Development and Factorial Validation of the Inventory of Deliberate Self-Harm Behaviours for Portuguese Adolescents


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.

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  1. 1.

    Hawton K, Saunders KE, O’Connor RC. Self-harm and suicide in adolescents. Lancet. 2012;379:2373–82.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    Article  PubMed  Google Scholar 

  3. 3.

    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.

    Article  PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  Google Scholar 

  5. 5.

    Nixon MK, Cloutier P, Jansson M. Nonsuicidal self-harm in youth: a population-based survey. Can Med Assoc J. 2008;178(3):306–12.

    Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

  8. 8.

    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.

  9. 9.

    Gonçalves SF, Martins C, Rosendo AP, Machado BC, Silva E. Self-injurious behavior in Portuguese adolescents. Psicothema. 2012;24(4):536–41.

    Google Scholar 

  10. 10.

    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.

    Article  PubMed  Google Scholar 

  11. 11.

    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).

  12. 12.

    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.

    Google Scholar 

  13. 13.

    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.

    Article  PubMed  Google Scholar 

  14. 14.

    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.

    Article  PubMed  Google Scholar 

  15. 15.

    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.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    Heath NL, Joly M, Carsley D. Coping self-efficacy and mindfulness in non-suicidal self-injury. Mindfulness. 2016;7(5):1132–41.

    Article  Google Scholar 

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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.

    Article  PubMed  Google Scholar 

  20. 20.

    Croyle KL, Waltz J. Subclinical self-harm: range of behaviors, extent, and associated characteristics. Am J Orthopsychiatry. 2007;77(2):332–42.

    Article  PubMed  Google Scholar 

  21. 21.

    Skegg K. Self-harm. Lancet. 2005;366(9495):1471–83.

    Article  PubMed  Google Scholar 

  22. 22.

    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.

    Article  PubMed  Google Scholar 

  23. 23.

    Joiner TE. Why people die by suicide. Cambridge: Harvard University Press; 2006.

    Google Scholar 

  24. 24.

    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.

    Article  Google Scholar 

  25. 25.

    Sun FK. A concept analysis of suicidal behavior. Public Health Nurs. 2011;28(5):458–68.

    Article  PubMed  Google Scholar 

  26. 26.

    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.

    Article  PubMed  Google Scholar 

  27. 27.

    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.

    Article  Google Scholar 

  28. 28.

    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.

    Article  Google Scholar 

  29. 29.

    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.

    Article  Google Scholar 

  30. 30.

    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.

    Article  PubMed  Google Scholar 

  31. 31.

    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.

    Article  Google Scholar 

  32. 32.

    Hamza CA, Willoughby T. Nonsuicidal self-injury and suicidal behavior: a latent class analysis among young adults. PLoS One. 2013;8(3).

    CAS  Article  Google Scholar 

  33. 33.

    Hargus E, Hawton K, Rodham K. Distinguishing between subgroups of adolescents who self-harm. Suicide Life Threat Behav. 2009;39:518–37.

    Article  PubMed  Google Scholar 

  34. 34.

    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.

    Article  PubMed  Google Scholar 

  35. 35.

    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.

    Article  PubMed  Google Scholar 

  36. 36.

    Walsh BW. Treating self-injury: a practical guide. New York: Guilford; 2006.

    Google Scholar 

  37. 37.

    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.

    Article  PubMed  Google Scholar 

  38. 38.

    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.

    Article  Google Scholar 

  39. 39.

    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.

    Article  PubMed  Google Scholar 

  40. 40.

    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.

    Article  PubMed  Google Scholar 

  41. 41.

    Gratz K. Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. J Psychopathol Behav Assess. 2001;23(4):253–63.

    Article  Google Scholar 

  42. 42.

    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.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    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.

    Article  PubMed  Google Scholar 

  44. 44.

    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.

    Google Scholar 

  45. 45.

    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.

    Article  PubMed  Google Scholar 

  46. 46.

    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.

    Article  Google Scholar 

  47. 47.

    Glenn CR, Klonsky ED. One-year test-retest reliability of the inventory of statements about self-injury (ISAS). Assessment. 2011;18(3):375–8.

    Article  PubMed  Google Scholar 

  48. 48.

    Hamza CA, Willoughby T. A longitudinal person-centered examination of nonsuicidal self-injury among university students. J Youth Adolesc. 2014;43(4):671–85.

    Article  PubMed  Google Scholar 

  49. 49.

    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.

    Article  Google Scholar 

  50. 50.

    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.

    Article  Google Scholar 

  51. 51.

    Saraff PD, Trujillo N, Pepper CM. Functions, consequences, and frequency of non-suicidal self-injury. Psychiatry Q. 2015;86(3):385–93.

    Article  Google Scholar 

  52. 52.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    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.

    Article  PubMed  Google Scholar 

  54. 54.

    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.

    Article  Google Scholar 

  55. 55.

    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.

    Article  Google Scholar 

  56. 56.

    Arbuckle, J. L. (2013). IBM® SPSS® Amos™ 22 User’s guide. Amos Development Corporation. Retrieved May 10, 2019, from

  57. 57.

    Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588–606.

    Article  Google Scholar 

  58. 58.

    Hooper D, Coughlan J, Mullen MR. Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods. 2008;6(1):53–60.

    Article  Google Scholar 

  59. 59.

    Marôco J. Análise de Equações Estruturais: Fundamentos Teóricos, Software e Aplicações. Pêro Pinheiro: Report Number; 2010.

    Google Scholar 

  60. 60.

    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.

    Google Scholar 

  61. 61.

    Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238–46.

    CAS  Article  Google Scholar 

  62. 62.

    Nunnally J. Psychometric theory. New York: McGraw-Hill; 1967.

    Google Scholar 

  63. 63.

    Aron A, Aron E. Statistics for psychology. 2nd ed. Upper Saddle River: Prentice Hall; 1999.

    Google Scholar 

  64. 64.

    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.

    Article  Google Scholar 

  65. 65.

    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.

    Google Scholar 

  66. 66.

    Zappe JG, Dell'Agli DD. Variáveis pessoais e contextuais associadas a comportamentos de risco em adolescentes. J Bras Psiquiatr. 2016;65(1):44–52.

    Article  Google Scholar 

  67. 67.

    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.

    Article  PubMed  Google Scholar 

  68. 68.

    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.

    Article  PubMed  Google Scholar 

  69. 69.

    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.

    Article  PubMed  Google Scholar 

  70. 70.

    Mangnall J, Yurkovich E. A literature review of deliberate self-harm. Perspect Psychiatr Care. 2008;44(3):175–84.

    Article  PubMed  Google Scholar 

  71. 71.

    Klonsky ED, Muehlenkamp JJ. Self-injury: a research review for the practitioner. J Clin Psychol In Session. 2007;63(11):1045–56.

    Article  PubMed  Google Scholar 

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Correspondence to Eva Duarte.

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Ethics Approval

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.

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Informed consent was obtained from all individual participants included in the study.

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Eva Duarte, Maria Gouveia-Pereira, and Hugo S. Gomes declare that they have no conflict of interest to disclose.

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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).

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  • Deliberate self-harm
  • Methods
  • Validation
  • Adolescents
  • Factor analysis