Skip to main content
SpringerLink
Log in

Impact of Non-Suicidal Self-Injury Scale: Initial Psychometric Validation

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

The current study examined the psychometric properties of the impact of non-suicidal self-injury scale (INS), a scale developed to assess the social, behavioral, and emotional consequences of engaging in non-suicidal self-injury (NSSI). University students (N=128) who endorsed a history of NSSI were administered the INS, as well as measures of hypothesized convergent and divergent validity. Results suggested that the INS is best conceptualized as a one-factor scale, and internal consistency analyses indicated excellent reliability. The INS was significantly correlated with well-known measures of NSSI severity (i.e., NSSI frequency, NSSI recency), and measures of suicide attempt history and emotional reactivity. Logistic regression analyses indicated that the INS contributed unique variance to the prediction of physical disfigurement (i.e., NSSI scarring) and clinically significant social anxiety, even after taking into account NSSI frequency. Furthermore, the INS demonstrated divergent validity. Implications for research on NSSI disorder and clinical practice are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotion dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39, 389–400. doi:10.1007/s10802-010-9465-3.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Andover, M. S. (2014). Non-suicidal self-injury disorder in a community sample of adults. Psychiatry Research, 219, 305–310. doi:10.1016/j.psychres.2014.06.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Andover, M. S., & Gibb, B. E. (2010). Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Research, 178, 101–105. doi:10.1016/j.psychres.2010.03.019.

    Article  PubMed  Google Scholar 

  • Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., et al. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 772–781. doi:10.1016/j.jaac.2011.04.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bachtelle, S. E., & Pepper, C. M. (2015). The physical results of nonsuicidal self-injury: The meaning behind the scars. The Journal of Nervous and Mental Disease, 203(12), 927–933.

  • Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. doi:10.1080/15402002.2011.606766.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory, second edition (BDI-II). San Antonio, TX: The Psychological Association.

    Google Scholar 

  • Bently, K. H., Cassiello-Robbins, C. F., Vittorio, L., Sauer-Zavala, S., & Barlow, D. H. (2015). The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clinical Psychology Review, 10, 65–78. doi:10.1016/j.cpr.2015.02.006.

    Google Scholar 

  • Boxer, P. (2010). Covariation of self-and other-directed aggression among inpatient youth: Continuity in the transition to treatment and shared risk factors. Aggressive Behavior,. doi:10.1002/ab.20343.

    PubMed  PubMed Central  Google Scholar 

  • Braga, C., & Gonçalves, S. (2014). Non suicidal self injury, psychopathology and attachment: A study with university students. The Spanish Journal of Psychology, 17, E66. doi:10.1017/sjp.2014.66.

    Article  PubMed  Google Scholar 

  • Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68, 609–620.

    Article  CAS  PubMed  Google Scholar 

  • Brown, E. J., Turovksy, J., Heimberg, R. G., Juster, H. R., Brown, T. A., & Barlow, D. H. (1997). Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders. Psychological Assessment, 9, 21–27.

    Article  Google Scholar 

  • Burke, T. A., Stange, J. P., Hamilton, J. L., Cohen, J. N., O’Garro-Moore, J., Daryanani, I., et al. (2015). Cognitive and emotion-regulatory mediators of the relationship between behavioral approach system sensitivity and nonsuicidal self-injury frequency. Suicide and Life Threatening Behavior, 45, 495–504. doi:10.1111/sltb.12145.

    Article  PubMed  Google Scholar 

  • Chandler, A. (2014). Narrating the self-injured body. Medical Humanities, 40(2), 111–116.

  • Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents: Prevalence and associations with identity formation above and beyond depression. Personality and Individual Differences, 61, 101–104. doi:10.1016/j.paid.2013.12.019.

    Article  Google Scholar 

  • Cohen, J. N., Heimberg, R. G., Burke, T. A., Hamilton, J. L., Jenkins, A., & Alloy, L. B. (2015). The interaction of affective states and cognitive vulnerabilities in the prediction of non-suicidal self-injury. Cognition and Emotion, 29, 539-9. doi:10.1080/02699931.2014.918872.

    Article  Google Scholar 

  • Darche, M. A. (1990). Psychological factors differentiating self-mutilating and non-self-mutilating inpatient females. The Psychiatric Hospital, 21, 31–35.

    Google Scholar 

  • Deliberto, T. L., & Nock, M. K. (2008). An exploratory study of correlates, onset, and offset of non-suicidal self-injury. Archives of Suicide Research, 12(3), 219–231.

  • DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 151, 1305–1311.

    Google Scholar 

  • Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4, 272–299. doi:10.1037/1082-989X.4.3.272.

    Article  Google Scholar 

  • Favazza, A. R. (1989). Normal and deviant self-mutilation: An essay-review. Transcultural Psychiatric Research Review, 26, 113–127. doi:10.1177/136346158902600202.

    Article  Google Scholar 

  • Floyd, F. J., & Widaman, K. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7, 286.

    Article  Google Scholar 

  • Glenn, C. R., Blumenthal, T. D., Klonsky, E. D., & Hajcak, G. (2011). Emotion reactivity in nonsuicidal self-injury: Divergence between self report and startle measures. International Journal of Psychophysiology, 80, 166–170. doi:10.1016/j.ijpsycho.2011.02.016.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253–263. doi:10.1023/A:1012779403943.

    Article  Google Scholar 

  • Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10(2), 192–205. doi:10.1093/clipsy.bpg022.

    Google Scholar 

  • Gratz, K. L., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2015). Diagnosis and characterization of DSM-5 nonsuicidal self-injury disorder using the clinician-administered nonsuicidal self-injury disorder index. Assessment, 22, 527–539. doi:10.1177/1073191114565878.

    Article  PubMed  Google Scholar 

  • Hankin, B. L., Stone, L. B., & Wright, P. A. (2010). Co-rumination, interpersonal stress generation, and internalizing symptoms: Accumulating effects and transactional influences in a multi-wave study of adolescents. Development and Psychopathology, 22, 217–235. doi:10.1017/S0954579409990368.

    Article  PubMed  PubMed Central  Google Scholar 

  • Heimberg, R. G., Mueller, G. P., Holt, C. S., Hope, D. A., & Liebowitz, M. R. (1992). Assessment of anxiety in social interaction and being observed by others: The Social Interaction Anxiety Scale and the Social Phobia Scale. Behavior Therapy, 23, 53–73. doi:10.1016/S0005-7894(05)80308-9.

    Article  Google Scholar 

  • Hinshaw, S. P., & Stier, A. (2008). Stigma as related to mental disorders. Annual Review of Clinical Psychology, 4(1), 367–393. doi:10.1146/annurev.clinpsy.4.022007.141245.

  • Hodgson, S. (2004). Cutting through the silence: A sociological construction of self-injury. Sociological Inquiry, 74(2), 162–179.

  • In-Albon, T., Ruf, C., & Schmid, M. (2013). Proposed diagnostic criteria fro the DSM-5 of non-suicidal self-injury in female adolescents: Diagnostic and clinical correlates. Psychiatry Journal,. doi:10.1155/2013/159208.

    PubMed  PubMed Central  Google Scholar 

  • Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11, 129–147. doi:10.1080/13811110701247602.

    Article  PubMed  Google Scholar 

  • Kerr, P. L., & Muehlenkamp, J. J. (2010). Features of psychopathology in self-injuring female college students. Journal of Mental Health Counseling, 32, 290–308. doi:10.17744/mehc.32.4.r805820715t6124q.

    Article  Google Scholar 

  • Keuthen, N. J., Deckersbach, T., Wilhelm, S., Engelhard, I., Forker, A., O’Sullivan, R. L., et al. (2001). The Skin Picking Impact Scale (SPIS): Scale development and psychometric analyses. Psychosomatics, 42, 397–403. doi:10.1176/appi.psy.42.5.397.

    Article  CAS  PubMed  Google Scholar 

  • Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41, 1981–1986. doi:10.1017/S0033291710002497.

    Article  CAS  PubMed  Google Scholar 

  • Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122, 231–237. doi:10.1037/a0030278.

    Article  PubMed  Google Scholar 

  • Klonsky, D. E., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology. In Session, 63, 1045–1056. doi:10.1002/jclp.20412.

    Article  PubMed  Google Scholar 

  • Kuentzel, J. G., Arble, E., Boutros, N., Chugani, D., & Barnett, D. (2012). Nonsuicidal self-injury in an ethnically diverse college sample. The American Journal of Orthopsychiatry, 82, 291–297. doi:10.1111/j.1939-0025.20.

    Article  PubMed  Google Scholar 

  • Kumar, G., Steer, R. A., Teitelman, K. B., & Villacis, L. (2002). Effectiveness of Beck Depression Inventory–II subscales in screening for major depressive disorders in adolescent psychiatric inpatients. Assessment, 9(2), 164–170. doi:10.1177/10791102009002007.

    Article  PubMed  Google Scholar 

  • Leibenluft, E., Gardner, D. L., & Cowdry, R. W. (1987). Special feature the inner experience of the borderline self-mutilator. Journal of Personality Disorders, 1(4), 317–324.

  • Lewis, S. P., & Baker, T. G. (2011). The possible risks of self-injury web sites: A content analysis. Archives of Suicide Research, 15(4), 390. doi:10.1080/13811118.2011.616154.

  • Lewis, S. P., & Mehrabkhani, S. (2016). Every scar tells a story: Insight into people’s self-injury scar experiences. Counselling Psychology Quarterly, 29(3), 296–310.

  • Lundh, L., Wångby-Lundh, M., & Bjärehed, J. (2011). Deliberate self-harm and psychological problems in young adolescents: Evidence of a bidirectional relationship in girls. Scandinavian Journal of Psychology, 52, 476–483. doi:10.1111/j.1467-9450.2011.00894.x.

  • Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behavior Research and Therapy, 36, 455–470. doi:10.1016/S0005-7967(97)10031-6.

    Article  CAS  Google Scholar 

  • Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 1–9. doi:10.1186/1753-2000-6-10.

    Article  Google Scholar 

  • Nock, M. K. (2009). Why do people hurt themselves?: New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18, 78–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nock, M. K., Wedig, M. M., Holmberg, E. B., & Hooley, J. M. (2008). The emotion reactivity scale: Development, evaluation, and relation to self-injurious thoughts and behaviors. Behavior Therapy, 39(2), 107–116. doi:10.1016/j.beth.2007.05.005.

    Article  PubMed  Google Scholar 

  • O’Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instruments, & Computers, 32, 396–402. doi:10.3758/BF03200807.

    Article  Google Scholar 

  • Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2015). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225(3), 276–282. doi:10.1016/j.psychres.2014.12.026.

    Article  PubMed  Google Scholar 

  • Rodebaugh, T. L., Heimberg, R. G., Brown, P. J., Fernandez, K. C., Blanco, C., Schneier, F. R., et al. (2011). More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety. Journal of Affective Disorders, 25, 623–630. doi:10.1016/j.janxdis.2011.02.002.

    Google Scholar 

  • Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The reverse of social anxiety is not always the opposite: The reverse-scored items of the Social Interaction Anxiety Scale do not belong. Behavior Therapy, 38, 192–206. doi:10.1016/j.beth.2006.08.001.

    Article  PubMed  Google Scholar 

  • Rodebaugh, T. L., Woods, C. M., Heimberg, R. G., Liebowitz, M. R., & Schneier, F. R. (2006). The factor structure and screening utility of the Social Interaction Anxiety Scale. Psychological Assessment, 18, 231–237. doi:10.1037/1040-3590.18.2.

    Article  PubMed  Google Scholar 

  • Rose, A. (2002). Co-rumination in the friendships of boys and girls. Child Development, 73, 1830–1843. doi:10.1111/1467-8624.00509.

    Article  PubMed  Google Scholar 

  • Safren, S. A., Turk, C. L., & Heimberg, R. G. (1998). Factor structure of the social interaction anxiety scale and the social phobia scale. Behaviour Research and Therapy, 36, 443–453. doi:10.1016/j.paid.2016.02.086.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz, R. H., Cohen, P., Hoffmann, N. G., & Meeks, J. E. (1989). Self-harm behaviors (carving) in female adolescent drug abusers. Clinical Pediatrics, 28, 340–346. doi:10.1177/000992288902800801.

    Article  CAS  PubMed  Google Scholar 

  • Selby, E. A., Bender, T. W., Gordon, K. H., Nock, M. K., & Joiner, T. E., Jr. (2012). Non-suicidal self-injury (NSSI) disorder: A preliminary study. Personality Disorders: Theory, Research, and Treatment, 3, 1–9. doi:10.1037/a0024405.

    Article  Google Scholar 

  • Snorrason, I., Olafsson, R. P., Flessner, C. A., Keuthen, N. J., Franklin, M. E., & Woods, D. W. (2013). The skin picking impact scale: Factor structure, validity and development of a short version. Scandinavian Journal of Psychology, 54(4), 344–348.

  • Storch, E. A., Roberti, J. W., & Roth, D. A. (2004). Factor structure, concurrent validity, and internal consistency of the beck depression inventory—Second edition in a sample of college students. Depression and Anxiety, 19, 187–189. doi:10.1002/da.20002.

    Article  PubMed  Google Scholar 

  • Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44, 273–303. doi:10.1111/sltb.12070.

    Article  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn and Bacon.

    Google Scholar 

  • Taliaferro, L. A., & Muehlenkamp, J. J. (2015). Risk factors associated with self-injurious behavior among a national sample of undergraduate college students. Journal of American College Health, 63, 40–48. doi:10.1080/07448481.2014.953166.

    Article  PubMed  Google Scholar 

  • Tatnell, R., Kelada, L., Hasking, P., & Martin, G. (2014). Longitudinal analysis of adolescent NSSI: The role of intrapersonal and interpersonal factors. Journal of Abnormal Child Psychology, 42, 885–896. doi:10.1007/s10802-013-9837-6.

    Article  PubMed  Google Scholar 

  • Turner, B. J., Chapman, A. L., & Gratz, K. L. (2014). Why stop self-injuring? Development of the reasons to stop self-injury questionnaire. Behavior Modification, 38(1), 69–106.

  • Victor, S. E., & Klonsky, E. D. (2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34(4), 282–297.

  • Washburn, J. J., Potthoff, L. M., Juzwin, K. R., & Styer, D. M. (2015). Assessing DSM-5 nonsuicidal self-injury disorder in a clinical sample. Psychological Assessment, 27, 31–41. doi:10.1037/pas0000021.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948. doi:10.1542/peds.2005-2543.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Muehlenkamp, J., Eckenrode, J., Purington, A., Abrams, G. B., Barreira, P., et al. (2013). Nonsuicidal self-injury as a gateway to suicide in young adults. Journal of Adolescent Health, 52, 486–492. doi:10.1016/j.jadohealth.2012.09.010.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Muehlenkamp, J., Purington, A., Eckenrode, J., Barreira, P., Baral Abrams, G., et al. (2011). Nonsuicidal self-injury in a college population: General trends and sex differences. Journal of American College Health, 59(8), 691–698. doi:10.1080/07448481.2010.529626.

    Article  PubMed  Google Scholar 

  • Young, R., Van Beinum, M., Sweeting, H., & West, P. (2007). Young people who self-harm. The British Journal of Psychiatry, 191(1), 44–49.

  • Zetterqvist, M., Lundh, L. G., Dahlström, Ö., & Svedin, C. G. (2013). Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Journal of Abnormal Child Psychology, 41, 759–773. doi:10.1007/s10802-013-9712-5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychology Department, Temple University, Weiss Hall, 1701 N 13th St., Philadelphia, PA, 19122, USA

    Taylor A. Burke, Brooke A. Ammerman, Jessica L. Hamilton & Lauren B. Alloy

Authors
  1. Taylor A. Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brooke A. Ammerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica L. Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lauren B. Alloy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taylor A. Burke.

Ethics declarations

Conflict of Interest

Taylor A. Burke, Brooke A. Ammerman, Jessica L. Hamilton, and Lauren B. Alloy declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burke, T.A., Ammerman, B.A., Hamilton, J.L. et al. Impact of Non-Suicidal Self-Injury Scale: Initial Psychometric Validation. Cogn Ther Res 41, 130–142 (2017). https://doi.org/10.1007/s10608-016-9806-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-016-9806-9

Keywords

Search

Navigation