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Testing an equifinality model of nonsuicidal self-injury among early adolescent girls

Published online by Cambridge University Press:  22 July 2014

Kate Keenan ,
Alison E. Hipwell ,
Stephanie D. Stepp  and
Kristen Wroblewski
Kate Keenan*
Affiliation:
University of Chicago
Alison E. Hipwell
Affiliation:
University of Pittsburgh
Stephanie D. Stepp
Affiliation:
University of Pittsburgh
Kristen Wroblewski
Affiliation:
University of Chicago
*
Address correspondence and reprint requests to: Kate Keenan, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, MC 3077, Room W415, 5841 South Maryland Avenue, Chicago, IL 60637; E-mail: kekeenan@uchicago.edu.
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Abstract

Nonsuicidal self-injury (NSSI) is a common behavior among females that has been shown to confer risk for continued self-injury and suicidal attempts. NSSI can be viewed conceptually as behavior that is pathognomonic with aggression and/or depression. Empirical research on concurrent correlates supports this concept: numerous and diverse factors are shown to be significantly associated with self-harm, including depression, emotion dysregulation, impulsivity, and aggression and other conduct problems, as well as environmental stressors such as bullying, harsh parenting, and negative life events. In the present study, we test hypotheses regarding developmental precursors (measured from ages 8 to 12 years) to NSSI in young adolescent girls (ages 13–14 years), specifically whether aggression, depression, and environmental stressors distinguish girls with and without self-harm, and whether there is evidence for multiple developmental pathways to NSSI. Data were derived from the longitudinal Pittsburgh Girls Study. In this community sample of girls, the prevalence of NSSI at ages 13 or 14 years of age was 6.0%. Initial levels in dimensions measured within the depression, aggression, and environmental stressor domains accounted for variance in NSSI in early adolescence. Changes over time in relational aggression and assertiveness were also significantly associated with risk for NSSI. To a large extent, adolescent NSSI was predicted by psychological deficits and stress exposure that began early in childhood. Risk indices were calculated using the 85th or 15th percentile. Close to 80% of girls who engaged in NSSI during adolescence were identified by at least one risk domain in childhood. A sizable proportion of adolescent girls who later engaged in NSSI had childhood risk scores in all three domains; the remaining girls with adolescent NSSI were relatively evenly distributed across the other risk domain profiles. The observation that multiple pathways to NSSI exist suggests that deficits underlying the behavior may vary and require different modes of prevention.

Type
Regular Articles
Information
Development and Psychopathology , Volume 26 , Special Issue 3: The Legacy of Nicki R. Crick's Contributions to Developmental Psychopathology , August 2014 , pp. 851 - 862
Copyright
Copyright © Cambridge University Press 2014 

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References

Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87, 49–74.Google Scholar
Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.Google Scholar
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., et al. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 772–81.CrossRefGoogle ScholarPubMed
Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity. Archives of Internal Medicine, 163, 2433–2445.Google Scholar
Barnard, K. E., Johnson, S., Booth, C. L., & Bee, H. (1989). Difficult Life Circumstances Scale. Seattle: NCAST Publications.Google Scholar
Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy, 1, 1–16.Google Scholar
Björkqvist, K., Lagerspetz, K. M., & Kaukiainen, A. (1992). Do girls manipulate and boys fight? Developmental trends in regard to direct and indirect aggression. Aggressive Behavior, 18, 117–127.Google Scholar
Centers for Disease Control and Prevention (2012). WISQARS (Web-based Injury Statistics Query and Reporting System) fatal injury reports. Retrieved from http://www.cdc.gov/injury/wisqars/ Google Scholar
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behavior Research & Therapy, 44, 371–394.Google Scholar
Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597–600.CrossRefGoogle Scholar
Cox, L. J., Stanley, B. H., Melhem, N. M., Oquendo, M. A., Birmaher, B., Burke, A., et al. (2012). Familial and individual correlates of nonsuicidal self-injury in the offspring of mood-disordered parents. Journal of Clinical Psychiatry, 73, 813–820.CrossRefGoogle ScholarPubMed
Crick, N. R., & Grotpeter, J. K. (1995). Relational aggression, gender, and social-psychological adjustment. Child Development, 66, 710–722.CrossRefGoogle ScholarPubMed
Crick, N. R., & Grotpeter, J. K. (1996). Children's treatment by peers: Victims of relational and overt aggression. Development and Psychopathology, 8, 367–380.Google Scholar
Crick, N. R., Murray-Close, D., & Woods, K. (2005). Borderline personality features in childhood: A short-term longitudinal study. Development and Psychopathology, 17, 1051–1070.Google Scholar
Crick, N. R., Ostrov, J. M., & Werner, N. E. (2006). A longitudinal study of relational aggression, physical aggression, and children's social-psychological adjustment. Journal of Abnormal Child Psychology, 34, 131–142.Google Scholar
Crick, N. R., & Zahn-Waxler, C. (2003). The development of psychopathology in females and males: Current progress and future challenges. Development and Psychopathology, 15, 719–742.Google Scholar
Csorba, J., Dinya, E., Plener, P., Nagy, E., & Páli, E. (2009). Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. European Child & Adolescent Psychiatry, 18, 309–320.CrossRefGoogle ScholarPubMed
Culkin, J., & Perrotto, R. S. (1985). Assertiveness factors and depression in a sample of college women. Psychological Reports, 57, 1015–1020.Google Scholar
Decety, J., Michalska, K. J., Akitsuki, Y., & Lahey, B. B. (2009). Atypical empathic responses in adolescents with aggressive conduct disorder: A functional MRI investigation. Biological Psychology, 80, 203–211.Google Scholar
Egger, H. L., Costello, E. J., Erkanli, A., & Angold, A. (2004). Somatic complaints and psychopathology in children and adolescents: Stomach aches, musculoskeletal pains, and headaches. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 852–860.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, research version, non-patient edition (SCID-I/NP). New York: New York State Psychiatric Institute, Biometrics Research.Google Scholar
Fisher, H. L., Moffitt, T. E., Houts, R. M., Belsky, D. W., Arseneault, L., & Caspi, A. (2012). Bullying victimisation and risk of self-harm in early adolescence: Longitudinal cohort study. British Medical Journal, 344, 2683.Google Scholar
Fuligni, A. J., Eccles, J. S., Barber, B. L., & Clements, P. (2001). Early adolescent peer orientation and adjustment during high school. Developmental Psychology, 37, 28–36.Google Scholar
Gadow, K., & Sprafkin, J. (1994). Child Symptom Inventories manual. Stonybrook, NY: Checkmate Plus.Google Scholar
Garber, J., Walker, L., & Zeman, J. (1991). Somatization symptoms in a community sample of children and adolescents: Further validation of the Children's Somatization Inventory. Psychological Assessment, 3, 588–595.CrossRefGoogle Scholar
Glenn, C. R., & Klonsky, E. D. (2011). Prospective prediction of nonsuicidal self-injury: A 1-year longitudinal study in young adults. Behavior Therapy, 42, 751–762.CrossRefGoogle ScholarPubMed
Gresham, F., & Elliot, S. The Social Skills Rating Systems. (1990). Circle Pines, MN: American Guidance Service.Google Scholar
Guerry, J. D., & Prinstein, M. J. (2010). Longitudinal prediction of adolescent nonsuicidal self-injury: Examination of a cognitive vulnerability-stress model. Journal of Clinical Child and Adolescent Psychology, 39, 77–89.Google Scholar
Hankin, B. L., & Abela, J. R. (2011). Nonsuicidal self-injury in adolescence: Prospective rates and risk factors in a 2½ year longitudinal study. Psychiatry Research, 186, 65–70.Google Scholar
Hankin, B. L., & Abramson, L. Y. (2001). Development of gender differences in depression: An elaborated cognitive vulnerability-transactional stress theory. Psychological Bulletin, 127, 773–796.Google Scholar
Hartlage, S., Arduino, K., & Alloy, L. B. (1998). Depressive personality characteristics: State dependent concomitants of depressive disorder and traits independent of current depression. Journal of Abnormal Psychology, 107, 349–354.CrossRefGoogle ScholarPubMed
Haugland, S., Wold, B., Stevenson, J., Aaroe, L. E., & Woynarowska, B. (2001). Subjective health complaints in adolescence. European Journal of Public Health, 11, 4–10.Google Scholar
Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self-harm in adolescents: Self report survey in schools in England. British Medical Journal, 325, 1207–1211.Google Scholar
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.Google Scholar
Kaess, M., Hille, M., Parzer, P., Maser-Gluth, C., Resch, F., & Brunner, R. (2012). Alterations in the neuroendocrinological stress response to acute psychosocial stress in adolescents engaging in nonsuicidal self-injury. Psychoneuroendocrinology, 37, 157–161.CrossRefGoogle ScholarPubMed
Keenan, K., Hipwell, A., Chung, T., Stepp, S., Stouthamer-Loeber, M., Loeber, R., et al. (2010). The Pittsburgh Girls Study: Overview and initial findings. Journal of Clinical Child and Adolescent Psychology, 39, 506–521.CrossRefGoogle ScholarPubMed
Keenan, K., Hipwell, A., Feng, X., Hinze, A. K., Babinski, D. E., Henneberger, A., et al. (2008). Subthreshold symptoms of depression in girls are stable and predictive of depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1433–1442.Google Scholar
Keenan, K., Hipwell, A., Feng, X., Rischall, M., Henneberger, A., & Klosterman, S. (2010). Lack of assertion, peer victimization, and risk for depression in girls: Testing a diathesis-stress model. Journal of Adolescent Health, 47, 526–528.Google Scholar
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76, 22–27.Google Scholar
Kolip, P. (1997). Gender differences in health status during adolescence: A remarkable shift. International Journal of Adolescent Medicine and Health, 9, 9–17.Google Scholar
LeResche, L., Mancl, L. A., Drangsholt, M. T., Saunders, K., & Von Korff, M. (2005). Relationship of pain and symptoms to pubertal development in adolescents. Pain, 118, 201–209.Google Scholar
Murray-Close, D., Ostrov, J. M., & Crick, N. R. (2007). A short-term longitudinal study of growth of relational aggression during middle childhood: Associations with gender, friendship intimacy, and internalizing problems. Development and Psychopathology, 19, 187–203.Google Scholar
Nock, M. K., & Favazza, A. R. (2009). In M. K. (Ed.), Nonsuicidal self-injury: Definition and classification. Washington, DC: American Psychological Association.Google Scholar
Olinger, L. J., Shaw, B. F., & Kupier, N. A. (1987). Nonassertiveness, dysfunctional attitudes, and mild levels of depression. Canadian Journal of Behavioral Science, 19, 40–49.CrossRefGoogle Scholar
Pajer, K., Gardner, W., Rubin, R., Perel, J., & Neal, S. (2001). Decreased cortisol levels in adolescent girls with conduct disorder. Archives of General Psychiatry, 58, 297–302.Google Scholar
Pajer, K., Tabbah, R., Gardner, W., Rubin, R. T., Czambel, R. K., & Wang, Y. (2006). Adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder. Psychoneuroendocrinology, 31, 1245–1256.Google Scholar
Plener, P. L., Bubalo, N., Fladung, A. K., Ludolph, A. G., & Lulé, D. (2012). Prone to excitement: Adolescent females with non-suicidal self-injury (NSSI) show altered cortical pattern to emotional and NSS-related material. Psychiatry Research, 203, 146–152.Google Scholar
Prinstein, M. J. (2008). Introduction to the special section on suicide and nonsuicidal self-injury: A review of unique challenges and important directions for self-injury science. Journal of Consulting and Clinical Psychology, 76, 1–8.Google Scholar
Prinstein, M. J., Heilbron, N., Guerry, J. D., Franklin, J. C., Rancourt, D., Simon, V., et al. (2010). Peer influence and nonsuicidal self injury: Longitudinal results in community and clinically-referred adolescent samples. Journal of Abnormal Child Psychology, 38, 669–682.Google Scholar
Stepp, S. D., Pilkonis, P. A., Hipwell, A. E., Loeber, R., & Stouthamer-Loeber, M. (2010). Stability of borderline personality disorder features in girls. Journal of Personality Disorders, 24, 60–72.Google Scholar
St. Germain, S. A., & Hooley, J. M. (2012). Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction. Psychiatry Research, 197, 78–84.Google Scholar
Straus, M. A., Hamby, S. L., Finkelhor, D., Moore, D. W., & Runyan, D. (1998). Identification of child maltreatment with the parent–child conflict tactic scales: Development and psychometric data for a national sample of American parents. Child Abuse and Neglect, 22, 249–270.Google Scholar
Tang, J., Ma, Y., Guo, Y., Ahmed, N. I., Yu, Y., & Wang, J. (2013). Association of aggression and non-suicidal self injury: A school-based sample of adolescents. PLOS ONE, 8, e78149.Google Scholar
Vernberg, B., Jacobs, A., & Hershberger, S. (1999). Peer victimization and attitudes about violence during early adolescence. Journal of Clinical Child Psychology, 28, 386–395.Google Scholar
Vivona, J. M., Ecker, B., Halgin, R. P., Cates, D., Garrison, W. T., & Friedman, M. (1995). Self- and other-directed aggression in child and adolescent psychiatric inpatients. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 434–444.Google Scholar
Walker, L., & Garber, J. (2003). Manual for the Children's Somatization Inventory. Unpublished manuscript.Google Scholar
Walker, L., Garber, J., & Greene, J. (1991). Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization. Journal of Abnormal Child Psychology, 19, 379–394.Google Scholar
Walker, L., & Greene, J. (1989). Children with recurrent abdominal pain and their parents: More somatic complaints, anxiety, and depression than other patient families? Journal of Pediatric Psychology, 14, 231–243.Google Scholar
Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O'Grady, K. E. (2012). Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42, 717–726.Google Scholar
Wilkinson, P. (2013). Non-suicidal self-injury. European Child and Adolescent Psychiatry, 22, 75–79.Google Scholar