Nonsuicidal Self-Injury and Identity Development in Adolescents

Abstract

Nesuicidalno samoozljeđivanje (NSSO) je značajan problem mentalnog zdravlja adolescenata. Pretpostavlja se da problemi u formiranju identiteta imaju važnu ulogu u nastanku samoozljeđujućeg ponašanja kod mladih. Ciljevi istraživanja su bili ispitati klinička obilježja u adolescenata s NSSO te istražiti razlike u razvoju identiteta između opće (školske) populacije adolescenata i adolescenata s NSSO. U istraživanju su sudjelovali adolescenti u dobi od 11 do 18 godina oba spola. Kliničku skupinu (n=31) činili su adolescenti prvi puta psihijatrijski hospitalizirani kod kojih je kliničkom procjenom utvrđena prisutnost NSSO unutar 6 mjeseci prije hospitalizacije. Školsku populaciju (n=294) činili su učenici osnovnih i srednjih škola Grada Zagreba. Svi adolescenti su popunjavali upitnik Procjena razvoja identiteta u adolescenciji (AIDA), dok su pacijenti ispunjavali i Inventar namjernog samoozljeđivanja (DSHI). U kliničkoj populaciji adolescenata utvrđena je visoka učestalost i multipli tipovi NSSO. Pacijenti s NSSO su imali značajno više rezultate difuzije identiteta u odnosu na učenike, što upućuje na veće poteškoće u razvoju identiteta kod adolescenata s NSSO. Bolje razumijevanje odnosa između oštećenja u razvoju identiteta i NSSO moglo bi unaprijediti procjenu i liječenje adolescenata s ovim značajnim psihijatrijskim problemom. / Nonsuicidal self-injury (NSSI) is a significant mental health problem among adolescents. Problems in identity formation have been hypothesised to play an important role in the emergence of self-harming behaviours among adolescents. The aims of the study were to examine clinical characteristics of hospitalized adolescents with NSSI and differences in identity development between inpatients with NSSI and general (school) adolescent population. The participants were adolescents aged 11 to 18 years of both genders. The clinical sample (n=31) included inpatients hospitalized for the first time at the psychiatric ward in whom NSSI was present 6 months before referral as established by clinical assessment. The school sample (n=294) consisted of elementary and high school students from the city of Zagreb. All adolescents completed the Assessment of Identity Development in Adolescence (AIDA), while inpatients with NSSI also completed the Deliberate Self-Harm Inventory (DSHI). A high frequency and multiple types of NSSI were found in the clinical sample. Inpatient adolescents with NSSI had significantly higher scores on Identity Diffusion than students, which indicates greater difficulties in identity development in hospitalized adolescents with NSSI. A better understanding of the relationship between impairment of identity development and NSSI could improve the assessment and treatment of adolescents with this significant psychiatric problem.

Psychometric Properties of the Italian Version of the Assessment of Identity Development in Adolescence (AIDA)

“…Literature showed that lack of identity integration is linked to several maladaptive behaviors, such as non-suicidal self-injury (Ercegović, Paradžik, Maršanić, & Marčinko, 2018;Nakar et al, 2016) and impairments in social functioning due to the inability to reflect on internal mental states of the self and others (De Meulemeester, Lowyck, Vermote, Verhaest, & Luyten, 2017;Penner et al, 2019). In sum, whether identity integration is considered as the healthy outcome of achiving an identity in various identity domains, identity diffusion and its implications are considered the core of PDs and are particularly characteristic of borderline personality organization (Clarkin, Yeomans, & Kernberg, 1999).…”

Understanding the self in nonsuicidal self-injury: A conceptual review and framework for future research

“…Cross-sectional NSSI studies with adolescents in clinical and community settings find positive associations between identity confusion and NSSI, as well as negative associations SELF-CONCEPT AND NONSUICIDAL SELF-INJURY 24 between identity synthesis and NSSI (Brickman, Ammerman, Look, Berman, & McCloskey, 2014;Claes, Luyckx, & Bijttebier, 2014;Claes, Luyckx, Bijttebier, Turner, Ghandi, Smets, …& Hoksbergen, 2015;Ercegović, Paradžik, Boričević Maršanić, & Marčinko, 2018;Gandhi, Claes, Bosmans, Baetens, Wilderjans, Maitra, …& Luyckx, 2016;Luyckx, Gandhi, Bijttebier, & Claes, 2015a;Luyckx, Gandhi, Bijttebier, & Claes, 2015b;Gandhi, Luyckx, Goossens, Maitra, & Claes, 2016;Gandhi, Luyckx, Maitra, Kiekens, & Claes, 2016;Gahndi, Luyckx, Maitra, Kiekens, Verschueren, & Claes, 2017;Gandhi, Luyckx, Adhikari, Parmar, De Sousa, Shah, … & Claes, 2020). These associations remain when controlling for additional factors such as age, gender, anxiety, and depression (Claes et al, 2014;Claes et al, 2015).…”

“…Two studies to date have examined identity diffusion in NSSI. One study in Croatia examined identity diffusion in a small sample of inpatient adolescents with NSSI and a larger comparison sample of middle-and high-school age adolescents (Ercegović, Paradžik, Boričević Maršanić, & Marčinko, 2018). Inpatient adolescents with NSSI showed heightened identity diffusion relative to the student sample.…”

Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18): Factor Structure, Validity, and Clinical Cut-Offs

“…In addition, given that the 23 LoPF-Q 12-18 identity items were drawn from the AIDA, we also calculated the total diffusion score excluding these overlapping items excluded (“AIDA—no LoPF”). The AIDA has demonstrated reliability and validity in adolescents from a wide range of cultural backgrounds (e.g., Ercegovic et al, 2018; Kassin et al, 2013; Ragelienė & Justickis, 2016; Tardivo et al, 2016) and in an inpatient sample of American adolescents (Lind et al, 2019). In the current study, Cronbach’s alpha indicated high internal consistency in both the healthy control (AIDA: α = .94, AIDA- no LoPF: α = .91) and clinical sample (α = .95, AIDA- no LoPF: α = .95).…”