Causes (with Richard Lieberman)

Part of the Developmental Psychopathology at School book series (DPS)


There is no single cause of NSSI in youth that reliably determines whether a child or adolescent will ultimately engage in these behaviors. Psychiatric problems and disorders often result from complex interactions of genetic predispositions, environmental events/stressors, and individual vulnerabilities, and the causes of NSSI are no different. This chapter begins with a review of several explanatory models for NSSI in youth, with a particular emphasis on the environmental/functional model, as this approach has the most support in the professional literature. Following this discussion, a comprehensive biopsychosocial framework developed by Walsh (2006) for understanding the causal variables contributing to the development of NSSI will be described. This framework leads directly to many of the recommended assessment and treatment techniques described in subsequent chapters.


Sexual Abuse Child Maltreatment Suicidal Behavior Childhood Adversity Borderline Personality Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alderman, T. (1997). Scarred soul: Understanding and ending self-inflicted violence. Oakland, CA: New Harbinger.Google Scholar
  2. Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and non-suicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–202.PubMedCrossRefGoogle Scholar
  3. D’Onofrio, A. A. (2007). Adolescent self injury: A comprehensive guide for counselors and health care professionals. New York: Springer.Google Scholar
  4. Farber, S. K. (2000). When the body is the target: Self-harm, pain, and traumatic attachments. Northvale, NJ: Jason Aronson.Google Scholar
  5. Favazza, A. (1996). Bodies under siege: Self-mutilation and body modification in culture and psychiatry (2nd ed.). Baltimore, MD: Johns Hopkins University Press.Google Scholar
  6. Favazza, A. (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental Disease, 186, 259–268.PubMedCrossRefGoogle Scholar
  7. Firestone, R. W., & Seiden, R. H. (1990). Suicide and the continuum of self-destructive behavior. Journal of American College Health, 38, 207–213.PubMedCrossRefGoogle Scholar
  8. Gratz, K. L. (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/ reactivity. American Journal of Orthopsychiatry, 76, 238–250.PubMedCrossRefGoogle Scholar
  9. Hartman, D. (1996). Cutting among young people in adolescent units. Therapeutic Communities, 17, 5–17.Google Scholar
  10. Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., et al. (1994). The functions of self-injurious behavior: An experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27, 215–240.PubMedCrossRefGoogle Scholar
  11. Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226–239.PubMedCrossRefGoogle Scholar
  12. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  13. Lloyd-Richardson, E. E., Nock, M. K., & Prinstein, M. J. (2009). Functions of adolescent nonsuicidal self-injury. In M. K. Nixon & N. L. Heath (Eds.), Self-injury in youth: The essential guide to assessment and intervention (pp. 29–41). New York: Routledge.Google Scholar
  14. Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37, 1183–1192.PubMedCrossRefGoogle Scholar
  15. Nixon, M. K., Cloutier, P. F., & Aggarwal, S. (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 1333–1341.CrossRefGoogle Scholar
  16. Osuch, E. A., & Payne, G. W. (2009). Neurobiological perspectives on non-suicidal self-injury. In M. K. Nixon & N. L. Heath (Eds.), Self-injury in youth: The essential guide to assessment and intervention (pp. 79–110). London, UK: Routledge.Google Scholar
  17. Skinner, B. F. (1938). The behavior of organisms: An experimental analysis. New York: Appleton-Century.Google Scholar
  18. Suyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18, 531–554.PubMedCrossRefGoogle Scholar
  19. Van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401–408.Google Scholar
  20. Walsh, B. W. (2006). Treating self-injury: A practical guide. New York: Guilford Press.Google Scholar
  21. Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948.PubMedCrossRefGoogle Scholar
  22. Yates, T. M. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24, 35–74.PubMedCrossRefGoogle Scholar
  23. Messer, J. M., & Fremouw, W. J. (2008). A critical review of explanatory models for self-mutilating behaviors in adolescents. Clinical Psychology Review, 28, 162–178.PubMedCrossRefGoogle Scholar
  24. Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.PubMedCrossRefGoogle Scholar
  25. Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140–146.PubMedCrossRefGoogle Scholar
  26. Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self injury: A research review for the practitioner. Journal of Clinical Psychology: In Session, 63, 1045–1056.PubMedCrossRefGoogle Scholar
  27. Haines, J., Williams, C. L., Brain, K. L., & Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104, 471–489.PubMedCrossRefGoogle Scholar
  28. Stanley, B., Winchel, R., Molcho, A., Simeon, D., & Stanley, M. (1992). Suicide and the self-harm continuum: Phenomenological and biochemical evidence. International Review of Psychiatry, 4, 149–155.CrossRefGoogle Scholar
  29. Winchel, R. M., & Stanley, M. (1991). Self-injurious behavior: A review of the behavior and biology of self-mutilation. American Journal of Psychiatry, 148, 306–317.PubMedGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. Suyemoto, K. L., & MacDonald, M. L. (1995). Self-cutting in female adolescents. Psychotherapy, 32, 162–171.CrossRefGoogle Scholar
  32. Crouch, W., & Wright, J. (2004). Deliberate self-harm in an adolescent unit: A qualitative investigation. Clinical Child Psychology & Psychiatry, 9, 185–204.CrossRefGoogle Scholar
  33. Miller, F., & Bashkin, E. A. (1974). Depersonalization and self-mutilation. Psychoanalytic Quarterly, 43, 638–649.PubMedGoogle Scholar
  34. Zila, L. M., & Kiselica, M. S. (2001). Understanding and counseling self-mutilation in female adolescents and young adults. Journal of Counseling and Development, 79, 46–52.CrossRefGoogle Scholar
  35. Skinner, B. F. (1953). Science and human behavior. New York: Free Press.Google Scholar
  36. Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: Comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 80–87.PubMedCrossRefGoogle Scholar
  37. Noll, J. G., Horowitz, L. A., Bonanno, G. A., Trickett, P. K., & Putnam, F. W. (2003). Revictimization and self-harm in females who experienced childhood sexual abuse. Journal of Interpersonal Violence, 18, 1452–1471.PubMedCrossRefGoogle Scholar
  38. Paivio, S. C., & McCulloch, C. R. (2004). Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse and Neglect, 28, 339–354.PubMedCrossRefGoogle Scholar
  39. Cicchetti, D., & Toth, S. L. (2005). Child maltreatment. Annual Review of Clinical Psychology, 1, 409–438.PubMedCrossRefGoogle Scholar
  40. Klonsky, E. D., & Moyer, A. (2008). Childhood sexual abuse and non-suicidal self-injury: A meta-analysis. British Journal of Psychiatry, 192, 166–170.PubMedCrossRefGoogle Scholar
  41. Whitlock, J. L., Powers, J. L., & Eckenrode, J. (2006). The virtual cutting edge: The Internet and adolescent self-injury. Developmental Psychology, 42, 407–417.PubMedCrossRefGoogle Scholar
  42. Whitlock, J., Lader, W., & Conterio, K. (2007). The Internet and self-injury: What psychotherapists should know. Journal of Clinical Psychology: In Session, 63, 1135–1143.PubMedCrossRefGoogle Scholar
  43. Lieberman, R., & Poland, S. (2006). Self-mutilation. In G. G. Bear & K. M. Minke (Eds.), Children’s needs III: Development, prevention, and intervention (pp. 965–976). Bethesda, MD: National Association of School Psychologists.Google Scholar
  44. Grossman, R., & Siever, L. (2001). Impulsive self-injurious behaviors: Neurobiology and psychopharmacology. In D. Simeon & E. Hollander (Eds.), Self-injurious behaviors: Assessment and treatment (pp. 117–148). Washington, DC: American Psychiatric Publishing.Google Scholar
  45. Conterio, K., & Lader, W. (1998). Bodily harm: The breakthrough healing program for self injurers. New York: Hyperion Press.Google Scholar
  46. Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of self. New York: Other Press.Google Scholar
  47. Gratz, K. L, & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
  48. Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 64, 609–620.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.University at Albany State University of New YorkAlbanyUSA
  2. 2.Department of Special Education, Rehabilitation, School Psychology and Deaf StudiesCalifornia State University, SacramentoSacramentoUSA

Personalised recommendations