Date of Award


Document Type


Degree Name

Clinical Psychology, PhD



Faculty Advisor

Lance Swenson


Non-suicidal self-injury (NSSI) is the direct, deliberate destruction of body tissue without suicidal intent (Nock & Favazza, 2009). Age of onset, based primarily on retrospective reports, commonly occurs between twelve and fourteen years old (e.g., Jacobson & Gould, 2007). Recent efforts have examined NSSI among children directly (Barrocas et al., 2012; Esposito-Smythers et al., 2010). The current study, a mixed-methods approach, examined NSSI among a sample of children treated on a psychiatric inpatient unit. Archival chart reviews assessed current/lifetime NSSI behaviors, demographic data, current/lifetime suicidal ideation and attempts, and self-reported clinical rating scales. Semi-structured interviews with self- injuring children assessed phenomenology (e.g., age of onset, discovery of NSSI, emotions/thoughts, triggers) and the functions of NSSI. NSSI was highly prevalent in this sample; 63.9% (n = 78; 47 boys, 31 girls) of inpatient children, age nine to twelve years old, had past or current NSSI documented in their medical charts. NSSI+ participants were found to report significantly higher depressive scores and significantly higher anger scores compared to NSSI- participants (ps < .05). Similarly, among the interviewed children (n = 7), they reported mostly internal (e.g., affect regulation) reasons for engaging in NSSI as well as bullying and family stressors triggering their NSSI behaviors. These findings indicate that NSSI is evident among psychiatrically impaired children as young as nine years old. In addition, depression and anger may play a role in the onset or maintenance of NSSI behavior among youth. Findings show many similarities between children and adolescents engaging in NSSI. Recognizing that NSSI may occur much earlier than previously thought and understanding how psychiatric distress (i.e., depression, anger) contributes to NSSI will inform better prevention and intervention treatments targeting NSSI. This study highlights that children are engaging in NSSI at much younger ages than previously thought, and are just as psychiatrically impaired as adolescents.

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