European Child & Adolescent Psychiatry

, Volume 21, Issue 9, pp 511–520 | Cite as

Adolescent nonsuicidal self-injury: the effects of personality traits, family relationships and maltreatment on the presence and severity of behaviours

  • Rossella Di PierroEmail author
  • Irene Sarno
  • Sara Perego
  • Marcello Gallucci
  • Fabio Madeddu
Original Contribution


Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.


Adolescence Nonsuicidal self-injury Family environment Personality Maltreatment 


  1. 1.
    Nock MK, Prinstein MJ (2004) A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol 72:885–890PubMedCrossRefGoogle Scholar
  2. 2.
    Herpertz S (1995) Self-injurious behavior: psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand 91:57–68PubMedCrossRefGoogle Scholar
  3. 3.
    Claes L, Vandereycken W (2007) Self-injurious behavior: differential diagnosis and functional differentiation. Compr Psychiatry 48:137–144PubMedCrossRefGoogle Scholar
  4. 4.
    Favazza AR (1998) The coming of age of self mutilation. J Nerv Ment Dis 186:259–268PubMedCrossRefGoogle Scholar
  5. 5.
    Sarno I, Madeddu F, Gratz KL (2010) Self-injury, psychiatric symptoms, and defense mechanisms: findings in an Italian nonclinical sample. Eur Psychiatry 25:136–145PubMedCrossRefGoogle Scholar
  6. 6.
    Resch F, Parzer P, Brunner R, the BELLA study group (2008) Self-mutilation and suicidal behavior in children and adolescents: prevalence and psychosocial correlates: results of the BELLA study. Eur Child Adolesc Psychiatry 17:92–98PubMedCrossRefGoogle Scholar
  7. 7.
    Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML (2007) Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med 37(8):1183–1192PubMedCrossRefGoogle Scholar
  8. 8.
    Cerutti R, Manca M, Presaghi F, Gratz KL (2011) Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian adolescents. J Adolesc 34:337–347PubMedCrossRefGoogle Scholar
  9. 9.
    Ross S, Heath N (2002) A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 31(19):67–77CrossRefGoogle Scholar
  10. 10.
    Nixon MK, Cloutier PF, Aggarwal S (2002) Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. J Am Acad Child Psychiatry 41:1333–1341CrossRefGoogle Scholar
  11. 11.
    Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ (2009) An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med 39(9):1549–1558PubMedCrossRefGoogle Scholar
  12. 12.
    Heath NL, Toste JR, Nedecheva T, Charlebois A (2008) An examination of non-suicidal self-injury among college students. J Ment Health Counsel 30(2):1–20Google Scholar
  13. 13.
    Hilt LM, Nock MK, Lloyd-Richardson EE, Prinstein MJ (2008) Longitudinal study of nonsuicidal self-injury among young adolescents: rates, correlates, and preliminary test of an interpersonal model. J Early Adolesc 28(3):455–469CrossRefGoogle Scholar
  14. 14.
    Goldstein AL, Flett GL, Wekerle C, Wall AM (2009) Personality, child maltreatment, and substance use: examining correlates of deliberate self-harm among university students. Can J Behav Sci 41(4):241–251CrossRefGoogle Scholar
  15. 15.
    Klonsky ED, Oltmanns TF, Turkheimer E (2003) Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 160:1501–1508PubMedCrossRefGoogle Scholar
  16. 16.
    Laukkanen E, Rissanen ML, Honkalampi K, Kylma J, Tolmunen T, Hintikka J (2009) The prevalence of self-cutting and other self-harm among 13- to 18-year-old Finnish adolescents. Soc Psychiatry Psychiatr Epidemiol 44:23–28PubMedCrossRefGoogle Scholar
  17. 17.
    O’Connor RC, Rasmussen S, Hawton K (2009) Predicting deliberate self-harm in adolescents: a six month prospective study. Suicide Life-Threat 39:364–375CrossRefGoogle Scholar
  18. 18.
    Gollust SE, Eisenberg D, Golberstein E (2008) Prevalence and correlates of self-injury among university students. J Am Coll Health 56:491–498PubMedCrossRefGoogle Scholar
  19. 19.
    Janis IB, Nock MK (2009) Are self-injurers impulsive? Results from two behavioral laboratory studies. Psychiatry Res 169:261–267PubMedCrossRefGoogle Scholar
  20. 20.
    Holmqvist R, Carlberg M, Hellgren L (2008) Deliberate self-harm behavior in Swedish adolescent girls reports from public assessment and treatment agencies. Child Youth Care Forum 37:1–13CrossRefGoogle Scholar
  21. 21.
    Castille K, Prout M, Marczyk G, Shmidheiser M, Yoder S, Howlett B (2007) The early maladaptive schemas of self-mutilators: implications for therapy. J Cogn Psychother 21(1):58–71CrossRefGoogle Scholar
  22. 22.
    Baetens I, Claes L, Willem L, Muehlenkamp JJ, Bijttebier P (2011) The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child- and parent-report. Pers Individ Differ 50:527–530CrossRefGoogle Scholar
  23. 23.
    Glenn CR, Klonsky ED (2010) A multimethod analysis of impulsivity in nonsuicidal self-injury. Pers Disord Theor Res Treat 1(1):67–75CrossRefGoogle Scholar
  24. 24.
    Fliege H, Lee JR, Grimm A, Klapp BF (2009) Risk factors and correlates of deliberate self-harm behavior: a systematic review. J Psychosom Res 66:477–493PubMedCrossRefGoogle Scholar
  25. 25.
    Herpertz S, Sass H, Favazza A (1997) Impulsivity in self-mutilative behavior: psychometric and biological findings. J Psychiatr Res 31:451–465PubMedCrossRefGoogle Scholar
  26. 26.
    van der Kolk BA, Perry C, Herman JL (1991) Childhood origins of self-destructive behavior. Am J Psychiatry 148:1665–1671PubMedGoogle Scholar
  27. 27.
    Boxer P (2010) Covariation of self- and other-directed aggression among inpatient youth: continuity in the transition to treatment and shared risk factors. Aggress Behav 36:205–217PubMedGoogle Scholar
  28. 28.
    King CA, Knox MS, Henninger N, Nguyen TA, Ghaziuddin N, Maker A, Hanna GL (2006) Major depressive disorder in adolescents: family psychiatric history predicts severe behavioral disinhibition. J Affect Disord 90:111–121PubMedCrossRefGoogle Scholar
  29. 29.
    Kerr DCR, Washburn JJ, Feingold A, Kramer AC, Ivey AZ, King CA (2008) Sequelae of aggression in acutely suicidal adolescents. J Abnorm Child Psychol 35:817–830CrossRefGoogle Scholar
  30. 30.
    Baetens I, Claes L, Muehlenkamp J, Grietens H, Onghena P (2012) Differences in psychological symptoms and self-competencies in non-suicidal self-injurious Flemish adolescents. J Adolesc. doi: 10.1016/j.adolescence.2011.11.001
  31. 31.
    Gratz KL (2006) Risk factors for deliberate self-harm among female college students: the role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. Am J Orthopsychiatry 76(2):238–250PubMedCrossRefGoogle Scholar
  32. 32.
    Gratz KL (2003) Risk factors and functions of deliberate self-harm: an empirical and conceptual review. Clin Psychol Sci Pract 10(2):192–205CrossRefGoogle Scholar
  33. 33.
    Yates TM, Carlson EA, Byron E (2008) A prospective study of child maltreatment and self-injurious behavior in a community sample. Dev Psychopathol 20:651–671PubMedCrossRefGoogle Scholar
  34. 34.
    Glassman LH, Weierich MR, Hooley JM, Nock MK (2007) Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Behav Res Ther 45:2483–2490PubMedCrossRefGoogle Scholar
  35. 35.
    Zoroglu SS, Tuzun U, Sar V, Tutkun H, Savas HA, Ozturk M, Alyanak B, Kora ME (2003) Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry Clin Neurosci 57:119–126PubMedCrossRefGoogle Scholar
  36. 36.
    Klonsky ED (2008) Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry 192:166–170PubMedCrossRefGoogle Scholar
  37. 37.
    Whitlock J, Eckenrode J, Silverman D (2006) Self-injurious behaviors in a college population. Pediatrics 117:1939–1948PubMedCrossRefGoogle Scholar
  38. 38.
    Gratz KL, Chapman AL (2007) The role of emotional responding and childhood maltreatment in the development and maintenance of deliberate self-harm among male undergraduates. Psychol Men Masc 8:1–14CrossRefGoogle Scholar
  39. 39.
    Dubo ED, Zanarini MC, Lewis RE, Williams AA (1997) Childhood antecedents of self-destructiveness in borderline personality disorder. Can J Psychiatry 42:63–69PubMedGoogle Scholar
  40. 40.
    Wiederman MW, Sansone RA, Sansone LA (1999) Bodily self-harm and its relationship to childhood abuse among women in a primary care setting. Violence Against Women 5:155–163CrossRefGoogle Scholar
  41. 41.
    Zweig-Frank H, Paris J, Guzder J (1994) Psychological risk factors and self-mutilation in male patients with BPD. Can J Psychiatry 39:266–268PubMedGoogle Scholar
  42. 42.
    Zweig-Frank H, Paris J, Guzder J (1994) Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder. Can J Psychiatry 39:259–264PubMedGoogle Scholar
  43. 43.
    Brunner R, Parzer P, Haffner J, Steen R, Roos J, Klett M et al (2007) Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolosc Med 7:641–649CrossRefGoogle Scholar
  44. 44.
    Yates TM, Carlson EA (2003) Self-injurious behavior questionnaire. University of Minnesota, Minneapolis, MNGoogle Scholar
  45. 45.
    Claes L, Vandereycken W (2007) The self-injury questionnaire-treatment related (SIQ-TR): construction, reliability, and validity in a sample of female eating disorder patients. In: Goldfarb PM (ed) Psychological tests and testing research trends. Nova Science Publishers, New YorkGoogle Scholar
  46. 46.
    Sansone RA, Wiederman MW, Sansone LA (1998) The self-harm inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol 54:973–983PubMedCrossRefGoogle Scholar
  47. 47.
    Brook JS, Brook DV, Gordon S, Whiteman M, Cohen P (1990) The psychosocial etiology of adolescent drug use: a family interactional approach. Genet Soc Gen Psychol Monogr 116(2):111–267PubMedGoogle Scholar
  48. 48.
    Bird HR, Canino G, Davies M, Duarte CS, Febo V, Ramírez R, Hoven C, Wicks J, Musa G, Loeber R (2006) A study of disruptive behavior disorders in Puerto Rican youth: I. Background, design and survey methods. J Am Acad Child Psychiatry 45:1032–1041CrossRefGoogle Scholar
  49. 49.
    Goodman SH, Hoven CW, Narrow WE, Cohen P, Fielding B et al (1998) Measurement of risk for mental disorders and competence in a psychiatric epidemiologic community survey: the National Institute of Mental Health Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Soc Psychiatry Psychiatr Epidemiol 33(4):162–173PubMedCrossRefGoogle Scholar
  50. 50.
    Finkelhor D, Dziuba-Leatherman J (1994) Children as victims of violence: a national survey. Pediatrics 94(4):413–420PubMedGoogle Scholar
  51. 51.
    Sheng Y, Sheng Z (2012) Is coefficient alpha robust to non-normal data? Front Psychol 3:34–47PubMedCrossRefGoogle Scholar
  52. 52.
    Agresti A (2007) An introduction to categorical data analysis. Wiley-Blackwell, New YorkCrossRefGoogle Scholar
  53. 53.
    Hougaard P, Lee MLT, Whitmore GA (1997) Analysis of overdispersed count data by mixtures of Poisson variables and Poisson processes. Biometrics 53:1225–1238PubMedCrossRefGoogle Scholar
  54. 54.
    Jørgensen B (1997) The theory of dispersion models. Chapman and Hall, LondonGoogle Scholar
  55. 55.
    Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ (2009) An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med 39:1549–1558PubMedCrossRefGoogle Scholar
  56. 56.
    Hankin BL, Abela JRZ (2011) Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2½year longitudinal study. Psychiatry Res 186:65–70PubMedCrossRefGoogle Scholar
  57. 57.
    Klonsky ED (2007) The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 27:226–239PubMedCrossRefGoogle Scholar
  58. 58.
    Lang CM, Sharma-Patel K (2011) The relation between childhood maltreatment and self-injury: a review of the literature on conceptualization and intervention. Trauma Violence Abuse 12(1):23–37PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Rossella Di Pierro
    • 1
    Email author
  • Irene Sarno
    • 1
  • Sara Perego
    • 1
  • Marcello Gallucci
    • 1
  • Fabio Madeddu
    • 1
  1. 1.Department of PsychologyUniversity of Milano-BicoccaMilanItaly

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