Self-Harm Reasons, Goal Achievement, and Prediction of Future
Stephen P. Lewis, PhD,* and Darcy A. Santor, PhD†
Abstract: Self-harm may have several reasons, and these reasons may have
corresponding implied goals. The current study examined reasons for self-
harm and whether the a priori goals intended by these reasons were achieved.
Fifty-seven individuals with a history of self-harm were recruited online and
volunteered their time to complete a series of online questionnaires assessing
past self-harm frequency, self-harm reasons, whether the goal associated
with these reasons was achieved, and future self-harm intent. Reasons to
reduce tension and dissociation associated with more past self-harm, a higher
intent to self-harm again, and it was reported that the goals associated with
reasons were achieved (i.e., these internal states were extinguished).
Achievement of these goals (i.e., reported reductions in tension and disso-
ciation) mediated the relation between corresponding self-harm reasons and
intent to self-harm in the future. Findings support the view that self-harm is
a maladaptive coping strategy and the reinforcement component of the
experiential avoidance model of self-harm. Results have clinical implications
and heuristic value for future research, which are discussed.
Key Words: Self-harm, self-injury, reasons, goal achievement, coping.
(J Nerv Ment Dis 2010;198: 362–369)
self-hitting, and overdosing. In this way, self-harm encompasses the
definition of nonsuicidal self-injury but includes behaviors (i.e.,
overdosing) that are not typically considered self-injury (see Nock
and Favazza, 2009). Understanding why people self-harm has be-
come a central focus for many researchers (for a review, see
Klonsky, 2007) and represents a significant issue in the health-
service field. Therefore, it is important to identify the reasons that
people give for self-harm as they may serve as foci when managing
the behavior (Brown et al., 2002; Klonsky, 2007, Lewis and Santor,
2008). Recent efforts have focused on the assessment and measure-
ment of these reasons (e.g., Lewis and Santor, 2008). Beyond
identifying the reasons that motivate self-harm behavior, it is critical
to understand whether self-harm behavior achieves the goal for
which it is enacted as it has been proposed that some reasons have
reinforcing properties that lead to self-harm repetition (Klonsky,
2007). This notion was proposed by Favazza (1998) who concep-
tualized self-harm as a maladaptive coping strategy. More re-
cently, researchers have offered an experiential avoidance model
(EAM) for self-harm (Chapman et al., 2006). Central to this
model is the view that self-harm is repeated as it works to
extinguish unwanted psychological states. These approaches sug-
gest that the reasons for self-harm initiate the behavior in the
elf-harm is defined as any behavior causing direct, immediate
injury to one’s body, including methods of cutting, burning,
short and long terms, and may lead to its repetition. The aims of
our study were to examine the relations between self-harm
reasons (e.g., to reduce anxiety), the achievement of the goal
linked to these reasons (e.g., the reported reduction of anxiety),
frequency of past self-harm, and future self-harm intent.
Reasons are believed to serve as proximal antecedents of
self-harm (Brown et al., 2002; Klonsky, 2007) and have been
suggested to account for why self-harm is repeated for some indi-
viduals. Favazza (1998) suggested that self-harm is a “morbid form
of self-help” (p. 264). In other words, it viewed as a maladaptive
form of coping that temporarily alleviates psychological turmoil but
is harmful as it carries risks such as resultant injury, psychiatric
symptoms, increased frequency and severity of the behavior, and
elevated risk for suicide (Favazza, 1999).
Types of Self-Harm Reasons
Extant self-harm literature indicates that people report differ-
ent reasons for (or functions of) self-harm (for a review, see
Klonsky, 2007). Perhaps, the most commonly cited reasons for
self-harm pertain to affect regulation, wherein individuals self-harm
to reduce unwanted states of emotion, including anxiety, tension,
and feeling overwhelmed (e.g., Briere and Gil, 1998; Favazza, 1998,
1999; Lewis and Santor, 2008; Nock and Cha, 2009; Nock and
Printsein, 2004, 2005; Osuch et al., 1999; Rodham et al., 2004).
Another commonly endorsed set of reasons refer to the reduction
and management of dissociative experiences, such as feeling numb,
unreal, or depersonalized (Brown et al., 2002; Klonsky, 2007;
Laye-Gindhu and Schonert-Reichl, 2005; Lewis and Santor, 2008;
Nock and Cha, 2009; Nock and Prinstein, 2004, 2005). Antidisso-
ciation reasons are also viewed as “feeling generation” reasons as
self-harm occurs in response to feeling nothing and is used with the
goal of feeling something (for a review, see Klonsky, 2007). These
intrapersonal reasons have garnered significant attention and are
considered central components in our understanding of self-harm
(Chapman et al., 2006; Klonsky, 2007).
In addition to regulating internal states, reasons for self-
harm can be communicative. For instance, some individuals
self-harm to express self-abhorrence and, related to this, to
punish the self (Briere and Gil, 1998; Brown et al., 2002; Hawton
et al., 2006; Klonsky, 2007; Lewis and Santor, 2008; Nixon et al.,
2002; Nock and Cha, 2009; Nock and Prinstein, 2004, 2005;
Rodham et al., 2004). Here, self-harm may be communicative at
an intrapersonal level. However, reasons may also be communi-
cative at a social level. Specifically, researchers have suggested
that individuals self-harm to communicate with others (for a
review, see Klonsky, 2007). In these instances, self-harm may
work as a means to: circumvent abandonment from others, cry for
help (e.g., get treatment), communicate one’s emotional pain or
be taken seriously (e.g., convey that one’s distress level is
gravely high), and influence others’ behavior (Briere and Gil,
1998; Brown et al., 2001; Lewis and Santor, 2008; Nock and Cha,
2009; Nock and Prinstein, 2004, 2005).
The Importance of Self-Harm Reasons
Besides understanding self-harm reasons, namely why people
self-harm, it is important to understand how these reason may
*Department of Psychology, University of Guelph, Guelph, Ontario, Canada;
†Department of Psychology, University of Ottawa, Ottawa, Ontario, Canada
Supported by the Social Science and Humanities Research Council of Canada (D.A.
Santor, principal investigator).
Send reprint requests to Stephen P. Lewis, PhD, Department of Psychology,
University of Guelph, MacKinnon Ext. (Bldg. 154), 87 Trent Lane, Guelph,
Ontario, Canada N1G 2W1. E-mail: firstname.lastname@example.org.
Copyright © 2010 by Lippincott Williams & Wilkins
The Journal of Nervous and Mental Disease • Volume 198, Number 5, May 2010
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