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Psychodynamic profiles of non-suicidal self-injury in adolescence: From the intra-psychic to the interpersonal dimension

INTRODUCTION Sarno, Madeddu & Gratz, 2010; Shaffer & Jacobson, 2009).
One of the research areas that has seen the most
In recent years we have seen an increase in nonsuicidal development in recent years in the field of NSSI in adolescents
self-injury behaviours (NSSI), defined as deliberate and is a focus on the functions (Lewis & Santor, 2010; Nock &
self-inflicted destruction of one’s own body tissue without Prinstein, 2004), which have been theorized as intrapersonal
suicidal intent and for purposes not socially or culturally and interpersonal (Klonsky, 2007). The term intrapersonal
sanctioned (e.g. cutting, burning and scratching the skin or refers to the functions aimed at changing an individual’s
hitting; Nock, 2010). internal state (emotions, thoughts and physical sensations),
It is well-known that nonsuicidal self-injury is particularly whereas the term interpersonal refers to functions that aim
widespread amongst the adolescent and young adult to alter the external setting, for example, withdrawal of
populations, increases in early adolescence and declines in demands or increased social support (Turner et al., 2012).
late adolescence, with an average age of onset of 14 years In the vast majority of research, participants reported
(Brown & Plener, 2017; Cerutti, Manca, Presaghi & Gratz, intrapersonal functions, mainly affect regulation (e.g. coping
2011; Cipriano, Cella & Cotrufo, 2017; Plener, Schumacher, with negative emotions) and self-punishment (e.g. expression
Munz & Groschwitz, 2015). Furthermore, females are more of anger at self) (Gratz, 2007; Klonsky 2007; Klonsky & Glenn,
likely to implement the indicated behaviours than males 2009). Interpersonal or social functions were also reported,
(Bresin & Schoenleber, 2015; Gargiulo & Margherita, 2014; though less frequently than intrapersonal ones. Among
Valencia-Agundo, Corbet Burcher, Ezpeleta & Kramer, 2018), these, interpersonal influence (e.g. communicating internal
with gender differences linked to aetiology, trajectories and distress to others) was the most frequently reported (Klonsky,
contexts (Gargiulo & Margherita, 2019; Gargiulo, Tessitore, Le 2007; Nock & Prinstein, 2004), followed by revenge function,
Grottaglie & Margherita, 2020; Whitlock & Rodham, 2013). getting revenge on others (Klonsky, 2007). Nonetheless, it
NSSI is particularly widespread among school populations, should be noted that more than one function can be adopted
thus 18% of teenagers who attend school report having severely and functions can vary over time.
self-harmed at least once in their lifetime (Lewis & Heath, 2015; Emotion regulation (to regulate, control or express
Swannell, Martin, Page, Hasking & St John, 2014). Although intense and pervasive emotions, such as anger, boredom and
studies have focused on the school context, there is a need to sadness, or generally painful moods such as depression, guilt
intercept and better comprehend self-injury behaviours at and shame) is the function of NSSI most commonly referred
school (Berger, Hasking & Reupert, 2014; Gargiulo, 2020). to by those who engage in the behaviour, in particular by
Within a scientific discussion (Plener & Fegert, 2015) adolescents (Klonsky, 2007; Laye-Gindhu & Schonert-Reichl,
regarding the nomenclature and classification of the 2005; Madge et al., 2008; Nock & Prinstein, 2005). Self-
behaviour, which aimed to distinguish it on the one hand injurious behaviour is usually preceded by negative emotions
from suicide attempts and on the other from generalized and high arousal, and followed by feelings of calm and relief
self-harming behaviours, the Diagnostic and Statistical (Di Pierro, Sarno, Gallucci & Madeddu, 2014; Klonsky,
Manual of Mental Disorder 5 proposed the definition of 2009). Therefore, emotional dis-regulation (the inability to
Nonsuicidal self-injury as a specific psychiatric diagnosis recognize, accept, control and be aware of one’s emotions) was
and not only as a symptom or syndrome present in different then conceptualized as a possible risk factor of nonsuicidal
personality disorders (APA, 2013). This classification allowed self-injury in adolescence (Adrian, Zeman, Erdley, Lisa &
for better differential diagnosis, particularly in adolescence, Sim, 2011). NSSI has been related to infrequent use of effective
by preventing early stigmatization through a diagnosis of coping strategies, lack of emotional expression, and lack of
suicide or borderline personality (Gargiulo et al., 2014). In emotional clarity (Dicé, Maiello, Dolce & Freda, 2017; Gratz
this sense, part of the literature focused on implementing & Roemer, 2004; Martino et al., 2019). In this sense, a part of
studies in NSSI in adolescence following the diagnostic the literature has shown that adolescents who self-harm have
criteria of DSM-5, such as the number of episodes in the last difficulty putting their sufferings into words and consider it a
year, to establish whether it is occasional or Repetitive NSSI means of communication that allows them to share emotions
(Madjar, Zalsmanb, Mordechaia & Shovalb, 2017; Manca, of anger and anguish, and which allows their families and
Cerutti & Presaghi, 2005; Manca, Presaghi & Cerutti, 2014; those round them to realize how much they are suffering

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