Non-suicidal self-injury (NSSI) is a complex and dangerous set of behaviours that has been gaining increased research attention in recent years. Although existing research indicates that NSSI is prevalent among both adolescent and young adult clinical and community samples, few studies have empirically examined models of factors involved in the etiology and maintenance of these behaviours, particularly the role of social factors. Further, although existing research supports the use of NSSI for emotion regulation purposes, less research attention has focused on the impact of emotion reactivity. The focus of the current project was to examine the role of emotional, interpersonal, and subcultural factors in NSSI. Utilizing a sample of 397 university students, Study 1 presents a psychometric re-evaluation of the Emotion Reactivity Scale (ERS; Nock et al., 2008), used to inform the most appropriate use of the measure in the subsequent studies. Results supported the reliability and validity of the ERS and suggested that the ERS is best utilized as a unidimensional measure of emotion reactivity. Study 2 examined an intra- and inter-personal model of NSSI among the same sample of 397 university students. Support was obtained for the Experiential Avoidance Model of NSSI (Chapman et al., 2006) as well as for the mediational influence of interpersonal relationships on NSSI via emotion regulation. Preliminary support was also provided for the influence of identification with more deviant subcultures, including Goth and Emo groups. Finally, Study 3 aimed to replicate support for the model among a sample of 178 members of self-injury internet forums. Contrary to hypotheses, little support was demonstrated for the model, and fewer significant associations were demonstrated for the influence of subcultural identification. Examination of the characteristics of the sample suggested that the online forum members represent a unique group in regard to the severity of their NSSI experiences that has been understudied in the existing literature. Alternative hypotheses to account for the observed findings are presented. Limitations and directions for future research are discussed.

The following thesis outlines a study assessing the levels of perfectionism, self-injurious behaviour, and functions of anorexia nervosa (AN) through use of a cross-sectional online survey, among English speaking participants 15 years or older, self-reporting a current, previous, or suspected diagnosis of AN. Three distinct clusters were found using self-report measures from individuals with a current or suspected diagnosis, with each cluster corresponding to a unique theoretical understanding of AN. The three clusters can be distinguished by high asceticism, appearance, and avoidance of fertility/sexuality functions for AN respectively. Two distinct clusters were found for participants with a previous diagnosis of AN. These clusters can be differentiated by lingering sentiments held for the condition, as the first cluster viewed AN negatively, and the second cluster continued to see some benefits of the condition. Possible implications for understanding etiology, mechanisms, and treatment of AN are discussed. / Canadian Institute of Health Research

Non-Suicidal Self-Injury (NSSI) is the self-inflicted damage to one’s bodily tissues without the intent to die. Previous research has sought to discover the motivation of an individual to perform such behavior and differences in the experience of pain among those who self-injure. The goals for the current study were to reveal any relationships between the function of NSSI, the subjective experience of pain, and an objective measurement of pressure pain threshold. Participants completed the Inventory of Statements About Self- Injury (ISAS; Klonsky & Glenn, 2009), which measures the functions that NSSI serves, and a measure assessing subjective pain experience, specifically frequency and severity of pain. Pain thresholds were also induced and recorded using a pressure algometer. The findings suggest that pain frequency significantly predicted pain threshold, whereas subjective pain severity did not. Furthermore, marking distress, the function of NSSI which serves as creating a tangible representation of emotional distress, was significantly associated with pain frequency, such that as marking distress increases in relevance, the less often one would be expected to experience pain. Therefore, the current study has implications relevant to both future research and the clinical setting.

Introdução: A automutilação é definida como qualquer comportamento intencional envolvendo agressão direta ao próprio corpo sem intenção consciente de suicídio. As formas mais frequentes de automutilação são cortar a própria pele, queimar-se, bater em si mesmo, morder-se e arranharse. Alguns pacientes apresentam rituais de automutilação e passam muito tempo pensando em como executá-la, lembrando sintomas compulsivos, porém com intenso componente de impulsividade. O DSM-IV classifica a automutilação como um dos critérios de diagnósticos para transtornos do controle dos impulsos não classificados em outro local ou Transtorno de Personalidade Borderline. O DSM-V propõe que a automutilação seja uma entidade diagnóstica à parte. A falta de homogeneidade na descrição da automutilação dificulta as pesquisas, tanto epidemiológicas como clínicas. A melhor caracterização clínica e psicopatológica da automutilação é fundamental para que intervenções terapêuticas mais efetivas possam ser desenvolvidas, incluindo novas abordagens psicofarmacológicas. Os objetivos deste estudo foram: fazer uma descrição clínica dos pacientes que procuram tratamento, tendo como principal queixa a automutilação e comparar estes com pacientes com Transtorno Obsessivo-Compulsivo (TOC) quanto a características compulsivas e impulsivas. Métodos: 70 pacientes foram avaliados, sendo 40 pacientes com automutilação e 30 pacientes com TOC. Todos estes pacientes foram avaliados de forma direta com os instrumentos: Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica (SCID-I); Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica, adaptada para Transtornos de Controle de Impulsos; Entrevista Clínica Estruturada para Transtornos de Eixo II, versão clínica (SCID-II); Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS); Escala Dimensional para Avaliação de Presença e Gravidade de Sintomas Obsessivo-Compulsivos (DY-BOCS); Escala para Avaliação da Presença e Gravidade de Fenômenos Sensoriais da Universidade de São Paulo (USP-SPS); Questionários de História de Traumas; Escala de Comportamento de Automutilação (FASM); e Barrat Impulsivity Scale (BIS-11). Para comparação das variáveis categóricas, foi utilizado o teste qui-quadrado e para variáveis contínuas, o test-t. Para análise multivariada, foram utilizados os testes ANCOVA ou Regressão Logística Linear. Foi considerado, para todos os testes, o nível de significância 5%. Resultados: A média de idade dos pacientes avaliados foi de 29 anos. Quanto às características clínicas dos pacientes com automutilação, estes iniciaram o comportamento em média aos 17 anos de idade, e apresentavam cinco tipos diferentes de automutilação em média. Os comportamentos mais frequentes foram: cortar a pele (90%), cutucar ferimentos (75%), bater em si mesmo (67,5%). Os motivos mais frequentemente relacionados à automutilação foram para: parar sentimentos ruins (75%), aliviar sensação de vazio (70%), se castigar (70%), sentir algo, mesmo que fosse dor (47,5%) e sentir-se relaxado (40%). Na comparação entre os grupos com automutilação e TOC, quanto às comorbidades do Eixo I, o grupo com automutilação apresentou mais comorbidades com depressão (92,5%, p=0,03) e bulimia (25%, p<0,001). O grupo com TOC apresentou mais fobia social (40%, p<0,001). Os pacientes do grupo com TOC tiveram maior gravidade em todas as medidas do Y-BOCS (média: 26, p<0,001) e DY-BOCS (média 23,1, p=0,01). No grupo com automutilação, 60% dos pacientes referiram a automutilação associada a fenômenos sensoriais. Este grupo teve mais relato de fenômenos sensoriais referente à \"sensação de incompletude\" (45%, p=0,007) e \"sensação de energia interna\" (57,5%, p=0,001). O transtorno de personalidade mais prevalente em ambos os grupos foi Transtorno de Personalidade Obsessivo-Compulsiva. O grupo com automutilação apresentou maior prevalência de Transtorno de Personalidade Histriônica (22,5 %, p=0,02) e Transtorno de Personalidade Borderline (15%, p=0,04). A gravidade da impulsividade foi maior no grupo com automutilação segundo as medidas da BIS-11 para características motoras (média 26,6, p=0,002) e dificuldade para planejamento (média 31, p=0,014). Conclusão: A automutilação e o TOC são transtornos heterogêneos que compartilham características compulsivas e impulsivas. Na automutilação, o componente impulsivo é maior e no TOC, a compulsividade é maior quando comparamos estes dois grupos. Entretanto, a automutilação esteve associada à ocorrência de fenômenos sensoriais, apontando também para a presença de aspectos compulsivos nestes quadros. O Transtorno de Personalidade Borderline não é regra entre os pacientes com automutilação. Outros transtornos de personalidade, inclusive cluster C como o Transtorno de Personalidade Obsessivo-Compulsiva, também podem estar presentes entre pacientes com automutilação, assim como com TOC. Os pacientes adultos com automutilação apresentam este comportamento desde a adolescência e os tipos de automutilação apresentados por estes são de moderada a grave intensidade, além de associarem diferentes tipos de automutilação. Isto evidencia a necessidade de desenvolvimento de instrumentos diagnósticos mais precisos para identificação e tratamento precoce específico para estes quadros, evitando a cronicidade dos mesmos / Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary physical self-injury without any conscious suicidal intent. Common forms of NSSI include cutting, burning, scratching, hitting, biting and interfering with wound healing. Some patients spend a lot of time thinking about how to perform their act doing it always the same way. They remember compulsive symptoms with intense component of impulsivity. The DSM-IV classifies NSSI as one diagnostic criteria for impulsive control disorders not elsewhere classified or as borderline personality disorder. The DSM-V proposes that the NSSI should be classified as a different disorder. The lack of a singular meaning for NSSI makes difficult the clinical and epidemiological researches about the subject. A better clinical and psychopathological definition for NSSI is crucial for the development of more effective therapeutic interventions, including new psychopharmacological treatment. The objective of this study is to describe the clinical features of patients seeking treatment for NSSI and compare their compulsive and impulsive features with patients with Obsessive Compulsive Disorder (OCD). Methods: 70 patients were interviewed, 40 patients who specifically sought treatment for NSSI and 30 patients who sought treatment for OCD. Standardized instruments were used: Structured Clinical Interview for Diagnosis of Axis I, according to DSM-IV and for impulse-control disorders, Structured Clinical Interview for Axis II Disorders (Clinical Version (SCID-II)), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS), University of São Paulo Sensory Phenomena Scale (USP-SPS); Trauma History Questionnaire; Functional Assessment of Self-Mutilation (FASM) and Barratt Impulsivity Scale, version-11 (BIS -11). To compare categorical variables the chi-square test was applied. For continuous variables, t-test was applied. For multivariate analysis, the ANCOVA test or Logistic Regression were applied when required. A significance level of 5% was applied for all statistical tests. Results: The mean age of patients was 29 years. The NSSI began at 17 years old, and had 5 different types of NSSI on average. The more common behaviors were: cutting the skin (90%), pick at a wound (75%), beat himself (67.5%). The most often reasons for NSSI were to: stop bad feelings (75%), relieve feeling numb or empty (70%), punish himself (70%), feel something, even if it was pain (47.5%) and feel relaxed (40%). In the comparison between NSSI and OCD groups, the NSSI group presented more axis I comorbidities with depression (92.5%, p = 0.03) and bulimia (25%, p <0.001). The OCD group showed more social phobia (40%, p <0.001). The OCD group had higher severity in all measures of the Y-BOCS (mean: 26, p <0.001) and DY-BOCS (mean 23.1, p = 0.01). In the NSSI group, 60% of the patients reported NSSI associated with sensory phenomena. This group had more reports of sensory phenomena related to the \"incompleteness\" (45%, p = 0.007) and \"internal energy\" (57.5%, p = 0.001). The most prevalent personality disorder in both groups was Obsessive-Compulsive Personality Disorder. The NSSI group had higher prevalence of Histrionic Personality Disorder (22.5%, p = 0.02) and Borderline Personality Disorder (15%, p = 0.04). The severity of impulsivity was higher in the NSSI group according to the measures of the BIS-11 for motor impulsivity (mean 26.6, p = 0.002) and non-planning impulsivity (mean 31, p= 0.014). Conclusion: NSSI and OCD are heterogeneous disorders that share compulsive and impulsive features. In NSSI, the impulsive component is stronger and in OCD the compulsive is stronger when comparing both groups. However, NSSI was associated with the occurrence of sensory phenomena which evidence the presence of compulsive aspects. The borderline personality disorder is not a rule among patients with NSSI. Other personality disorders, including cluster C personality disorders, may also be present among patients with NSSI and OCD, as well. Adult patients with NSSI started this behavior during adolescence. The NSSI symptoms presented were moderate to severe, different types of NSSI were also involved. These results highlights the needs for development of more accurate diagnostic tools for early identification and specific treatment of the NSSI, avoiding chronicity

Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. NSSI is strongly associated with self-criticism (Gilbert et al., 2010) and individuals who self-injure often report doing so to punish themselves. Conversely, self-compassion, or the tendency to be caring with oneself, is associated with psychological well-being (Neff et al., 2007). The aim of the present study was to determine whether experimentally inducing self-criticism or self-compassion would lead to changes in implicit identification with NSSI. The Self-Injury Implicit Association Test (SI-IAT; Nock & Banaji, 2007) is an assessment of the strength of the automatic associations that a person holds between themselves and NSSI. Participants were randomly assigned to a self-criticism induction, a self-compassion induction, or a neutral condition and completed the SI-IAT before and after the induction. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion and control conditions generally did not change. Results were not significantly different for those with or without a history of NSSI and highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.

This study explored the potential for physical activity to be an effective, healthy coping strategy alternative to self-harm behaviors. Regression analyses were performed to assess how physical activity level related to risk factors (i.e., emotional dysregulation, self-esteem, and depression) and self-harm behaviors. The relationship between selfharm and exercise motivations was also examined. Participants were recruited from two high schools (n = 95) and one university (n = 72) in the southeastern region of the United States. Analyses were run using the following measures from a survey packet: adapted Exercise Questionnaire (Helmerhorst, Brage, Warren, Besson, & Ekelund, 2012), Exercise Motivations Inventory—Second Edition (Markland & Ingledew, 1997), Inventory of Statements About Self-Injury (Klonsky & Olino, 2008), Reynolds Adolescent Depression Scale – 2nd Edition (Reynolds, 2002), Eating Disorders Inventory – 3 (Garner, 2004), and Center for Epidemiologic Studies Depression Scale (Miller, Anton, & Townson, 2008). Of the 167 who participated, 41.3% endorsed at least one instance of nonsuicidal self-injury (NSSI). Results indicated that NSSI frequency was significantly negatively associated with physical activity (β = -.22, p < 0.01). An interaction was found between physical activity and depression, such that physical activity moderated the relationship between depression and self-harm. The overall model explained 28.2% of the variance, F(3,145) = 10.02, p < .01. Affiliation and appearancebased exercise motivations significantly associated with decreased (β = -.244, p = .047) and increased (β = .320, p = .001) frequencies of self-harm, respectively. Overall, the findings suggest that physical activity may possess a protective nature against self-harm behaviors, especially in individuals with depressive symptoms.

Självskadebeteenden beskrivs i forskning som komplexa och svåra att förstå, bemöta och behandla. Ett flertal studier påpekar bristen på kunskap inom området samt information om och vägledning i hur man bör bemöta dessa beteenden. Ett flertal studier belyser självskadande individers negativa erfarenheter av omsorgspersonalens bemötande. Syftet med nuvarande studien är att få en djupare förståelse för hur omsorgspersonal bemöter de individer som har ett självskadebeteende. Fokus ligger på hur personalen upplever att de agerar direkt när självskadan sker. Även hur personalen påverkas av att arbeta med självskadande individer undersöks. Studien är kvalitativ med en fenomenologisk metodansats. Fyra kvinnliga anställda inom omsorgen har intervjuats. I analysen som hade en fenomenlogisk utgångspunkt framträdde sex teman: förhållningssätt, visar omsorgspersonalens olika bemötande till individers självskadebeteenden. Förhållningssättet varierar utifrån situationerna som uppstår samt självskadans allvarlighetsgrad står för denna variation. Strategi, visar hur personalen arbetar med olika strategier i olika skeden vid självskador. Som kan bestå av sysselsättning, omplåstring och genom samtal beroende på individernas aktuella situation. Svårigheter - de komplexa situationerna, beskriver omsorgspersonalens upplevelse av att det är svårt att bemöta självskadebeteenden. Skapa förtroende, framhöll vikten av att det fanns en bra kommunikation. Självskadebeteende väcker känslor, beskrev personalens känslor av rädsla, osäkerhet, oro och frustration som uppstår i mötet med individernas självskador. Slutligen visar behovet av att öka kunskaperna om personalens sätt att bemöta självskadebeteenden är ett lämpligt agerande. / In research, self-injuring is described as complex, hard to understand and treat. Several studies are pointing to the lack of knowledge within the area, and also to information and guidance on how to deal with these behaviors. There are a handful of studies, which sheds light on individuals who have felt that care providers have treated them with negative attitudes. The purpose of the present study is to get a deeper understanding of how care providers approach individuals who self-injure. The main focus lies on how care providers experience how they themselves act when self-injuring occurs. It is also explored how care providers are affected while working with people who self-injuries. The study is qualitative with a phenomenological method. Four female care providers have been interviewed. In the analysis that had a phenomenological outset, six themes came forth: approach, shows the care provider´s different approaches to individuals who self-injures. The approach varies depending on the situations that arises, and also the severity of the self-injuring. Strategy, which illuminates how care providers works with different strategies in different stages of self-injuring, which can consist of activities, care and through conversation depending on the individual´s current situation. Hardships - the complex situation, which made clear that care providers experience hardships while treating people who self-injures. Creating trust, sheds light on the importance of a good communication. Self-injuring has an emotional impact, describes the care provider´s feelings of fear, insecurity, worry and frustration which arises while treating individuals who self-harm. Lastly the theme of the need for increased knowledge discusses if the care provider´s experiences their own way of treating people whom self-harm as appropriate behavior.

Non-suicidal self-injury (NSSI) is a destructive behaviour engaged in by a large proportion of youth and young adults in current society. Despite previous work, the recent revision of the DSM does not include NSSI as a distinct syndrome; instead it remains in a category for disorders requiring additional research. Thus, in order to better understand the many etiological components underlying NSSI behaviour, still more investigation is required. To this end the current investigations aimed to further elaborate upon known links between NSSI behaviour and parent-child relationships from two perspectives: first, with regard to the overall quality of relationships with parents, and second, with specific focus on the impact of attachment representations of early relationships with parents. Though both perspectives have been investigated in the past, the current studies were developed to alleviate methodological limitations of the existing literature. Study 1 adopted a person-centered approach to examine patterns of perceived relationship quality reported by self-injuring youth based on the combination of multiple relational characteristics; these patterns were then compared with several indices related to different manifestations of NSSI behaviour. Results show heterogeneity in the perceptions of parent-child relationship quality in self-injurers, such that both negative and positive family backgrounds were implicated in the behaviour. Further analyses demonstrate that the level of risk presented by a self-injuring individual can be differentiated based on perceived quality of parent-child relationship. Study 2 investigated how individuals’ internalized states of mind regarding early attachment experiences are related to NSSI, with particular attention dedicated to the relative influences of child maltreatment and attachment representation. Attachment representations reflecting deficits in emotion regulation (preoccupied, unresolved/cannot classify) were most common in self-injurers. Moreover, self-reported childhood maltreatment and attachment states of mind independently contributed to the prediction of NSSI. Lastly, findings suggest that distinct relational influences characteristic of relationships with mothers and fathers are associated with NSSI. The two studies presented here significantly contribute to existing knowledge concerning parental influences in the etiology of NSSI. These investigations add to existing knowledge of NSSI, and may ultimately aid in preventing and treating this damaging behaviour.

Nonsuicidal self-injury (NSSI) refers to direct and deliberate damage of one’s bodily tissue without the intent to die. Although NSSI abates over time for most young people, 8-32% of those with a history of NSSI exhibit a severe pattern of engagement characterized by high or increasing NSSI frequency (i.e., number of episodes) and versatility (i.e., number of methods). Unfortunately, despite these markers of NSSI severity conferring risk for psychosocial dysfunction and suicidal behaviour, the mechanisms that explain why NSSI increases in frequency or versatility are poorly understood. Behavioural models of NSSI propose that experiencing desirable emotional and social consequences following NSSI is a key mechanism that increases the intensity/strength of the behaviour. Yet, behavioural models of NSSI do not specify whether experiencing more desirable consequences relative to other people (i.e., between-person) or experiencing more desirable consequences relative to one’s own average (i.e., within-person) more strongly predicts future NSSI severity. To address this gap in theory, the present study investigated the influence of between- and within-person desirable NSSI consequences on the frequency and versatility of NSSI over four lags spaced three months apart. 210 adolescents and adults (93.81% female, Mage = 22.95 [SD = 7.17]) with a history of NSSI were recruited from NSSI communities on social networking websites and completed self-report surveys assessing the desirable consequences, frequency, and versatility of NSSI every three months for one year. At the within-person level, time-lagged hierarchical linear models revealed that experiencing more desirable emotional consequences following NSSI at TimeT, relative to one’s own average, was unrelated to NSSI frequency at TimeT+1, but predicted a rise in NSSI versatility at TimeT+1. Conversely, experiencing more desirable social consequences following NSSI at TimeT, relative to one’s own average, predicted a decrease in NSSI frequency at TimeT+1, but was unrelated to NSSI versatility at TimeT+1. At the between-person level, neither desirable emotional consequences nor desirable social consequences of NSSI predicted NSSI frequency or versatility during the study. While only partially consistent with behavioural models of NSSI, these results suggest that: (1) desirable emotional and social consequences of NSSI exert opposing influences on NSSI severity, (2) within-person increases in desirable emotional consequences of NSSI portend periods of elevated NSSI risk, and (3) empirical tests of behavioural models of NSSI should consider not only how many times but how many ways a person self-injures. By enhancing our understanding of why some individuals persistently self-injure, this study provides a springboard for refining behavioural models of NSSI, advancing longitudinal research on the contingencies that maintain self-injury, and ameliorating intervention efforts that draw on the principle of operant conditioning to reduce NSSI. / Graduate

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