Non-suicidal self-injury (NSSI) is the direct, purposeful self-infliction of injury, which results in tissue damage, is performed without conscious suicidal intent and through methods that are not socially sanctioned (Nixon & Heath, 2009). The phenomenon of self-injurious behaviours is alarming, especially among adolescents and young adults (Muehlenkamp, 2005). In fact, it is estimated that lifetime prevalence of NSSI in young adults within the general population is around 12% to 38% (for reviews, see Heath, Schaub, Holly, & Nixon, 2009; Jacobson & Gould, 2007; Rodham & Hawton, 2009). While this proportion declines when assessing recent NSSI (i.e., usually performed in the past six months or in the past year), the numbers are still disturbing with 2.5% to 12.5% of young adults reporting current NSSI (for reviews, see Heath et al., 2009; Jacobson & Gould, 2007; Rodham & Hawton, 2009). The goal of this thesis is to investigate the associations between romantic relationships and NSSI in young adults and to address two major limitations that emerge from the literature, namely: a) several theoretical hypotheses have yet to be validated despite considerable advances in the scientific study of NSSI; and b) with the exception of one study, the few studies available relating romantic relationships and NSSI solely focused on the individual level of analysis instead of including both partners in the model. This goal will be addressed through three articles, each targeting specific objectives. For the sake of methodological rigor and for adequate evaluation of the constructs under study, the purpose of the first study was to validate the factorial structure of the English version of the Dyadic Coping Inventory (DCI; Bodenmann, 2008). A confirmatory factor analysis (CFA) corroborated the measurement theory of the DCI by revealing the presence of five coping factors (i.e., stress communication, supportive dyadic coping, delegated dyadic coping, negative dyadic coping, common dyadic coping) and two target factors (i.e., one’s own dyadic coping and partner’s dyadic coping). The English DCI also demonstrated good internal reliability and yielded preliminary evidence of concurrent validity. All together, these findings lead to the conclusion that the English DCI is an accurate and reliable measure of dyadic coping, and that researchers can use the English DCI confidently in their research to evaluate dyadic coping processes. The established factorial structure of the English DCI was then used in subsequent studies of this thesis. The purpose of the second study was to investigate direct and indirect associations between insecure romantic attachment, difficulties in emotion regulation and common dyadic coping strategies, and endorsement of NSSI behaviours. From an empirical standpoint, this study is the first to explore these specific relationships in one comprehensive model, targeting both interpersonal and intrapersonal strategies to deal with stressful experiences and the role it might have on one’s NSSI behaviours. Overall, the results revealed that difficulties in emotion regulation mediated the relationships between romantic attachment insecurity (i.e., attachment anxiety and attachment avoidance) and NSSI, whereas no such effects were found for common dyadic coping strategies. Findings from this study suggest that intrapersonal strategies (i.e., emotion regulation) might be more influential on one’s NSSI behaviours than behavioural strategies (i.e., common dyadic coping). This study also offers a first step towards the understanding of the romantic relational context of individuals struggling with NSSI behaviours. The next step remains to explore the couple as the unit of analysis rather than focusing on only one member of the relationship, giving way to the third study of this thesis. The primary aim of the third study was to generate a general portrait of young women’s romantic relationship functioning, distinguishing women who recently self-injured from those who have never self-injured. This study was designed to permit the exploration of not only the individual-level effects, but also potential effects from the romantic partner. Through a series of nonparametric Mann-Whitney U tests, results revealed that women who engage in NSSI behaviours are more likely to report subjective distress in the form of attachment anxiety and distrust compared to women who do not engage in NSSI behaviours. They also reported good, but slightly lower levels of, relationship satisfaction and adaptive dyadic coping strategies compared to women who have never engaged in NSSI. Findings also showed that partners of women who engage in NSSI behaviour reported more attachment anxiety than partners of women who do not engage in NSSI behaviours. The women and their partner’s reports about their romantic relationship experiences provide unique insight into the similarities and differences of individuals who self-injure and those who do not. Furthermore, a cursory exploration of the partners’ NSSI behaviours revealed that nearly one-third of the partners in a relationship with women who self-injured also reported having recently engaged in NSSI behaviours. These findings add some depth to the understanding of the relational context of those who are struggling with NSSI and provide future directions in research.

Young adults who self-injure may prefer to disclose these experiences to peers versus professionals, however, past research has demonstrated that their responses are rated as less helpful compared to other recipients. To better understand this phenomenon, the current study sought to investigate NSSI disclosures from the point of view of the disclosure recipient. Given the relation between various interpersonal trait variables (e.g., receptiveness, responsiveness, agreeableness), relationship factors (friendship quality, duration), and intimate self-disclosures, aspects of particular individuals and relationships may also play a role in the context of peer-to-peer NSSI disclosures and how effective these disclosure responses may be. An online battery of questionnaires was administered to examine these research questions in a population of 230 university students (178 females, M age = 18.38). 107 participants reported receiving a NSSI disclosure from a friend. Having a history of NSSI, lower social support, and greater perceived relative power were found to significantly predict receiving a NSSI disclosure from a friend and receptiveness and social support were found to significantly predict the recipients’ degree of helpful responding to the NSSI disclosure. Findings illuminate the important role of friends and of the friendship itself in facilitating the help-seeking process and promoting NSSI cessation. Research directions and implications are discussed.

No description available.

Non-suicidal self-injury (NSSI), such as intentionally cutting, burning or hitting oneself, is a behavior with potentially detrimental consequences and empirical studies are necessary to gain knowledge of how to prevent NSSI in adolescents. The aims of this thesis were to investigate the prevalence, methods, characteristics and functions of NSSI in a large community sample of Swedish adolescents, and to examine the relationship between NSSI and adverse life events and trauma symptoms. All empirical studies had a cross-sectional design and were based on 3,097 adolescents in the county of Östergötland, aged 15-17 years, in their first year of high school. Participating school classes were selected through a randomization process and administered self-report questionnaires. In study I (n = 3,060) a single item NSSI question resulted in a prevalence rate of 17.2%, while 35.6% of adolescents reported having engaged in NSSI at least once during the past year when given a checklist. The most commonly reported type of NSSI in this sample was “bit yourself”, followed by “hit yourself on purpose”, “erased your skin” and “cut or carved on your skin”. Applying the proposed DSM-5 diagnostic criteria of NSSI resulted in a prevalence rate of 6.7%. Results in study II (n = 2,964) showed that after controlling for gender, parental occupation and living conditions, adolescents with no self-injurious behavior reported the lowest level of adversities and trauma symptoms, while adolescents with both NSSI and suicide attempts (5.7%) reported the highest levels compared to those with only NSSI or a suicide attempt. Adolescents reporting frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. Automatic functions, such as affect regulation, self-punishment and feeling-generation, were the most commonly reported functions of NSSI. Attempts in study I to confirm Nock and Prinstein’s (2004) four-factor model of underlying factors of NSSI functions resulted in a close to acceptable fit. An attempt to refine the factor analysis on this community sample of Swedish adolescents, using Mplus with cross-validation, was made in study III (n = 836). An exploratory factor analysis resulted in a three-factor model (social influence, automatic functions and non-conformist peer identification), which was validated in confirmatory analysis. In order to adhere more closely to learning theory and the concept of negative and positive reinforcement, the third factor was then split into two factors, resulting in a four-factor model (social influence, automatic functions, peer identification and avoiding demands), which showed excellent fit to the data in the confirmatory factor analysis. Study IV (n = 816) showed that NSSI frequency, gender (female), self-reported experience of emotional and physical abuse, having made a suicide attempt, prolonged illness or handicap and symptoms of depression and dissociation were significant predictors in the final model of the automatic functions, indicating that these variables are important in understanding the mechanisms underlying the need to engage in NSSI to regulate emotions, generate feelings, gain control or to self-punish. Symptoms of depression and dissociation mediated the relationship between sexual, physical and emotional abuse and the automatic  functions. Furthermore, frequency of NSSI, gender, emotional abuse, prolonged illness or handicap and symptoms of depression uniquely predicted automatic functions but not social functions. Self-reported experience of physical abuse, having made a suicide attempt, symptoms of anxiety and dissociation were significant in the final model of social functions, i.e., performing NSSI to influence or  communicate with others, to avoid demands or to identify with peers. Of these, symptoms of anxiety were uniquely associated with social functions. Symptoms of anxiety and dissociation mediated the relationship between physical abuse and social functions of NSSI. Taken together, this thesis has shown that NSSI is prevalent in Swedish adolescents and findings contribute to the discussion of a potential NSSI diagnosis. It is important to consider the effect of different types of negative life events and trauma symptoms in relation to NSSI in adolescents. Assessing the specific reinforcing functions of NSSI and the underlying factor structure can be helpful in developing functionally relevant individualized treatment. / Självskadebeteende, t ex att avsiktligt skära, bränna eller slå sig själv är potentiellt skadliga beteenden. Empiriska studier är viktiga för att kunna förebygga självskadebeteende hos ungdomar. Föreliggande avhandling syftar till att undersöka självskadebeteendets förekomst, funktion, karaktäristik och metoder hos svenska ungdomar, samt att undersöka relationen till negativa livshändelser och traumasymptom. Samtliga fyra empiriska studier hade en tvärsnittsdesign och baserades på 3,097 ungdomar i Östergötland, 15-17 år, i gymnasieskolans årskurs 1, vars skolklasser valts ut slumpmässigt och som besvarat självskattningsformulär. I studie I (n = 3,060) angav 17.2%, som svar på en allmän självskadefråga, att de avsiktligt skadat sig under sin livstid. När ungdomarna däremot svarade på en checklista med olika självskadebeteenden, angav 35.6% att de hade ägnat sig åt någon typ av självskadebeteende under det senaste året. De vanligaste metoderna var att avsiktligt bita eller slå sig själv, sudda på huden och att skära sig. De föreslagna diagnoskriterierna för icke-suicidal självskada i DSM-5 resulterade i en förekomst av 6.7%. Studie II (n = 2,964) visade att ungdomar utan självskadebeteende rapporterade de lägsta antalet negativa livshändelser och traumasymptom, medan de med erfarenhet av både självskadebeteende och självmordsförsök (5.7%) rapporterade de högsta antalen jämfört med de med endast självskadebeteende eller självmordsförsök. Ungdomar med fler självskadetillfällen rapporterade fler negativa livshändelser och traumasymptom än de med färre tillfällen. Automatiska/intrapersonella funktioner, såsom att generera och reglera känslor samt att straffa sig själv var de vanligaste funktionerna som rapporterades. Försök att konfirmera Nock och Prinsteins (2004) fyrfaktormodell av underliggande funktionsfaktorer i studie I resulterade i en modell med nära acceptabel passform. Ett försök att förbättra faktoranalysen på den aktuella urvalsgruppen gjordes med Mplus i studie III (n = 836). En exploratorisk analys resulterade i en trefaktormodell (interpersonell påverkan, automatisk/intrapersonell funktion samt ”icke-konformistisk” kamratidentifikation), vilken även validerades i den konfirmatoriska analysen. Med utgångspunkt i inlärningsteori och begreppen negativ och positiv förstärkning delades därefter den tredje faktorn upp i två faktorer. Det resulterade i en fyrfaktormodell (interpersonell påverkan, automatisk/intrapersonell funktion, kamratidentifikation samt undvikande av krav). Fyrfaktormodellen visade utmärkt passform i den konfirmatoriska analysen. Studie IV (n = 816) visade att självskadebeteendets frekvens, kön (flicka), självrapporterade erfarenheter av psykisk och fysisk misshandel, självmordsförsök, kronisk sjukdom eller handikapp under uppväxten, liksom symptom på depression och dissociation predicerade automatiska självskadefunktioner. De variablerna är potentiellt viktiga för förståelsen av de mekanismer som är involverade när ungdomar skadar sig själva för att generera och reglera känslor, få kontroll, liksom att straffa sig själva. Relationen mellan psykisk och fysisk misshandel och de automatiska funktionerna medierades av symptom på depression och dissociation. Självskadefrekvens, kön, psykisk misshandel, sjukdom/handikapp och symptom på depression predicerade enbart automatiska men inte sociala funktioner. Självrapporterad fysisk misshandel, självmordsförsök, symptom på ångest och dissociation var signifikanta prediktorer för de sociala funktionerna (att påverka/kommunicera med andra, undvika krav eller identifiera sig med kamrater). Ångestsymptom var unikt associerade med sociala funktioner. Symptom på ångest och dissociation medierade vidare relationen mellan fysisk misshandel och sociala självskadefunktioner. Sammanfattningsvis visade resultaten att självskadebeteende är vanligt förekommande hos ungdomar. Avhandlingen bidrar med empiri till diskussionen gällande icke suicidal självskada i DSM-5. Det är viktigt att beakta olika negativa livserfarenheter och traumasymptom i relation till självskadebeteende hos ungdomar. Att undersöka självskadebeteendets funktioner kan vara kliniskt hjälpsamt för att utveckla och utvärdera individuellt anpassade behandlingsstrategier.

The widespread practice of non-suicidal self-injury suggests that it might no longer be reasonable to frame such behaviours as individual pathologies and highlights the need to understand such acts as sociological phenomena instead. This dissertation therefore explored the core elements of self-injury such as the self, the body, and meanings ascribed to acts of injuring the self/body, in relation to forms of sociation. Focusing on intent and aetiology, this qualitative enquiry used an interpretive mode of explanation, and collected data via indepth face-to-face interviews from a characteristically diverse community sample of fifteen participants. Findings indicated that respondents' aetiologies of self-injury were located in social interactions characterised by abuse, neglect, bullying, and invalidation. Individuals who perceived themselves as worthless and unlovable objects punished themselves, or branded themselves as failures. Paradoxically, sufficient castigation averted the complete annihilation of the existential self. Findings concur with previous studies which reported that, at its deepest level, self-injury is antithetical to suicide. This study also highlighted the body's communicative role in the symbolic expression of traumatic experiences, and emphasised its physiological role in (a) emotion regulation and (b) self-injury's propensity to become addictive. From a sociological perspective, instant emotion regulation via self-injury allowed individuals to avoid social stigma; well managed social performances in turn protected social bonds. Although self-injury constitutes a maladaptive coping mechanism, its reported physiological, psychological and social gains are significant and need to be considered in intervention programmes and policy. This dissertation therefore makes two recommendations: firstly, restorative practices should be reinstituted, particularly in schools; secondly, the growing and alarming trend of copycat behaviours reported in children and young teens needs to be researched further in relation to the mediation, ideation and imitation of self-injurious behaviours.

Indiana University-Purdue University Indianapolis (IUPUI) / While deliberate self-harm (DSH) in adolescents and adults has been established as a reliable predictor of future suicidal behavior and attempts, whether the same is true for younger children has rarely been studied. Two separate articles will address issues regarding intentional self-injury in young children. The first identified describes the demographic profile of young children who engage in NSSI and evaluated whether predictors of adolescent NSSI are also associated with NSSI in children. The second manuscript analyzed NSSI behaviors to see if they can be correctly predicted from knowledge of a child's history of maltreatment to identify which trauma variables are central in prediction of NSSI status. A Chi-square and logistic regression were run on data from 16,271 records of children ages 5-9 years who received services from the IDMHA in 2018. NSSI was significantly (p < .000) associated with trauma history (x2 = 75.54, df = 1), anxiety (x2 = 107.59, df = 1), depression (x2 = 217.011, df = 1), suicide risk (x2= 993, df = 1), and impulsivity (x2 = 122.49, df = 1. Presence of a caregiver mental health problem (x2 =38.29, df = 1), age (x2 = 14.18, df = 4), being male (x2 = 11.59, df = 1), and being Caucasian (x2 = 23.29, df = 6) at p < .05. Regression results indicated the overall model of seven predictors (sexual abuse [OR 1.14], physical abuse [OR 1.26], emotional abuse [OR1.3], neglect [OR .895], medical trauma [OR 1.34], exposure to natural disaster [OR 1.81] and victim of a crime [1.14] was statistically reliable in distinguishing between children who self-injure and those who do not. [-2 Log Likelihood = 6228.78, x2(6) = 105.416, p < .000]. NSSI does occur in preadolescent children and while there is some indication that the risk factors and co-variates are like those of adolescents, there are some differences which need further study. Training clinicians to inquire about self-injury during assessment of younger children is a simple step. The variables of age and sex throughout development as well as identifying protective as well as risk factors with children should be studied.

There is a growing literature supporting the idea that those who engage in non-suicidal deliberate self-harm (DSH) have altered pain perception compared to individuals who do not. For example, individuals who report a history of non-suicidal DSH behavior have a decreased sensitivity to transient pain during laboratory-based pain induction (e.g., Glenn et al., 2014). Research suggests that brief manipulations targeting individual beliefs can affect performance on subsequent tasks, including measures of pain sensitivity. To date, however, no study has examined the effects of experimentally manipulated pain perception on DSH behavior. The Self-Aggression Paradigm (SAP: Berman & Walley, 2003; McCloskey & Berman, 2003) allows for the prospective observation of the effects of experimental manipulations on a laboratory analogue of DSH. Therefore, the aim of the current study was to determine if experimentally manipulated false feedback about pain tolerance affects DSH behavior during the SAP, thus potentially providing evidence for a causal linkage between pain perception and DSH. Eighty participants were randomly assigned to one of three feedback groups: High pain tolerance, low pain tolerance, and a control condition with neutral feedback provided after completing the SAP. Participants were provided false feedback regarding their pain tolerance after a pressure algometer task. It was predicted that participants in the high pain tolerance feedback groupwould have the highest DSH on the SAP, with DSH defined as the level of shock self-administered during a series of reaction-time trials. No significant group differences, however, emerged based on group assignment. Men engaged in more DSH than women during the study independent of feedback group assignment. A secondary aim of the current study was to provide further validation for the SAP using multiple pain induction modalities. Implications of the current findings and future research directions are discussed.

No description available.

The aim of this study was to investigate how adults 25 years old and over describe the functions of their non-suicidal self-injury (NSSI) and to explore whether they report any changes in their experience with NSSI as they become older. Qualitative e-mail interviews were used in order to capture the participants’ experiences. The results of the study were analysed based on coping theory and previous research. The results indicate that, consistent with previous literature, adults self-injure for mostly the same reasons as adolescents – however, as the previous research shows adolescents are more likely to hurt themselves in order to communicate with others. The adults in the present sample report using problem-solving coping strategies to the same extent as emotion-focused strategies; a slight deviation from previous research which has suggested that people who self-injure are more likely to employ emotion-focused strategies. The participants of the study generally experience a feeling of increased control and deliberation of their self-injury as they have gotten older; hurting themselves has become a purposeful coping strategy. The results of this study might have implications for treatment of self-injury in adults; focusing the treatment on strengthening the adults’ autonomy and encouraging further problem-solving coping strategies might be beneficial.

I Sverige och globalt har det de senaste decennierna rapporterats en ökning av icke suicidalt självskadebeteende. Icke suicidalt självskadebeteende har definierats som skada en person medvetet tillfogar sin kropp. Forskning inom området har visat på att personer med icke suicidalt självskadebeteende känt sig stigmatiserade och upplevt dåligt bemötande inom vården. Syftet i denna studie var att beskriva hur det är att leva med icke suicidalt självskadebeteende (NSSI), genom att studera bloggar. En kvalitativ innehållsanalys på sex bloggar gjordes. En induktiv ansats användes för att fånga olika perspektiv angående hur det är att leva med NSSI. Analysen av innehållet resulterade i två kategorier som genomgående kunde återfinnas i alla studerade bloggar. En evig kamp med subkategorierna Att leva med ett beroende, Att sluta skada sig, Att känna sig utanför och Att dömas av vården, Att finna hopp och mening med subkategorierna Att känna stöd från andra och Att ha framtidstro. Personer med NSSI upplever ofta stigmatisering från samhället, vilket skapar lidande. Genom att, som sjuksköterska, möta dessa personer där de befinner sig i sitt lidande kan en trygg och respektfull relation skapas med vårdsökande person. / The recent decades, the number of Non-suicidal Self-injury (NSSI), has increased in Sweden and globally. NSSI has been defined as a conscious self-inflicted physical injury. Research within this field has shown that individuals with NSSI have been stigmatised and has received poor treatment by the healthcare. The purpose with this study is to describe what it is like to live with Non-Suicidal Self-Injury (NSSI) through the study of blogs. Qualitative content analysis of six blogs has been done, and an inductive approach was chosen to capture different perspectives of what it is like living with NSSI. The analysis of the content resulted in two categories that could consistently be found in all the studied blogs. An eternal struggle with the subcategories To live with addiction, To end self-harming, To feel left out, and To be judged by the care system, To find hope and meaning with the subcategories, To feel support from others and To have hope for the future. Individuals with NSSI often experience stigmatisation from the society, which causes further suffering. As a nurse, by meeting these care seekers at where they are in their suffering could help to create a safe and respectful relationship.