A Functional Approach to the Assessment of Self-Mutilative Behavior.

Department of Psychology, Harvard University, Cambridge, MA 02138, USA. .
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 11/2004; 72(5):885-90. DOI: 10.1037/0022-006X.72.5.885
Source: PubMed

ABSTRACT This study applied a functional approach to the assessment of self-mutilative behavior (SMB) among adolescent psychiatric inpatients. On the basis of past conceptualizations of different forms of self-injurious behavior, the authors hypothesized that SMB is performed because of the automatically reinforcing (i.e., reinforced by oneself; e.g., emotion regulation) and/or socially reinforcing (i.e., reinforced by others; e.g., attention, avoidance-escape) properties associated with such behaviors. Data were collected from 108 adolescent psychiatric inpatients referred for self-injurious thoughts or behaviors. Adolescents reported engaging in SMB frequently, using multiple methods, and having an early age of onset. Moreover, the results supported the structural validity and reliability of the hypothesized functional model of SMB. Most adolescents engaged in SMB for automatic reinforcement, although a sizable portion endorsed social reinforcement functions as well. These findings have direct implications for the understanding, assessment, and treatment of SMB.

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    • "Motives for DSH were assessed with an English translation (Turner et al., 2012) of the Questionnaire for Nonsuicidal Selfinjury (QNSSI; Kleindienst et al., 2008), supplemented with 13 items from the Suicide Attempt Self-injury Interview (SASII; Linehan , Comtois, Brown, Heard, & Wagner, 2006). Although there are other measures that broadly assess affect regulation functions of DSH (e.g., Klonsky & Glenn, 2009; Nock & Prinstein, 2004), the QNSSI (when supplemented with the SASII items as done here) is the only measure with a specific scale assessing emotion relief motives in particular. Specifically, past factor analytic work using these items has found that the 22 QNSSI and SASII items assessing motives for DSH yield five reliable subscales, including emotion relief, feeling generation, interpersonal communication, interpersonal influence, and self-punishment (Turner et al., 2012). "
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    ABSTRACT: Despite the growing consensus that negative reinforcement in the form of emotional relief plays a key role in the maintenance of deliberate self-harm (DSH), most of the research in this area has relied exclusively on self-report measures of the perceived motives for and emotional consequences of DSH. Thus, the primary aim of this study was to extend extant research on the role of emotional relief in DSH by examining the strength of the association of DSH with emotional relief using a novel version of the Implicit Association Test (IAT). The strength of the DSH-relief association among both participants with (vs. without) DSH and self-harming participants with (vs. without) BPD, as well as its associations with relevant clinical constructs (including DSH characteristics, self-reported motives for DSH, BPD pathology, and emotion dysregulation and avoidance) were examined in a community sample of young adults (113 with recent recurrent DSH; 135 without DSH). As hypothesized, results revealed stronger associations between DSH and relief among participants with versus without DSH, as well as among DSH participants with versus without BPD. Moreover, the strength of the DSH-relief association was positively associated with DSH frequency and versatility (both lifetime and at 6-month follow-up), BPD pathology, emotion dysregulation, experiential avoidance, and self-reported emotion relief motives for DSH. Findings provide support for theories emphasizing the role of emotional relief in DSH (particularly among individuals with BPD), as well as the construct validity, predictive utility, and incremental validity (relative to self-reported emotion relief motives) of this IAT. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 07/2015; DOI:10.1037/per0000138 · 3.54 Impact Factor
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    • "In this sense, although stressors may predict Contents lists available at ScienceDirect journal homepage: their social support network, which in turn reinforces NSSI when such social rewards are attained (Nock and Prinstein, 2004). Preliminary research supports this hypothesis, finding that among young adolescents, self-injurers were more likely to exhibit an increase in closeness with fathers over an 11-month follow-up period than those without NSSI (Hilt et al., 2008). "
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    ABSTRACT: Non-suicidal self-injury (NSSI) is the deliberate self-harm of one's tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 07/2015; DOI:10.1016/j.psychres.2015.06.021 · 2.68 Impact Factor
    • "With regards to a theoretical model for NSSI, the four function model of NSSI (Nock and Prinstein, 2004) describes four functions maintaining the engagement in NSSI by different types of reinforcement (for review see Bentley et al., 2014). The most commonly described function is the reduction of negative feeling states (automatic negative reinforcement, ANR). "
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    ABSTRACT: Non-suicidal self-injury (NSSI) and suicidal behaviors frequently occur among adolescent psychiatric patients. Although those behaviors are distinct with regards to intent, NSSI has been shown to be an important risk-factor for suicide attempts. However, the association of NSSI and Suicidal Behavior Disorder (SBD) according to DSM-5 criteria has not yet been investigated. For investigating distinctive features and mutual risk-factors of NSSI-disorder and SBD, adolescent psychiatric inpatients (N=111, aged 12-19 years; 65.8% females) were interviewed using the Self-Injurious-Thoughts-And-Behaviors-Interview-German (SITBI-G). NSSI started significantly earlier in life (M=12.5 years, SD=2.2) than first suicide attempts (M=14.1 years, SD=2.0). Patients meeting NSSI-disorder and/or SBD were significantly more likely to be female and to be diagnosed with an affective disorder. NSSI-disorder and SBD seem to have several distinctive features (i.e. age of onset or frequency), but also seem to share certain mutual risk-factors (i.e. affective disorders, female gender). While both NSSI and SBD seem to be maintained by mainly automatic negative reinforcement, positive automatic and social functions were rated significantly higher for NSSI. Most importantly, NSSI seems to be a strong risk factor for the occurrence of SBD (even when controlling for suicidal ideation) and should therefore always be assessed when dealing with psychiatric adolescent patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; DOI:10.1016/j.psychres.2015.06.019
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