THIRTEEN REASONS WHY. MOTIVES FOR SELF-HARM IN ADOLESCENT BOYS AND GIRLS
Demuthova Slavka1*, Demuth Andrej2
1 Faculty of Arts, University of Ss. Cyril and Methodius in Trnava, Slovakia
2 Faculty of Law, Comenius University in Bratislava, Slovakia
*Corresponding Author: [email protected]
Accepted: 1 December 2019 | Published: 30 December 2019
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Abstract: Self-harm is a very common form of high-risk behaviour prevalent among children and youths. In addition to studying the forms and types of this behaviour, one of the key issues is to reveal what motivates young people to commit intentional self-harm. Information on what motivates them enables us to not only understand the psychological mechanisms that lie behind the phenomenon of self-harm, but it also provides valuable data that is critical for clinical interventions and prevention. Using the Inventory of Statements about Self-Injury, this study provides an overview of the prevalence of thirteen different motives for self-harm on a group of 390 Slovak adolescents aged between 11 and 19 who have self-harmed. It also identifies the most frequent motives, explores the presence of cross-gender differences, and searches for a link between the individual motives and the ages of the participants.
Keywords: self-harm, motivation, youth, sex, age
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1. Introduction
During the last decades, the occurrence of self-harming behaviour in adolescents became a serious problem. The increasing prevalence (up to 47% – Dyl 2008 or even 69% – Hallab &
Covic 2010) and new forms of self-harm (Demuthova & Demuth 2019a) has attracted the attention of experts to this undesirable and highly risky phenomenon. Even though the question of the prevalence of self-harming behaviour among adolescent is not a new one, in the past it has been mainly discussed in connection with certain psychiatric diagnoses and mental disorders – i.e. autism (Maddox, Trubanova & White 2017), mental retardation (van den Bogaard et al. 2018), suicide behaviour (Brent 2011); among the victims of sexual abuse (Klonsky, Victor & Saffer 2014) or as a symptom of borderline personality disorder (Brown
& Plener 2017). Recent findings (e.g. Klonsky & Moyer 2008; Wan et al. 2011; Tormoen, Rossow, Larsson & Mehlum 2013;) have shown that this relatively narrow view needs to be revised. Even though self-harming behaviour still often occurs in comorbidity with the depression (Lundh et al. 2011; Zubrick et al. 2017), it has increasingly been found in the adolescent population with no psychiatric illnesses (Glenn & Klonsky 2013). It also seems that it is neither a definite symptom of the development or future onset of a mental disorder.
The data show that self-harm should be moved out of the group of specific psychiatric diagnoses and transferred into the environment of the mentally healthy population who suffer from this specific problem.
The systematic research in the area of self-harm repeatedly points to the need for exploration of its motivation. Besides extensive evidence from abroad (see e.g. Klonsky 2009;
Zetterqvist, Lundh, Dahlstrom & Svedin 2013; Doyle, Sheridan & Treacy 2017; Nielsen &
Townsend 2018). Also, our research (see e.g. Demuth & Demuthova 2019; Demuthova &
Demuth 2019a; Demuthova & Doktorova 2019) on the population of Slovak adolescents revealed that it is crucial to map out the motivation behind the self-harm. This is especially necessary for three main reasons.
The first reason for the detailed identification of the motivation for self-harm is connected with its definition. Even though the generally accepted definition of this term does not exist (for the wider discussion, see e.g. Demuthova & Demuth 2019c), an intention is definitely considered to be the key factor in the determination of whether specific behaviours that cause damage to the mental or physical health of the subject may be referred to as self-harming behaviour. For example, an injury or illness differs from self-harming behaviour (despite the possibility that there are similar consequences) through the lack of any intention to deliberately harm oneself. Self-harming behaviour must have the primary intention to get hurt. The second reason comes from the findings that despite apparent differences in the occurrence, forms, and duration of self-harming behaviour, only a few of them are related to age, gender or other demographic characteristics. Just as with most psychologically- determined phenomena, self-harm seems to be probably closely linked to personality traits (Doktorova 2019), temperament or other psychological mechanisms, such as the motivation of the self-harming individual. The third reason is based on the fact that a poor understanding of self-harm contributes to negative perceptions about self-harming individuals and also causes poor healthcare. This points to e.g. commonly held – but wrong – belief attributed by others that self-harm is just an attention-seeking behaviour of young people (Doyle, Sheridan
& Treacy 2017).
2. Literature Review
Regarding the motivation for self-harm, scholarly literature frequently states that the most prevalent motive is the regulation of affects that are difficult to control. This has been a major factor considered to trigger self-harming behaviour. E.g. Klonsky (2009) in his sample of 39 young adults with a history of self-injury noticed that self-harming behaviour “is associated with improvements in affective valence and decreases with affective arousal. Specifically, participants tended to feel overwhelmed, sad, and frustrated before self-injury and relieved and calm after self-injury” (Klonsky 2009, 260). Other studies have also come to similar conclusions, the results of Laye-Gindhu and Schonert-Reichl provide support for the coping or affect regulation model of self-harm. The authors of this study also highlight the need to analyse the gender-related motivation for self-harming behaviour, as there are substantial differences between boys and girls (Laye-Gindhu & Schonert-Reichl 2005). The diminishment of negative feelings or thoughts (i.e., anger, tension) and other functions tied to automatic negative reinforcement were also confirmed by Zetterqvist, Lundh, Dahlstrom &
Svedin (2013); Bentley, Nock & Barlow (2014); Groschwitz et al. (2015), etc.
However, there are also other motives typical of adolescents – e.g. self-harming behaviour associated with initiation rituals within peer groups or other specific subcultures (e.g. Emo) (Favazza & Rosenthal 1990; Dyl 2008), self-harming behaviour as a demonstration of toughness or seeking sensations (mainly among boys – Glenn & Klonsky 2010) or even such reasons as “to show love” or “make people understand” (Loughrey & Kerr 1989) According to Adshead (2010), self-harm can also be as a form of communication which is used to express self-hatred and rage. Thus, it appears that self-harm may fulfil several functions and may originate from various motives (even subconscious) that lead to such actions.
3. Objective
It is apparent that self-harm, just as with other psychological phenomena, evolves and changes over time. There is also undoubtedly a link with cultural and social circumstances.
One of the most essential characteristics of self-harm is what motivates it, which points to the possible function of self-harm as a psychological mechanism. Considering the absence of this type of data, it seems desirable to investigate whether the Slovak population of adolescents may be characterized with similar motivational areas as those reported as the motivation for self-harming in adolescents from other countries in the past and, perhaps, whether there are sex-related or age-related specificities to such motivations. The aim of this study will be:
- to provide an overview of the prevalence of 13 areas as motivation for self-harm;
- to identify the most frequent areas of motivation for self-harm;
- to explore the existence of cross-gender differences in the motivation for self-harm;
- to observe the link between the individual motives for self-harm and the age of the population of Slovak adolescents.
4. Method
4.1 Participants and Procedure
The study sample comprised of Slovak adolescents who were enrolled within the primary and secondary public schools. All the participants were recruited from randomly selected classes from various school surroundings representing all the different types of schools in Slovakia. The collection of data was anonymous and included participants´ consent. The administration of the battery of tests was completed in a standard manner by trained administrators. Of the total number of 1,429 questionnaires, 116 (8.12%) were excluded due to incomplete data. 1,313 participants were included in the research, of whom 29.7%
(N=390) were found to be self-harming individuals. The analysis of the motivation for self- harm was conducted using this sample, comprised of individuals aged 11 to 19 (mean age = 15.42; st. dev. = 1.47 years), of which 73.1% (N=285) were women.
4.2 Measures
To explore the motivations for self-harm, the second section of the Inventory of Statements about Self-Injury (ISAS – Klonsky 2007, Klonsky & Glenn 2009, Klonsky 2018) was used.
Table 1: Names and sample-items for 13 areas measured by the ISAS (Klonsky & Glenn 2009, 218) Affect Regulation …calming myself down.
Anti-Dissociation …causing pain so I will stop feeling numb.
Anti-Suicide …putting a stop to suicidal thoughts.
Autonomy …demonstrating that I do not need to rely on others for help.
Interpersonal Boundaries …creating a boundary between myself and others.
Interpersonal Influence …letting others know the extent of my physical pain.
Marking Distress …creating a physical sign that I feel awful.
Peer Bonding …fitting in with others.
Revenge …getting back at someone.
Self-Care …creating a physical injury that is easier to care for than my emotional distress.
Self-Punishment …expressing anger towards myself for being worthless or stupid.
Sensation Seeking …doing something to generate excitement or exhilaration.
Toughness …seeing if I can stand the pain.
The ISAS assesses 13 potential motives (functions) for self-harm and each of those 13 areas is covered by three items, beginning with the stem “When I harm myself I am…” (the sample items for each of the 13 areas are listed in Table 1). The available answers in the ISASare “0- not relevant,” “1-somewhat relevant,” or “2-very relevant”. Thus, the scores for each of the 13 ISAS functions can range from 0 to 6. The psychometric properties of the ISAS have been reported in various studies – Klonsky & Glenn (2009), Kortge, Meade & Tennant (2013), Glenn & Klonsky (2011) or Bildik et al. (2013).
For data collection from the Slovak population, the wording of the corresponding part of ISAS was translated by a specialist – psychologist into Slovak, followed by a back-translation into English by another expert, which was subsequently reviewed again by a psychologist.
5. Results
The first aim of this study was to provide an overview of the prevalence of 13 motivation areas for self-harm. The descriptive Table 2 provides basic data on the incidence of studied areas, however, as the Kolmogorov-Smirnov test did not show the normal distribution of these variables, the nonparametric data (e.g. median) should be considered as more appropriate.
Table 2: The descriptive data for 13 areas of motivation for self-harm
Area Min. Max. Mean Median
Affect Regulation 0.00 7,00 2.71 3.00 Anti-Dissociation 0.00 6,00 1.68 1.00
Anti-Suicide 0.00 6,00 1.52 0.00
Autonomy 0.00 6,00 0.77 0.00
Interpersonal Boundaries 0.00 6,00 1.05 0.00 Interpersonal Influence 0.00 6,00 0.84 0.00 Marking Distress 0.00 6,00 1.88 2.00
Peer Bonding 0.00 5,00 0.29 0.00
Revenge 0.00 6,00 0.58 0.00
Self-Care 0.00 6,00 1.03 0.00
Self-Punishment 0.00 8,00 2.58 2.00 Sensation Seeking 0.00 6,00 0.67 0.00
Toughness 0.00 8,00 1.30 1.00
The highest prevalence can be seen in Affect Regulation (mean=2.21; median=3) followed by Self-Punishment (mean=2.12; median=2) and Marking Distress (mean=1.8808; median=2).
On the other hand, the least common were Revenge (mean=0.59, median=0) and Peer Bonding (mean=0.29, median=0). The detailed analysis of the individual items present in the ISAS showed that the following statements had the highest score (“When I harm myself I am…”): “… releasing emotional pressure that has built up inside me” (mean=0.82);
“…reducing anxiety, frustration, anger, or other overwhelming emotions” (mean=0.79); “…
expressing anger towards myself for being worthless or stupid” (mean=0.74 and
“…punishing myself” (mean=0.74).
The third aim focused on the exploration of the existence of cross-gender differences in the motivation for self-harm. Adolescent boys only ranked higher than girls in three areas – Peer Bonding (mean rank in boys=197.7; in girls=194.7), Sensation Seeking (mean rank in
boys=224.3; in girls=184.9), and Toughness (mean rank in boys=219.9; in girls=186.5); the girls’ scores were higher in all the remaining areas. However, statistically significant differences between boys and girls tested by the Mann-Whitney U-test were only found in four areas – Marking Distress (Asymp. Sig=0.0002) and Self-Punishment (Asymp.
Sig=0.0115 which were more prevalent among girls and Toughness (Asymp. Sig=0.0058) and Sensation Seeking (Asymp. Sig=0.0003) more prevalent among boys.
The observation of a link between the individual motives for self-harm and the age of the population of Slovak adolescents using the non-parametric Spearman Test revealed that the mutual correlations between most areas of motivation and age were not statistically significant (p>0.05). This means that the level of motivation of the majority of the areas observed does not exhibit any significant changes during the adolescents’ lives. These are only observable in the case of Autonomy (p=0.009), Interpersonal Influence (p=0.005), Marking Distress (p=0.039), and Self-Care (0.018), with their significance decreasing with age.
6. Discussion
As to the prevalence of the individual areas of motivation for self-harm, the most dominant in our study sample were Affect Regulation and Self-Punishment. This result corresponds with the data of several studies, where, for example, Klonsky reports that the most frequent motivation for self-harm is to alleviate negative affects (Klonsky 2007), or that the most common statements that account for self-harming behaviour are: “to release the emotional pressure that builds up inside of me”, “to control how I am feeling” or “to get rid of intolerable emotions” (Klonsky 2009). However, these findings only apply to adolescents as a whole – our analyses suggest that the dominance of the areas of motivation, Affect Regulation and Self-Punishment, may result from the dominance of female subjects in the sample of self-harming adolescents. If we look at the typical motivation for boys and girls separately, we may see that there are cross-gender differences in this respect. These were also confirmed by the Mann-Whitney Test; it, therefore, seems appropriate to consider sex when observing the motivation for self-harm.
Affect Regulation and Self-Punishment as typical areas that motivate self-harming girls suggests that for the female sex, self-harm may be considered as a form of maladaptive coping with uncontrollable emotions or maladaptive cognitive schemes. This reflects previous ideas about the coping or affect regulation model of self-harm (see e.g. Zetterqvist, Lundh, Dahlstrom & Svedin 2013; Bentley, Nock & Barlow 2014; Groschwitz et al. 2015).
On the other hand, for boys, the dominance of Sensation Seeking and Toughness indicate that it may be a way of satisfying the desire for sufficiently strong sensations or the enhancement of self-esteem through risk-taking and overcoming pain. These discrepancies reflect the natural differences in the behaviour of boys and girls in adolescence, when boys are more impulsive, need higher intensity impulses to become aroused than girls and the social pressures in the period when they are becoming men have a remarkably strong effect, especially on their ability to handle pain and their willingness to take risks. Such differences were observed also in a study by Laye-Gindhu & Schonert-Reichl (2005) where more boys than girls were likely to report reasons such as boredom, to join a group or thinking it would be fun. Although self-harming behaviour is an undesirable form of problem-solution or for the satisfaction of needs in both – male and female – groups, it is apparent that the mechanisms that underlay this highly risky behaviour may differ between the individual sexes.
The studies that suggest a link between the age and self-harming behaviour mostly refer to the link between the age when self-harming behaviour starts and the severity of self-harm or the presence of attempted suicide (Demuthova & Demuth 2019b). Several studies have indicated a slight rise in the prevalence of self-harm with age during adolescence (e.g.
Buresova, Bartosova & Cernak 2015), but no significant increase in the prevalence of self- harm with increasing age was found in the population of Slovak adolescents. Instead, age was associated with changes in the form of self-harm – the occurrence of indirect and mental forms of self-harm was more typical of older adolescents and, vice versa, the occurrence of the “classic” physical forms (e.g. cutting, banging, burning, scratching…) was characteristic of the younger subjects (Demuth & Demuthova 2019). Our analysis of the motivation for self-harm showed a statistically significant correlation with age in only four areas:
Autonomy, Interpersonal Influence, Marking Distress, and Self-Care, with a negative correlation. Hence, the reasons for self-harm are more striking at a younger age and their significance diminishes with time.
The dominance of Autonomy and Interpersonal Influence in the younger age group may be interpreted as the pivotal importance of interpersonal contacts and the need to gain independence during the periods of early and middle adolescence in general. These are typical developmental stages at these ages, hence the importance of these phenomena decreases once the mature identity (Erikson) develops during the period of late adolescence.
Marking Distress is a way in which adolescents, through their self-harm, create a physical sign that they feel bad, showing their emotional distress or to create an analogy between their psychological and physical pain. This domain in the ISAS has been covered by statements as (“When I harm myself I am…”): “…creating a physical sign that I feel awful”, or “… letting others know the extent of my emotional pain”. The decreasing occurrence of this motive with increasing age could be related to two phenomena. The first is the tendency of the younger adolescent group to express mental pain and suffering as an effort to seek support or help from others. This may decrease with age, as their experience increases and their coping mechanisms improve, older individuals rely more on themselves and their internal sources of support. This may equally indicate the end of the effort to outwardly express their problems, as this strategy failed (which may be assumed among the older individuals, as they continue with the self-harming behaviour when older). The second phenomenon might be the above- mentioned change in the forms of self-harm, which become more sophisticated and better concealed with age, thus this might lead to the change in the purpose of self-harm, which is no longer of a “presentational” nature. In the case of Self-Care, it is perhaps that it is difficult for younger children to take care of their mental health. They are more knowledgeable about their physical health, about how their bodies work, what causes diseases and how to treat them. This is certainly not the case for mental health – adolescents lack knowledge of their mental mechanisms, about potential effective coping mechanisms or “treatments” for mental issues. Thus it is easier for them to take care of their bodies than their psyche, and thus the attention they pay to mental problems and their treatment of mental problems is substituted by the need to care for their bodies and the treatment of injuries.
7. Limitations of the study
The interpretation of the presented outcomes is partly limited by the size of our sample. Even though it initially consisted of nearly 1.5 thousand adolescents, the final analyses were executed on 390 self-harming participants only. However, it seems, that the sample selection
for the problem of self-harm may be considered adequate, as the prevalence of self-harming behaviour was 29.7%, which corresponds to the prevalence levels reported by other authors in neighbouring countries (e.g. Czech Republic – Buresova, Bartosova & Cernak 2015;
Germany – Plener et al. 2009) as well as in more distant countries (e.g. USA – Swahn et al.
2012). On the other hand, the dominance of girls in our sample could affect the findings of the overall prevalence of motives for self-harm. Sex differences in motivation, which were revealed, point to the fact that the distribution of the sex in the sample may have a possible strong influence on these specific results.
Another limitation is tight to the method used for the data collection. Besides the general limitation of the questionnaires per se (answers influenced by the willingness of participants to pass the correct information), our questionnaire offered the prepared set of items pointing to thirteen different motives for self-harm. As there was not any possibility to add individual motives, our investigation could miss some data. A solution could be to enable participants to add their personal motives e.g. by answering the question about the reasons that lead them to self-harm. However, it is questionable, whether all children of such age group (11-19 years) are able to execute such an introspection.
8. Conclusion
Self-harm as a serious phenomenon is present in approximately 20 – 30% of adolescents as a maladaptive mechanism of an uncontrolled mental burden, which may fulfil several functions. It turns out that in addition to the chronically reported motive of the regulation of hard-to-manage affects, there are other major motives that also play a role among present-day adolescents, e.g. self-harm as a way to mark distress or to punish oneself. A more profound insight into the issue of the motivation for self-harm suggests that it is the sex of the subject which is the significant variable in this area, and not, as is more commonly reported, age. It seems that differences in the experience and behaviour of adolescent boys and girls are the relevant variables that require attention. Considering these findings, it appears appropriate to shift the main focus of studies into self-harm from the demographic characteristics to the psychological specificities which may, in addition to gender, also include the individual's personality.
9. Acknowledgement
This work was supported by the Slovak Research and Development Agency under contract No. APVV-17-0123.
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