Functions, Etiology, and Psychological Factors in Non-Suicidal Self-Injury (from Non-suicidal self-injury: A brief overview and diagnostic considerations)
There are several specific functions self-injury has been reported to serve with an affect regulation function of self-injury receiving the strongest support; that is, where self-injury functions to alleviate acute negative affect or affective arousal (Klonsky, 2007). Strong support has also been found for a self-punishment function of self-injury, where self-injury functions to express anger or derogation towards oneself. Other functions received modest support. These findings were consistent overall regardless of the characteristics of the population sampled (see Klonsky, 2007).
Etiology and Psychological Factors
Current researchers and theorists suggest that self-injury is best viewed as having a complex etiology with multiple determinants (e.g., Gratz, 2006; Gratz et al., 2002). Several environmental factors have been associated with self-injury including: childhood abuse and/or neglect (Akyuz et al., 2005; Briere & Gil, 1998; Deiter, Nicholls & Pearlman, 2000; Gratz et al., 2002; Whitlock et al., 2006); childhood loss, separation, placement outside the home, surgery, significant illness, and family alcoholism (Gratz et al., 2002; Walsh, 2006); sexual assault during adulthood (Greenspan & Samuel, 1989); other significant stressors such as academic pressures, family conflicts, cross-cultural stresses (Favazza, 1996; Garrison et al., 1993; Patton et al., 1997; Ross & Heath, 2002); and the repeated experience of invalidation (Ivanhoff, Linehan & Brown, 2001).
In addition, various psychological factors have also been associated with self-injury and are hypothesized to be risk factors for at least some individuals. Examples include: insecure parental attachment (Gratz et al., 2002), dissociation (Gratz et al., 2002), lower emotional expressivity (Gratz, 2006), and impaired self-capacities including emotion dysregulation, as well as difficulties in the areas of identity and relatedness (Briere & Gil, 1998; Deiter et al., 2000; Klonsky, 2009). Gratz et al. (2002) found that specific risk factors can be significantly different between men and women and suggested future research examine this issue in more detail.
With respect to maintenance of self-injury, principles of classical and operant conditioning may play a role. It is hypothesized that self-injury is negatively reinforced via the reduction of unwanted affect a person experiences following self-injury; as well, that over time self-injury may become a more automatic, conditioned response to feeling the unwanted affect that precedes the self-injurious behaviour (Chapman, Gratz & Brown, 2006).
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