The Four-Function Model of Nonsuicidal Self-Injury

Abstract

Recent years have witnessed a proliferation of research exploring the phenomenon of nonsuicidal self-injury (NSSI); however, a great deal remains unknown about this alarmingly pervasive behavior. Our aim in the present review was to use the recently developed, empirically supported four-function model (FFM) of NSSI (Nock, 2009(Nock, , 2010Nock & Prinstein, 2004) as a conceptual base to generate important next steps for research on self-injury. Functional approaches have guided the understanding of a wide range of disorders, including anxiety (e.g., Barlow, 2002), depression (e.g., Dimidjian et al., 2006), and substance use (e.g., Dutra et al., 2008). Drawing from this functional model of self-injury may similarly help identify research initiatives necessary to advance knowledge of NSSI and bolster the development of much-needed evidence-based treatments. In this review, we first briefly discuss the classification, prevalence, clinical significance, and transdiagnostic nature of NSSI. Next, we present the evidence-based FFM of NSSI. We then use the model to inform the understanding of seven unanswered questions about self-injury and a research agenda for studies aimed to answer them.

Reasons for Non-Suicidal Self-Harm in Adult Male Offenders With and Without Borderline Personality Traits

“…In the USA the term "self-harm" is typically synonymous with "self-RUNNING HEAD: Reasons for Non-Suicidal Self-Harm in Adult Male Offenders 5 injurious behaviours" and denotes a broad spectrum of behaviours ranging from indirectly self-damaging behaviours such as smoking and alcohol abuse, to "nonsuicidal self-injury" (NSSI) and suicidal behaviours which are seen as distinct but related phenomena (Bentley, Nock & Barlow, 2014;Nock, 2010). NSSI was recently included within the DSM-5 (APA, 2013) as a condition requiring further study, and refers to attempts to deliberately and directly hurt one's body in some way in the absence of suicidal intent (APA, 2013;Klonsky & Glenn, 2009;Nock, 2008).…”

Public perceptions of self-harm—A test of an attribution model of public discrimination.

“…Secondly, the stated motivation for self-harm was intrapersonal or interpersonal (or unknown). Future research may seek to refine this manipulation to consider the type of reinforcement (positive vs. negative) as well as the behaviors' social or automatic functions (Bentley, Nock, & Barlow, 2014).…”

Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities

“…One of the issues at hand concerns whether the automatic functions are distinct 25 (Bentley, Nock, & Barlow, 2014;Selby, Nock, & Kranzler, 2014) and can be divided into separate APR and ANR. Klonsky (2009), for example, postulates that self-injury is mainly associated with reductions in negative affect rather than increases in positive affect, and more likely to be negatively reinforced, a perspective also endorsed by Chapman et al (2006).…”

“…Furthermore, there are differences in the way functions are defined: as specific antecedents and consequences that cause and maintain NSSI within the framework of learning theory or by using a broader concept of reasons and motives. Researchers have also placed a slightly different emphasis on the role that social functions play in NSSI (Bentley et al, 2014;Chapman et al, 2006;Klonsky, 2007Klonsky, , 2009Nock & Prinstein, 2004. Some view social/interpersonal functions not as primary goals of NSSI, while nevertheless considering that NSSI can be reinforced by the elicitation of caring responses (e.g., Gratz, 2003).…”