Psychological Meanings and Functions of Non-suicidal Self-Injury and Eating Disorders

Abstract

Non-suicidal self-injury (NSSI) and eating disorder behaviors have many things in common, including some of the reasons why people do them. Many researchers have taken a syndromal approach, whereby such behaviors are seen as symptoms of some underlying illness, but it may be more fruitful to examine these behaviors from a functional approach, in which maladaptive behaviors are instead goal-directed behaviors performed to obtain some desired end. This chapter focuses on a functional perspective, presenting evidence for a four-factor model that might underlie both eating disorders and NSSI behavior. This model proposes two dichotomous dimensions including contingencies that are automatic versus social and reinforcement that is positive (i.e., followed by the presentation of a favorable stimulus) versus negative (i.e., followed by the removal of an aversive stimulus). Such an approach has a considerable impact on methodological considerations in research and clinical assessment and treatment. It suggests that a functional assessment might be useful in evaluating such patients and influencing treatment options, especially when these behaviors overlap.

Similarities and Differences in the Functions of Nonsuicidal Self‐Injury (NSSI) and Sex as Self‐Injury (SASI)

“…Specifically, items “to relieve feeling numb or empty,” “to punish yourself,” and “to stop bad feelings” were the three functions most frequently endorsed, irrespective of SIB category. This confirms well‐established data, replicated in several studies (Klonsky, ; Lloyd‐Richardson, Perrine, Dierker, & Kelley, ; Nock & Prinstein, ; Wedig, ; Zetterqvist et al., ), which show that these functions are the main reason why adolescents engage in NSSI. There thus seems to be functional equifinality in these topographically different behaviors, in that they can be performed to achieve similar goals.…”

“…There thus seems to be functional equifinality in these topographically different behaviors, in that they can be performed to achieve similar goals. This has previously been shown with regard to eating disorders and NSSI (Wedig, ; Wedig & Nock, ), but has up to now been largely unexplored with regard to NSSI and using sex to self‐injure.…”

“…Despite being harmful and abusive to the individual and often associated with negative consequences in the long run, the answer to why adolescents engage in maladaptive behaviors (Wedig & Nock, ) is usually found in the underlying purpose of the self‐injurious behavior; that is, to cope with and relieve distress and problems (Claes & Vandereycken, ). As the behaviors chosen to reach this goal can vary in one and the same individual, a functional approach can be useful in understanding and treating such behaviors (Wedig, ).…”

“…There is support that difficulties regulating emotions are associated with several maladaptive behaviors (Tull, Weiss, Adams, & Gratz, ). A functional perspective can thus be useful in clinical practice to understand and treat these goal‐directed behaviors, where negative emotions usually precede several maladaptive behaviors (Wedig, ). In this approach, previous research has found that both NSSI and suicide attempts were performed to relieve negative emotions (e.g., Brown, Comtois, & Linehan, ), but differences in functions have also been reported (Brown et al., ; Chapman & Dixon‐Gordon, ).…”

“…Furthermore, a previous model of functions for NSSI was found to be applicable to female binge eating and purging, using the same functional assessment instrument (Wedig & Nock, ). There is thus an overlap in functions between the topographically different behaviors of eating disorders and NSSI (Wedig, ), with both behaviors serving to regulate strong negative emotions and generate feelings, as well as social functions (to receive attention or help and/or to decrease demands from others).…”