Psychosocial Factors of Non-suicidal Self-Injury Among Adolescents and Young Adults


  • Rukhsana Kasusar Government College Women University Sialkot
  • Soulat Khan The University of Punjab


Non-suicidal self-injury, family dynamics, interpersonal problems, anger, self-criticism, emotional regulation


Present research examines the factors of Non-suicidal Self-Injury (NSSI) in self-injuring individuals. Sample comprised of 164
(n = 82 self-injurers, n = 82 non self-injurers) adolescents and young adults aged 16 to 24 years (M = 20.47, SD = 1.80). Family Adaptability and Cohesion Evaluation Scale-IV (Olson, 2011), Inventory of Interpersonal Problems (Horowitz, Alden, & Wiggins, 1996), Anger Self Report Questionnaire (Reynolds, Walkey, & Green, 1994), Emotional Regulation Questionnaire (Gross & John, 2003), Self-Harm Behavior Questionnaire (Osman & Guiterrez, 2001), Self-Rating Scale (Hooley, Glassman, Weierich, Deliberto, & Nock, 2002), and Demographic Information Questionnaire were used for assessment. Findings demonstrated that self-criticism, anger, emotional suppression, and interpersonal problems had significant, positive; while cognitive reappraisal, family cohesion, and communication had significant negative relationship with NSSI. Family rigidity, enmeshment, self-criticism, and anger emerged as significant positive predictors of NSSI. Cognitive reappraisal mediated the relationship between family cohesion and NSSI. Study findings enhanced the understanding of the underlying mechanisms involved in NSSI and subsequent conceptualization and treatment of adolescents and young adults with NSSI.


Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39(3), 389-400. doi:10.1007/s10802-010-9465-3

Aftab, A., Khan, F., & Arain, F. (2011). Inquiry of a potential link with depression to determine the frequency of depression in patients of first episode of Deliberate Self Harm. Journal of Mental Health, 6(1), 187-230.

American Psychological Association (2013). Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC.

Andover, M. S., Pepper, C. M., Ryabchenko, K. A., Orrico, E. G., & Gibb, B. E. (2005). Self mutilation and symptoms of depression, anxiety, and borderline personality disorder. Suicide and Life-Threatening Behavior, 35, 581-591.

Ayton, A., Rasool, H., & Cottrell, D. (2003). Deliberate self-harm in children and adolescents: Association with social deprivation. Journal of Child Adolescents Psychiatry, 12(6).

Baetens, I., Claes, L., Hasking, P., Smits, D., Grietens, H., Onghena, P., & Martin, G. (2015). The relationship between parental expressed emotions and non-suicidal self-injury: The mediating roles of self-criticism and depression. Journal of Child and Family Studies, 24(2), 491-498. doi:10. 1007/s10826-013-9861

Barge, J. A., & Williams, L. E. (2007). The nonconscious regulation of emotion. In J. J. Gross (Ed.), Handbook of Emotion Regulation (pp. 429-445). New York: The Guilford Press.

Bedi, R., Muller, R. T., & Classen, C. C. (2014). Cumulative risk for deliberate self-harm among treatment-seeking women with histories of childhood abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 6(6), 600.

Borges, G., Azrael, D., Almeida, J., Johnson, R.M., Molnar, B. E., Hemenway, D., & Miller, M. (2011). Immigration, suicidal ideation, and deliberate self-injury in the Boston Youth Survey. Suicide and Life-Threatening Behavior, 41(2), 193-202. doi:10.1111/j.1943-278X.2010.00 016.x

Bresin, K., & Schoenleber, M. (2015). Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clinical Psychology Review, 38, 55-64.

Brown, T. B., & Kimball, T. (2013). Cutting to live: A phenomenology of self?harm. Journal of Marital and Family Therapy, 39(2), 195-208.

Christensen, J. S. (2012). Early adolescent non-suicidal self-injury and sensory preference differences: An Exploratory Study. Retrieved from

Cox, L. J., Stanley, B. H., Melhem, N. M., Oquendo, M. A., Birmaher, B., Burke, A., Kolko, D. J., Zelazny, J. M., Mann, J. J., Porta, G., & Brent, D. A. (2012). Familial and individual correlates of non-suicidal self-injury in the offspring of mood disordered parents. The Journal of Clinical Psychiatry, 73(6), 813.

Deliberto, T. L., & Nock, M. K. (2008). An exploratory study of correlates, onset, and offset of non-suicidal self-injury. Archives of Suicide Research, 12(3), 219-231. doi:10.080/13811110802101096

Evren, C., & Evren B. (2005). Self-mutilation in substance-dependent patients and relationship with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Drug and Alcohol Dependence, 80, 15-22.

Favazza, A. R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22, 60-63.

Gilbert, P. (2010). Self-harm in a mixed clinical population: The roles of self-criticism, shame, and social rank. British Journal of Clinical Psychology, 49(4), 563-576.

Gindhu, L. A., & Reichl, S. K. (2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34, 447-457. doi:10.1007/s1096 4-005-7262-z

Glassman, L. H., Weierich, M. R., Hooley, J. M., Deliberto, T. L., & Nock, M. K. (2007). Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Journal of Behaviour Research and Therapy, 45(10), 2483-2490. doi:10.1016/j.brat.2007.04.002

Gratz, K. (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional in expressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry, 76, 238-250. doi:10.1037/0002 9432.76.2.238

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348-362.

Halstead, R. O., Pavkov, T. W., Hecker, L. L., & Seliner, M. M. (2014). Family dynamics and self?injury behaviors: A correlation analysis. Journal of Marital and Family Therapy, 40(2), 246-259.

Herpertz, S., Sass, H., & Favazza, A. (1997). Impulsivity in self-mutilative behavior: Psychometric and biological findings. Journal of Psychiatric Research, 31, 451-465.

Hooley, J. M., Glassman, L. H., Weierich, M. R., Deliberto, T. L., Nock, M. K. (2002). Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Journal of Behaviour Research and Therapy, 45(10), 2483-2490. doi:10.1016/j.brat.2007.04.002

Horowitz, L. M., Alden, L. E., & Wiggins, J. S. (1996). Short version of Inventory of Interpersonal Problems IIP-32. Retrieved from http://www. mind products /iip.htm#example

Husain, M., Waheed, W., & Husain, N. (2006). Self-harm in British South Asian women: Psychosocial correlates and strategies for prevention. Journal of Annals of General Psychiatry, 7(5). doi:10.1186/1744-859X-5-7.

Husain, N., Afsar, S., Ara, J., Fayyaz, H., Ur Rahman, R., Tomenson, B., & Naeem, F. (2014). Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. The British Journal of Psychiatry, 204(6), 462-470.

Jacobson, C. M., Muehlenkamp, J. J., Miller, A. L., & Turner, J. B. (2008). Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. Journal of Clinical Child and Adolescent Psychology, 37, 363-375. doi:10.1080/15374410801955771

Kelada, L., Hasking, P., & Melvin, G. (2016). The relationship between nonsuicidal self-injury and family functioning: Adolescent and parent perspectives. Journal of Marital and Family Therapy, 42, 536-549.

Khan, H., Laeeque, B., & Firdous, N. (2017). Prevalence, causes and most common method of deliberate self-harm used by adolescent of Pakistan. doi:10.5296/ISS.V5I1.11172

Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self?injury: A research review for the practitioner. Journal of Clinical Psychology, 63(11), 1045-1056.

Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements about Self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215-219.

Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160, 1501-1508.

Lieberman, R. (2004). Understanding and responding to students who self-mutilate. Principal Leadership, 4(7), 10-13.

Miller, D. N., & Brock, S. E. (2010). Identifying, assessing, and treating self-injury at school. Springer New York Dordrecht Heidelberg London.

Olson, D. H. (2011). Family Adaptability and Cohesion Evaluation Scale IV and the circumplex model: Validation study. Journal of Marital and Family Therapy, 37(1), 64-80.

Osman, A., & Guiterrez, S. (2001). Self-Harm Behavior Questionnaire. Sage Publication.

Peterson, J., Freedenthal, S., Sheldon, C., & Andersen, R. (2008). Nonsuicidal self-injury in adolescents. Journal of Psychiatry, 5(11), 6-20. Retrieved from http://www.ncb

Rao, S., Shah, N., Jawed, N., Inam, S., & Shafique, K. (2015). Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: Results from the National Survey of 4583 individuals. BMC Public Health, 15(1), 431.

Reynolds, N. S., Walkey, F. H., & Green, D. E. (1994). The anger self-report: A psychometrically sound (30 item) version. New Zealand Journal of Psychology. Retrieved from download.php ?id=791

Salman, S., Shah, F. H., Idrees, J., Khan, A., Tariq, M., Floric, S., Rubya, K., & Usman, M. (2018). Psychosocial and Clinical Predictors of Attempted 2 Suicide, Hopelessness and Non-Suicidal Self-Injury 3 in Adolescents on Venlafaxine 4. Preprints doi:10.20944/Preprints201807.0339.v1

Shahid, M., Iqbal, R., Khan, M. M., Khan, M. Z., Shamsi, U. S., & Nakeer, R. (2015). Risk factors for deliberate self-harm in patients presenting to the emergency Departments of Karachi. Journal of the College of Physicians and Surgeons, Pakistan, 25(1), 50.

Shekhani, S. S., Perveen, S., Akbar, K., Bachani, S., & Khan, M. M. (2018). Suicide and deliberate self-harm in Pakistan: A scoping review. BMC Psychiatry, 18(1), 44.

Suyemoto, L. K. (1998). The functions of self-mutilation. Journal of Clinical Psychology Review, 18(5), 531-554. doi:10.1016/S0272-7358(97)00105-0

Tan, A. C., Rehfuss, M. C., Suarez, E. C., & Savage, A. (2014). Nonsuicidal self-injury in an adolescent population in Singapore. Clinical Child Psychology and Psychiatry, 19(1), 58-76. doi:10.1177/1359104512467273.

Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. New York: Guilford Press.

Tatnell, R., Kelada, L., Hasking, P., & Martin, G. (2014). Longitudinal analysis of adolescent NSSI: The role of intrapersonal and interpersonal factors. Journal of Abnormal Child Psychology, 42(6), 885-896. doi:10.1 007/s10802-013-9837-6

Trepal, H. C., Wester, K. L., & Macdonald, C. A. (2006). Self-injury and postvention: Responding to the family in crisis. The Family Journal, 14, 342-348.

Turner, B. J., Wakefield, M. A., Gratz, K. L., & Chapman, A. L. (2017). Characterizing interpersonal difficulties among young adults who engage in non-suicidal self-injury using a daily diary. Behavior Therapy, 48(3), 366-379.

World Health Organization (2014). Preventing suicide: A global imperative. Retrieved from 1564878_eng.pdf?ua=1&ua

Yurkowski, K., Martin, J., Levesque, C., Bureau, J. F., Lafontaine, M. F., & Cloutier, P. (2015). Emotion dysregulation mediates the influence of relationship difficulties on non-suicidal self-injury behavior in young adults. Psychiatry Research, 228(3), 871-878.