model), Hooley and Franklin (2017) suggest that although brief exposure to pain may provide affective gains to most individuals, individuals who engage in NSSI to self-punish may experience added benefits.
Nonsuicidal self-injury (NSSI; e.g., self-cutting without lethal intent) is a widespread mental health concern among emerging adults in university. Although accumulating evidence suggests that NSSI is primarily an emotion coping behaviour, little is known about variability in emotional response to pain among individuals who self-injure. Recent theory on NSSI suggests that individuals who engage in NSSI to self-punish may experience additional affective gains in response to pain compared to individuals without self-punishment motivations for NSSI and individuals who do not self-injure. To test this hypothesis, 82 undergraduate students (Mage = 21.52 years) were recruited from a mid-sized university, and reported on their emotions three times: at baseline, following a stress-induction task, and after a cold-pressor task. Although all participants showed decreased negative emotions (e.g., hostility, fear) and increased serenity following cold pain, students who engaged in NSSI specifically to self-punish also showed decreased guilt and sadness. The present findings demonstrate that pain may serve to regulate different emotions for students who self-injure depending on their motivations for engaging in NSSI. Additionally, findings suggest that prevention and intervention efforts aimed at reducing the need to self-punish may help to reduce some of the emotionally reinforcing properties of NSSI.
A longitudinal investigation of the relation between nonsuicidal self-injury and spirituality/religiosity
2017, Psychiatry Research
Citation Excerpt :
Nonsuicidal self-injury (NSSI)1, which refers to the direct and deliberate destruction of bodily tissue (American Psychiatric Association, 2013), is a widespread mental health concern, particularly among university students. Recent estimates suggest that as many as 38% of young adults report lifetime histories of NSSI (Gratz et al., 2002; Hamza et al., 2013), and as many as 15–19% of students self-injure during the university years (Mental Health Commission of Canada, 2015). Despite increased research on risk factors for NSSI engagement in recent years, one widely neglected factor that may be associated with NSSI engagement is an individual's spirituality/religiosity (i.e., beliefs in the sacred/higher power and involvement in religious organizations).
Despite increased research on factors that predict engagement in nonsuicidal self-injury (NSSI), one factor that has been neglected is spirituality/religiosity. While some researchers suggest that spiritual/religious beliefs and practice may protect against aversive mental health outcomes, it also is possible that certain aspects of spirituality/religiosity - specifically doubt and questioning - may be distressing. In this study, we examined whether multiple dimensions of spirituality/religiosity, including the often-overlooked experience of doubt/questioning, were associated with engagement in NSSI among university students over time. Participants included 1,132 (70.5% female) first-year undergraduate students (Mean age=19.06, SD=1.05) from a Canadian university who were surveyed first in their freshman year, and again one year later. Auto-regressive cross-lagged analyses revealed a bidirectional relation between doubt/questioning and NSSI, where higher doubt/questioning predicted increased NSSI over time (after controlling for baseline depressive symptoms), and vice versa. There were no longitudinal associations between general spirituality/religiosity (i.e., general beliefs/practice) and NSSI. Our findings suggest questioning and doubt may be distressing for some individuals, and predict increased risk for NSSI as a form of coping. Further, higher NSSI may predict increases in questioning/doubt over time. However, the hypothesis that general spirituality/religiosity may protect against NSSI, was not supported.
Impulsivity and nonsuicidal self-injury: A review and meta-analysis
2015, Clinical Psychology Review
Citation Excerpt :
Finally, despite findings that self-reported impulsivity was associated with NSSI, it remains unclear why individuals who are impulsive choose to engage in NSSI, rather than other health-risk behaviors. Nock (2010) suggests that individuals may specifically choose NSSI because it requires little planning or preparation (i.e., a highly accessible means of coping behavior), but there is research to suggest that individuals who engage in NSSI are more likely to engage in other risk behaviors too, such as drug use and purging behaviors (Gollust et al., 2008; Hamza et al., 2013; Peterson & Fischer, 2012; Serras et al., 2010). Longitudinal research exploring pathways from impulsivity to multiple risk behaviors may provide increased insight into which risk behaviors are most strongly associated with impulsivity.
Nonsuicidal self-injury (NSSI; direct self-injury without lethal intent) often is thought to be associated with impulse control problems. Recent research, however, offers conflicting results about whether impulsivity is a risk factor for NSSI engagement. To disentangle findings on the link between impulsivity and NSSI, an extensive review of the literature was conducted using several electronic databases (i.e., PsychInfo, PsychArticles, ERIC, CINAHL, and MEDLINE). In total, 27 studies that met the specific inclusion criteria were identified. Results of a meta-analysis revealed that individuals who engaged in NSSI self-reported greater impulsivity than individuals who did not engage in NSSI, and that this effect was most consistent for measures of negative urgency. In contrast, there was little evidence of an association between lab-based measures of impulsivity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. Moreover, the link between impulsivity and NSSI found for self-report measures was sometimes eliminated when other risk factors for NSSI were controlled (e.g., abuse, depression, post-traumatic stress disorder). In addition to integrating findings, the present review provides several explanations for the discrepancies in findings between studies employing self-report versus lab-based measures of impulsivity. To conclude, several specific recommendations for future research directions to extend the literature on impulsivity and NSSI are offered.
Temperamental Contributions to the Development of Psychological Profiles: I. Basic Issues
2014, Social Anxiety: Clinical, Developmental, and Social Perspectives
This chapter considers the concept of temperamental biases and the conditions that contribute to their development. These include the infant's genes and prenatal environment, which create a very large number of neurochemical profiles that are the more proximal bases for a large number of temperaments. The evidence used to posit a temperament bias is a critical issue. Although parental report remains the most popular source of data, this information is flawed because of parental distortions in their perception and description of the infant. Direct behavioral observations of the child should therefore always be a component of a claim for the presence of a temperamental bias.

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Brief reportA preliminary examination of the specificity of the functions of nonsuicidal self-injury among a sample of university students

Abstract

Introduction

Section snippets

Participants

Results

Discussion

Self-mutilation in clinical and general population samples: prevalence, correlates, and functions

American Journal of Orthopsychiatry

Psychological factors differentiating self-mutilating and non self-mutilating adolescent inpatient families

The Psychiatric Hospital

Risk factors for deliberate self-harm among college students

American Journal of Orthopsychiatry

An examination of nonsuicidal self-injury among college students

Journal of Mental Health Counselling

Longitudinal study of nonsuicidal self-injury among young adolescents: rates, correlates, and preliminary test of an interpersonal model

Journal of Early Adolescence

Psychiatric impairment among adolescents engaging in different types of deliberate self-harm

Journal of Clinical Child & Adolescent Psychology

Brief report
A preliminary examination of the specificity of the functions of nonsuicidal self-injury among a sample of university students