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Body image as a mediator of non-suicidal self-injury in adolescents
Abstract
Attitudes towards the body have been largely overlooked as a potential risk factor for adolescent non-suicidal self-injury (NSSI) despite theorizing that a negative body image may play a critical role in the development of this behavior. The current study used structural equation modeling to evaluate the fit of a theoretical model specifying body image as a mediator between negative affect and NSSI in a combined clinical and non-clinical sample of 284 adolescents. The data supported the model, accounted for 21.6% of the variance in NSSI, and body image significantly mediated the relationship between negative affect and NSSI. These findings provide essential preliminary evidence that body image may represent a necessary but not sufficient risk factor for NSSI in adolescents and that treatment for NSSI should consider targeting body-related pathology in addition to emotion regulation. The findings also support including body image within developing etiological models of NSSI.
... In addition, some individuals have proposed that negative body attitudes and experiences moderate the effects of known risk factors to help explain why some people choose the body as a target when coping with identity confusion or self-blame/punishment thoughts [53,73]. Muehlenkamp and Brausch [47] has described the concept of body regard, a multifaceted construct consisting of attitudes towards and experiences with the body including subjective satisfaction, perceptions of athleticism, respect for, and sense of connection to or ownership of the body; suggesting that poor body regard may represent a necessary but not sufficient factor for NSSI to occur. ...
... Furthermore, body regard mediates, and moderates, relationships between NSSI and well-established risk factors. For example, in a study of 284 clinical and non-clinical adolescents, body image (a facet of body regard) significantly mediated the relationship between negative affect and NSSI [47]. Similarly, within a sample of 422 women seeking treatment for eating disorders, Muehlenkamp et al. [49] found that body dissatisfaction was a mediator of the effect of low self-esteem on NSSI after accounting for effects of trauma and psychopathology within a complex model of risk [49]. ...
... In contrast, increased frequency of past year NSSI frequency was significantly associated with poor SCC and self-blame coping only when body regard was average or low. These results are consistent with prior studies also reporting that risk factors such as negative affect and emotion dysregulation related to NSSI only when there was lowered body regard [47,50]. Furthermore, in the current study, the mediational effect of self-blame coping was not significant when high levels of body regard were endorsed, suggesting that positive body perceptions can reduce the impact of risk factors for NSSI. ...
Background
Prior work suggests that an unstable identity is an important developmental factor impacting risk for non-suicidal self-injury (NSSI), partly because it can foster lowered self-esteem and self-blame coping styles. Theoretical models suggest that how one regards the self, including experiences of and reactions to one's body (e.g., body regard), impact how factors such as identity instability and coping styles influence NSSI behavior. This study tested whether body regard moderated the mediational effect of self-blame coping on the relationship between poor self-concept clarity and past-year NSSI.
Methods
A sample of 1906 university students had complete data from an anonymous online questionnaires measuring self-concept clarity, self-blame coping, and past-year NSSI behaviors.
Results
Past-year NSSI was reported by 23.5% of the sample. Moderated mediational regression analyses using the PROCESS macro for SPSS were run. Body regard significantly moderated the effects of self-blame coping and poor self-concept clarity on NSSI such that neither risk factor was associated with NSSI when body regard was high. Poor self-concept clarity also retained a significant, although weakened, direct relationship with NSSI in the full model.
Conclusions
Positive body regard is protective and appears to mitigate the strength of the relationships between poor self-concept clarity and self-blame coping on past year NSSI. When body regard is low or average, poor self-concept clarity is associated with increased NSSI, partly through the effect of self-blame coping. Treatments that address body- and self-perceptions related to self-concept may enhance the effectiveness of interventions used to reduce NSSI behavior.
... Considering the negative effects of NSSI, research efforts have been devoted to understanding the factors contributing to NSSI [2,10,11]. In particular, body dissatisfaction is recognized as an important factor [12,13]. Body dissatisfaction is about the negative and subjective evaluations of one's physical appearance, including both body size and shape [14]. ...
... On the other hand, a number of studies have suggested that a positive correlation existed between body dissatisfaction and negative affect [19][20][21]. Moreover, negative affect is also very important for the initiation of NSSI acts (e.g., negative body image; [13]). According to the integrated theoretical model of NSSI proposed by Klonsky [2], negative emotions appear before NSSI occurs, and NSSI is a means of alleviating negative emotions. ...
... According to the integrated theoretical model of NSSI proposed by Klonsky [2], negative emotions appear before NSSI occurs, and NSSI is a means of alleviating negative emotions. Thus, body dissatisfaction may represent a critical risk factor for NSSI [13,22,23]. Brausch, Gutierrez [22] reported that body dissatisfaction was significantly higher, and self-esteem was significantly lower, in two NSSI groups compared to the comparison groups of without NSSI. ...
Objective
Extensive evidence from Western societies supports the role for body dissatisfaction in the etiological models of non-suicidal self-injury (NSSI). However, research of the underlying mechanisms of this relationship has been limited, especially in China. Therefore, the aim of this study was to examine the association between body dissatisfaction and NSSI among college students in China. Possible mediating roles for psychological distress and disordered eating, as well as a moderating role for self-compassion, were also examined.
Methods
College students (n = 655, Mage = 20.32 years, SD = 1.02) were recruited from Henan province, China. Each participant completed questionnaires regarding body dissatisfaction, psychological distress, disordered eating, and self-compassion.
Results
A close to medium positive relationship between body dissatisfaction and NSSI was revealed with r = 0.24 (p < .001). The relationship was found to be fully mediated by psychological distress and disordered eating. The mediation role for disordered eating was found to be further moderated by self-compassion, suggesting that self-compassion acted as a buffer against the relationship between disordered eating and NSSI.
Conclusion
These findings indicate that body dissatisfaction, psychological distress, disordered eating, and self-compassion may play important roles in Chinese young adults’ NSSI. Researchers and practitioners need to pay closer attention to the underlying mechanisms of how body dissatisfaction links to NSSI to deepen the understanding of their linkage as well as to provide appropriate interventions.
Level of evidence
Level V, cross-sectional descriptive study.
... In this regard, an emerging body of research suggests that negative experiences and perceptions related to the body may facilitate a devaluing of and feelings of detachment from the body, supporting the salient role of body attitudes and experiences in the occurrence of NSSI (Muehlenkamp, Bagge, Tull, & Gratz, 2013). Using a combined sample of inpatient and community adolescents, Muehlenkamp and Brausch (2012), for example, found a significant effect of body image on NSSI development. The risk of engaging in repetitive self-injury was three times higher within ninth-grade students with both NSSI history and body dissatisfaction than the no-NSSI group (Brunner et al., 2007). ...
... Subscale scores are obtained by summing the value of each response, with a higher score indicating higher levels of self-concept in that domain. According to empirical research that supports the close association between specific life-domains and NSSI (Baetens, Andrews, Claes, & Martin, 2015;Muehlenkamp & Brausch, 2012;Victor, Hipwell, Stepp, & Scott, 2019), and the independence of the MSCS facets (Bracken, 1992), the subscales social ("I am too sky"), affect ("I am not a happy person"), family ("My parents care about my future"), and physical ("I feel good about how I look") were used in this study. A general score of self-concept was obtained by summing up the subscales administered. ...
... The present findings are consistent with previous theorizations suggesting that adolescents who have a disregard for the body are at higher risk of engaging in NSSI (Walsh, 2006). A sense of detachment from the body may facilitate the occurrence of NSSI, making it easy to injure the body (Muehlenkamp & Brausch, 2012). Building from a functional model of NSSI (Chapman, Gratz, & Brown, 2006), negative body image (i.e., low body protection and body care) may contribute to engaging in NSSI as means to punish oneself. ...
Objective:
Parental rejection, poor self-concept, anger expression, and negative body investment have often been associated with non-suicidal self-injury (NSSI). However, research has investigated each factor separately. To address this shortcoming, the main aim of the study was to integrate these factors and test a hierarchical regression to examine the impact of each factor above and beyond the others.
Method:
A cross-sectional sample of 481 Italian high school students aged 13-19 (Mage=15.48; SD=1.46) were screened by self-report measures that assess parental rejection, self-concept, anger expression, body emotional investment, and NSSI. A semi-structured interview was administered in order to assess the characteristics of self-injurious behaviors.
Results:
After the interview, twenty-three (4.8%) students reported having engaged in NSSI (Mage =12.63; SD=1.58). Neither gender nor age differences were found. The hierarchical regression revealed the NSSI was associated with the inward expression of anger (ORs=1.1-1.7) and the negative body investment (ORs=.037-.281).
Conclusions:
These findings point out that the expression of anger inwardly and the emotional investment in the body may be salient factors to consider in understanding the occurrence of NSSI among adolescents. The clinical relevance of these findings was discussed.
... A nomenclatura que diz respeito a tais comportamentos ainda está em processo de construção, tanto no que diz respeito à definição como à busca do consenso dentro da literatura vigente, pois diversas são as formas encontradas dentro da literatura de nomear a prática de AMNS (Silva & Siqueira, 2017). Por exemplo, alguns termos alternativos para AMNS são autodano deliberado, autolesão, automutilação e parasuicídio (Durand & McGuinness, 2015;Muehlenkamp & Brausch, 2012;Nock, 2010). Em estudo de revisão, Borges (2012) compilou diversos nomes utilizados, os quais apresentam diferenças em sua conceituação, como self-harm, self-injury e self-mutilation, enquanto que pesquisa realizada por Arcoverde e Soares (2012) mostrou que, em países com tradição em estudos sobre a AMNS como Inglaterra e Estados Unidos da América, é traçada uma diferenciação entre self-harm, self-injury e selfmutilation. ...
... Neste estudo será considerada a AMNS como um ato deliberado de danificar fisicamente o próprio tecido corporal sem intenção suicida, conforme preconiza a International Society for the Study of Self-Injury (2018), excluindo-se os comportamentos socialmente aceitos, como tatuagens e piercings, por exemplo (Nock, 2010). Entre as formas mais comuns de AMNS estão corte de pele, arranhões leves e severos, morder-se, bater em si mesmo, bater a cabeça na parede e puxar os próprios cabelos (Muehlenkamp & Brausch, 2012;Nock, 2010). A AMNS acontece, geralmente, em cenário privado, uma vez que se encontra associada a um forte sentimento de vergonha (Siqueira & Silva, 2017). ...
... Caracterizada por um comportamento diferenciado da tentativa de suicídio, a AMNS denota um cunho de significativa dor emocional (Nock, 2010). Por meio da AMNS, o adolescente busca alívio imediato diante de um evento que lhe desperte inúmeros afetos negativos, para os quais não encontra outra via de expressão (Muehlenkamp & Brausch, 2012;Nock, 2010). Logo após a AMNS, o adolescente sente alívio, um sentimento instantâneo e imediato que ocasiona a liberação da endorfina, o que acaba por diminuir a tensão que comumente antecede à prática (Somer et al., 2015). ...
... Most of the research conducted in Israel and examined the intercultural encounter in higher education institutions, focused on education colleges and education faculties in university [27], [28], [51], [54], [55], whereas other studies have examined a change in intercultural attitudes only following a multicultural intervention program [56], [57]. Despite the positive change that emerges from the studies, most students still do not hold positive attitudes towards multiculturalism, especially in the Jewish majority group. ...
... Low self-esteem may be associated with repetitive self-injurers in youth [51]). Finally, poor body image (which is strongly associated with low self-esteem [55]) was shown to be a risk factor for adolescents with NSSI: body image may be a mediator between negative affect and NSSI [56]. ...
... There is evidence of gender differences in frequencies and specific methods of NSSI that may also have implications for intervention and prevention programs. While women may prefer cutting, scratching, bruising, and nail biting more often than men, men more likely reported burning behaviors [55,56] and the most preferable method for men is self-hitting [56]. Moreover, some studies have found that men reported more episodes of NSSI per day than women [55], although others revealed that women reported an earlier age of onset [56]. ...
Motherhood is an existential human relationship that
lasts for the whole life and is always interwoven with subjectivity and
culture. As a result of the brain drain, the motherhood becomes
motherhood at distance. Starting from the hypothesis that resignification
of the mother at distance practices is culturally relevant;
the research aims to understand the experience of mother at a
distance in order to extrapolate the strategies of management of the
empty nest. Specifically, the research aims to evaluate the experience
of a brain drain’s mother, who created a blog that intends to take care
of other parents at a distance. Actually, the blog is the only artifact
symbol of the Italian culture of motherhood at distance. In the
research, a Netnographic Analysis of the blog
mammedicervelliinfuga.com is offered with the aim of understanding
if the online world becomes an opportunity to manage the role of
mother at a distance. A narrative interview with the blog creator was
conducted and then the texts were analyzed by means of a Diatextual
Analysis approach. It emerged that the migration projects of talented
children take on different meanings and representations for parents.
Thus, it is shown that the blog becomes a new form of understanding
and practicing motherhood at a distance.
... 9,10 A variety of environmental and biological factors may be involved in the etiology of self-harm. 11 These include depression and anxiety 12 ; stress 13 ; being bullied 13 ; body image 14 ; low self-esteem 7 ; abuse and neglect 15 ; and cigarette, alcohol, and drug abuse. 7,16 Oral health and dentofacial esthetics are part of the general perception of body image and self-esteem. ...
... 29,39 Researchers have also found that adolescents who show disregard for their body may be more prone to engaging in self-harm when faced with aversive, overwhelming emotional states. 14 Shaw et al 22 reported that orthodontic appliances negatively influenced children's opinion of dentofacial attractiveness. However, the present study has shown that wearing fixed and removable orthodontic appliances were among the least 3 likely features contributing to self-harm or bullying resulting in self-harm. ...
Introduction
Self-harm is a growing public health problem. The study aimed to investigate the prevalence of self-harm among a representative sample of school children and the contribution of dentofacial appearance and being bullied because of dentofacial appearance to self-harm.
Methods
This was a cross-sectional study in which a representative sample of eighth-grade students (aged 13-14 years) from randomly selected schools was asked to complete anonymous questionnaires distributed in the classroom. The final sample size was 699 children (339 girls, 360 boys) with a mean age of 13.3 years, representing 1.26% of the target population.
Results
The prevalence of self-harm was 26.9% (n = 188), with no statistically significant gender differences (P >0.05). Among all the subjects who reported self-harm, 47.9% (n = 90) reported self-harm because of dentofacial features. A total of 41 subjects reported self-harm because of bullying targeted at dentofacial features, representing around one fifth of subjects who reported self-harm. The 3 most common dentofacial features contributing to self-harm and self-harm as a result of bullying were tooth color and shape, spacing between the teeth or missing teeth, and prominent maxillary anterior teeth.
Conclusions
This study demonstrated a relatively high experience of self-harm reported by adolescent school children, with many reporting self-harm as a result of their dentofacial appearance and bullying because of dentofacial features. The present study provides baseline data to better understand the relationship between self-harm and dentofacial features.
... Drawing from these assumptions, we have designed a theoretical-driven program-NSSI-PEP-to effect empirically selected psychological factors that contribute to the development of NSSI among youth, working on risk reduction and the enhancement of protective factors. The program aims to target the vulnerabilities factors that-both theoretically and empirically-have been associated with NSSI among youth: pubertal transformation, body image, self-esteem, and emotion regulation (40)(41)(42). Moreover, NSSI-PEP relies on implementing a peer-education approach representing a new way of working in this field to face NSSI. ...
... Rapid physical, endocrinological and psychosocial changes associated with puberty increase the relevance of body experienced during adolescence and leads youth to greater concerns about body image (43). Researchers demonstrated that a negative body image constitutes a critical risk factor for NSSI onset within clinical and non-clinical samples of adolescents (36,42). Negative feelings and perceptions related to the body can make it easier to attack the body (35,44) by encouraging feelings of devaluation and detachment from the body and reducing emotional investment in protecting physical integrity (34,45). ...
Introduction: Non-suicidal self-injury (NSSI) constitutes a major health concern among youth. However, less is known about the useful ways to prevent NSSI. As such, the NSSI- Peer Education Program (NSSI-PEP) aims to intervene on the vulnerability factors that predispose to NSSI by applying a peer education approach. The NSSI-PEP is grounded on the psychoanalytic tradition's tenets, implementing modules targeting four crucial risk factors for NSSI: pubertal transformation, body image, self-esteem, and emotion regulation.
Methods: Selected 8 th grade students were trained to serve as peer educators and held a peer-education intervention for 6 th and 7 th grade students. Pre- and post-intervention assessments were conducted in order to evaluate the program's effectiveness.
Results: Results revealed preliminary support for the program's feasibility, as students reported greater emotion regulation abilities ( p = 0.038) and significant changes in self-esteem ( p < 0.0 01), personal alienation ( p = 0.005), body image ( p < 0.001), and maturity fear ( p < 0.001). Also, NSSI-PEP was positively evaluated by participants.
Discussion: Our pilot study provides preliminary empirical support for the NSSI-PEP, representing a promising way to address areas of vulnerability for NSSI onset. Findings may also help current policies to promote targeted preventive activities and produce sizable benefits to society.
... Adults often attempt suicide because of psychiatric illnesses, but adolescents are often affected by emotional factors, such as anger, frustration, and rejection in interpersonal relationships (17,18). Adolescents often seem to choose suicide attempts impulsively as a means of avoiding psychological conflict or expressing extreme pain (19,20). ...
... According to previous studies, adults often attempt suicide because of psychiatric illnesses, but adolescents are often affected by emotional factors, such as anger, frustration, and rejection in interpersonal relationships (17,18). Adolescents tend to choose suicide as a means of expressing extreme pain because of emotional factors rather than attempting suicide because they really want to die (19,20,35). In fact, adolescents find it difficult to control negative feelings caused by interpersonal problems in family or peer relationships and are likely to engage in non-suicidal self-injury (36). ...
The purpose of this study was to compare the characteristics of suicide attempts by drug overdose between young people and adults, and evaluate the cost-effectiveness of a multi-disciplinary emergency consultation system (MECS) for suicide attempters with drug overdose. It was verified by comparing and analyzing data from June 1, 2017 to May 31, 2018 (before the MECS was implemented; pre-MECS), and from June 1, 2018 to May 31, 2019 (after the MECS was implemented; post-MECS). The data were retrospectively reviewed for a total of 251 such patients with suicide attempts by drug overdose who visited the emergency room of a university hospital in Seoul during the period. The young people group were shown to be more likely to use painkillers and less likely to use psychoactive drugs for a suicide attempt ( p < 0.01), had more unplanned attempts than planned ones ( p < 0.01), and had lower levels of intentionality for suicide ( p = 0.04) and of suicide lethality ( p = 0.02), compared to the adult group. We defined suicide attempts as being “serious” when there was both high intentionality and lethality. On this basis, the young people group had less serious suicide attempts, compared to the adult group ( p = 0.02). Young people in the post-MECS group had lower intensive care unit (ICU) costs ( p = 0.01) and lower costs in the 6-months after the suicide attempt ( p = 0.02) compared to those in the pre-MECS group. Young people, both with serious ( p < 0.01) and non-serious attempts ( p < 0.01) in the post-MECS group had lower ICU costs compared to those in the pre-MECS group. Adults with non-serious attempts in the post-MECS group had lower ICU costs ( p < 0.01) compared to those in the pre-MECS group. Therefore, it can be concluded that fast and precise cooperation from the multidisciplinary departments for patients who attempted suicide by drug overdose reduced unnecessary ICU treatment and costs, especially in young attempters and those with lower levels of intentionality and lethality.
... Research to date has focused on validating models of emotional dysregulation which are thought to facilitate and maintain self-harm [228]. However, these have failed to fully explain such behaviours in adolescents and young adults [229,230] and there is a need to examine other psychological processes involved in non-suicidal and suicidal self-harm. ...
... Despite overlap between the different types of self-harm (NSSH and suicide attempts), essential qualitative and phenomenological differences do distinguish suicidal from nonsuicidal self-injurious behaviour in adolescents [229]. This was demonstrated in the current findings, where there was overall consistency between the two models but with some key differences, where, for example, substance use and low self-esteem resulted in a greater than 10% reduction in the log OR for the auditory HE-suicide attempt association, but not for the auditory HE-NSSH association. ...
... Nevertheless, the manifestation of problem behaviour is found dissimilar between genders. Male adolescents were more likely to externalize their problems through the expression of overt misconducts whereas female adolescents were more likely to internalize their problems via non-suicidal self-injury (Van Camp, Desmet, & Verhaeghe, 2011;Muehlenkamp & Brausch, 2012;Whitlock, Powers, & Eckenrode, 2006). Similar findings are supported by previous studies whereby female adolescents have higher tendency to engage in problem behaviour, for instance self-injury (Van Camp et al., 2011;Muehlenkamp & Brausch, 2012;Whitlock et al., 2006;Yang, Li, Zhang, Tein, & Liu, 2008). ...
... Male adolescents were more likely to externalize their problems through the expression of overt misconducts whereas female adolescents were more likely to internalize their problems via non-suicidal self-injury (Van Camp, Desmet, & Verhaeghe, 2011;Muehlenkamp & Brausch, 2012;Whitlock, Powers, & Eckenrode, 2006). Similar findings are supported by previous studies whereby female adolescents have higher tendency to engage in problem behaviour, for instance self-injury (Van Camp et al., 2011;Muehlenkamp & Brausch, 2012;Whitlock et al., 2006;Yang, Li, Zhang, Tein, & Liu, 2008). ...
... Finally, greater body dissatisfaction has been observed among those reporting NSSI compared to non-clinical controls [23], and has mediated the relationship between negative affect and NSSI [24]. This is also considered a proximal risk factor within the experiential avoidance model of NSSI [3]. ...
... This is also considered a proximal risk factor within the experiential avoidance model of NSSI [3]. Similarly, individuals diagnosed with an eating disorder with a history of NSSI endorse higher body dissatisfaction compared to non-eating disorder individuals with NSSI [1,24]. These robust findings suggest body dissatisfaction is a risk factor for this comorbidity, consistent with the hypothesized theoretical framework. ...
Purpose
Risk factors of negative affect, body dissatisfaction, distress tolerance, and negative urgency are independently associated with bulimia symptoms and non-suicidal self-injury (NSSI). However, relationships of these risk factors within comorbid presentations are not fully understood. The current study examined specific roles of these risk factors within this relationship.
Methods
An at-risk community sample of young adults (N = 429) completed an online survey of negative affect, body dissatisfaction, distress tolerance, negative urgency, bulimia symptoms, and NSSI.
Results
A hypothesized path model was a good fit to the data. Results indicated direct paths from body dissatisfaction, negative urgency, and distress tolerance to bulimia symptoms. Negative urgency, distress tolerance, and bulimia symptoms were directly associated with NSSI. Consistent with hypotheses, distress tolerance and negative urgency acted as vulnerability factors, increasing the strength of associations between bulimia symptoms and NSSI. Distress tolerance also strengthened associations between negative urgency and NSSI. In addition to the direct effect, negative urgency was indirectly associated with NSSI via body dissatisfaction bulimia. Hypothesized indirect effects through distress tolerance were not supported.
Conclusions
Results support etiological models of bulimia and NSSI, and suggest deficits in emotion regulation strengthen risk of comorbid presentations. Furthermore, individuals with greater impulsivity and difficulty tolerating distress are at increased risk of engaging in both bulimia behaviors and NSSI, providing targets for clinical intervention.
Level of evidence
Level V, cross-sectional descriptive study.
... The family stress model (Conger & Conger, 2002) could explain the connection between the risk factors of lower financial status, living in single-parent Nevertheless, adolescents who are less satisfied with their physical appearance (which is more common in girls) have a greater risk of prolonged NSSI. Oktan (2017) found that body image is a significant regressor of self-harm behaviour, while Muehlenkamp & Brausch (2011) concluded that body image mediates the relationship between negative affect and NSSI. Like previously reported results (Björkenstam et al., 2016;Serafini et al., 2017;Cipriano et al., 2017;Cromer et who continue such behaviours perceive their competence in school as worse, as confirmed in previous studies (Andrews et al., 2013;Tatnell et al., 2014). ...
Suicide is one of the leading causes of death among adolescents and repetitional suicidal ideations (SI) and non-suicidal self-injury (NSSI) often precede it. In order to improve recognition of youth who are at high risk of suicide, current study aims to identify which individual variables (personality, self-concept and adverse childhood experiences – ACE) predict prolonged NSSI and SI from middle to late adolescence. A 3-year longitudinal study was conducted with 1101 Croatian adolescents (aged 15–17). 181 students (72.4% females) reported either NSSI or SI or both in T1 and were included in all waves of the study. Analyses are focused on differentiation between adolescents who continue with NSSI/SI and those who stop with it in a 3-year period. Results showed that adolescents with prolonged NSSI/SI had more ACE, especially domestic violence, worse family financial status, higher neuroticism and lower results on self-concept variables. The prediction model of classification of those who have prolonged NSSI or SI was better for SI than NSSI, with predictors explaining 31% of variation in SI. Adolescents who experienced more ACE and report more neuroticism have a higher chance of prolonged SI, while youth who perceive better family financial status and have better relationships with parents have a greater chance to stop with it. For NSSI only neuroticism was a significant predictor. Considering significant variables which could predict prolonged NSSI and/or SI, data presented in this paper have both scientific and practical contribution in understanding, treating and preventing adolescents’ mental health problems.
... There is no possibility of enduring it, so action is taken immediately to alleviate the pain. The shift from mental pain to physical pain makes suffering visible and thereby controllable, even if it remains unacceptable [83]. This action may become a repeated behavior, implemented automatically-and without explanation-in reaction to suffering. ...
The COVID-19 pandemic had an unprecedented impact on mental health. In particular, the impact on adolescents was likely significant due to vulnerability factors linked to this developmental stage and pre-existing conditions of hardship. The present work aimed at grasping the particular effects of the pandemic on social and cultural aspects of adolescence, providing a cross-sectional picture of this historical moment of contemporary youth culture. Further research is needed to verify the findings.
... The concept of body esteem is closely related with body image and self-esteem (Ferrer-Garc ıa & Guti errez-Maldonado, 2012). Body image is a multidimensional set of emotions, thoughts, and appraisals about one's physical appearance and body satisfaction (Muehlenkamp & Brausch, 2012). Whereas appearance selfesteem is a general feeling toward one's physical appearance (Javornik et al., 2021). ...
Artificial Intelligence (AI) color cosmetics applications emerged as an innovative solution to promote branded color cosmetics and enhance consumer decision making, primarily as a trial function. This research aims to investigate factors influencing AI color cosmetics applications adoption in the lens of social comparison theory. The data was analyzed using Structural Equation Modeling (SEM) via SPSS and AMOS software. The results suggest that 1) the positive-view (versus negative-view) of body esteem increases price consciousness to a larger extent 2) the negative-view (versus positive-view) of body esteem increases AI color cosmetics applications adoption to a larger extent 3) price consciousness mediates the effect of body esteem on AI color cosmetics applications adoption 4) price consciousness moderates the effect of body esteem on AI color cosmetics applications adoption. Managerial implications of this research are provided for promotion managers of cosmetic retailers and AI color cosmetics applications developers seeking to promote and reach a larger segment.
... Body dissatisfaction has also been linked to the promotion of unrealistic 'ideal' body images (Muehlenkamp & Brausch, 2012). A systematic review by Hielscher and colleagues (2019) found increased levels of body dissatisfaction are reported in those who engaged in self-harming, in comparison to control groups; with many studies concluding significant links between disturbed body image and self-harm (n = 25; 78.1%). ...
Background: In recent years, the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together.
Methods: A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles.
Results: Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media.
Conclusion: Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area, including the development of potential differentiated prevention and treatment approaches.
... On the other hand, prisoners who exhibit low self-esteem may be exposed to a range of adverse emotional states, especially shame and rejection and reduced regard for the body (Forrester et al., 2017). In addition, prisoners who display low self-esteem may show high levels of pain tolerance and fearlessness of death and use NSSI as a compensatory strategy to deal with and regulate overwhelming emotions (Hooley and St. Germain, 2014;Muehlenkamp & Brausch, 2012;Peh et al., 2017). Previous findings have also indicated that an indirect link between childhood trauma and NSSI may be manifested through low self-esteem in the general population (Low et al., 2000;Muehlenkamp et al., 2011). ...
Nonsuicidal self-injury (NSSI) is a global public health problem that particularly affects youth in prisons. Although there is a well-documented link between childhood maltreatment and NSSI, the underlying mechanisms connecting the two remain unclear. Based on Nock’s integrated theoretical model of NSSI, the current study examined the association between childhood maltreatment and NSSI among younger Chinese prisoners and whether self-esteem mediates this association. A cross-sectional convenience sample of 1,040 participants was recruited from two prisons in central China. A self-administered anonymous questionnaire including information on childhood maltreatment, self-esteem, NSSI and demographic characteristics was administered for each participant. Pearson’s correlation analysis was used to investigate the correlation between two variables. Bootstrapping procedures were employed to assess the mediating effect. NSSI was positively correlated with childhood maltreatment and negatively associated with self-esteem. The relationship between childhood maltreatment and NSSI was mediated by self-esteem, with 33.4% of the total effect of childhood maltreatment being explained. The ratio was higher in males (62.5%) than in females (14.4%), and it was higher in prisoners under 24 years old (37.5%) than in those over 24 years old (27.9%). These observations emphasize the importance of combining environmental and intrapersonal factors when assessing NSSI among prisoners, thereby contributing to its prevention and intervention in prisons.
... The first finding of our study was that maladaptive perfectionism was indirectly related to NSSI through negative body image and anxiety in Chinese LGB populations. These results are similar to those of previous research showing that negative perfectionism is strongly linked with social physique anxiety, and negative body image is a risk predictor of NSSI (Haase et al., 2002;Muehlenkamp & Brausch, 2012). The minority stress model (Meyer, 2003) has provided explanations to this finding. ...
IntroductionNonsuicidal self-injury (NSSI) is a highly prevalent and serious public health concern among Chinese LGB (lesbian, gay, and bisexual) populations, and a variety of cognitive and affective factors caused by sexual minority stress is influential in the development of NSSI. This study tested a chain mediating model to examine the roles of negative body image (i.e., a cognitive factor) and anxiety (i.e., an emotional factor) in the relationship between maladaptive perfectionism and NSSI. Potential gender differences on these associations were also tested.MethodsA total of 682 Chinese LGB individuals (57.8% gay men, 6.0% bisexual men, 16.0% lesbian women, and 20.2% bisexual women; mean age = 24.4 years, SD = 6.5) from across the country participated in this study in August 2020. They completed self-report measures of maladaptive perfectionism, negative body image, anxiety, and NSSI.ResultsThere were significant positive correlations among maladaptive perfectionism, negative body image, anxiety, and NSSI in Chinese LGB populations. In the chain mediation analyses, maladaptive perfectionism was indirectly related to NSSI via negative body image and anxiety. In addition, negative body image was related to anxiety only in gay males, but not in sexual minority females, and anxiety was related to NSSI more strongly in sexual minority females than in gay males.Conclusions
Findings of the study contribute to our understanding of the mechanisms of NSSI in Chinese sexual minorities. Maladaptive perfectionism was related to NSSI through negative body image and anxiety. Gender differences were noteworthy.Policy ImplicationsPsychological education regarding proper body image expectations may be necessary for LGB populations, and clinicians may pay special attention to gender differences when addressing related mental health problems of LGB individuals in China.
... Additionally, this connection was impacted by the presence of a negative emotional state, suggesting that experiencing heightened distress when one already has negative body regard makes self-injury a likelier option for coping. In a latter study, Muehlenkamp and Brausch (2012) similarly found that "adolescents who evaluate their body negatively and experience a disregard for their body may be more prone to engaging in [non-suicidal self-injury] when confronted with aversive, overwhelming emotional states" (p. 6), and even speculated that this may play a larger role than negative affect in SESI. ...
In this paper, I assess one dimension of self-injury through a framework of psychological oppression. Certain effects of psychological oppression, I argue, share a surprising degree of overlap with subjective features of self-injury, and may thereby partly explain socially marginalized agents' high risk of self-injury. I first discuss certain subjective features of self-injury that are particularly salient in agents' self-reports. I then canvass some of the literature on the risk of self-injury among members of socially marginalized groups. Focusing on one socio-cultural analysis of self-injury as a start, I discuss Sarah Naomi Shaw's (2002) feminist analysis of self-injury. I argue that while Shaw's analysis pays important attention to certain features of self-injury, its reliance on white feminine socialization, and body and beauty norms in particular, is overly restrictive. Finally, using Sandra Bartky's (1990) conception of psychological oppression, I focus on three features of psychological oppression and their connections to self-injury: 1) self-loathing and intra-self fragmentation; 2) bodily objectification; and 3) shame over acting out one's agency.
... Sumado a lo anterior, cabe resaltar que ambas problemáticas tienen una estrecha relación con la insatisfacción corporal, la cual es uno de los criterios diagnósticos de la anorexia y la bulimia nerviosa (APA, 2013). De hecho, la insatisfacción corporal se considera como el mejor predictor de anorexia y bulimia (Stice, 2001), como factor predisponente de conductas autolesivas (Walsh, 2006) y como variable mediadora entre la autolesión y el afecto negativo; por ende, esta es determinante en el mantenimiento de la autolesión (Muehlenkamp & Brausch, 2012). Al respecto de dicha relación, Brausch & Gutiérrez (2009) desarrollaron un modelo de senderos para explicar la ideación suicida en hombres y mujeres a partir de la depresión, la imagen corporal y la CAR. ...
La información sobre la relación de las autolesiones, las conductas alimentarias de riesgo (CAR) e insatisfacción corporal y la conducta suicida en poblaciones no clínicas es escasa, por lo que el objetivo del presente estudio fue analizar el potencial explicativo de dichas variables sobre riesgo suicida en una muestra no clínica de adolescentes. Participaron 94 estudiantes, M=14.07 años (DE=1.72). Se aplicaron instrumentos psicométricos online. Se realizaron modelos de regresión lineal múltiple de riesgo suicida con la predicción de sintomatología depresiva (β=.63, p=.001) e impulsividad (β=.29, p=.01) en hombres, y sintomatología depresiva (β =.43, p=.001), efecto adictivo de autolesión (β=.35, p=.001) e insatisfacción corporal (β=.25, p=.01) en mujeres. Además, se elaboró un modelo de ecuaciones estructurales de riesgo suicida en mujeres con un ajuste aceptable (X2/gl=1.01 (p=.315) R2=.42 RMSEA=.014 GFI=.98 TLI=.99). Se halló que la insatisfacción corporal y las CAR influyen directa e indirectamente sobre el riesgo suicida en las mujeres, no así en los hombres.
... Body dissatisfaction has also been linked to the promotion of unrealistic 'ideal' body images (Muehlenkamp & Brausch, 2012). A systematic review by Hielscher and colleagues (2019) found increased levels of body dissatisfaction are reported in those who engaged in self-harming, in comparison to control groups; with many studies concluding significant links between disturbed body image and self-harm (n = 25; 78.1%). ...
Background
In recent years the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together.
Methods
A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles.
Results
Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media.
Conclusion
Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area including the development of potential differentiated prevention and treatment approaches.
... 40,41 Furthermore, many prior studies on the positive relationship between body dissatisfaction and NSSI have focused on body fat dissatisfaction, while omitting the effect of muscularity dissatisfaction. [42][43][44][45][46] Thus, to fill this research gap, body fat and muscle dissatisfaction were considered in the present study. ...
Purpose: Sexual minority men (SMM) have been shown to be at high risk of nonsuicidal self-injury (NSSI). Internalized homophobia, body dissatisfaction, and psychological distress have been found to be related to NSSI among SMM, but few studies have focused on the mechanisms underlying these associations. Thus, the current study was conducted to examine the association between internalized homophobia and NSSI, and whether body dissatisfaction and psychological distress mediate this relationship among young SMM in China.
Methods: In total, 264 young SMM (mean age, 22.00 – 2.86 years) in Henan Province, China, participated in the study. A set of questionnaires were used to assess participants’ internalized homophobia, body fat dissatisfaction, muscularity dissatisfaction, psychological distress, and NSSI. Correlation and mediation analyses were used to examine the data.
Results: Internalized homophobia correlated positively with NSSI (r = 0.24, p < 0.001) among young SMM in China. This relationship was partly mediated by body fat dissatisfaction, muscularity dissatisfaction, and psychological distress.
Conclusion: The study findings suggest that internalized homophobia is a risk factor for NSSI among young SMM in China, and that body fat and muscle dissatisfaction and psychological distress underlie the association between internalized homophobia and NSSI. In developing interventions targeting NSSI among SMM, the findings of the current study should be considered to improve intervention outcomes.
... Hormone therapy has not only demonstrated improved ED outcomes but is also associated with improved mental health and lower suicidality Nguyen et al., 2018). The prevalence of suicidality among queer youths with EDs and body image concerns is an alarming public health concern requiring urgent systemic attention and change (Muehlenkamp & Brausch, 2012; The Trevor Project, National Eating Disorders Association, and Reasons Eating Disorder Center, 2018). ...
Conceptualizations of eating disorders (ED) have primarily been based on the experiences of cisgender women. Yet trans and nonbinary individuals (TNB) may be at greater risk than cisgender individuals to suffer from eating disorders, disordered eating, and body image concerns. The current study takes a phenomenological approach to explore how TNB individuals conceptualize eating and/or body image issues. Qualitative data were obtained from 82 TNB participants who self-reported eating and/or body image concerns. Primary analyses focused on participants’ responses to an open-ended prompt regarding how participants understand the relationships among gender identity, gender expression, and weight and shape control behaviors. Thematic analysis identified five themes: (a) gender dysphoria, (b) puberty, (c) emotion (dys)regulation, (d) gender expression, and (e) recovery/transition. Results indicate various factors salient to gender identity and expression and eating concerns. Findings extend beyond the traditional focus on gender dysphoria by highlighting other important factors for TNB individuals, such as the function ED psychopathology serves (e.g., gender avoidance and self-punishment). This broadens the ED field’s understanding of how gender dysphoria relates to ED psychopathology, rather than focusing solely on the physical body. Distress and associated behaviors related to both gender dysphoria and eating disorder psychopathology may be reciprocal and reinforcing and, as such, should be considered in tandem in treating TNB clients experiencing EDs and body image concerns. This work may better identify ED risk and maintenance within this population and thus optimize prevention and intervention.
... Given that suicide is one of the principal causes of mortality among individuals with eating disorders (Bhatt-Poulose et al., 2016;Greydanus & Apple, 2011;Rufino et al., 2018), it can be hypothesized that body dissatisfaction is linked to suicide, a link that has already been directly and indirectly identified (Kim & Kim, 2009;Perkins & Brausch, 2019;Peterson et al., 2017). Among adolescents, body dissatisfaction predicts suicidal ideation progression beyond depression and hopelessness (Muehlenkamp & Brausch, 2012). Also, suicidal adolescents report higher levels of body dissatisfaction and negative body feelings and lower body care and body assurance levels than non-suicidal adolescents (Brausch & Muehlenkamp, 2007;Orbach et al., 2006). ...
Identifying risk and protective factors for suicidal ideation during adolescence is essential for suicide prevention. One potential risk factor is body dissatisfaction which appears to peak during adolescence. The present study investigated the self-compassion buffering effects in the relationship between body dissatisfaction and suicidal ideation. A convenience sample comprising 580 adolescents (mean age 16.35 years; SD = .87; range 14-18 years) was recruited from public schools. The results indicated a strong positive association between body dissatisfaction and suicidal ideation (Cohen's f 2 = .25). The association was significantly moderated by the self-compassion (β = - .16, SE = .04, p = .01, t = 2.4.34, .95% CI [- .16, - .01]). Structural equation modeling analysis showed that the lack of self-kindness was associated with a moderate suicidal ideation level (Cohen's f 2 = .14). Also, higher levels of self-judgment predicted suicidal ideation with a moderate to large effect size (Cohen's f 2 = .28). The findings suggest that therapeutic programs designed to develop self-compassion should be implemented to reduce the risk of suicidal ideation among adolescents with body dissatisfaction. The findings empirically show that a higher degree of self-judgment is strongly associated with suicidal thoughts among adolescents, which must be systematically addressed in clinical studies on suicidal risk.
Supplementary information:
The online version contains supplementary material available at 10.1007/s11469-021-00727-4.
... Given that suicide is one of the principal causes of mortality among individuals with eating disorders (Bhatt-Poulose et al., 2016;Greydanus & Apple, 2011;Rufino et al., 2018), it can be hypothesized that body dissatisfaction is linked to suicide, a link that has already been directly and indirectly identified (Kim & Kim, 2009;Perkins & Brausch, 2019;Peterson et al., 2017). Among adolescents, body dissatisfaction predicts suicidal ideation progression beyond depression and hopelessness (Muehlenkamp & Brausch, 2012). Also, suicidal adolescents report higher levels of body dissatisfaction and negative body feelings and lower body care and body assurance levels than non-suicidal adolescents (Brausch & Muehlenkamp, 2007;Orbach et al., 2006). ...
Identifying risk and protective factors for suicidal ideation during adolescence is essential for suicide prevention. One potential risk factor is body dissatisfaction, which appears to peak during adolescence. The present study investigated the self-compassion buffering effects on the relationship between body dissatisfaction and suicidal ideation. A convenience sample comprising 580 adolescents (mean age 16.35 years; SD=.87; range 14-18 years) was recruited from public schools. The results indicated a strong positive association between body dissatisfaction and suicidal ideation (Cohen’s f 2=.25). The association was significantly moderated by self-compassion (β= -.16, SE=.04, p=.01, t=2.4.34, .95% CI [-.16, -.01]). Structural equation modeling analysis showed that the lack of self-kindness was associated with a moderate suicidal ideation level (Cohen’s f 2 =.14). Additionally, higher levels of self-judgment predicted suicidal ideation with a moderate to large effect size (Cohen’s f 2 =.28). The findings suggest that therapeutic programs designed to develop self-compassion should be implemented to reduce the risk of suicidal ideation among adolescents with body dissatisfaction. The findings empirically show that a higher degree of self-judgment is strongly associated with suicidal thoughts among adolescents, which must be systematically addressed in clinical studies on suicidal risk.
... [6][7][8] Researchers have also found that adolescents who show disregard for their body may be more prone to engaging in self-harm when faced with ''aversive, overwhelming emotional states.'' 9 Oral health-related quality of life (OHRQoL) is defined as the absence of negative effects of oral conditions on social life and a positive sense of dentofacial self-confidence. 10 Systematic reviews have shown that malocclusion has a negative impact on OHRQoL, which usually increases with the severity of the malocclusion. ...
Objectives
To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL).
Materials and Methods
Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13–14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11–14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05.
Results
Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11–14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year.
Conclusions
Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.
... A multiple regression analysis was performed to examine the impact of years from realization to transition, years since NSSI, and body investment (including feeling, touch, care, Consistent with prior research suggesting that a lack body investment is a significant predictor of NSSI, the results of the exploratory hypotheses revealed that lack of body investment suggested a significant impact on participants' level of anxiety, stress, and depression (Morris & Galupo, 2019;Muehlenkamp & Brausch, 2012;Orbach et al., 2006). Regarding anxiety, results revealed that participants who last engaged in NSSI longer ago and had higher levels of body investment feeling and protection tended to have lower levels of anxiety. ...
We hypothesized that transgender and nonbinary (TNB) individuals who reported a longer period of time from realizing they were TNB to beginning their transition will have a longer history of nonsuicidal self-injury (NSSI) and that participants who report higher levels of body investment, fewer years from realization of TNB identity to transition, and more years since NSSI will report lower levels of current anxiety, stress, and depression. We conducted a secondary data analysis of a dataset collected online, which included 217 participants. We conducted multiple regressions to explore the hypotheses. Results revealed that TNB people who had a longer time between realizing their gender identity and beginning a transition had a longer history of NSSI. Exploratory analyses were also conducted to help understand the relationship between NSSI, transition, and body investment on mental health outcomes. Providers are cautioned that the presence of NSSI should not necessarily be a contraindication to transition.
... Therefore, the present sample size (we had aimed to recruit approximately 90 participants per group) was based on previous research examining NSSI and body related constructs (Muehlenkamp & Brausch, 2012), self-criticism and NSSI in relation to other physical sensations (e.g., pain) (Fox et al., 2019), and studies assessing heartbeat perception and other behaviors (Young et al., 2017). Shortly after data collection was completed an effect size became available for the link between rumination and interoceptive accuracy (Schlinkert et al., 2020: Study 2). ...
Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior. Those with a history of NSSI often report high levels of self-critical rumination (SCR), a form of negatively-valenced introspective self-referential processing. It is plausible that this overly analytical style of relating to the self might hinder the ability to process interoceptive signals, thereby increasing the capacity to engage in behaviors that cause bodily harm. Two studies investigated whether trait or state SCR influenced aspects of interoception in those with and without a history of NSSI. In Study 1 (N = 180), irrespective of NSSI history, trait SCR was associated with finding attending to the heartbeat unpleasant. However, no associations were observed for interoceptive confidence, or metacognitive insight into their interoceptive abilities (confidence-accuracy correspondence). Trait SCR was associated with having higher interoceptive accuracy, but only in those without a history of NSSI. In Study 2 (N = 98), irrespective of NSSI history, state self-criticism led to a more negative interoceptive valence, and reduced participant’s metacognitive insight. In those without a history of NSSI, state self-criticism also increased interoceptive accuracy; an effect attenuated in those with NSSI. These findings suggest that those with NSSI are characterised by a blunted interoceptive response to negatively-valenced self-focused attention.
... Ей установлено, что восприятие собственного тела играет роль медиатора между самоповреждением и отрицательными эмоциями. Переживая негативные чувства, подростки склонны наносить себе порезы, шрамы, уколы в том случае, когда собственное тело воспринимается ими негативно [49]. Суммируя сказанное, подчеркнем, что деструктивное интраперсональное поведение проявляется в самоповреждающих и самоизменяющих действиях человека. ...
The work is devoted to the problem of destructive behavior of teenagers at school. It is shown in violation of school order, conflict interaction with peers and teachers, destruction of school property. Destructive behavior is diverse, but in general reflects aggressive-oppositional attitude of the teenager to the social space of school. Modern ideas about its occurrence are focused mainly on questions of mental development of the child, problems of the parental family, the negative influence of peers and adults. School-related socio-psychological factors of destructive behavior are often not covered by the attention of researchers. Therefore, the purpose of the article is to present the result of the teenager's identification with the social space of school as one of the causes of destructive behavior. To do this, the authors describe the contribution of the social environment to the formation of social and personal identity, discuss the influence of adults and peers surrounding the teenager on his criminal and self-destructive behavior. The contribution of the school social space to the development of social identity is analyzed. A review of research leads to the conclusion that the consequences of adolescent identity are social role, self-esteem and self-efficacy, and their negative quality depends on the degree of adolescent involvement in the space of school relationships. Thus, inconsistency of the social role to the claims of the schoolboy, impossibility to receive social estimation of behavior, ineffective influence of the teenager on peers leads to negative thoughts and experiences, is expressed in various forms of destructive behavior. In addition, the teenager's desire to change his or her social identity contributes to destructive influence on the objects of the social space of school.
... The effect of body image on life satisfaction among adolescents is revealed by a lot of studies, mentioning that dissatisfaction with the image of their physical appearance can lead to difficulties of social integration, eating disorders, avoidance behaviours or suicides (Carmona, Tornero-Quinones & Sierra-Robles, 2015;Flament et al., 2012;Holsen, Jones and Birkeland, 2012;Muehlenkamp & Brausch, 2012). Body image and self-esteem levels are frequently associated with sociocultural factors and correlations between the use of internet, the preoccupation for self-photos, the parental and peers factors and the thin models promoted by the media were identified (Meier & Gray, 2014;Michael et al., 2014;Rosen, 2013;Tiggemann & Slater, 2014).Body image misperception has important consequences on future adult life, especially among female subjects. ...
The purpose of the study is to identify the level of stress among adolescents regarding body image and the strategies that they use to cope with it. 282 adolescents in 10th and 11th grade answered three questionnaires: the Adolescent Stress Questionnaire, the Body Image Coping Strategies Inventory and the Body Esteem Scale for Adolescents and Adults. In the order of results, factors generating stress in adolescents are money pressure, uncertain future, school/leisure conflicts, school performance, assuming adult responsibilities, school attendance, romantic relationships, home life, interactions with teachers and peer pressure. Girls are more stressed by home life, peer pressure, an uncertain future, money pressure and adult responsibilities, while boys by school attendance. The most frequently used coping mechanism is positive rational acceptance. The level of stress among adolescents correlates with the level of satisfaction regarding the body image. Keywords: Body image, coping mechanisms, stress, adolescence, boys, girls.
... A higher pain threshold and longer pain tolerance or endurance in patients with NSSI have been demonstrated by several studies (Kirtley et al., 2016). Both body modifications and NSSI might correlate with a distortion of body image (Muehlenkamp & Brausch, 2012) that is in line with our results on eating disorders. ...
Background: Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia.
Methods: A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated.
Results: Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8).
Limitations: Retrospective design, referral population, single center study, and exclusion of psychotic patients.
Conclusions: NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders. HIGHLIGHTS Nonsuicidal self-injury is a significant public health concern for its association with suicidal behavior. 60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI. NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.
... Therefore, the findings are consistent with other studies conducted on community samples Lundh et al., 2007;Oktan, 2014). However, Muehlenkamp and Brausch (2012) observed no significant differences in types of SIB between inpatient and community samples. "Cutting" was the most prevalent SIB among both of these groups. ...
This study aimed to examine self-injurious behaviour in terms of coping with stress and emotional regulation. The study sample included 527 students who volunteered for the study; 278 females (52.7%) and 249 males (47.2%) from six high schools. Permission was obtained from the high schools in the city centre of Trabzon, Turkey for data collection, which was carried out using the Inventory of Statements about Self-injury, the Ways of Coping Inventory, the Emotional Regulation Scale, and a Personal Information Form. The analysis results revealed a positive correlation between self-injurious behaviour, coping with stress and emotional regulation. Self-injurious behaviour, rather than gender, is a significant predictor of emotional regulation and coping with stress.
... In addition to these SGM-specific factors, SGM-identifying youth may also be at higher risk of SITBs because they experience elevated levels of more "general" factors previously shown to be related to SITBs. Such factors include self-criticism (Fox et al., 2018;Hooley, Ho, Slater, & Lockshin, 2010), negative body image (Muehlenkamp & Brausch, 2012), depression (Marshall, Tilton-Weaver, & Stattin, 2013;Mustanski & Liu, 2013;Wang, Shi, & Luo, 2017), and contagion via friends engaging in SITBs (Jarvi, Jackson, Swenson, & Crawford, 2013). Providing support for this possibility, there is evidence that self-criticism (Puckett, Levitt, Horne, & Hayes-Skelton, 2015) and negative body image (Kaminski, Chapman, Haynes, & Own, 2005;McGuire, Doty, Catalpa, & Ola, 2016) are more common among people identifying as SGM. ...
Sexual and gender minority (SGM) populations are at increased risk for several negative psychological outcomes, including self-injury. Although correlates of self-injurious thoughts and behaviors (SITBs) have been identified, it is unclear which factors are prospective predictors of SITB engagement in SGM youth. The current study investigated an online sample of 252 SGM adolescents over a 6-month period. Participants reported attitudes based on SGM identity, depression, self-criticism, body image, family support and family strain, friend NSSI engagement, and experiences of everyday discrimination. Lasso and elastic net regularized logistic regressions were used to examine which baseline variables were associated with SITB engagement at follow-up. Models resulted in excellent predictive accuracy of nonsuicidal self-injury and suicidal ideation (mean Area Under the Receiving Operating Characteristics Curve [AUC] of 0.90 and 0.91), good predictive accuracy for suicide plans (mean AUC = 0.85), and fair predictive accuracy for suicidal behaviors (mean AUC = 0.78). Several variables emerged as prospectively related to SITB risk, with varied associations across different SITBs. Results suggest that minority-specific factors may predict SITBs in SGM adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Low self-esteem, unworthiness and self-criticism all came across in the young people's accounts with cutting forming a response of punishment. This idea is widely reported in current literature (Muehlenkamp & Brausch, 2012;Xavier, Pinto-Gouveia, & Cunha, 2016), however young people also reported cutting as a function of releasing emotions and to bring them back to reality, therefore they cut in order to help deal with difficult emotions (Kidger et al., 2015). In practice it is important to understand that these feelings may have origins in early childhood and have developed and strengthened over time. ...
Self-harm continues to be a growing concern within adolescence and is a globally recognised public health and social problem. Adolescents living in the community who self-harm are extremely common however less is known about these young people. This study focussed on capturing the voice of young people who engage in cutting behaviour to provide insight into the risks associated with this phenomenon. Single semi-structured interviews were conducted with 9 adolescents aged 16–18 years who lived within one Trust area in Northern Ireland. Thematic analysis was applied to the transcribed interviews in which themes emerged. The three subordinate themes of onset, persistence and ending of the behaviour encompassed six sub-themes which were further identified as risk factors for the behaviour. Risk factors identified were: ACE’s, poor relationships and difficulties in support networks, exposure to self-harm, psychological issues, “addiction” to self-harm, concealment of harming behaviour—to control and professional and peer support that helps or hinders. These factors support the current literature base however individual and diverse explanations are highlighted which provide further depth, particularly around the concept of addiction and support that hinders young people. Despite the small nature of the study, recommendations for social work practice, clinical practice and other relevant professional practice as well as future research are considered in view of the findings. Key direction outlines the importance of building trusting relationships, continuity of care and continuing to listen to young people as vital to the helping relationship.
... The relationships between depressive symptoms, negative attitudes towards body and deviations of conceptual aspects of bodily experiences are stronger in clinical group. This conforms to the findings by Muehlenkamp & Brausch (2012) that body image plays a mediating role in linking the negative affect and self-harm. Engaging in self-injurious activity, hypothetically, may be conceived as an attempt to make the bodily experiences more precise and to strengthen the defensive function of body image, that normally should help to maintain some stability of self-perception and self-esteem. ...
... Along these lines, and as further detailed below, body image problems may not only affect how individuals think about themselves (Wängqvist & Frisén, 2013), but these body image issues may become closely intertwined with a sense of identity diffusion or even clinical identity disturbance. Such a suboptimal self-trajectory, in turn, may make individuals especially vulnerable for body 10 dissatisfaction, and partially as a consequence, pathological self-harm behaviors such as disordered eating and NSSI (Muehlenkamp & Brausch, 2012;Orbach, 1996;Vartanian, Hayward, Smyth, Paxton, & Touyz, 2018). Below we describe recent research efforts examining how identity issues may become intertwined with such self-harm behaviors. ...
Research has demonstrated the important impact of identity on psychosocial functioning in both community and clinical populations. The present paper aims to identify different mechanisms through which identity may be related to psychopathology. Emphasis is placed on neo-Eriksonian identity models targeting identity mechanisms both at the structural and process levels. With respect to psychopathology, the present paper focuses mainly on disturbed eating behaviors and non-suicidal self-injury, with both behaviors sharing a focus on the body. Emerging research lines are identified and recent research is discussed as a sample case of how developmental theorizing on identity can yield insights in the emergence and development of psychopathological behaviors. In integrating these research lines, the present article discusses emerging themes originating from the field and provides important avenues for future research and intervention efforts.
... In addition to emotion regulation, research suggests that body-image and regard, or how an individual experiences the body, may be important to consider in NSSI prevention eff orts. Research has shown that body disregard and negative evaluations of the body are associated with NSSI risk (Muehlenkamp & Brausch, 2012 ). Moreover, Muehlenkamp claims that body disregard is a necessary -but not suffi cient -antecedent that facilitates the development of NSSI behavior. ...
Objectives:
This study sought to empirically examine the Emotional Cascade Model of nonsuicidal self-injury (NSSI), and to examine if body regard mitigates these variables' impact on NSSI in college students. We tested a three-way interaction between emotional reactivity, maladaptive cognitive regulation strategies, and body regard predicting NSSI frequency.
Methods:
Two thousand sixty-six undergraduate students (Mage = 20.38; 72.4% identified as female; 91.7% White; 22.7% with NSSI) completed measures of emotion reactivity, maladaptive cognitive regulation strategies, body regard, and lifetime NSSI frequency.
Results:
The three-way interaction between emotion reactivity, maladaptive cognitive regulation strategies, and body regard was significant. The interaction effect of emotional reactivity and maladaptive cognitive regulation strategies on NSSI was significant when body regard was low but not significant at average and high levels of body regard. The highest NSSI frequency was reported by those high in emotion reactivity and maladaptive cognitive regulation strategies, and low in body regard.
Conclusion:
These results support the emotional cascade theory of NSSI, and support assertions that body regard might act as a protective barrier against NSSI in the context of heightened emotion reactivity and maladaptive cognitive regulation strategies.
Introduction:
This project tested whether Service Members (SM) and Veterans with current suicidal ideation or a history of suicide attempt had greater interoceptive dysfunction than SM and Veterans with past or no suicidal ideation.
Method:
Participants (N = 195; 69% male) were SM (62%) and Veterans (38%) who completed measures of suicidal thoughts and behaviors and subjective and objective interoceptive dysfunction. Participants were split into the following suicide groups: no suicidality, lifetime ideation, current ideation, and past attempt. Planned orthogonal contrasts tested for differences.
Results:
The combined suicidality group (lifetime ideation, current ideation, or past attempt) had worse body trust relative to the no suicidality group, and the current ideation group had worse body trust relative to those with lifetime ideation. Those with a history of suicide attempt had worse body appreciation than the combined group of ideators, and those with current ideation had worse body appreciation relative to those with lifetime ideation. The groups did not differ on objective interoception.
Conclusion:
Interoception is disrupted among individuals with suicidality histories within a predominantly male-identified military sample. Individuals with current suicidal ideation had both worse body trust and appreciation relative to those with past ideation. Suicide risk assessments may benefit from including questions related to body trust.
Objective:
Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area.
Method:
Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership.
Results:
A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation.
Discussion:
DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI.
Public significance:
Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.
Non-suicidal self-injury (NSSI) is a prevalent maladaptive body-focused behavior among youth and young adults. Yoga is associated with improved mindfulness, body image, and self-compassion; all of which are associated with decreased NSSI. This study evaluated the relationship between yoga and NSSI frequency, and if the relationship would be mediated by mindfulness, self-compassion, and/or body appreciation. Participants were recruited from a random sample of university students via email and included those with some yoga experience (N = 384; Mage = 19.98, SD = 2.20). Participants completed an anonymous online survey assessing their levels of yoga participation, NSSI, mindfulness, self-compassion, and body appreciation. Bias corrected serial mediation regression models indicated the relationship between yoga participation and NSSI frequency was significantly mediated by self-compassion followed by body appreciation. Body appreciation was also a significant single mediator of yoga’s relationship with NSSI. Mindfulness was not a significant mediator in any of the analyzes. Yoga practice is associated with reduced NSSI behaviors through its positive relationships with body appreciation and self-compassion. Body appreciation appears to be an important mechanism underlying the link between yoga participation and NSSI behavior suggesting that interventions promoting positive body image, such as yoga, could be innovative strategies for clinicians to consider.
Приводятся результаты анализа связи самоповреждающего поведения и различных показателей телесных представлений и ощущений у подростков и молодых женщин, страдающих депрессией. В исследовании приняли участие 85 пациенток в возрасте от 16 до 25 лет, страдающие эндогенной депрессией. Использовались опросник SCL-90-R, Шкала инвестиций в тело (BIS), Шкала «Сравнения с окружающими» (PACS-R), Шкала удовлетворенности телом (BSS), Кембриджская шкала деперсонализации (CDS). Ответ на вопрос «Иногда я намеренно травмирую себя» использовался в качестве показателя причинения себе вреда. Выявлена связь самоповреждающего поведения и эмоциональных, когнитивных, поведенческих особенностей восприятия своего тела: более негативный образ тела (неудовлетворенность его отдельными частями и телом в целом) находит отражение в поведенческих проявлениях – сниженная «Защита», более высокие показатели самонаблюдения и сравнения себя с другими, деперсонализации, телесной диссоциации, соматизации. Для молодых женщин с депрессиями показано, что при самоповреждениях тело «обесценивается», воспринимается как «плохое», игнорируется необходимость его защиты. Выраженность самоповреждений напрямую коррелирует с явлениями соматопсихической деперсонализации. Полученные результаты могут свидетельствовать о том, что неприятие своего тела, «отчужденное» отношение и лишение тела «субъектности» может способствовать его использованию в качестве инструмента для решения психологических проблем, что является фактором риска развития, закрепления и утяжеления самоповреждающего поведения. При психотерапевтическом воздействии важно рассматривать возможность работы с патологией восприятия тела как дополнение к работе со способностью к эмоциональной регуляции.
The link between engagement in non-suicidal self-injury (NSSI)–related activities on SNS (e.g. viewing, commenting, sharing and uploading NSSI content) with body image and NSSI behaviour remains under researched in adolescents with EDs. The main aim of the current research was to examine associations between NSSI-related activities on SNS with body image and NSSI behaviour severity among female adolescents diagnosed with an ED. A total of 52 female adolescents (mean age = 15.35 years, SD = 1.49) diagnosed with an ED completed self-report questionnaires related to NSSI behaviour, SNS usage and body image. Participants were divided into two groups: low NSSI behaviour severity (from 0 to 10 NSSI behaviours; n = 28) and high NSSI behaviour severity (more than ten NSSI behaviours; n = 24). Within the high NSSI severity group, individuals that comment and share NSSI online content significantly reported higher negative body image. A hierarchical binary logistic regression showed that the frequency of NSSI online content on SNS emerged as significant predictor of NSSI behaviour severity within last year after controlling for body image and searching for ED content on SNS. Our findings suggest that not only searching for ED content, but also being daily engaged in NSSI online activities may increase the risk of NSSI behaviour severity in female adolescents with EDs.
Introduction: Suicide is one of the mental health problems and the third leading cause of death among adolescents.
Aim: This study aimed to investigate the role of experimental avoidance, emotional regulation difficulties, and body image concern in predicting the probability of suicide among adolescent girls.
Method: The method of the present study was descriptive of the type of correlation and the statistical population included all adolescent girls in Kermanshah City in 2019. By available sampling method and based on Morgan table, 350 people were selected as a sample. The research instruments included the adolescents Suicide Questionnaire, the Bond et al. Experimental Avoidance Questionnaire, the Grater and Roemer Emotional Regulation Difficulties Scale, and the Lillton body image concern questionnaire, all of which were valid and reliable. To analyze the data, Pearson correlation and multivariate regression analysis were used simultaneously, which were finally analyzed by SPSS software version 22.
Results: The results showed that experimental avoidance, emotional regulation difficulties components (except lack of emotional awareness), and body image concern had a significant effect on the probability of suicide (P>0.001). The results of the analysis also showed that the predictor variables together can accurately determine the 27.7% the probability of suicide.
Conclusion: The probability of suicide in adolescent girls can be predicted by the variables of experimental avoidance, emotional regulation difficulties, and body image concern. Therefore, it is suggested that psychologists and counselors pay attention to the role of experimental avoidance, emotional regulation difficulties, and body image concern to reduce adolescent's suicide.
The study investigated the relations between body dissatisfaction and emotional dysregulation. This is the first research focusing on the mediating effect of emotional dysregulation on the relationship between negative affect and body dissatisfaction in a Russian female population. It is particularly relevant given that both emotional dysregulation and body dissatisfaction may lead to the emergence of psychopathological symptoms (e.g., depression, self-injurious behavior, and eating disorders). 778 girls and women aged 14–40 years (M=19,8; SE=3,31) participated in the study. The following measures were used: Body Image Questionnaire (Skugarevsky, 2006), Emotional Dysregulation Questionnaire (Polskaya, Razvaliaeva, 2017), Emotion Regulation Questionnaire (Gross, John, 2003; Russian version by Pankratova, Kornienko, 2017) and Positive and Negative Affect Schedule (Watson et al., 1988; Russian version by Osin, 2012). High level of body dissatisfaction was significantly associated with high scores of rumination, avoidance and difficulties in mentalizing from the Emotional Dysregulation Questionnaire, high level of negative affect and low level of positive affect. Respondents with high body dissatisfaction also preferred expressive suppression to cognitive reappraisal for emotion regulation. Regression analysis showed that negative affect (b=0,20; p<0,001) and emotion dysregulation scales — rumination (b=0,66; p<0,001), avoidance (b=0,69; p<0,001) and difficulties in mentalizing (b=0,33; p<0,001) — significantly predicted body dissatisfaction (F(4, 773)=130,8, p<0,001; R2=0,405; R2adj=0,402). Emotion dysregulation scales mediated the effect of negative affect on body dissatisfaction.
In recent decades, one can notice the increase in self-mutilation behaviors in adolescence. Although this can be explained by the growing interest of researchers and study specialists in this phenomenon, it is notorious that non-suicidal self-mutilation, considered until recently as a specific behavior inherent to severe pathological conditions, has been used as a strategy of poorly adaptive coping by an expressive number of adolescents at least once in life or even for the entire period of adolescence. In this narrative review of continuing education, non-suicidal self-mutilation will be discussed in terms of prevalence, functions and associated factors. The results indicate significant prevalences of non-suicidal self-mutilation worldwide, linked to various functions and associated factors related to sociodemographic, individual-- aspects of problem management and relational emotions and psychosocial aspects.
Body image dissatisfaction (BID) is a negative evaluation of personal physical characteristics, including dissatisfaction with body shape, gender, sexual organs, appearance and so forth, and it plays an important role in growth and development. The second-to-fourth digit ratio (2D:4D) is recognized as a putative indicator of intra-uterine testosterone to estrogen ratio exposure, and it has been observed that higher levels of fetal testosterone exposure are associated with a lower 2D:4D. The present paper contributes to a better understanding of the biological underpinnings of BID by analyzing BID and the digit ratio (2D:4D). We found that the 2D:4D was positively related to appearance dissatisfaction in boys with first spermatorrhea, which means that low prenatal androgen exposure may increase boys’ dissatisfaction with their appearance. In girls with breast development being lower than Tanner stage II, their 2D:4D was negatively related to their body shape dissatisfaction, which means that high prenatal androgen exposure may increase girls’ dissatisfaction with their body shape. These results suggest that the prenatal androgen exposure level might play an important role in the body image dissatisfaction of the offspring.
The aim of this study was to examine trait, state, and temporal instability measures of self-critical and self-punishment cognitions to evaluate their respective roles in nonsuicidal self-injury (NSSI). Participants were university students with a history of NSSI (n = 64) and those with no history of NSSI (n = 59). At baseline, participants completed measures assessing history of NSSI behavior, as well as trait measures of self-criticism and self-punishment. After completion of baseline procedures, participants subsequently participated in a 10-day ecological momentary assessment protocol in which self-critical and self-punishment cognitions were assessed in real time three times daily. Employing bivariate and multivariate frameworks, our results demonstrate that both trait and state levels of self-critical and self-punishment cognitions robustly differentiate between young adults with and without a lifetime history of NSSI. The present results also confirm that the temporal instability of these cognitive states also meaningfully differentiate between groups, such that those who exhibit greater fluctuations in these cognitive states are more likely to have a history of NSSI. The current findings suggest that trait, state, and temporal instability of negative self-focused cognitions may be vulnerability factors for engagement in NSSI.
Body image is typically studied through the framework of internalising gender binary standards of attractiveness. However, not all individuals adhere to traditional appearance norms. This study aimed to understand the meaning of cis (non-trans) individuals’ androgynous or nonstereotypical body ideals and the actions they engage in to achieve these ideals. We recruited an online sample of 78 participants (42 cis women and 36 nonbinary individuals who also identified as cis). Participants responded to two open-ended prompts: 1) What does your androgynous or nonstereoypical body mean to you? and 2) What actions have you taken to achieve this ideal? Authors identified three overarching
themes of what an androgynous body ideal meant to our participants. An androgynous appearance was central to participants’ beauty standards, authenticity, and gender expression. To achieve or maintain an androgynous body ideal, participants described actions that altered their gender expression, primary and secondary sex characteristics, and body. Our findings underscore the way androgynous appearance ideals function to
transgress binary gender in affirming ways to cis individuals. Further, recruiting on the basis of androgyny yielded a wider understanding of cis identity, as our participants were diverse across both sexuality (queer and heterosexual) and gender (women and nonbinary individuals).
Objective:
Eating disorder symptomatology generally develops during adolescence and emerging adulthood. Previous research has focused on the role of identity formation or body image in the development of eating disorder symptomatology, but integrative work is lacking. For this reason, the present cross-sectional study examined the mediating role of body dissatisfaction in the relation between identity formation and eating disorder symptomatology.
Method:
The sample comprised 659 participants between 15 and 30 years old (68.9% females; Mage = 19.44; SDage = 3.99). All participants completed self-report measures on identity (Self-concept and Identity Measure), body dissatisfaction (the Body Image Feelings and Attitudes subscale of the Body Investment Scale and the Body Dissatisfaction subscale of the Eating Disorder Inventory-3), and eating disorder symptomatology (Eating Disorder Inventory-3). Latent variable modeling from a structural equation modeling approach was used.
Results:
First, identity formation significantly predicted eating disorder symptomatology. Additionally, indirect effects were found linking identity formation to eating disorder symptomatology through the mechanism of body dissatisfaction. No significant differences between males and females or between adolescents and emerging adults on direct or indirect effects were found.
Conclusion:
The present study indicated that body dissatisfaction mediated the relationship between identity formation and eating disorder symptomatology during mid-to-late adolescence and emerging adulthood. Provided that the present findings can be replicated in a future longitudinal study, they demonstrate that both identity formation and body dissatisfaction should be taken into account in prevention and intervention programs targeting eating disorder symptomatology.
In the painting “Lucretia,” Artemisia Gentileschi, one of the major painters of the 17th century, depicts Lucretia’s suicide. This artwork empathic vision offers the spectator the apprehension of a unique phenomenon where psychological pain is transformed into self-aggression. To understand why the body becomes an object to attack, it is important to study the role of interoception and self-awareness in the suicidal process. This essay discusses how bodily representations are crucial for interacting efficiently and safely with the outside world and for establishing the sense of self. It presents some of the available evidence showing that alterations in the body representation and in the sensations perceived by it contribute to suicide. Indeed, neuroimaging studies show that social environmental factors and their biological consequences in the body (e.g., increased neuroinflammation) can alter the neural networks of suicidal behavior by increasing the sensitivity to psychological pain and the disconnection from self-awareness. Therefore, body image, sensations and awareness as well as psychological pain should be examined to improve the understanding of the dynamic interactions between body, brain, and mind that underly suicidal behavior. This conceptualization brings clinical and therapeutic perspectives in a domain where they are urgently needed.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article offers objectification theory as a framework for understanding the experiential consequences of being female in a culture that sexually objectifies the female body. Objectification theory posits that girls and women are typically acculturated to internalize an observer's perspective as a primary view of their physical selves. This perspective on self can lead to habitual body monitoring, which, in turn, can increase women's opportunities for shame and anxiety, reduce opportunities for peak motivational states, and diminish awareness of internal bodily states. Accumulations of such experiences may help account for an array of mental health risks that disproportionately affect women: unipolar depression, sexual dysfunction, and eating disorders. Objectification theory also illuminates why changes in these mental health risks appear to occur in step with life-course changes in the female body.
For structural equation models, a huge variety of fit indices has been developed. These indices, however, can point to conflicting conclusions about the extent to which a model actually matches the observed data. The present article provides some guide-lines that should help applied researchers to evaluate the adequacy of a given struc-tural equation model. First, as goodness-of-fit measures depend on the method used for parameter estimation, maximum likelihood (ML) and weighted least squares (WLS) methods are introduced in the context of structural equation modeling. Then, the most common goodness-of-fit indices are discussed and some recommendations for practitioners given. Finally, we generated an artificial data set according to a "true" model and analyzed two misspecified and two correctly specified models as examples of poor model fit, adequate fit, and good fit. In structural equation modeling (SEM), a model is said to fit the observed data to the extent that the model-implied covariance matrix is equivalent to the empirical co-variance matrix. Once a model has been specified and the empirical covariance matrix is given, a method has to be selected for parameter estimation. Different estimation meth-ods have different distributional assumptions and have different discrepancy functions to be minimized. When the estimation procedure has converged to a reasonable
There is a relative dearth of studies in the field of adolescent attachment despite the potential impact of such developmental changes on the organization of attachment systems. This omission is even more acute among clinical populations, although adolescence is notable for dramatic increases in specific psychopathologies, e.g. eating disorders, delinquency, and suicide and self-harm. This article attempts to address the shortfall using a mixed quantitative/qualitative research design. First, it examines the association between attachment styles and suicidality by comparing two groups of adolescent participants attending a psychotherapy clinic. Second, it explores the phenomenology of different presentations of suicidality in adolescence from a psychodynamically informed attachment theory perspective. The clinical and research implications from these findings are discussed.
A new measure of emotional investment in the body is presented. The Body Investment Scale (BIS) pertains especially to self-destructive behavior and can be used to study a variety of normal and pathological behaviors. Studies 1 and 2 describe the construction of the BIS, factor analysis, and a group comparison (suicidal and nonsuicidal inpatients and normal adolescents). Study 3 tested the relationship between the BIS, physical anhedonia, depression, and suicidal tendencies. Study 4 examined the relationship between the BIS, perceived early care, self-esteem, and suicidal tendencies. The BIS consists of four internally reliable factors (body image feelings and attitudes, comfort in touch, body care, and body protection). The construct validity hypotheses were confirmed. The relevance of the BIS to self-destructive behavior and related processes is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although the majority of adolescents report body dissatisfaction and the consequences of body image concerns are developmentally significant, most research addressing body image has been conducted by clinicians. Developmental scientists are in a unique position to contribute to body image research given their understanding of the intrapersonal (e.g., pubertal development) and interpersonal (e.g., family relationships) factors that affect the development of body image. The adolescent years provide a particularly good example of the developmental nature of body image because a myriad of "normal" developmental factors (e.g., peer relationships) coalesce to shape adolescents' body image. This commentary will summarize some of the significant body image research--focusing on adolescence--in the hope that it will encourage developmental psychologists to recognize the central role body image plays in development and address this topic in future research.
Analytical solutions for point and variance estimators of the mediated effect, the ratio of the mediated to the direct effect, and the proportion of the total effect that is mediated were studied with statistical simulations. We compared several approximate solutions based on the multivariate delta method and second order Taylor series expansions to the empirical standard deviation of each estimator and theoretical standard error when available. The simulations consisted of 500 replications of three normally distributed variables for eight sample sizes (N = 10, 25, 50, 100, 500, 1000, and 5000) and 64 parameter value combinations. The different solutions for the standard error of the indirect effect were very similar for sample sizes of at least 50, except when the independent variable was dichotomized. A sample size of at least 500 was needed for accurate point and variance estimates of the proportion mediated. The point and variance estimates of the ratio of the mediated to nonmediated effect did not stabilize until the sample size was 2,000 for the all continuous variable case. Implications for the estimation of mediated effects in experimental and nonexperimental studies are discussed.
As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.
Although past research has explored self-injurious behaviors and disordered eating among adults in clinical settings, little research has been conducted examining nonsuicidal self-injury (NSSI) and eating pathology in community samples of adolescents. Four hundred and 40 students were screened for the presence of NSSI; a prevalence rate of 13.9% was found. Those who indicated that they engaged in NSSI (n = 59) and a comparison group of non-self-injurers (n = 57) completed the Eating Disorders Inventory. Results indicate that students who engage in NSSI display significantly more eating pathology than their non-NSSI peers, including poor interoceptive awareness; difficulties with impulse regulation; an increased sense of ineffectiveness, distrust, and social insecurity; and increased bulimic tendencies and body dissatisfaction. Relationships were found between increased lifetime frequency of NSSI behaviors and poor impulse control and deficits in affective regulation. In addition, adolescents who had stopped self-injuring reported comparable rates of eating pathology as did adolescents who continued to self-injure. The theoretical connection between NSSI and eating pathology are discussed with reference to enhancing knowledge regarding the characteristics of NSSI.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
Individuals who mutilate themselves are at greater risk for suicidal behavior. Clinically, however, there is a perception that the suicide attempts of self-mutilators are motivated by the desire for attention rather than by a genuine wish to die. The purpose of this study was to determine differences between suicide attempters with and without a history of self-mutilation.
The authors examined demographic characteristics, psychopathology, objective and perceived lethality of suicide attempts, and perceptions of their suicidal behavior in 30 suicide attempters with cluster B personality disorders who had a history of self-mutilation and a matched group of 23 suicide attempters with cluster B personality disorders who had no history of self-mutilation.
The two groups did not differ in the objective lethality of their attempts, but their perceptions of the attempts differed. Self-mutilators perceived their suicide attempts as less lethal, with a greater likelihood of rescue and with less certainty of death. In addition, suicide attempters with a history of self-mutilation had significantly higher levels of depression, hopelessness, aggression, anxiety, impulsivity, and suicide ideation. They exhibited more behaviors consistent with borderline personality disorder and were more likely to have a history of childhood abuse. Self-mutilators had more persistent suicide ideation, and their pattern for suicide was similar to their pattern for self-mutilation, which was characterized by chronic urges to injure themselves.
Suicide attempters with cluster B personality disorders who have a history of self-mutilation tend to be more depressed, anxious, and impulsive, and they also tend to underestimate the lethality of their suicide attempts. Therefore, clinicians may be unintentionally misled in assessing the suicide risk of self-mutilators as less serious than it is.
The incidence of self-injurious behavior (SIB) in adolescent psychiatric inpatients has been reported to be as high as 61%, yet few data exist on the characteristics and functional role of SIB in this population. Because of the repetitive nature of SIB and its potential to increase in severity, features of SIB and its specific reinforcing effects were examined.
Participants were 42 self-injuring adolescents admitted to a hospital over a 4 month period. Data sources consisted of self-report questionnaires and medical chart review.
Mean age was 15.7 +/- 1.5 years. Reported urges to self-injure were almost daily in 78.6% of the adolescents ( n= 33), with acts occurring more than once a week in 83.3% (n = 35). The two primary reasons endorsed for engaging in self-injury were "to cope with feelings of depression" (83.3%, n= 35) and "to release unbearable tension" (73.8%, n= 31). Of the sample, 97.6% ( n= 41) endorsed three or more addictive symptoms.
SIB in hospitalized adolescents serves primarily to regulate dysphoric affect and displays many addictive features. Those with clinically elevated levels of internalized anger appear at risk for more addictive features of this behavior.
In this article, we provide guidance for substantive researchers on the use of structural equation modeling in practice for theory testing and development. We present a comprehensive, two-step modeling approach that employs a series of nested models and sequential chi-square difference tests. We discuss the comparative advantages of this approach over a one-step approach. Considerations in specification, assessment of fit, and respecification of measurement models using confirmatory factor analysis are reviewed. As background to the two-step approach, the distinction between exploratory and confirmatory analysis, the distinction between complementary approaches for theory testing versus predictive application, and some developments in estimation methods also are discussed.
The authors describe dialectical behavior therapy (DBT) as developed by Linehan for the treatment of adults with borderline personality disorder and explain how they have adapted DBT for the treatment of suicidal adolescents. The modifications involved in dialectical behavior therapy for adolescents include shortening the length of treatment from 1 year to 12 weeks, reducing the total number of skills taught, incorporating family members into the treatment, simplifying the language used in handouts and skills training lectures, and adding an optional 12 week follow-up Patient Consultation Group. The implementation of DBT for suicidal adolescents is then illustrated by a case study.
In this article, we provide guidance for substantive researchers on the use of structural equation modeling in practice for theory testing and development. We present a comprehensive, two-step modeling approach that employs a series of nested models and sequential chi-square difference tests. We discuss the comparative advantages of this approach over a one-step approach. Considerations in specification, assessment of fit, and respecification of measurement models using confirmatory factor analysis are reviewed. As background to the two-step approach, the distinction between exploratory and confirmatory analysis, the distinction between complementary approaches for theory testing versus predictive application, and some developments in estimation methods also are discussed.
The psychometric properties of the Beck Hopelessness Scale (BHS) were examined among 544 university students. Internal consistency of scores was satisfactory (Cronbach’s alpha = .88). A principal-axis factor analysis with oblique rotation suggested four factors that were largely uninterpretable. Removal of items and further analysis suggested a two-factor structure of questionable interpretability. Convergent validity was demonstrated by high correlations with the Hope Scale and the Life Orientation Test (LOT). A correlation of .57 between the BHS and perceived stress reduced to .24 when trait negative affect was controlled for, indicating a degree of discriminant utility. It is concluded that for normal populations, measures such as the LOT and Hope Scale are more appropriate.
This paper focuses on the role of the body experience in self-destructive behavior. It is postulated that early caretaking processes have a powerful role in the development of self-destruction through the formation of alterations in the experience of the body and negative attitudes toward the body. The hypothesis that emerges from the literature review is that the internalization of early negative caretaking processes and negative attachment may lead to a distorted experience of the body, as well as to a basic negative attitude and feelings toward one's body. Such body experience and attitudes are believed to interact with anguish, hopelessness and mounting stress and culminate in self-destruction. Some of the destructive processes intervening between distorted caretaking, experiences of and attitudes toward the body include: lack of moderating self-directed aggression, lack of attunement to bodily needs, lack of representational learning to care for the body, symbolized hate toward the body, distorted perception of pain and pleasure, and dissociation. It is suggested that the role of the body in suicide may evolve into a most important avenue for future research in suicide.
This paper offers an in-depth phenomenological exploration of the self-cutting experience and the meanings of the gesture, the wound, and the resulting scar.The phenomenon of self-cutting lends itself to qualitative questions. To address these questions, six female self-cutters were interviewed. Their audiotaped responses were analysed according to the phenomenological method of data analysis (Giorgi, 1975). The purpose of such research is to explicate the structure of a phenomenon from the descriptions of individuals who experience it. By including all that was common across participants' situated structures, the general structural description or essential meaning of the phenomenon was reached. Results revealed that ‘bodily mineness’, pain, despair, and competence all factor into the embodied nature of self-cutting. The act of self-cutting pulls the individual together while simultaneously tearing her apart with its self-destructive, shaming, and addictive consequences. Nevertheless, findings reveal how ‘wounding to heal’ is the cutter's way of coping.
Compared 48 nonsuicidal self-mutilating female psychiatric patients (aged 13–17 yrs) with 48 age- and sex-matched nonmutilating patients, using chart reviews of clinical and descriptive characteristics. Self-mutilating Ss were characterized by higher frequencies of sleep disorders and sexual abuse and greater treatment with psychotropic medications. They had higher levels of depression, anxiety, hostility, and somatic complaints and greater difficulties with body comfort and confidence. They exhibited more severe symptoms, as indicated by the SCL-90 (Revised), and had more Axis 1 diagnoses of affective and eating disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Nonsuicidal self-injury (NSSI) is the deliberate damaging of one's own body in the absence of any intent to die. Although reports of this behavior span centuries, reported instances of NSSI have increased dramatically over the past 20 years. This authoritative book provides new information about why this behavior occurs and what evidence-based assessment and treatments are available. Editor Matthew K. Nock has compiled a comprehensive overview of NSSI written by leading theorists, researchers, and clinicians in the field. Drawing on the historical, biological, cognitive, behavioral, and interpersonal literature, the contributors help to provide answers to some key questions: How prevalent is NSSI? What is its history? Does it occur more frequently among youth? Among females? What influences its occurrence? And, most important, how can mental health professionals help those who self-injure? The result is a monumental and highly accessible study of NSSI.
Understanding Non-suicidal Self-Injury: Origins, Assessment, and Treatment is a must-read for both researchers and clinicians, including psychologists, psychiatrists, social workers, nurses, and all who wish to help those who struggle with this disturbing behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Part I of the book focuses on the scope of the problem of self-mutilation. This entails reviewing the forms of SMB [self-mutilative behavior] that have been reported in the literature. . . . In addition, reviewing the scope of self-mutilation requires a look at the incidence of the behavior as it has been reported in a number of Western countries.
In Part II of the book, self-mutilation is discussed as it occurs in different clinical populations. In this section, we also examine SMB as it occurs in different types of client groups, including borderline personalities, psychotics, and retarded and autistic individuals. In this section, emphasis is placed on the determinants of the behavior that are specific to a particular client group.
In the third and final section of the book, the focus is on treatment. Here we review some of the therapeutic techniques that have been used by others, and we present a number of our own. We also identify clinical strategies or responses that we believe are likely to be especially counterproductive. In this treatment section, the focus is on four types on interventions: cognitive-behavioral, psychoanalytic, family therapy, and group treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Fredrickson and Roberts (1997) proposed objectification theory as an integrative framework for understanding how women's socialization and experiences of sexual objectification are translated into mental health problems. This article reviews the past decade of research grounded in objectification theory and highlights needed directions for future scholarship in this area. Specifically, this article reviews research organized according to the following themes: (a) self-objectification and its proposed consequences, (b) sexual objectification experiences as a proposed precursor, and (c) disconnections from bodily functions. An overview of emerging objectification theory research with men is also provided. The review concludes with needed directions for future theoretical and research efforts aimed to advance the psychology of women.
Objectification theory proposes that the objectification of women's bodies causes women to self-objectify, adopting an outsider's view of themselves. Engaging in a high amount of self-objectification is thought to place women at increased risk for mental health problems such as body dissatisfaction and depression. It was hypothesized that self-objectification would contribute to negative body regard and depression, which would increase participation in risk-taking and self-harmful behaviors. Structural equation modeling was used to test a model of risk for self-harm based upon objectification theory in a sample of 391 college women. Results indicate that the model provided a good fit to the data, but only the paths from self-objectification to negative body regard, negative body regard to depression, and depression to self-harm were significant. Implications of these findings for objectification theory and our understanding of self-harm in women are discussed.
The relationships between cognitive and affective attitudes toward the body, body experiences (dissociation, insensitivity, and lack of control), and suicidal tendencies were examined as a derivative of the hypothesis that bodily attitudes and experiences may facilitate suicidal acting out. Three groups of adolescents (aged 14–18), including suicidal (made a suicide attempt) and nonsuicidal inpatients and controls, were compared with regard to suicidal tendencies, various body aspects, and depression and anxiety. A series of MANOVAs, discriminant analysis, Pearson correlations, and regressions were employed. The results show that the suicidal group differed from the two nonsuicidal groups in feelings toward the body, body protection, and body dissociation. Some aspects of bodily measures discriminated between suicidal and nonsuicidal subjects. In addition, various bodily measures were associated with and statistically predicted suicidal tendencies. The discussion focuses on the web of associations between body attitudes and experiences and their role in suicidal behavior.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
The objectification of women by our society can become internalized by women, resulting in negative psychological outcomes. Using Fredrickson and Roberts’ (1997) objectification theory, we tested a model of the relationships between self–objectification and disordered eating and depressive symptoms in a sample of undergraduate women (n= 384). One postulate of self–objectification theory is that self–objectification can lead to a lack of internal awareness, which may mediate the relationship between self–objectification and restrictive eating, bulimic, and depressive symptoms. Results of structural equation modeling suggest that self–objectification has a direct relationship to restrictive eating, bulimic, and depressive symptoms. The mediational role of internal awareness was relevant for depressive symptoms but not for restrictive eating or bulimic symptoms. Depressive symptoms did, however, mediate the relationship between self–objectification and bulimic symptoms. The relevance of our findings to the understanding of objectification theory are discussed and future areas of research recommended.
We have reviewed the literature on the association between self-injurious behaviors (SIB) and eating disorders from the psychological-behavioral perspective. Our aims were to investigate the extent and possible reasons for the association. A literature search was conducted using the following electronic databases (1989–2005): Medline, PsychInfo and EMBASE. References in identified articles were also screened. The reported occurrence of SIB in eating disorder patients ranged between 25.4% and 55.2%. The figures for occurrence of eating disorders in SIB patients ranged between 54% and 61%. These figures indicate that there is a strong association between these disorders. Impulsivity, obsessive-compulsive characteristics, affect dysregulation, dissociation, self-criticizing cognitive style and need for control were identified as potential factors involved in the association. Early trauma such as childhood sexual abuse and possibly certain characteristics of early family environment might contribute to the development of these factors. We present a hypothetical model which includes these factors and argue that the co-existence of eating disorders and SIB in patients results from several factors being present. SIB and eating disorder symptoms may provide a means whereby patients can deal with each factor simultaneously. The clinical implications of the findings are discussed.
Objective
To determine the importance of self-injurious behaviour in people with eating disorders (ED) and to analyse the possible differences between ED subtypes.Method109 patients with ED (51 anorexia nervosa (AN) and 58 bulimia nervosa (BN)), according to DSM-IV diagnostic criteria, who were consecutively referred to our unit, participated in this study. All cases were female.AssessmentSubjects were assessed by means of a semi-structured clinical interview and self-report questionnaires (Eating Attitudes Test, EAT-40; Eating Disorders Inventory, EDI; Bulimic Investigatory Test Edinburgh, BITE; Body Shape Questionnaire, BSQ; Beck Depression Inventory, BDI; Social Anxiety Scale, SAD).DesignComparison of cases by considering the factors diagnosis and self-injurious behaviour.ResultsThe presence of self-injurious behaviour (SIB) (32% of cases) was not associated with the diagnosis (p = 0.28). There was no association between SIB, suicide attempts, alcohol abuse and stealing, but a positive correlation between SIB and drug abuse was found (r = 0.284, p < 0.003). Likewise, patients with SIB showed higher scores on severity of the disorder (EDI, p < 0.04), depressive symptoms (BDI, p < 0.02), social anxiety (SAD, p < 0.02) and body image dissatisfaction (BSQ, p < 0.03).Conclusions:Eating disorders are pathologies in which self-injurious behaviour will be commonly present. SIB is associated with greater depression and anxiety and in general terms with greater severity of the disorder. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.