Attachment theory as a conceptual framework for risk pathways in non-suicidal self-injury

This thesis examines possible risk pathways for non-suicidal self-injury using attachment theory as a conceptual framework. It proposes a model with three pathways for self-injury, which are initiated by the distal risk factors of insecure attachment to the mother, the father and peers. The research suggests that from this initial point the pathways are then developed by means of proximal risk factors: the first via stressful life events and emotional distress; the second through low self-efficacy and non-productive coping strategies and the third pathway via emotion deregulation and impulsivity. The study explores the model by empirically testing the proposed risk pathways for self-injury in young people in the community. Participants were 275 young people (aged 13-26) recruited from secondary schools, youth groups and one large university, who completed a self-report pencil and paper questionnaire. The self-report instruments were used to measure the variables of non-suicidal self-injury, self-injury motivation, attachment to parents and peers, stressful life events, depressive, anxiety and stress symptoms, self-efficacy, coping strategies, emotion regulation and impulsivity. For each of the three proposed pathways, separate multiple regressions were performed to examine the relationship between the distal risk factors of attachment to the mother, father and peers, and self-injury. The final step involved examination of the relationship between attachment and self-injury to determine any possible mediation by the proximal risk factors. The study reports on self-injury in an Australian non-clinical sample of young people. Twenty-two per cent of the sample participants reported at least one episode of self-injury. Mean age for the first episode of self-injury was 13.37 years and for the last episode 15.82 years. Of those reporting self-injury, 66 per cent told someone about their behaviour, mostly their friends, and 16.39 per cent visited a medical practitioner. The most frequent motivation for self-injury, described by 36.7 per cent of those who self-injured, was to be distracted from emotional pain by experiencing physical pain. The study reveals that the relationship between maternal attachment and self-injury was fully mediated by stressful life events, depressive symptoms, low self-efficacy and non-productive coping strategies. The relationship between paternal attachment and self-injury was partly mediated by these proximal factors. The relationship between peer attachment and self-injury was partly mediated by the above proximal factors and also by impulsivity. Unexpectedly, emotion deregulation was not related to self-injury. A number of implications are suggested by the findings. These include preparing children at the onset of adolescence to develop effective coping strategies in stressful conditions; providing information to principals, counselors and teachers on factors that may be involved in pathways to self-injury; and familiarizing adolescent leaders with resources on how to support other adolescents at risk. Clinical implications include the need for a focus among self-injuring individuals and their parents on strengthening the security of the attachment relationship: for example, by working on being open to, and aware of, negative emotions. This holds out the possibility for young people and parents to become more fully attuned to the whole spectrum of feelings, thereby facilitating more effective responses to distress.