This dissertation investigated the relations between values-based acculturation and conceptualizations of internalized distress among immigrant Chinese Canadian families with adolescents. Parents and adolescents were classified into one of three primary acculturation profiles (separated, integrated, or assimilated), according to Berry's (1997) model of acculturation based on their endorsement of Chinese and Western cultural values. Confirmatory factor analyses were used to determine if the factor structure of measures of internalized distress (e.g., the CES-D) differed according to individual's acculturation profile. Next, multivariate analyses of variance were used to compare the proportion of various symptom types (somatic, affective, interpersonal, low positive affect) across acculturation profiles, as well as with a comparison sample of non-immigrant families. Finally, hierarchical regression analyses were used to assess the relations between the proportion of somatic symptoms reported and both cultural and demographic variables believed to increase one's susceptibility to experience stigma related to mental health symptoms. As hypothesized, the traditional Western four-factor model of the CES-D fit best for participants who endorsed high levels of Canadian values and low levels of Chinese values (i.e., those classified as assimilated). Both the Western four-factor and more holistic three-factor models showed acceptable model fit for individuals who endorsed both Canadian and Chinese values highly (i.e., those classified as integrated), and neither model fit the data among participants who endorsed low levels of Canadian values and high levels of Chinese values (i.e., those classified as separated). Contrary to hypotheses, parents and adolescents from non-immigrant families endorsed higher proportions of somatic symptoms compared to their immigrant counterparts. Furthermore, among immigrant Chinese Canadians, factors believed to lead to less reporting of somatic symptoms because of less perceived stigma (e.g., greater endorsement of Canadian values, younger age, longer time in Canada) were instead related to higher proportions of somatic symptoms. These unexpected findings were understood in the context of the cultural appropriateness of the specific somatic symptoms assessed by the CES-D. The expected pattern of group differences in the proportion of positive affect was found. Females reported a higher proportion of affective symptoms compared to males, and no acculturation-based or gender differences were found with respect to interpersonal symptoms. Several key implications emerged from the results of this dissertation. The value in grouping participants by cultural value endorsement rather than cultural background was demonstrated, in terms of both research and clinical practice. Future research could employ qualitative methods for a more nuanced understanding of how individuals conceptualize the various cultures that influence their perceptions of health, illness, and stigma. In terms of clinical practice, the importance of assessing cultural values in relation to symptom reporting was discussed, as well as the importance of ensuring front line health care professionals have the training needed to identify cultural variations in the reporting of distress. / Graduate

Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. The purposes of this dissertation were to: 1) describe four theories of traditional Korean medicine; 2) review mechanisms of acupuncture and moxibustion and develop a conceptual model; 3) review findings from randomized controlled trials that tested the effects of acupressure used for the management of symptoms such nausea, pain, and dyspnea; 4) examine the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) in heart failure patients with constipation compared to those with gastrointestinal disease; 5) describe how Korean women experienced constipation and how constipation affected the quality of life and the experience of using complementary and alternative medicine for constipation; 6) test the effect of acupressure on constipation and to examine the quality of life and depressive symptoms in cancer patients with constipation. Meridian theory explains that acupressure stimulates meridians, a network of energy pathways in the body to increase the flow of bio-energy. Authors of 48 studies supported that acupressure reduced nausea and vomiting during pregnancy, pain, fatigue, and dyspnea. The Patient Health Questionnaire-9 (PHQ-9) was used to examine the depressive symptoms in cancer patients with constipation, but has not been tested in patients with constipation. Therefore, in this study, the psychometric properties of PHQ-9 were tested in patients with constipation. Cronbach’s alphas for the Patient Health Questionnaire were .89 and the correlation between the PHQ-9 and the BDI-II (Beck Depression Inventory) was .81 (p<.01) in 382 heart failure patients with constipation. Ten Korean women reported that living with constipation is a stressful and uncomfortable experience which impacts daily activity, lifestyle, social relationships, and diet. In this pilot study, three out of five patients in the acupressure group reported that acupressure was effective in improving constipation. Cancer patients with less than a four-month history of constipation had less depressive symptoms and higher quality of life compared to patient with more than a four-month history of constipation. In conclusion, acupressure can be a safe and cost effective alternative medicine for constipation.

The Miller Forensic Assessment of Symptoms Test (M-FAST) is a relatively new measure shown to be a valid and effective tool for screening psychiatric malingering in criminal forensic and psychiatric inpatient settings. The present study attempts to cross-validate the M-FAST in civil forensic and neurologic samples. Three-hundred-eight civil forensic patients referred by their attorneys for neuropsychological testing were studied. Assessment batteries administered included tests of both psychiatric and neurocognitive feigning. Based on these gold standards, 4 sets of contrasts were formed in order to examine how the M-FAST performs in identifying psychiatric malingering, neurocognitive malingering, any malingering (including either or both types of malingering), as well as any malingering among a neurologic subset of this sample. At the level of group discrimination, the M-FAST Total score performed well in all contrasts. However, at the level of individual classification rates, although the M-FAST Total score was well supported for identifying psychiatric feigning, when neurocognitive malingering was present, performance dropped considerably. Thus, using the M-FAST recommended cutting score of 6, the M-FAST was able to successfully identify psychiatric malingering; however, the M-FAST is not an appropriate measure to use for identifying neurocognitive malingering within this sample.

The aim of this study was to evaluate the psychometric properties of the attachment scale added in the newly developed self-rating questionnaire Trauma Symptom Inventory-2 (TSI-2). Participants were recruited from the Swedish parent-infant unit Hagadal (N=58). Reliability analyses concluded Cronbach´s α .92 for attachment total scale, .88 for avoidance subscale, and .91 for rejection sensitivity subscale. Convergent validity analyses concluded moderate to strong correlations between TSI-2 attachment scale and subscales, and Experiences in Close Relationships (ECR) total scale and subscales (r= .34 - .68, p ≤ .01). Criterion validity analyses concluded that adverse childhood circumstances measured by Linköping Youth Life Experiences Scale (LYLES) signficantly estimated 17 % of variance in TSI-2 attachment scale scores. Preliminary support for reliability and validity of the TSI-2 attachment scale was obtained. No previous trauma symptom rating instrument has included information about adult attachment styles. The present findings point to the benefits of such inclusion.

The basic purpose of the study was to examine the effects of intake interviews an the anxiety and depression of clients. It was hypothesized that intake interviews would reduce symptomology, as it has been shown that even brief interactions with clinicians can be beneficial. Gender of both client and counselor were also examined for main effects and/or interactions. No difference in symptomology based on gender of client or counselor was anticipated.Two hundred ninety-nine adult out-patients of a university training practicum clinic were administered anxiety and depression inventories either before or after intake interviews. Intake interviews were performed by doctoral or masters level students assigned to fellowship duties at the clinic.The intake interview consisted of two parts. The First part was the gathering of relevant demographic information and questions which solicited information about the problems clients were experiencing which prompted the need For counseling. The second part of the intake consisted of a testing battery composed of the Beck Depression Inventory (SDI), Speilberger State-Trait Anxiety Inventory (STAI), and Tennessee Self-Concept Scale CTSCS). Only the BDI and State component of the STAI were used in the study.Each of the parts in the intake took approximately 45 minutes to complete. Intakes were scheduled in two-hour time blocks which allowed sufficient time For completion of the entire intake. The experimental manipulation was accomplished by having counselors alternate the order of the interview and assessment battery.The design of the study was a 2 x 2 x 2 (order of interview/assessment battery, client gender, counselor gender). Analysis of the data was performed using a Multiple Analysis of Variance (MANOVA) procedure.There were no significant results for any of the BDI score analyses, and only one significant result For the STAI score analyses. The intake interview was not found to affect the anxiety or depression of clients, failing to support the main hypothesis of the study. Depression and anxiety were also not affected by client gender. However, anxiety was significantly lower for clients of Female vs. male counselors. Depression was not affected. No interactions were found to be significant. / Department of Counseling Psychology and Guidance Services

A predominance of symptomology related to neurological dysfunction has been reported for at least some learning disabled (LD) students. This investigation examined the self-reported neuropsychological symptoms of LD and normal students in grades 3 through 12. Determination of group membership based on the childrens' responses to items on the Neuropsychological Symptom Inventory (NSI) was made for all subjects in the study.A discriminant analysis was conducted in order to determine the degree of group separation based on the item responses and which reported symptoms add significantly to that separation. Out of 40 possible items, 19 added to the discriminant function. Prediction of group membership was accomplished with a high degree of accuracy. Nearly 80% of the total population examined were correctly classified according to actual group membership. Of the LD population, 32% were identified as normal but only 16% of the normal population were misdiagnosed as LD. Additionally, nine individual symptoms were identified as reported by a greater percentage of LD students than normals.The results of this investigation suggest that the NSI as a screening instrument may be valuable for some populations. The 80% accuracy rate with the low number of false-positives (16%) is extremely encouraging. Additional research with the NSI to validate the presence of the symptomology reported would add to the already existing data related to the neuropsychological implications related to learning disabilities. / Department of Educational Psychology

There is an increasing awareness in the food industry about the role that proper nutrition plays in maintaining health and preventing disease. Women especially have always been interested in nutrition and its impact on their well-being. This awareness has placed more pressure on the food industry to provide a greater variety of nutritious and wholesome products which has led to the development of a new field in the food industry, called functional foods. These are food products that apart from the micro- and macronutrients that it already provides have additional important physiologically active functions that enhance health. These active components, called phytochemicals (from plant sources) and zoochemicals (from animal sources) have changed the role of diet in health. Functional foods can, by nature or design, bridge the traditional gap between food and medicine and thereby provide consumers with the opportunity to become involved in their own health care. One of these functional foods that have been receiving increased attention and research is soy. Apart from other health benefits of soy, such as cholesterol reduction and bone strengthening, scientific evidence has shown that soy can be used as an alternative for hormone replacement therapy (HRT). The increased interest in the latter can be ascribed to the changed attitude of women, as well as evidence of the side effects of conventional hormone replacement therapies. Consumer research in the nutraceutical area is, however, still in its infancy stage. Objective: The main objective of this study was thus to assess South African consumers' opinion of the potential health benefits of soy and soy products as an alternative for HRT. To attain this main objective, the following specific objectives were stated: To determine, by means of a consumer questionnaire, the percentage of South African consumers who are aware of soy. To determine, by means of an attitude scale, the attitudinal disposition of South African consumers towards the potential health benefits of soy and soy products as an alternative for HRT. To determine South African consumers' opinions regarding the menopausal related health benefits of soy. To determine whether there is a relation between respondents who Eat/drink soy and their opinion of the potential health benefits of soy. To determine whether there is a relation between respondents who never use soy and their opinion of the bone strengthening benefit of soy. To determine whether there is a relation between respondents' opinion of the health benefits of soy and their opinions of soy as an alternative for HRT and reliever of menopausal symptoms, respectively. Methods: In this study, consumers' opinion regarding the health benefits of soy was evaluated using a questionnaire. Respondents were randomly selected from nine metropolitan, as well as rural areas in South Africa, representing the four main race groups, namely whites, blacks, coloureds and Indians. The total sample size of the metropolitan and rural subjects was 3001. A sub-dataset was created which included female respondents that have heard of soy before and were premenopausal (35-44 years) and post-menopausal (50-59 years) of age. Thus, the total number of respondents used for further statistical analyses was 825. The respondents expressed their opinions of the health benefits of soy on a five-point hedonic (Likert) scale which was adapted to a three-point scale for easier interpretation of the tables. Results: 1. Of the 3 001 respondents, 2 437 (80%) were aware of soy. 2. A mean attitudinal disposition score of 2.47 on a three-point scale indicated a neutral to positive attitudinal disposition of the South African consumer population towards the potential health benefits of soy and soy products as alternative for HRT. No practically significant differences were found between the mean values of each statement, which indicated that no specifically strong opinions were expressed between different races or between different age groups. 3. Of all the consumers surveyed and those who did express a specific opinion, 72% agreed that soy has many health benefits compared to only 7% who disagreed. Although 34% of South Africans expressed a positive opinion when asked if soy can be used as alternative for HRT, the majority (46%) of the population had a neutral opinion. Forty-two percent of the consumers who held an opinion regarding soy as reliever of menopausal symptoms were positive, 35% had a neutral opinion and 23% of South Africans did not agree that soy can relieve menopausal symptoms. 4. A relation, although not of practical significance, was found between respondents who eat/drink soy and their opinion of the health benefits of soy. Of the respondents who indicated that they eat/drink soy, the majority agreed that soy has many health benefits. The respondents who disagreed when asked if they eat/drink soy, still expressed an overall positive opinion when asked whether soy has many health benefits. 5. A relation, although not of practical significance, was found between respondents who never use soy and their opinion of the bone strengthening benefit of soy. Of those who indicated that they use soy, the majority agreed that soy has a bone strengthening benefit. On the contrary, only 43% of those who agreed that they never use soy were positive about the bone strengthening benefit of soy, whereas 37% held a neutral opinion and 20% expressed a negative opinion. 6. The relation between respondents' opinion of the overall health benefits of soy and their opinion of soy as alternative for HRT and reliever of menopausal symptoms was of practical significance. Of the respondents who did not agree that soy has many health benefits, the majority expressed a negative opinion of soy as an alternative for HRT. Of those who agreed that soy has many health benefits, 45% expressed a neutral opinion and 44% a positive opinion of soy as alternative for HRT. Almost half (47%) of the respondents who agreed that soy does have many health benefits, expressed a neutral opinion when asked if soy can relieve menopausal symptoms, whereas only 30% had a positive opinion in this regard. The majority (86%) of the respondents who disagreed that soy has many health benefits, also expressed a negative opinion of soy as reliever for menopausal symptoms Conclusion: The results of this study indicate that 80% of the South African consumer population are aware of soy and that South African consumers have a neutral to positive attitudinal disposition towards the potential health benefits of soy. Respondents did not express a particularly strong opinion regarding several health benefits of soy. It may be hypothesized that they are not informed well enough on the health benefits of soy as to take a stand and to form a definite opinion. Neither different race groups, nor pre- or post-menopausal women differ significantly in the frequency of their opinions, indicating that in this study, race and age did not have a practical significant influence on opinion of the health benefits of soy. Of all those surveyed and who did express a specific opinion, 72% agreed that soy has many health benefits, which is almost the same percentage (74%) as American consumers who perceive soy products as healthy as according to the United Soybean Board (USB) National Report (2003-2004:4). A survey by Adams (2001:433) reported that 71% of American consumers believed that plant-derived HRT have fewer risks and can thus be used as a safe alterative for conventional HRT. According to the results of the present study only 34% of South African consumers expressed a positive opinion when asked if soy can be used as an alternative for HRT. Insufficient evidence on the safety and efficacy of the potential health benefits of soy, as well as a lack of consumer education in South Africa, could be the reason for this uncertainty among XIV South African consumers. While only 26% of American consumers are aware that soy might relieve menopausal symptoms (USB National Report, 2003- 2004:4), results of the current study found that 42% of South Africans were of opinion that soy can relieve menopausal symptoms. A relation, although not of practical significance, was found between respondents who eat/drink soy and their opinion of the health benefits of soy. This can be an indication that whether or not the South African consumer population consume soy doesn't have an influence on their opinion of soy's health benefits in practice. The relation found between respondents who never use soy and their opinion of the bone strengthening benefit of soy were not of practical significance. This can be an indication that whether or not South Africans use soy does not influence their opinion of the bone strengthening benefit of soy in practice. Furthermore, a practically significant relation was found between respondents' opinion of the overall health benefits of soy and their opinion of soy as alternative for HRT and reliever of menopausal symptoms, respectively. Interestingly, respondents who expressed a positive opinion regarding the health benefits of soy did not have a convincingly positive opinion of soy as alternative for HRT and as reliever of menopausal symptoms. They expressed a more neutral opinion. As expected, consumers that were not of opinion that soy has certain health benefits, also disagreed when asked if soy can be used as an alternative for HRT or as reliever of menopausal symptoms. Although the causes for the respondents' opinion or uncertainty were not determined in this study, it can be hypothesised that it may be due to lack of standardisation of evidence on the safety and efficacy of alternative hormone replacement therapies. Further studies are still needed to determine the contributing factors which influence consumers' opinion or lack of opinion on soy. If consumers are not educated about the benefits and disadvantages of soy as alternative for HRT, they cannot make intelligent decisions and choices as to whether or not to use soy as alternative for HRT. / Thesis (M. Consumer Science)--North-West University, Potchefstroom Campus, 2004.

Klimakteriet är en naturlig process i kvinnanslivscykel där kroppen genomgår fysiologiska förändringar på grund av omställningari hormonnivån. Samtidigt är klimakteriet en utvecklingsrelaterad transition. Enligttransitionsteorin sker övergångsprocesserna inom en bestämd tidsram, följer enriktning och leder till förändringar i identitet, roll, relationer ellerbeteendemönster. Kunskap om dessa skeenden ochvad som påverkar kvinnors beteende under transitionen är en förut-sättning föratt sjuksköterskan skall kunna hjälpa dem att nå en hälsosam transition. Syftet med litteraturstudien var att belysa faktorer som påverkar val avkvinnors copingstrategier. Till resultatet användes 12 artiklar som granskadesoch analyserades utifrån syftet. Resultatet visade att det finns fem grupper avfaktorer som påverkar kvinnors val av copingstrategi: sociokulturella och socioekonomiska,typ och svårighetsgrad av klimakteriesymptom, tillgång till stödjande socialtnätverk, personlighetsrelaterade samt aktuell livssituation. Kvinnor som har etablerade nätverk kan söka hjälp och stöd i sin familjoch bland vänner. När nätverk saknas kan sjukvården bli den enda kontakten attdiskutera sina klimakteriebesvär med. Med beaktande av faktorerna som ligger till grund förolika copingstrategier bör sjukvården skapa utbildningsformer och modeller somkan hjälpa kvinnor medklimakteriesymtom att utveckla en effektiv copingstrategi. / Menopause is a natural process during a woman’slifecycle when her body goes through physiological changes due to hormonalalterations. Also, menopause is a development-related tran-sition.According to the theory of transition it will appear within a certain timeframe, follows a clear route and leads to alterations in identity, role,relations or behavioral patterns. Knowledge of these stages of change and whataffects women’s behavior during transition is a vital qualification requiredfor nurses to succeed in providing healthy transition. Thepurpose of this literature study was to high-light factors that affect thechoice of coping strategies. Twelve articles were studied and analyzed based onthe purpose of the study. The result showed that there are five groups offactors that can affect women’s choice of coping strategies; socio-cultural andsocio-economical, type and severity of menopause symptoms, availability ofsupportive social networks, personality related factors and the current lifesituation. Women with established networks can seek help and support withintheir family and amongst their friends. When there is a lack of these types ofnetworks, healthcare personnel can become the only resource for discussingmenopause-related issues. Keeping these factors in mind, which serve the basisfor different coping strategies, healthcare-institutions should createeducation and models to assist women with menopause symptoms and develop aneffective coping-strategy.

Dating violence (DV) is a common experience among college-age Canadians, affecting between one quarter and one third of both men and women. A significant predictor of DV perpetration and victimization is childhood physical abuse (CPA). While there is evidence of an intergenerational transmission of violence from CPA to both victimization and perpetration of DV in young adulthood, there remain gaps in our understanding of what factors influence these relationships throughout an individual’s development. Using survey data collected from a convenience sample of 660 University of Manitoba students, this study analyzed the strength of a model of violence development from CPA to DV including the mediating effects of personality symptoms and attachment security. The current study suggested partial support for theoretical frameworks that have been applied to the understanding of the relationship between CPA and DV, namely social learning theory, the criminological framework, and attachment based theories. CPA was correlated with DV perpetration and victimization. However, in multivariate analyses, witnessing interparental violence, rather than experiencing CPA, was a direct predictor of DV perpetration and victimization. CPA predicted DV indirectly through witnessing interparental violence. More severe dating violence items were significantly predicted by other variables in the model. Antisocial personality symptoms increased odds of severe DV perpetration and victimization while borderline personality symptoms increased odds of severe DV victimization. Attachment insecurity had the strongest impact on dating violence perpetration in the female subsample. These findings, suggesting a number of distinct pathways in the intergenerational transmission of violence, should be further tested in larger and more diverse samples. It would be beneficial to include additional risk and protective variables in future research in order to understand what impacts each distinct pathway to dating violence, under what circumstances, as well as the influence of these variables at different points in individuals’ development. This research is valuable for understanding the impact of childhood abuse on young adult attachment, personality, and dating violence. Further, it is hoped that this research will be helpful for establishing appropriate and comprehensive DV interventions which take into account mediating influences from the intergenerational transmission of violence.

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.