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


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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    • "Similarly, given that individuals often report engaging in NSSI to regulate very painful emotions and for self-punishment purposes (Nock and Prinstein, 2004), viewing a particular scar might activate negative emotions related to the circumstances that prompted engagement and trigger distressing memories. Thus, it is possible that NSSI scarring may be associated with elevated levels of distress, which in turn, may augment one's vulnerability for exhibiting STBs. "
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    • "This model does not speak to the possibility that NSSI also directly impacts suicidal desire; however, past research has demonstrated that NSSI is associated with suicidal ideation (Andover and Gibb 2010) and some researchers have posited that NSSI may exhibit a unique association with suicidal behavior due to its potential to contribute not only to the acquired capability, but also to suicidal desire (Klonsky et al. 2013). Nock and Prinstein's (2004) "
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    • "The heightened emotion dysregulation reported by inpatients with co-occurring PTSD-SUD (e.g., Weiss et al., 2012, 2013a,c) is theorized to underlie the elevated rates of risky behaviors within this population; however, the precise nature of this relation remains unclear (see Tull et al., in press, for a review). Risky behaviors may have an emotion regulating function, serving to escape or avoid the heightened levels of emotional distress common among individuals with PTSD (e.g., Baker et al., 2004; Khantzian, 1997) or to elicit, maintain, or enhance positive emotional states (e.g., Cox and Klinger, 1988; Nock and Prinstein, 2004). Alternatively, the elevated levels of emotion dysregulation among inpatients with co-occurring PTSD-SUD may interfere with the ability to control behaviors in the context of intense emotions (Baumeister et al., 1998). "
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