| Most clinicians and researchers define self-injurious behavior (SIB) as a deliberate act performed with the intention to alter bodily tissue or integrity -- without regard to health or safety, but with no suicidal intent (e.g., cutting). However, other behaviors that involve people mistreating themselves may have much in common with more 'traditional' forms of SIB. Such 'indirect' methods of SIB might include involvement in abusive relationships, substance abuse, risky/reckless behavior, or eating disordered behavior. In this dissertation, I consider the possibility that conceptualizations of SIB should be expanded to include indirect forms of self-injury. I describe the results of two studies that directly compare indirect and direct self-injurers on clinical characteristics and response to pressure pain.;Study one showed that individuals in both SIB groups scored similarly (and significantly higher than controls) on clinical measures assessing dissociation, impulsivity, aggression, trait negative temperament, disinhibition, and Borderline Personality Disorder pathology. However, direct self-injurers were more self-critical, scored higher on a measure of suicide proneness, and had made more lifetime suicide attempts than those who engaged in only indirect methods. The increased suicidality of direct self-injurers, even when considered alone, provides a compelling reason to keep a distinction between direct and indirect SIB.;In study two, I replicated previous research documenting that direct self-injurers endure pressure pain for significantly longer than healthy controls. Indirect self-injurers had raw pain endurance values that were intermediate between the direct SIB and control groups, but statistically different from the control group only. This suggests that abnormal pain perception may not be specific to forms of self-injury involving immediate physical pain, and has implications for primarily biological models of pain sensitivity in direct self-injury.;Taken together, the data gleaned from these two studies offer no strong support that direct and indirect forms of self-injury should be seen as merely interchangeable behaviors. Rather, the findings seem most consistent with a distinct condition model. In this way, these data reinforce the idea that direct self-injurious behavior should be conceptualized as an independent clinical syndrome. |
