Non-suicidal self-injury (referred to hereafter as self-injury) is considered a serious health concern among young adult populations, and is associated with a host of devastating physical and psychological consequences (Hasking, Momeni, Swannell, & Chia, 2008). Self-injury encompasses both thoughts of harming oneself in addition to acts of self-injury. Elevated lifetime prevalence rates of 13-17% suggest that self-injury is an issue of widespread nature, with reports indicating that a considerable proportion of young adults engage in self-injurious thoughts and behaviours (Nixon, Cloutier, & Jansson, 2008; Swannell, Martin, Page, Hasking, & St John, 2014; Whitlock, Eckenrode, & Silverman, 2006). Identifying the factors that precede self-injury is crucial to advancing current clinical conceptualizations and treatment strategies for those engaging in such thoughts and behaviours (Schenk, Noll, & Cassarly, 2010). Despite the recognized role of romantic relationship experiences in contributing to the functioning and adjustment of the individuals comprising the romantic dyad, very little empirical attention has been paid to examining whether dimensions of romantic relationships are linked to the use of self-injury. The present thesis, consisting of two independent studies, sought to provide a better understanding of the factors underlying this troubling phenomenon by examining links between dimensions of romantic relationships and self-injurious thoughts and behaviours among community-based young adults involved in couple relationships. The studies presented in the present thesis were approved by the University of Ottawa’s Research Ethics Board (see Appendix A for the Ethics Approval Certificate). The first study involved testing a novel conceptual model in which intimate partner violence victimization (i.e., physical, psychological, and sexual violence) was examined as a potential mediator of the relationship between child maltreatment (i.e., neglect; witnessing family violence; and physical, psychological, and sexual abuse) and self-injurious thoughts and behaviours. The sample consisted of 406 young adults (346 females; M = 19.87 years) who were involved in a couple relationship for a duration of at least six months at the time of participation. Results from bootstrapping procedures partially supported the theory put forth. Intimate partner violence victimization partially mediated the direct effect of child maltreatment on self-injurious behaviours. Contrary to predictions, intimate partner violence victimization did not mediate the association between child maltreatment and self-injurious thoughts. Hence, findings suggest that individuals who have experienced both forms of family violence may be particularly vulnerable to engaging in self-injurious behaviours. The second study comprised an investigation of the links between the three romantic behavioural systems (consisting of the attachment, caregiving, and sexual systems) and self-injurious thoughts and behaviours, and examined the incremental contributions of the systems in the prediction of young adult self-injury. The sample consisted of 255 young adults (223 females; Mage = 19.98 years) currently involved in a couple relationship. Linear discriminant analyses revealed that participants endorsing self-injurious thoughts experienced greater attachment anxiety and avoidance, controlling and compulsive romantic caregiving behaviours, and lower sexual satisfaction than did participants who did not endorse such thoughts. In contrast, findings indicated that the behavioural systems did not predict self-injurious behaviours. Such findings suggest that dimensions of the three interrelated behavioural systems hold unique roles in understanding young adult self-injurious thoughts, and that the constructs that predict self-injurious thoughts may differ from those that predict 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.

This thesis examined the borderline personality disorder symptom profiles of teenage girls who were referred to a tertiary child and youth psychiatry clinic. Self-injury and unstable mood are key features of Borderline Personality Disorder (BPD) but are also associated with other disorders such as depression and anxiety disorders. The aim of the larger study was to determine whether BPD can be differentiated from other disorders in a highly comorbid adolescent sample who self-injure. To answer this question, individuals in our sample were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. The subgroups that emerged from our sample were then compared to each other across other clinical measures. Four latent classes were identified. The most impaired class had a high prevalence of BPD (70%). An intermediate class had a significantly higher prevalence of PTSD (41.7%). Another intermediate group had a higher prevalence of anxiety disorders (62%) (Social Phobia and Generalized Anxiety Disorder). The largest class had a low prevalence of all psychiatric disorders. The results indicated that only a small subset of teenage girls who presented with self-injury and unstable mood met criteria for BPD. These girls represented a distinct and severely impaired group with high comorbidity. The subgroups that emerged from our sample provide guidance to clinicians regarding the likelihood of a personality disorder diagnosis in this population and the pattern of emotional difficulties of youth who self-injure. / Thesis / Master of Science (MSc)

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.

Nonsuicidal self-injury (NSSI), the deliberate self-destruction of one’s own body tissue engaged in without associated suicidal intent, is a prevalent behavior among adolescents and young adults. The current study examined whether one aspect of cognitive control, inhibitory control in response to negative emotional stimuli, is associated with repetitive engagement in NSSI. It further sought to examine whether sleep deficiency/irregularity, stress, and reward sensitivity moderate this relationship. A multi-method approach (self-report, behavioral measures, actigraphy) was employed to sensitively probe these relationships among 114 late adolescents with and without a history of repetitive NSSI. Findings suggested no relationship between inhibitory control in response to negative emotional stimuli and NSSI, as measured by a behavioral measure, but a significant positive relationship as measured by self-report. Stress and sleep irregularity, but not sleep deficiency or reward sensitivity, were associated with NSSI group status. Interaction analyses suggested that sleep irregularity and stress moderated the relationship between inhibitory control in response to negative emotional stimuli and NSSI. Results are discussed in terms of conceptual and clinical implications. Findings highlight the necessity of examining the temporal dynamics between the study’s constructs and NSSI by employing an ecologically valid approach. / Psychology

Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue (e.g., cutting, skin picking, biting, hitting) without conscious suicidal intent. Cognitive and affective difficulties may contribute to the development and maintenance of NSSI, such that emotion regulation may mediate the link between cognitive control difficulties and NSSI in youth. This study examined developmental links between cognitive control and emotion regulation on several facets of self-injurious thoughts and behaviors in a large sample of youth, collected via the ABCD Study (N=6447). Although a mediation of emotion regulation on cognitive control and self-injurious thoughts and behaviors was not supported, important direct effects were found between neural correlates of inhibition (at ages 9-10 years) on NSSI at 11-12 years, and behavioral measures of cognitive flexibility (at 10-11 years) and inhibition (at 9-10 years) on suicidality at 11-12 years. Further, links between poorer cognitive control and poorer emotion regulation were found. An exploratory aim of this study was examining the potential moderating role of autistic traits on significant associations. Although greater autistic traits significantly predicted presence of self-injurious thoughts and behaviors, this study did not find a moderation of autistic traits. These results provide developmental risk markers for NSSI and suicidality in youth. / Doctor of Philosophy / Nonsuicidal self-injury (NSSI) is the direct and intentional harm to one's own body (e.g., cutting, skin picking, biting, hitting) without suicidal intent. One's ability to regulate their cognitions and emotions may explain risk and continuation of NSSI and other suicidal thoughts and behaviors. In specific, one's ability to regulate their emotions may explain the relationship between cognitive control and NSSI in youth. This study examined the relationship between cognitive control and emotion regulation on NSSI and suicidality in a large sample of youth, , collected from the ABCD Study (N=6447). Although emotion regulation did not explain the relationship between cognitive control and NSSI or suicidality, results showed that brain activation when trying to inhibit a response at ages 9-10 related to presence of NSSI at ages 11-12. Additionally, behavior related to one's ability to flexibly shift (at ages 10-11) and inhibit responses (at ages 9-10) related to suicidality at ages 11-12. Links between poorer cognitive control and poorer emotion regulation were also found. Recent work has also found that autistic youth have high rates of NSSI and suicidality, thus, the level of autistic traits on these relationships were evaluated. Although greater autistic traits significantly predicted presence of self-injurious thoughts and behaviors, this study did not find that level of autistic traits impacted links between cognitive control, emotion regulation, and NSSI or suicidality. These results provide developmental risk markers for NSSI and suicidality in youth.

This study is an exploration of the ways that female self-mutilation has been medicalized in Western society and the consequences of this medicalization. The goal of this study is to provide an alternative approach to the way female self-mutilation is understood—one that views self-mutilation not as a symptom of individual psychopathology, but as an extreme response to a set of deeply embedded social expectations. Using the feminist constructionist model, semi-structured interviews were conducted with five women who have participated in various forms of self-injurious behavior. Findings indicate that this behavior does indeed occur within a social context—one rooted in patriarchal ideologies. These ideologies also seemed to influence whether the women in this study, who had been medically treated for this behavior, perceived this form of intervention as a positive or negative experience. / Master of Science

Archived data was utilized for the present study which examined self-injurious behaviors in a college population. College students, who engage in non-suicidal self-injury, or NSSI, were expected to evidence a higher knowledge base for the behavior than those who do not. The demographic variables of gender and sexual orientation were predicted to be over represented in the NSSI group. Further, this study examines the perceived riskiness of the behavior in individuals who self-injure, as well as their perceptions of others who engage in NSSI. The survey consisted of four sections: demographics, knowledge ofNSSI, experience with NSSI, and perceptions ofNSSI. Individuals who engage in or have a history of NSSI evidence a higher mean score or better knowledge of the behavior than those who do not. The NSSI population evidences disproportionate numbers of females and individuals with gay, lesbian, and questioning sexual orientations. Further, when examining the perceived riskiness of self-injury, the NSSI group views the behavior as less risky than the non self-injury group. Results are discussed in relation to the need for accurate knowledge about NSSI and additional research directions.

Syftet med denna studie var att öka kunskapen om hur professionella inom socialtjänsten bemöter och arbetar med unga vilka har sex som självskadebeteende. Behovet av studien baserades på att unga med sex som självskada har ökat och att socialtjänsten är en central aktör för att uppmärksamma denna målgrupp. Socialtjänsten ska verka för att unga växer upp under trygga förhållanden och särskilt uppmärksamma utvecklingen hos unga som visar tecken på ogynnsam utveckling. Uppsatsens ansats var kvalitativ där semistrukturerad intervjumetod tillämpats, vilket innebar möjligheten för intervjupersonerna att bidra till en nyanserad bild av studiens syfte. Resultatet tolkades tematiskt och analyserades sedan med hjälp av en teoretisk referensram för att bättre kunna förstå hur professionella inom socialtjänsten bemöter och arbetar med unga vilka har sex som självskadebeteende. Den teoretiska referensramen bestod av två teoretiska begrepp och ramverk: sex som social konstruktionoch relationens betydelse i professionellt arbete med människor. Uppsatsens resultat visar att de professionella inom socialtjänsten inte aktivt arbetar med unga som har sex som självskada, enbart vid fåtal tillfällen när problematiken är uttalat i ett ärende. Resultatet visar även att problematiken ännu inte har uppmärksammats inom socialtjänsten och att de professionella sällan eller aldrig för samtal kring det, varken inom verksamheten eller med de unga. Resultatet visar vidare att relationen är en förutsättning för att de unga ska berätta om denna typ av problematik och att de professionella behöver mer kunskap. / The aim of this study was to raise awareness of how professionals in social services treat and work with adolescents who have sex as self-injury behavior. The need for this study was based on the increased numbers of the adolescents who have sex as self-injury and also that social service is a key actor to notice these adolescents. Swedish social service should work for adolescents to grow up under safe conditions and pay special attention to adolescents who show signs of contrary development. In order to answer to the aim of this study the approach was qualitative in which semi structured interviewing was used. By using semi structured interviewing, the interviewees were given the opportunity to contribute to a nuanced aspect of the problem. The result was interpreted thematically and then analysed using a theoretical framework in order to better understand how professionals in social services treat and work with adolescents who have sex as self-injury behavior. The theoretical framework consisted of two theoretical concepts and frameworks: sex as a social construction and the significance of the relationship in professional work with people. The result of this essay show that professionals within social service do not actively work with adolescents with sex as self-injury, only when the problem is explicit in a specific case. The result also shows that the problem has not been addressed in social services and that the professionals rarely or never talk about it, either within the organization or with the adolescents. Besides that, the result also shows that the professionals need more knowledge about the problem and that the relationship is a prerequisite for the adolescents to tell professionals about this type of problems.