Direct and Indirect Non-Suicidal Self-Injury (NSSI) Expression: An Investigation into the Nature of NSSI and Childhood Maltreatment
Abstract
Non-Suicidal Self-Injury (NSSI) involves deliberate damage to the body without suicidal intent. St. Germain and Hooley (2012) classify two forms of NSSI: direct and indirect. Direct NSSI is expressed through behaviours with immediate results (e.g. cutting), whereas indirect NSSI is expressed through means that are damaging to the body without immediate injury (e.g. promiscuity, substance abuse, risk behaviours, etc.). Research supports that NSSI behaviours occur in youth with histories of childhood maltreatment (CM; Trocmé et al., 2010); however, no study has examined if experiences of CM influence NSSI expression. Utilizing the InterRAI Child and Youth Mental Health tool (N= 4,616), an association between childhood maltreatment and NSSI expression (direct-only, indirect-only, and direct and indirect) was determined, with over half of participants reported experiencing polyvictimization. Engagement in NSSI was most commonly presented in older youth (16-18) and exhibited more frequently in females (vs. males); however, no gender differences were identified in those who engage in indirect-only NSSI. Of those youth who experienced maltreatment, they most commonly engaged in behaviours associated with indirect-only forms of NSSI expression (e.g. substance use, eating disorder symptomatology, risky behaviours, and sexual promiscuity). In relation to polyvictimization, a significant association was found between the three dimensions of NSSI expression, with polyvictimization significantly predicting engagement in indirect-only NSSI behaviours. Implications for targeted prevention within clinical practice and directions from future research are discussed.