The functions of nonsuicidal self-injury: converging evidence for a two-factor structure

E David Klonsky, Catherine R Glenn, Denise M Styer, Thomas M Olino, Jason J Washburn, E David Klonsky, Catherine R Glenn, Denise M Styer, Thomas M Olino, Jason J Washburn

Abstract

Research has identified more than a dozen functions of non-suicidal self-injury (NSI), but the conceptual and empirical overlap among these functions remains unclear. The present study examined the structure of NSI functions in two large samples of patients receiving acute-care treatment for NSI. Two different measures of NSI functions were utilized to maximize generalizability of findings: one sample (n = 946) was administered the Inventory of Statements About Self-injury (ISAS; Klonsky and Glenn in J Psychopathol Behav Assess 31:215-219, 2009), and a second sample (n = 211) was administered the Functional Assessment of Self-Mutilation (FASM; Lloyd et al. in Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Poster session at the annual meeting of the Society for Behavioral Medicine, New Orleans, LA, 1997). Exploratory factor analyses revealed that both measures exhibited a robust two-factor structure: one factor represented Intrapersonal functions, such as affect regulation and anti-dissociation, and a second factor represented Social functions, such as interpersonal influence and peer bonding. In support of the two-factor structure's construct validity, the factors exhibited a pattern of correlations with indicators of NSI severity that was consistent with past research and theory. Findings have important implications for theory, research, and treatment. In particular, the two-factor framework should guide clinical assessment, as well as future research on the implications of NSI functions for course, prognosis, treatment, and suicide risk.

Figures

Fig. 1
Fig. 1
Scree plot for the exploratory factor analysis of the 39 ISAS items
Fig. 2
Fig. 2
Scree plot for the exploratory factor analysis of the 22 FASM items

References

    1. Andover MS, Morris BW, Wren A, Bruzzese ME. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child Adolesc Psychiatry Ment Health. 2012;6:11. doi: 10.1186/1753-2000-6-11.
    1. Asarnow JR, Porta G, Spirito A, Emslie G, Clarke G, Wagner KD, Vitiello B, Keller M, Birmaher B, McCracken J, Mayes T, Berk M, Brent DA. Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. J Am Acad Child Adolesc Psychiatry. 2011;50:772–781. doi: 10.1016/j.jaac.2011.04.003.
    1. Bildik T, Somer O, Kabukçu Başay B, Başay Ö, Özbaran B. The validity and reliability of the Turkish version of the inventory of statements about self-injury. Turk J Psychiatry. 2013;24:49–57.
    1. Brown MZ, Comtois KA, Linehan MM. Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol. 2002;1:198–202. doi: 10.1037/0021-843X.111.1.198.
    1. Chapman AL, Gratz KL, Brown M. Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behav Res Ther. 2006;44:371–394. doi: 10.1016/j.brat.2005.03.005.
    1. Clark LA, Watson D. Constructing validity: basic issues in objective scale development. Psychol Assess. 1995;7:309–319. doi: 10.1037/1040-3590.7.3.309.
    1. Dahlström Ö, Zetterqvist M, Lundh LG, Svedin CG. Functions of nonsuicidal self-injury: exploratory and confirmatory factor analyses in a large community sample of adolescents. Psychol Assess. 2015;27:302–313. doi: 10.1037/pas0000034.
    1. Frazier TW, Youngstrom EA. Historical increase in the number of factors measured by commercial testings of cognitive ability: are we overfactoring? Intelligence. 2007;35:169–182. doi: 10.1016/j.intell.2006.07.002.
    1. Glenn CR, Klonsky ED. One-year test-retest reliability of the Inventory of Statements About Self-injury (ISAS) Assessment. 2011;18:375–378. doi: 10.1177/1073191111411669.
    1. Glenn CR, Klonsky ED. Prospective prediction of non-suicidal self-injury: a 1-year longitudinal study in young adults. Behav Ther. 2011;42:751–762. doi: 10.1016/j.beth.2011.04.005.
    1. Hair JF, Jr, Anderson RE, Tatham RL, Black WC. Multivariate data analysis. 5. Upper Saddle River: Prentice Hall; 1998.
    1. Hooley JM, Ho DT, Slater J, Lockshin A. Pain perception and non-suicidal self-injury: a laboratory investigation. Personal Disord: Theory Res Treat. 2010;1:170–179. doi: 10.1037/a0020106.
    1. International Society for the Study of Self-Injury (ISSS) (n.d.) About self-injury. Retrieved from
    1. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev. 2007;27(2):226–239. doi: 10.1016/j.cpr.2006.08.002.
    1. Klonsky ED. The functions of self-injury in young adults who cut themselves: clarifying the evidence for affect-regulation. Psychiatry Res. 2009;166(2–3):260–268. doi: 10.1016/j.psychres.2008.02.008.
    1. Klonsky ED. Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography, and functions. Psychol Med. 2011;41(9):1981–1986. doi: 10.1017/S0033291710002497.
    1. Klonsky ED, Glenn CR. Assessing the functions of non-suicidal self-injury: psychometric properties of the Inventory of Statements About Self-injury (ISAS) J Psychopathol Behav Assess. 2009;31:215–219. doi: 10.1007/s10862-008-9107-z.
    1. Klonsky ED, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. J Abnorm Psychol. 2013;122:231–237. doi: 10.1037/a0030278.
    1. Klonsky ED, Olino TM. Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. J Consult Clin Psychol. 2008;76:22–27. doi: 10.1037/0022-006X.76.1.22.
    1. Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry. 2003;160:1501–1508. doi: 10.1176/appi.ajp.160.8.1501.
    1. Leong CH, Wu AM, Poon MMY. Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents. Arch Suicide Res. 2014;18:193–212. doi: 10.1080/13811118.2013.824828.
    1. Lewis SP, Santor DA. Self-harm reasons, goal achievement, and prediction of future self-harm intent. J Nerv Ment Dis. 2010;198:362–369. doi: 10.1097/NMD.0b013e3181da8500.
    1. Lloyd EE, Kelley ML, Hope T (1997) Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Poster session at the annual meeting of the Society for Behavioral Medicine, New Orleans, LA
    1. Lloyd-Richardson E, Perrine N, Dierker L, Kelley ML. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007;37:1183–1192. doi: 10.1017/S003329170700027X.
    1. Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health. 2012;6:10. doi: 10.1186/1753-2000-6-10.
    1. Nock MK, Prinstein MJ. A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol. 2004;72:885–890. doi: 10.1037/0022-006X.72.5.885.
    1. Nock MK, Prinstein MJ. Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol. 2005;114:140–146. doi: 10.1037/0021-843X.114.1.140.
    1. Nock MK, Holmberg EB, Photos VI, Michel BD. Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychol Assess. 2007;19(3):309–317. doi: 10.1037/1040-3590.19.3.309.
    1. Ross S, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc. 2002;31:67–77. doi: 10.1023/A:1014089117419.
    1. Warner RM (2012) Applied statistics: from bivariate through multivariate techniques (Chapter 20: Principal Components and Factor Analysis). Sage Publications, California
    1. Washburn JJ, Juzwin KR, Styer DM, Aldrige D. Measuring the urge to self-injure: preliminary data from a clinical sample. Psychiatry Res. 2010;178:540–544. doi: 10.1016/j.psychres.2010.05.018.
    1. Whitlock J, Eckenrode J, Silverman D. Self-injurious behaviors in a college population. Pediatrics. 2006;117:1939–1948. doi: 10.1542/peds.2005-2543.
    1. Wilkinson P, Kelvin R, Roberts C, Dubicka B, Goodyer I. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-Injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT) Am J Psychiatry. 2011;168:495–501. doi: 10.1176/appi.ajp.2010.10050718.
    1. Young R, Sproeber N, Groschwitz RC, Preiss M, Plener PL. Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity. BMC Psychiatry. 2014;14:137. doi: 10.1186/1471-244X-14-137.

Source: PubMed

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