Abstract
Research suggests that difficulties in emotion regulation are an important correlate of nonsuicidal self-injury (NSSI) in adults. Research examining this link in adolescents is limited by the lack of comprehensive instruments to assess difficulties in emotion regulation. Against this background, the aims of the current study were to (a) confirm the six-factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263, 2004) in a sample of adolescent inpatients (N = 218); (b) explore the relation between different aspects of emotion dysregulation and lifetime NSSI while controlling for psychopathology and sex; and (c) assess the clinical utility of the DERS in detecting lifetime NSSI status. Fit indices obtained through Confirmatory Factor Analysis indicated that the six-factor structure of the DERS fit the data adequately and that most items loaded strongly on their respective latent factor. All six latent factors were significantly correlated with each other, with the exception of lack of emotional awareness and difficulties engaging in goal-directed behavioral when distressed. Regression analyses revealed that only the limited access to emotion regulation strategies subscale accounted for a significant portion of the variance in NSSI when controlling for other aspects of emotion dysregulation, sex, and psychopathology. Receiver Operating Characteristic analysis indicated that the DERS limited access to emotion regulation strategies subscale score has moderate diagnostic accuracy in detecting the presence of NSSI. The optimal cut-off score was 21.5 when detecting NSSI among inpatient adolescents. Results provide further support for the relation between emotion regulation difficulties and NSSI. The DERS appears to be a useful measure of detecting NSSI in clinical samples of adolescents.


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Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2010). Emotion dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology. doi:10.1007/s10802-010-9465-3.
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park: Sage.
Andover, M. S., Pepper, C. M., Ryabchenko, K. A., Orrico, E. G., & Gibb, B. E. (2005). Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder. Suicide & Life-Threatening Behavior, 35(5), 581–591. doi:10.1521/suli.2005.35.5.581.
Brain, K. L., Haines, J., & Williams, C. L. (1998). The psychophysiology of self-mutilation: evidence of tension reduction. Archives of Suicide Research, 4(3), 227–242. doi:10.1023/A:1009692507987.
Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39(3), 233–242. doi:10.1007/s10964-009-9482-0.
Bresin, K., & Gordon, K. H. (2011). Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personality Disorders: Theory, Research, and Treatment. doi:10.1037/a0025736.
Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: Guilford Press.
Brown, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills: Sage.
Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–202. doi:10.1037/0021-843X.111.1.198.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behaviour Research and Therapy, 44, 371–394. doi:10.1016/j.brat.2005.03.005.
DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 735–739. doi:10.1016/S0890-8567(10)80007-3.
Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491. doi:10.1037/1082-989X.9.4.466.
Fombonne, E. (1991). The use of questionnaires in child psychiatry research: measuring their performance and choosing an optimal cut-off. Journal of Child Psychology and Psychiatry, 32(4), 677–693. doi:10.1111/j.1469-7610.1991.tb00343.x.
Franklin, J. C., Hessel, E. T., Aaron, R. V., Arthur, M. S., Heilbron, N., & Prinstein, M. J. (2010). The functions of nonsuicidal self-injury: support for cognitive–affective regulation and opponent processes from a novel psychophysiological paradigm. Journal of Abnormal Psychology. doi:10.1037/a0020896.
Gratz, K. (2001). Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. doi:10.1023/A:1012779403943.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. doi:10.1023/b:joba.0000007455.08539.94.
Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37(1), 14–25. doi:10.1080/16506070701819524.
Gratz, K. L., & Tull, M. T. (2010). The relationship between emotion dysregulation and deliberate self-harm among inpatients with substance use disorders. Cognitive Therapy and Research, 34(6), 544–553. doi:10.1007/s10608-009-9268-4.
Haines, J., Williams, C. L., Brain, K. L., & Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104, 471–489. doi:10.1037/0021-843X.104.3.471.
Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143, 29–36. http://radiology.rsna.org/.
Hawton, K., & Harriss, L. (2008). The changing gender ratio in occurrence of deliberate self-harm across the lifecycle. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(1), 4–10. doi:10.1027/0227-5910.29.1.4.
Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. doi:10.1093/jpepsy/27.1.87.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118.
Klonsky, E. D. (2007). The functions of deliberate self-injury. A review of the evidence. Clinical Psychology Review, 27, 226–239. doi:10.1016/j.cpr.2006.08.002.
Kumar, G., Pepe, D., & Steer, R. A. (2004). Adolescent psychiatric inpatients’ self-reported reasons for cutting themselves. The Journal of Nervous and Mental Disease, 192(12), 830–836. doi:10.1097/01.nmd.0000146737.18053.d2.
Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34(5), 447–457. doi:10.1007/s10964-005-7262-z.
Lewczyk, C. M., Garland, A. F., Hurlburt, M. S., Gearity, J., & Hough, R. L. (2003). Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 349–356. doi:10.1097/00004583-200303000-00016.
Linehan, M. M. (1993). Cognitive-behavioral treatment for borderline personality disorder. New York: Guildford Press.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristic and functions on non-suicidal self-injury in a community sample of adolescents. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(8), 1183–1192. doi:10.1017/s003329170700027x.
MacDermott, S. T., Gullone, E., Allen, J., King, N. J., & Tonge, B. (2010). The emotion regulation index for children and adolescents (ERICA): a psychometric investigation. Journal of Psychopathology and Behavioral Assessment, 32(3), 301–314. doi:10.1007/s10862-009-9154-0.
Menard, S. (1995). Applied logistic regression analysis. Sage university paper series on quantitative applications in the social sciences (pp. 7–106). Thousand Oaks: Sage.
Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302. doi:10.1016/j.beth.2006.09.001.
Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: the protective role of trait emotional intelligence. British Journal of Clinical Psychology, 48(2), 181–193. doi:10.1348/014466508x386027.
Muthén, L. K., & Muthén, B. O. (1998–2010). Mplus users’ guide (Sixth Edition). Los Angeles, CA: Muthén & Muthén.
Myers, R. (1990). Classical and modern regression with applications. Pacific Grove: Duxbury Press.
Neumann, A., van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the Difficulties in Emotion Regulation Scale. Assessment, 17(1), 138–149. doi:10.1177/1073191109349579.
Nixon, M. K., Cloutier, P. F., & Aggarwal, S. (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(11), 1333–1341. doi:10.1097/00004583-200211000-00015.
Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6339–363. doi: 10.1146/annurev.clinpsy.121208.131258
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior in adolescents. Journal of Consulting and Clinical Psychology, 72, 885–890. doi:10.1037/0022-006X.72.5.885.
Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. doi:10.1016/j.psychres.2006.05.010.
Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2010). Revealing the form and function of self-injurious thoughts and behaviors: a real-time ecological assessment study among adolescents and young adults. Psychology of Violence, 1(S), 36–52. doi:10.1037/2152-0828.1.S.36.
Penn, J. V., Esposito, C. L., Schaeffer, L. E., Fritz, G. K., & Spirito, A. (2003). Suicide attempts and self-mutilative behavior in a juvenile correctional facility. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 762–769. doi:10.1097/01.CHI.0000046869.56865.46.
Penza-Clyve, S., & Zeman, J. (2002). Initial validation of the Emotion Expression Scale for Children (EESC). Journal of Clinical Child and Adolescent Psychology, 31(4), 540–547. doi:10.1207/153744202320802205.
Phillips, K. V., & Power, M. J. (2007). A new self-report measure of emotion regulation in adolescents: the regulation of emotions questionnaire. Clinical Psychology & Psychotherapy, 14(2), 145–156. doi:10.1002/cpp.523.
Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 80–87. doi:10.1097/00004583-200401000-00017.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39(1), 28–38. doi:10.1097/00004583-200001000-00014.
Sharp, C., Goodyer, I. M., & Croudace, T. J. (2006). The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of children aged 7 through 11. Journal of Abnormal Child Psychology, 34(3), 365–377. doi:10.1007/s10802-006-9027-x.
Sim, L., Adrian, M., Zeman, J., Cassano, M., & Friedrich, W. N. (2009). Adolescent deliberate self-harm: linkages to emotion regulation and family emotional climate. Journal of Research on Adolescence, 19(1), 75–91. doi:10.1111/j.1532-7795.2009.00582.x.
Sourander, A., Aromaa, M., Pihlakoski, L., Haavisto, A., Rautava, P., Helenius, H., & Sillanpää, M. (2006). Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15. Journal of Affective Disorders, 93(1–3), 87–96. doi:10.1016/j.jad.2006.02.015.
SPSS for Windows, Rel. 17.0.3. (2009). Chicago: SPSS, Inc.
Suyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18, 531–554. doi:10.1016/S0272-7358(97)00105-0.
Swets, J. A., & Pickett, R. M. (1982). Evaluation of diagnostic systems: Methods from signal detection theory. Orlando: Academic.
Thapar, A., & McGuffin, P. (1998). Validity of the shortened Mood and Feelings Questionnaire in a community sample of children and adolescents: a preliminary research note. Psychiatry Research, 81(2), 259–268. doi:10.1016/s0165-1781(98)00073-0.
Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621. doi:10.1037/a0016669.
Zeman, J., Shipman, K., & Penza-Clyve, S. (2001). Development and initial validation of the Children’s Sadness Management Scale. Journal of Nonverbal Behavior, 25(3), 187–205. doi:10.1023/A:1010623226626.
Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental and Behavioral Pediatrics, 27(2), 155–168. doi:10.1097/00004703-200604000-00014.
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Perez, J., Venta, A., Garnaat, S. et al. The Difficulties in Emotion Regulation Scale: Factor Structure and Association with Nonsuicidal Self-Injury in Adolescent Inpatients. J Psychopathol Behav Assess 34, 393–404 (2012). https://doi.org/10.1007/s10862-012-9292-7
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DOI: https://doi.org/10.1007/s10862-012-9292-7