Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder
Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI.
KeywordsNonsuicidal self-injury Major depressive disorder Posttraumatic stress disorder
This project was funded by the Canadian Institutes of Health Research (Operating grant #222112), awarded to ALC and KLG.
Compliance with Ethical Standards
Conflict of Interest
Courtney N. Forbes, Matthew T. Tull, Julia R. Richmond, Alexander L. Chapman, Katherine L. Dixon-Gordon and Kim L. Gratz declare that they have no conflicts of interest.
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 was obtained from all individual participants included in the study.
- Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., Vitiello, B., Keller, M., Birmaher, B., McCracken, J., Mayes, T., Berk, M., & Brent, D. A. (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.PubMedPubMedCentralGoogle Scholar
- Budden, A. (2009). The role of shame in posttraumatic stress disorder: A proposal for a socio-emotional model for DSM-V. Social Science & Medicine, 69, 1032–1039.Google Scholar
- DePrince, A. P., Chu, A. T., & Pineda, A. S. (2011). Links between specific posttrauma appraisals and three forms of trauma-related distress. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 430–441.Google Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IV Axis I disorders–patient edition (SCID-I/P, version 2.0). New York, NY: New York State Psychiatric Institute.Google Scholar
- Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. S., Pulay, A. J., Pickering, R. P., & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(4), 533–545.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.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, 192–205.Google Scholar
- Gratz, K. L., Chapman, A. L., Dixon-Gordon, K. L., & Tull, M. T. (2016). Exploring the association of deliberate self-harm with emotional relief using a novel implicit association test. Personality Disorders: Theory, Research, and Treatment, 7, 91–102.Google Scholar
- Homan, K. J., Sim, L. A., Fargo, J. D., & Twohig, M. P. (2017). Five-year prospective investigation of self-harm/suicide-related behaviors in the development of borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8, 183–188.Google Scholar
- Joiner, T. E., Conwell, Y., Fitzpatrick, K. K., Witte, T. K., Schmidt, N. B., Berlim, M. T., Fleck, M. P. A., & Rudd, M. D. (2005). Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. Journal of Abnormal Psychology, 114, 291–303.PubMedGoogle Scholar
- Kim, G.-M., & Woo, J.-M. (2017). Clinical characteristics and associations with psychiatric disorders of nonsuicidal self-injury in Korean adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), S223.Google Scholar
- Kleindienst, N., Bohus, M., Ludäscher, P., Limberger, M. F., Kuenkele, K., Ebner-Priemer, U. W., Chapman, A. L., Reicherzer, M., Stieglitz, R. D., & Schmahl, C. (2008). Motives for nonsuicidal self-injury among women with borderline personality disorder. Journal of Nervous and Mental Disease, 196, 230–236.PubMedGoogle Scholar
- Leibenluft, E., Gardner, D., & Cowdry, R. (1987). The inner experience of the borderline self-mutilator. Journal of Personality Disorders, 1, 317–324.Google Scholar
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
- Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72, 475–482.PubMedGoogle Scholar
- Marx, B. P., & Sloan, D. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behavior Research and Therapy, 43, 569–583.Google Scholar
- Roemer, L., Litz, B. T., Orsillo, S. M., & Wagner, A. W. (2001). A preliminary investigation of the role of strategic withholding of emotions in PTSD. Journal of Traumatic Stress, 14, 149–159.Google Scholar
- Soloff, P. H., Lis, J. A., Kelly, T., Cornelius, J., & Ulrich, R. (1994). Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 8, 257–267.Google Scholar
- Tanaka, H., Yagi, A., Komiya, A., Mifune, N., & Ohtsubo, Y. (2015). Shame-prone people are more likely to punish themselves: A test of the reputation-maintenance explanation for self-punishment. Evolutionary Behavioral Sciences, 9, 1–7.Google Scholar
- Turner, B. J., Chapman, A. L., & Layden, B. K. (2012). Intrapersonal and interpersonal functions of non-suicidal self-injury: Associations with emotional and social functioning. Suicide and Life-Threatening Behavior, 42, 36–55.Google Scholar
- Turner, B. J., Arya, S., & Chapman, A. L. (2015). Nonsuicidal self-injury in Asian versus Caucasian university students: Who, how, and why? Suicide and Life-threatening Behavior, 45, 119–216.Google Scholar
- Weiss, N. H., Tull, M. T., Viana, A. G., Anestis, M. D., & Gratz, K. L. (2012). Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. Journal of Anxiety Disorders, 26, 453–458.PubMedPubMedCentralGoogle Scholar
- Westphal, M., Olfson, M., Gameroff, M. J., Wickramaratne, P., Pilowsky, D. J., Neugebauer, R., Lantigua, R., Shea, S., & Neria, Y. (2011). Functional impairment in adults with past posttraumatic stress disorder: Findings from primary care. Depression and Anxiety, 28, 686–695.PubMedPubMedCentralGoogle Scholar
- Wolff, J. C., Frazier, E. A., Esposito-Smythers, C. E., Becker, S. J., Burke, T. A., Cataldo, A., & Spirito, A. (2014). Negative cognitive style and perceived social support mediate the relationship between aggression and NSSI in hospitalized adolescents. Journal of Adolescence, 37(4), 483–491.PubMedPubMedCentralGoogle Scholar
- Zanarini, M. C., Frankenburg, F. R., Sickel, A. E., & Yong, L. (1996). The diagnostic interview for DSM-IV personality disorders (DIPD-IV). Boston, MA: McLean Hospital.Google Scholar
- Zanarini, M. C., Skodol, A. E., Bender, D., Dolan, R., Sanislow, C., Schaefer, E., & Gunderson, J. G. (2000). The collaborative longitudinal personality disorders study: Reliability of Axis I and II diagnoses. Journal of Personality Disorders, 14, 291–299.Google Scholar