Why Do People Hurt Themselves?: New Insights Into the Nature and Functions of Self-Injury

ABSTRACT— Nonsuicidal self-injury (NSSI) is a prevalent but perplexing behavior problem in which people deliberately harm themselves without lethal intent. Research reveals that NSSI typically has its onset during early adolescence; most often involves cutting or carving the skin; and appears equally prevalent across sexes, ethnicities, and socioeconomic statuses. Less is known about why people engage in NSSI. This article presents a theoretical model of the development and maintenance of NSSI. Rather than a symptom of mental disorder, NSSI is conceptualized as a harmful behavior that can serve several intrapersonal (e.g., affect regulation) and interpersonal (e.g., help-seeking) functions. Risk of NSSI is increased by general factors that contribute to problems with affect regulation or interpersonal communication (e.g., childhood abuse) and by specific factors that influence the decision to use NSSI rather than some other behavior to serve these functions (e.g., social modeling). This model synthesizes research from several different areas of the literature and points toward several lines of research needed to further advance the understanding of why people hurt themselves.     

青少年非自杀性自伤行为持续和停止的预测性因素

非自杀性自伤是指个体在没有自杀意图的情况下故意伤害自己的身体,且不被社会所认可的行为,是个体未来自杀意图、自杀行为以及长期心理障碍等问题的重要风险因素。青少年作为高发人群,非自杀性自伤行为会对其身心健康造成严重危害,且具有明显的社会“传染”效应。因此了解对青少年非自杀性自伤行为的持续或停止具有预测作用的因素,有助于为该行为的早期预防及干预提供新视角。 通过梳理国内外采用纵向追踪、回溯性研究等方法的相关文献,并基于Nock的整合理论模型,将青少年非自杀性自伤行为的持续或停止具有预测作用的因素划分为生理机制、个人特质和社会因素三类。在生理机制上,青少年非自杀性自伤行为的持续或停止存在一定的神经生物学基础,如当青少年体内的β-内啡肽水平、杏仁核-额叶之间的静息态功能连接(RSFC)处于异常状态时,个体为恢复体内平衡,可能会对非自杀性自伤行为产生依赖,进而将该行为持续下去。在个人特质上,情绪调节存在缺陷的青少年更易出现并维持非自杀性自伤行为,而善于接受自己的情绪反应且能够使用适应性情绪调节策略的青少年在未来更易停止该行为;具有边缘型人格障碍、冲动型人格特征、低自尊水平、高自我批评与自我惩罚水平等特点的青少年通常会在较长时间内持续非自杀性自伤行为,相反,具有高自尊水平、对逆境持积极信念、低自我惩罚水平等特点的青少年则更可能停止该行为;青少年所依赖的非自杀性自伤功能也会影响该行为的发展进程,因自我功能(如情绪调节、自我惩罚等)而依赖于非自杀性自伤的青少年有很大的可能性长时间维持这一行为,而因人际功能(如引起他人关注、融入群体等)而依赖于非自杀性自伤的青少年在一段时间后更有可能停止该行为。在社会因素上,如同伴欺凌、不良家庭关系等风险因素可能会削弱个体应对痛苦的能力,进而诱发或加剧青少年的非自杀性自伤行为,反之,有效的社会支持资源(如同伴支持、家庭支持、心理咨询与治疗等)则有助于青少年非自杀性自伤行为的停止。 目前国内外相关研究多集中于非自杀性自伤行为的流行、研究方法、相关影响因素和功能等领域,对非自杀性自伤行为持续或停止的理论和实践探讨相对较少,未来相关研究应注意采用多样化的研究方法及非自杀性自伤行为测量技术,拓展研究领域(如性格、认知取向等),同时还应关注不同的年龄群体及文化背景差异,以进一步明确对非自杀性自伤行为发展进程具有显著预测作用的风险因素和保护性因素,并深入探究各因素之间的交互作用。     

Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury

Although emotion regulation deficits have been frequently implicated in the incidence of nonsuicidal self-injurious behavior (NSSI), no research to date has examined in vivo change of affect associated with real-world NSSI behavior. The present study employed Ecological Momentary Assessment (EMA) to assess change in affect associated with episodes of experienced NSSI in a sample of 36 college students with a self-reported history of NSSI. Results indicated that individuals who reported NSSI behavior over the course of the study experienced increases in negative affect prior to an episode of NSSI that peaked during the episode and faded gradually in the hours following the episode, with affect change roughly approximating a quadratic curve. These changes in affect were detected only at times in which individuals engaged in NSSI and were absent for individuals who did not report NSSI over the course of the study. Moreover, changes in negative affect associated with NSSI were, on average, detectable hours prior to the NSSI event. These findings suggest that episodes of NSSI may be predicted through a careful examination of affect change long before actual NSSI behavior occurs.     

Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions

The aims of the present study were to determine the prevalence of non-suicidal self-injury (NSSI) in different eating disorder (ED) groups and morbid obesity, and to investigate whether NSSI in different ED/obesity groups co-occur with impulsivity. We assessed 535 individuals (365 ED and 170 obese patients) by means of a single item assessing lifetime NSSI and the Barratt Impulsivity Scale, which measures different dimensions of impulsivity. The results showed that 19.1% of the ED patients engaged in at least one act of NSSI during their life-time. NSSI was more prevalent in Bulimia Nervosa, Binge Eating Disorder, Eating Disorder Not Otherwise Specified compared to Anorexia Nervosa, Restrictive type and morbid obesity. Finally, ED/obese patients who engaged in NSSI scored significantly higher on the attentional, motor and non-planning subscales than patients without NSSI. The implications of these findings for the treatment of NSSI in binge/purging ED patients are discussed.     

Composite Trauma and Mental Health Diagnosis as Predictors of Lifetime Nonsuicidal Self-Injury History in an Adult Online Sample

Some research indicates that trauma history might be related to nonsuicidal self-injury (NSSI), but the exact nature of this relationship is unknown. Therefore, we created and tested a structural equation model for the relationships between composite trauma, NSSI, mental health diagnosis, and gender in a community sample of 296 U.S. adults recruited through Amazon Mechanical Turk. Composite trauma and mental health diagnosis were significantly predictive of an NSSI history. The pathway between NSSI and gender was not significant. It is important to consider multiple domains of trauma, in the form of composite lifetime trauma, as risk factors for NSSI.     

Cutting the silence: initial,impulsive self-cutting in adolescence

The paper explores initial, impulsive self-cutting in adolescence and conceives of early cutting as having the most potential for a communicative function, as the adolescents themselves and those around them may be most shocked at their self-harm. The author also conceives of the symptom of early, initial cutting as an effort to ‘cut through’ an emotional and familial circumstance that has been silent, suggesting that cutting generally implies a failure in containment and symbolisation. Using Green’s (1975) discussion of the original word symbol as ‘an object cut in two, constituting a sign of recognition when those who carry it can assemble the two pieces’ (Dictionnaires Le Robert), the author demonstrates that cutting has the potential to elicit intense feelings in the analyst who can have (in Green’s terms) a homologous experience to that of the patient. This elaboration within the analyst’s feelings returns a part to the patient. The meeting of the two communications (the patient’s cutting and the elaboration in the analyst’s mind) can create a potential space between them. The paper uses clinical vignettes and extended clinical material from a 16-year-old girl to elucidate the relationship between cutting – an emotionally inarticulate state – and the development of communication, containment and symbolisation through homologous experiences in the analyst.     

累积环境风险与大学生自伤的关系:情绪调节策略的作用

通过两个子研究分别考察累积环境风险与大学生自伤行为间的关系模式,并探讨注意分散与认知重评两种情绪调节策略对高风险大学生自伤意图的缓解作用。研究1在1066名大学生中采用问卷调查,探索累积环境风险对大学生自伤行为的作用及模式。基于研究1的结果,研究2选取符合高风险背景的62名大学生为被试,采用实验室实验对两种情绪调节策略的作用予以考察。本研究结果表明：累积环境风险对男女大学生自伤行为均有显著的正向作用,且均符合非线性“正加速模式”,但男生群体随累积风险数量增加而引发的自伤行为增长速度明显快于女生。对于高环境风险背景下的大学生,注意分散和认知重评两种策略均能降低其自伤倾向性与自伤认同,但不能降低其自伤意念。这提示应重视对经历了高环境风险的大学生进行情绪调节策略等方面的干预,以减少其采取自伤行为的倾向性。     

TREATING SELF-INJURY: WATER MIST SPRAY VERSUS FACIAL SCREENING OR FORCED ARM EXERCISE

In three experiments, the effect of water mist spray on self-injurious and collateral behaviors was compared with either facial screening or forced arm exercise. Water mist spray was as effective as facial screening in suppressing face-slapping in Experiment 1. However, it was not as effective as facial screening for self-injurious finger-licking in Experiment 2 or forced arm exercise for excessive ear-rubbing in Experiment 3. These results suggest that while water mist spray is effective, it may be less so than alternative procedures. In Experiments 2 and 3 there was a consistent decrease in the occurrence of untreated maladaptive behaviors. In addition, there was a moderate increase in appropriate social interaction in Experiment 2 and a substantial increase in Experiment 3.     

FUNCTIONAL ANALYSIS AND TREATMENT OF EYE POKING

In four studies we analyzed the eye poking of a youth with profound disabilities. In Study 1, a functional analysis showed that eye poking occurred during the no-attention condition, but not during demand, attention, or recreation conditions. The analysis did not identify socially mediated variables involved in the maintenance of eye poking; rather, eye poking may have been maintained by consequences produced directly by the response. In Study 2 we had the student wear goggles to prevent potential reinforcement from finger—eye contact. The results of Study 2 indicated that eye-poking attempts were reduced when the student wore goggles. We then tested in Study 3 the effects of two alternative topographies of stimulation. Study 3 demonstrated that eye poking was reduced when a video game was provided as a competing source of visual stimulation, and that music was less effective in reducing eye poking. In Study 4, a contingency analysis using the video game was conducted in an attempt to (a) reduce the frequency of eye poking and (b) study whether the video game functioned as a reinforcer. The results of Study 4 demonstrated substantive reductions in the frequency of eye poking, and suggested that the video game served as a reinforcer.     

FUNCTIONAL ANALYSIS OF EPISODIC SELF-INJURY CORRELATED WITH RECURRENT OTITIS MEDIA

A functional analysis examined the consequences that maintained episodic self-injury and the relationship between those consequences and otitis media for a child with moderate developmental disabilities. Results indicated that self-injury occurred only during periods of otitis media. Otitis media may have served as an establishing operation related to escape from ambient noise.