Deliberate self-harm (DSH) is a public health problem that mainly affects adolescents and young adults. Evidence suggests that multiple methods are used with a self-aggressive intent. The present article focuses on the development and factorial validation of the Inventory of Deliberate Self-harm Behaviours for Portuguese adolescents. This instrument assesses the lifetime frequency of 13 DSH methods, with and without suicidal intent. Study 1 consisted of an exploratory factor analysis with a sample of 131 adolescents with a reported history of DSH. Results revealed a three-factor structure with acceptable internal consistency: High Severity DSH, Mild Severity DSH, and Substance Use DSH. After item reduction, this structure was tested in Study 2 through a confirmatory factor analysis with an independent sample of 109 adolescents also with a history of DSH. Results showed an acceptable model fit. This instrument presents a solid structure and acceptable psychometric properties, allowing its use in further research.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Hawton K, Saunders KE, O’Connor RC. Self-harm and suicide in adolescents. Lancet. 2012;379:2373–82. https://doi.org/10.1016/S0140-6736(12)60322-5.
Brunner R, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW, et al. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry. 2014;55(4):337–48. https://doi.org/10.1111/jcpp.12166.
Madge N, Hewitt A, Hawton K, Wilde E, Corcoran P, Fekete S, et al. Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) study. J Child Psychol Psychiatry. 2008;49(6):667–77. https://doi.org/10.1111/j.1469-7610.2008.01879.x.
Moran P, Coffey C, Romaniuk H, Olsson C, Borschmann R, Carlin JB, et al. The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet. 2012;379(9812):236–43. https://doi.org/10.1016/S0140-6736(11)61141-0.
Nixon MK, Cloutier P, Jansson M. Nonsuicidal self-harm in youth: a population-based survey. Can Med Assoc J. 2008;178(3):306–12. https://doi.org/10.1503/cmaj.061693.
Carvalho CB, Motta C, Sousa M, Cabral J. Biting myself so I don’t bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths. Rev Bras Psiquiatr. 2017;39(3):252–62. https://doi.org/10.1590/1516-4446-2016-1923.
Duarte E, Gouveia-Pereira M, Gomes HS, Sampaio D. How do families represent the functions of deliberate self-harm? A comparison between the social representations from adolescents and their parents. Arch Suicide Res. 2019a:1–17. https://doi.org/10.1080/13811118.2018.1545713.
Duarte E, Gouveia-Pereira M, Gomes HS, Sampaio D. Social representations about the functions of deliberate self-harm: construction and validation of a questionnaire for Portuguese adolescents. J Pers Assess. 2019b:1–10. https://doi.org/10.1080/00223891.2018.1557667.
Gonçalves SF, Martins C, Rosendo AP, Machado BC, Silva E. Self-injurious behavior in Portuguese adolescents. Psicothema. 2012;24(4):536–41.
Guerreiro DF, Sampaio D, Figueira ML, Madge N. Self-harm in adolescents: a self-report survey in schools from Lisbon, Portugal. Arch Suicide Res. 2017;21(1):83–99. https://doi.org/10.1080/13811118.2015.1004480.
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). https://doi.org/10.1186/1753-2000-6-10.
Carvalho Á, Peixoto B, Saraiva CB, Sampaio D, Amaro F, Santos JC, et al. Plano Nacional de Prevencão do Suicídio 2013/2017. Lisboa: Direccão Geral da Saúde; 2013.
Madge N, Hawton K, McMahon EM, Corcoran P, De Leo D, De Wilde EJ, et al. Psychological characteristics, stressful life events and deliberate self-harm: findings from the child & adolescent self-harm in Europe (CASE) study. Eur Child Adolesc Psychiatry. 2011;20(10):499–508. https://doi.org/10.1007/s00787-011-0210-4.
Jacobson CM, Muehlenkamp JJ, Miller AL, Turner JB. Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol. 2008;37(2):363–75. https://doi.org/10.1080/15374410801955771.
Zhand N, Matheson K, Courtney D. Self-harm in child and adolescent psychiatric inpatients: a retrospective study. J Can Acad Child Adolesc Psychiatry. 2016;25(3):169–76.
Swannell S, Martin G, Scott J, Gibbons M, Gifford S. Motivations for self-injury in an adolescent inpatient population: development of a self-report measure. Australas Psychiatry. 2008;16(2):98–103. https://doi.org/10.1080/10398560701636955.
Heath NL, Joly M, Carsley D. Coping self-efficacy and mindfulness in non-suicidal self-injury. Mindfulness. 2016;7(5):1132–41. https://doi.org/10.1007/s12671-016-0555-3.
Calvete E, Orue I, Aizpuru L, Brotherton H. Prevalence and functions of non-suicidal self-injury in Spanish adolescents. Psicothema. 2015;27(3):223–8. https://doi.org/10.7334/psicothema2014.262.
Duarte E, Gouveia-Pereira M, Gomes HS, Sampaio D. Social representations about the functions of deliberate self-harm: adolescents and parents. J Adolesc. 2019b;73:113–21. https://doi.org/10.1016/j.adolescence.2019.05.001.
Croyle KL, Waltz J. Subclinical self-harm: range of behaviors, extent, and associated characteristics. Am J Orthopsychiatry. 2007;77(2):332–42. https://doi.org/10.1037/0002-9422.214.171.1242.
Skegg K. Self-harm. Lancet. 2005;366(9495):1471–83. https://doi.org/10.1016/S0140-6736(05)67600-3.
Whitlock J, Muehlenkamp J, Eckenrode J. Variation in nonsuicidal self-injury: identification and features of latent classes in a college population of emerging adults. J Clin Child Adolesc Psychol. 2008;37(4):725–35. https://doi.org/10.1080/15374410802359734.
Joiner TE. Why people die by suicide. Cambridge: Harvard University Press; 2006.
Stanley B, Winchel R, Molcho A, Simeon D, Stanley M. Suicide and the self-harm continuum: phenomenological and biological evidence. Int Rev Psychiatry. 1992;4(2):149–55. https://doi.org/10.3109/09540269209066312.
Sun FK. A concept analysis of suicidal behavior. Public Health Nurs. 2011;28(5):458–68. https://doi.org/10.1111/j.1525-1446.2011.00939.x.
Jacobson CM, Gould M. The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Arch Suicide Res. 2007;11(2):129–47. https://doi.org/10.1080/13811110701247602.
Victor SE, Styer D, Washburn JJ. Characteristics of nonsuicidal self-injury associated with suicidal ideation: evidence from a clinical sample of youth. Child Adolesc Psychiatry Ment Health. 2015;9:1–20. https://doi.org/10.1186/s13034-015-0053-8.
Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006;144(1):65–72. https://doi.org/10.1016/j.psychres.2006.05.010.
Stewart JG, Esposito EC, Glenn CR, Gilman SE, Pridgen B, Gold J, et al. Adolescent self-injurers: comparing non-ideators, suicide ideators, and suicide attempters. J Psychiatr Res. 2017;84:105–12. https://doi.org/10.1016/j.jpsychires.2016.09.031.
Klonsky ED, Olino T. Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. J Consult Clin Psychol. 2008;76(1):22–7. https://doi.org/10.1037/0022-006X.76.1.22.
Bjärehed J, Wångby-Lundh M, Lundh L. Nonsuicidal self-injury in a community sample of adolescents: subgroups, stability, and associations with psychological difficulties. J Res Adolesc. 2012;22:678–93. https://doi.org/10.1111/j.1532-7795.2012.00817.x.
Hamza CA, Willoughby T. Nonsuicidal self-injury and suicidal behavior: a latent class analysis among young adults. PLoS One. 2013;8(3). https://doi.org/10.1371/journal.pone.0059955.
Hargus E, Hawton K, Rodham K. Distinguishing between subgroups of adolescents who self-harm. Suicide Life Threat Behav. 2009;39:518–37. https://doi.org/10.1521/suli.2009.39.5.518.
Somer O, Bildik T, Kabukçu-Başay B, Güngör D, Başay Ö, Farmer RF. Prevalence of non-suicidal self-injury and distinct groups of self-injurers in a community sample of adolescents. Soc Psychiatry Psychiatr Epidemiol. 2015;50(7):1163–71. https://doi.org/10.1007/s00127-015-1060-z.
Stanford S, Jones MP. Psychological subtyping finds pathological, impulsive, and ‘normal’ groups among adolescents who self-harm. J Child Psychol Psychiatry. 2009;50:807–15. https://doi.org/10.1111/j.1469-7610.2009.02067.x.
Walsh BW. Treating self-injury: a practical guide. New York: Guilford; 2006.
You J, Leung F, Fu K, Lai CM. The prevalence of nonsuicidal self-injury and different subgroups of self-injurers in Chinese adolescents. Arch Suicide Res. 2011;15(1):75–86. https://doi.org/10.1080/13811118.2011.540211.
Craigen LM, Healey AC, Walley CT, Byrd R, Schuster J. Assessment and self-injury: implications for counselors. Meas Eval Couns Dev. 2010;43(1):3–15. https://doi.org/10.1177/0748175610362237.
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):309–17. https://doi.org/10.1037/1040-35126.96.36.1999.
Vrouva I, Fonagy P, Fearon PRM, Roussow T. The risk-taking and self-harm inventory for adolescents: development and psychometric evaluation. Psychol Assess. 2010;22(4):852–65. https://doi.org/10.1037/a0020583.
Gratz K. Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. J Psychopathol Behav Assess. 2001;23(4):253–63.
Santa Mina EE, Gallop R, Links P. The self-injury questionnaire: evaluation of the psychometric properties in a clinical population. J Psychiatr Ment Health Nurs. 2006;13(2):221–7. https://doi.org/10.1111/j.1365-2850.2006.00944.x.
Whitlock J, Exner-Cortens D, Purington A. Assessment of nonsuicidal self-injury: development and initial validation of the non-suicidal self-injury–assessment tool (NSSI-AT). Psychol Assess. 2014;26(3):935–46. https://doi.org/10.1037/a0036611.
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(1):41–9.
Lindholm T, Bjärehed J, Lundh L-G. Functions of nonsuicidal self-injury among young women in residential care: a pilot study with the Swedish version of the inventory of statements about self-injury. Cogn Behav Ther. 2011;40(3):183–9. https://doi.org/10.1080/16506073.2011.565791.
Dickey L, Reisner SL, Lee Juntunen C. Non-suicidal self-injury in a large online sample of transgender adults. Prof Psychol Res Pract. 2015;46(1):3–11. https://doi.org/10.1037/a0038803.
Glenn CR, Klonsky ED. One-year test-retest reliability of the inventory of statements about self-injury (ISAS). Assessment. 2011;18(3):375–8. https://doi.org/10.1177/1073191111411669.
Hamza CA, Willoughby T. A longitudinal person-centered examination of nonsuicidal self-injury among university students. J Youth Adolesc. 2014;43(4):671–85. https://doi.org/10.1007/s10964-013-9991-8.
Klonsky ED, Glenn CR, Styer DM, Olino TM, Washburn JJ. The functions of nonsuicidal self-injury: converging evidence for a two-factor structure. Child Adolesc Psychiatry Ment Health. 2015;9(44):1–9. https://doi.org/10.1186/s13034-015-0073-4.
Kortge R, Meade T, Tennant A. Interpersonal and intrapersonal functions of deliberate self-harm (DSH): a psychometric examination of the inventory of statements about self-injury (ISAS) scale. Behav Chang. 2013;30(1):24–35. https://doi.org/10.1017/bec.2013.3.
Saraff PD, Trujillo N, Pepper CM. Functions, consequences, and frequency of non-suicidal self-injury. Psychiatry Q. 2015;86(3):385–93. https://doi.org/10.1007/s11126-015-9338-6.
Victor SE, Glenn CR, Klonsky ED. Is non-suicidal self-injury an "addiction"? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry Res. 2012;197(1–2):73–7. https://doi.org/10.1016/j.psychres.2011.12.011.
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(3):215–9. https://doi.org/10.1007/s10862-008-9107-z.
Kogar H, Kogar EY. Comparison of different estimation methods for categorical and ordinal data in confirmatory factor analysis. .Journal of Measurement and Evaluation in Education and Psychology. 2015;6(2):351–64. https://doi.org/10.21031/epod.94857.
Yang-Wallentin F, Jöreskog KG, Luo H. Confirmatory factor analysis of ordinal variables with misspecified models. Struct Equ Model Multidiscip J. 2010;17(3):392–423. https://doi.org/10.1080/10705511.2010.489003.
Arbuckle, J. L. (2013). IBM® SPSS® Amos™ 22 User’s guide. Amos Development Corporation. Retrieved May 10, 2019, from http://www.sussex.ac.uk/its/pdfs/SPSS_Amos_User_Guide_22.pdf.
Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588–606. https://doi.org/10.1037/0033-2909.88.3.588.
Hooper D, Coughlan J, Mullen MR. Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods. 2008;6(1):53–60. https://doi.org/10.21427/D7CF7R.
Marôco J. Análise de Equações Estruturais: Fundamentos Teóricos, Software e Aplicações. Pêro Pinheiro: Report Number; 2010.
Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online. 2003;8(2):23–74.
Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238–46. https://doi.org/10.1037/0033-2909.107.2.238.
Nunnally J. Psychometric theory. New York: McGraw-Hill; 1967.
Aron A, Aron E. Statistics for psychology. 2nd ed. Upper Saddle River: Prentice Hall; 1999.
Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, Angermeyer M, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO world mental health surveys. PLoS Med. 2008;5(7):1053–67. https://doi.org/10.1371/journal.pmed.0050141.
Matos MG, Simões C, Tomé G, Camacho I, Ferreira M, Ramiro L, et al. A Saúde dos Adolescentes Portugueses: Relatório do Estudo HBSC 2010. Lisboa: Centro de Malária e outras Doenças Tropicais/IHMT/UNL; 2012.
Zappe JG, Dell'Agli DD. Variáveis pessoais e contextuais associadas a comportamentos de risco em adolescentes. J Bras Psiquiatr. 2016;65(1):44–52. https://doi.org/10.1590/0047-2085000000102.
Haw C, Hawton K, Casey D, Bale E, Shepherd A. Alcohol dependence, excessive drinking and deliberate self-harm – trends and patterns in Oxford, 1989-2002. Soc Psychiatry Psychiatr Epidemiol. 2005;40:964–71. https://doi.org/10.1007/s00127-005-0981-3.
Hawton K, Hall S, Simkin S, Bale L, Bond A, Codd S, et al. Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000. J Child Psychol Psychiatry. 2003;44(8):1191–8. https://doi.org/10.1111/1469-7610.00200.
Hasking P, Momeni R, Swannell S, Chia S. The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults. Arch Suicide Res. 2008;12:208–18. https://doi.org/10.1080/13811110802100957.
Mangnall J, Yurkovich E. A literature review of deliberate self-harm. Perspect Psychiatr Care. 2008;44(3):175–84. https://doi.org/10.1111/j.1744-6163.2008.00172.x.
Klonsky ED, Muehlenkamp JJ. Self-injury: a research review for the practitioner. J Clin Psychol In Session. 2007;63(11):1045–56. https://doi.org/10.1002/jclp.20412.
This research was approved by the General Education Directorate of the Ministry of Education and Science from Portugal. All procedures performed in both 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. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
Eva Duarte, Maria Gouveia-Pereira, and Hugo S. Gomes declare that they have no conflict of interest to disclose.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Duarte, E., Gouveia-Pereira, M. & Gomes, H.S. Development and Factorial Validation of the Inventory of Deliberate Self-Harm Behaviours for Portuguese Adolescents. Psychiatr Q 90, 761–776 (2019). https://doi.org/10.1007/s11126-019-09660-1
- Deliberate self-harm
- Factor analysis