Non-suicidal self-injury (NSSI) and suicidal behavior are prevalent problems, particularly among young adults. However, previous research on factors that might impact the severity of NSSI is limited, with no studies examining concurrently demographic and psychological risk factors, along with how reasons for engaging in, and emotional states surrounding, NSSI might impact its course. Furthermore, no studies to date have examined how these variables may be associated with laboratory-based behavioral indicators of NSSI severity. Similarly, the relationship between NSSI and suicide has been largely unexplored until recently. The few studies that have been conducted to date have relied primarily on self-report batteries of symptoms, largely neglecting interview and performance-based methodologies. The current study used a multi-method approach to elucidate factors associated with: 1) co-morbid suicidal behavior and 2) NSSI severity among a sample of young adults who engage in NSSI. Finally, the current study sought to develop an algorithm for predicting suicidal behavior among self-injurers by simultaneously examining all study variables to determine which variables best differentiated between those with and without a history of suicidal behavior. Hypotheses: It was hypothesized that: 1) greater endorsement of self-punishment, emotion regulation, sensation seeking, and addiction functions of NSSI, along with decreases in negative affect and increases in positive affect during NSSI, would be independently associated with a history of suicidal behavior after controlling for relevant demographic and diagnostic characteristics, and 2) greater endorsement of self-punishment, emotion regulation, sensation seeking, and addiction functions, along with decreases in negative affect and increases in positive affect during NSSI, each would be independently associated with a more severe course of NSSI as indicated by a greater number of self-reported acts and methods of NSSI, stronger implicit associations with NSSI, and higher levels of behavioral self-aggression. Methods: Participants were 68 undergraduates aged 18-26 who had engaged in at least 5 acts of NSSI, with at least one in the past six months. Twenty-eight participants endorsed little or no previous suicidal ideation and were in the NSSI Only group. Forty participants endorsed clinical levels of suicidal behavior (plans or attempts) in their lifetime and were in the NSSI+Suicidal Behavior group. Participants completed a screening procedure during which they completed self-report measures of lifetime history of NSSI and suicidal behavior, as well as self-report measures of impulsivity and affect regulation. Participants who met inclusion criteria were enrolled in the full study during which they completed diagnostic interviews for Axis I and II psychopathology, structured interviews to assess detailed lifetime self-injurious and suicidal behavior, self-report measures to assess current mood, and behavioral tasks assessing implicit associations with NSSI and self-aggression. Results: In terms of predicting group membership, mean level of behavioral self-aggression in the lab and engaging in NSSI for the purpose of emotion regulation significantly predicted membership in the NSSI+S study group. Regarding NSSI severity, engaging in NSSI because one feels addicted, significantly predicted more self-reported lifetime acts and methods of NSSI. Engaging in NSSI in order to meet interpersonal needs was significantly associated with implicit associations with NSSI, and increases in positive affect during NSSI were significantly associated with greater mean behavioral self-aggression in the lab. Finally, a simple algorithm was developed that correctly classified 87% of study participants into their correct study groups. This algorithm included only four variables: a history of suicidal ideation, trait sensation seeking, mean level of behavioral self-aggression in the lab, and current alcohol abuse. Conclusions: The current study revealed that although NSSI and suicidal behavior have several similarities, they are distinct in several ways and many self-injurious individuals are not suicidal. Furthermore, the two study groups did not differ significantly on any Axis I or II diagnosis, suggesting that focusing primarily on diagnostic differentiators between NSSI and suicide may be misguided. Rather, the current study found that reasons for engaging in NSSI, affective states surrounding NSSI, and behavioral self-aggression, contribute significantly to NSSI severity and the relation between NSSI and suicide. / Psychology

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.

Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.

Self-injury (SI) is a growing concern for professionals working in educational settings who desire more information on SI and express a lack of confidence in working with youth who self injure (Carlson, DeGreer, Deur, & Fenton, 2005; Heath, Toste, & Beettam, 2008). A sample of 263 teachers from a small, rural Kentucky county completed a survey (response rate of 45.5%) designed to address educators’ knowledge of SI, training needs, and knowledge of school response plans for working with youth who self-injure. A 20-item measure developed by Jeffery and Warm (2002) assessed SI knowledge. Educators evidenced significantly lower scores on the knowledge measure than school psychologists (Beld, 2007), and professionals working in a medical setting (Jeffrey & Warm, 2002) with the exception of psychiatrists. Analysis of the response patterns of the educators on the knowledge measure indicated 11 out of 20 items evidenced serious inaccurate understandings of basic fact and myths, prevalence, relationship of SI to psychopathology and suicide, and media influences. There were no gender differences when comparing self-rated knowledge of SI; however, female educators evidenced greater mean scores on the knowledge measure. Females evidence significantly greater knowledge of SI than males. There is no relation between knowledge of SI and the amount of experience working with youth who self-injure for this sample. Knowledge of SI and amount of experience working with students who SI was not correlated. Further, educators who report knowledge of school plans did not report higher confidence in helping students. Descriptive information regarding knowledge of SI and school response plans, confidence, and training indicate the majority of educators in this sample do not have any experience working with youth who self-injure. Further, most lacked knowledge of a school response plan and did not know the existence of or steps included in the district’s school response plan. A majority of participants indicated never attending in-service training on SI; however, they did indicate an interest in receiving more information on SI. Results support the need for districts to educate staff on school response plans and/or to develop a specific school response plan for dealing with youth who engage in SI. Also supported are training needs regarding the school plan, basic knowledge of SI, and extended areas of SI such as media and suicide. Lastly, follows the discussion of practical implications, limitations, and suggestions for future research in relation to results.

Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.

BACKGROUND: Non-suicidal self-injury (NSSI) occurs in 13% to 20% of adolescents, and is often indicative of deeper internal or social problems. A close review of current explanatory models of NSSI suggested that underlying individual sensory preferences may contribute substantial explanations for the self-regulatory functions of NSSI, as well as have implications for treatment approaches. In the context of integrating sensory processing models with prominent functional NSSI models, this dissertation research compared sensory preferences in youth who engaged in NSSI to sensory preferences of youth who did not engage in NSSI. OBJECTIVE: NSSI-engaging youth were hypothesized to have lower threshold sensory preferences (sensation avoiding and sensory sensitive), and higher sensitivity (low threshold) in touch processing, auditory processing, and modulation of sensory input affecting emotional response. Sensory preferences were hypothesized to predict NSSI functionality, and trauma history and symptomology were hypothesized to predict NSSI and sensory preferences. METHODS: Youth (n = 108; 56% female; 43% Hispanic) aged 8-14 completed self-report items regarding knowledge, thoughts, and engagement in NSSI, the Functional Assessment of Self-Mutilation (FASM) to evaluate type and functionality of NSSI, and the Adolescent / Adult Sensory Profile to evaluate sensory preferences (low registration, sensation seeking, sensory sensitive, sensation avoiding). Parents (90% female; Mage = 39.4 (SD = 6.9)) completed the Sensory Profile as a secondary measure of youth sensory preferences and the UCLA post- traumatic stress disorder reaction index (PTSD-RI) to evaluate youth trauma history and symptomology. RESULTS: NSSI-engaging youth (N = 14) scored significantly higher than Non-NSSI-engaging youth (N = 85) in the sensation avoiding (Cohen's d = .83) and low registration (Cohen's d = .66) domains. Auditory sensitivity (youth-reported) significantly predicted NSSI after controlling for age. While parent-reported sensory preferences and trauma history and symptomology were not predictive of NSSI, auditory sensitivity (parent-reported) predicted PTSD symptomology in youth with trauma history. CONCLUSIONS: Results provide preliminary insight into better understanding the self-regulatory role of NSSI, and offer insight into specific sensory preferences of young adolescents who engage in NSSI. In combination with future research, findings contribute to existing comprehensive models of NSSI, and provide evidence for sensory considerations in NSSI treatment.

The phenomenon of cutting is extremely complex, as is the care of those who engage in it. This work provides exhaustive knowledge of the kinds of clinical interpretations of cutting that exist and interventions offered to curb this maladaptive behavior. It empowers volunteer youth workers to feel more confident in responding to young women who are cutting. It also encourages those who work in evangelical Christian contexts to draw carefully, cautiously, and judiciously, from the resources of their faith tradition as their contribution to the care of young women who cut.

According to the policy on Inclusive Education, teachers are increasingly expected to play a community and pastoral role in order to, in this way, be able to measure up to the needs of learners who are experiencing barriers to learning (such as, for example, self-mutilation). This study was undertaken to determine what knowledge and skills teachers have at their disposal to identify self-mutilators in inclusive classrooms and to provide basic aid to these learners. By means of a literature study, self-mutilation was elucidated, and attention was paid to an explanation of what exactly self-mutilation involved, the forms of self-mutilation, the causes of self-mutilation, self-mutilation and related conditions, and the characteristics of the self-mutilator. Linked to this, the focus was on the extent to which the teacher is capable of identifying self-mutilators in inclusive classrooms and providing basic aid to them. Focus was also placed on the community and pastoral role of the teacher, the teacher’s experience of inclusive education, and the National Strategy with regard to the Screening, Identification, Assessment, and Support of learners who experience barriers to learning. A full description of various therapeutic approaches and aid programmes that can be undertaken with self-mutilators concluded the literature review. This literature review indicated a gap regarding the availability of training programmes for South-African teachers without training or background knowledge of Psychology, to assist them in identifying self-mutilators and providing basic aid to self-mutilators. Quantitative descriptive research was used to gather data from teachers by means of a questionnaire with open and closed items. In this particular study, 319 teachers were purposively and randomly chosen from 16 secondary schools (eight Ex Model C schools and eight Township schools) from Districts D2 and D12 in the Krugersdorp/Roodepoort area of the Gauteng Department of Education. On the one hand, the questionnaire determined teachers‟ knowledge and skills with regard to the nature of, reasons for and characteristics of self-mutilation in inclusive classrooms, and whether they possessed skills to provide basic aid to self-mutilators. On the other hand, it was also determined by means of open questions how the teachers become aware of self-mutilators, the type of training they received to provide basic aid to self-mutilators, what they viewed being the influence of self-mutilation on teaching and learning and on emotional and social development, their views of the pastoral role of the teacher as well as what their attitude/view was with regard to the possible implementation of a training programme to identify self-mutilators in inclusive classrooms and to provide basic aid to them. Furthermore, the open questions explored the availability of support structures to teachers to assist them in identifying self-mutilators and providing basic aid to these learners, as well as the opportunities that teachers create for learners to talk about their problems. Results indicated that the teachers who took part in the study did not have adequate knowledge and skills at their disposal regarding the identification of, and provision of basic aid to self-mutilators. They were however in favour of the implementation of a training programme that would enable them to identify self-mutilators and provide basic aid to them. On the basis of the data obtained through the questionnaire, and in accordance with the literature, a training programme was developed. In the absence of training programmes for the support of teachers in the identification of, and aid to self-mutilators in South African schools, this study makes a distinct contribution. / PhD, Educational Psychology, North-West University, Vaal Triangle Campus, 2012

This thesis comprises a narrative exploration of the lived experience of being someone who has self-injured. Self-injury, like pain, emotions, sensation and social life, is understood and examined as inherently embodied. The thesis is intended to contribute to sociological approaches to the study of embodiment and to sociological understandings of self-injury. Twelve participants were recruited in non-clinical sites. The sample was heterogeneous in terms of their experience of self-injury, contact with medical and psychiatric services, socio-economic background, household type, age and sexuality. Both men and women were interviewed in an attempt to counter the relative neglect of men in previous research. Two interviews were carried out with each participant: the first was a life-story interview, while the second explored self-injury more directly. The approach to data collection and analysis was intended to be collaborative, and comprised both narrative and thematic techniques. The thesis demonstrates the importance of studying self-injury as an embodied, socially situated and socially mediated behaviour. An embodied approach underlines the importance of the visibility of self-injury. The existence of visible marks and scars created by self-injury were important aspects of the lived experience of participants. The ways in which these marks were negotiated in social life represented a key focus of analysis. My analysis reveals the importance and utility of attending to the practical and material aspects of self-injury in attempting to understand the behaviour. I highlight the diverse ways in which self-injury is practised, and the equally various meanings and understandings it holds for practitioners A variety of complex and contradictory justifications for self-injury are critically examined. These justifications share a concern with pain, incarnate, suggesting that self-injury is: a method of transforming emotional pain into physical pain; a way of relieving emotional pain; painful; painless; attention-seeking; private. A sociological, narrative analysis illuminates the ways in which these understandings and justifications can be located within biographical, interpersonal and socio-cultural contexts. By locating these justifications within socio-cultural contexts, the complexities and contradictions of the accounts become understandable. My analysis confirms the importance of attending to socio-cultural understandings of bodies, emotions, authenticity and morality in exploring narratives about self-injury.

Outcomes of experimental analyses during which protective equipment (PE) was placed on three participants were compared to those during which PE was not provided to them. Experimental analysis conditions were presented using a multielement format, and the effects of PE were evaluated using a withdrawal design. Results of experimental analysis without PE suggested that self-injurious behavior (SIB) was maintained by negative reinforcement for two participants and nonsocial mechanisms for the third participant. However, SIB was eliminated either immediately or eventually for all participants when PE was provided during experimental analysis. Thus, outcomes of assessments with PE did not match those without PE, and no conclusion about variables associated with SIB could be drawn from experimental analyses with PE alone. Therefore, the present findings do not support the use of PE as an alternative to standard methods for conducting experimental analysis (i.e., without PE).