Academic journal article Journal of Cognitive Psychotherapy

Body Regard in Nonsuicidal Self-Injury: Theoretical Explanations and Treatment Directions

Academic journal article Journal of Cognitive Psychotherapy

Body Regard in Nonsuicidal Self-Injury: Theoretical Explanations and Treatment Directions

Article excerpt

Nonsuicidal self-injury among youth and young adults remains a challenging behavior for clinicians to treat. Etiological models of self-injury have laid a foundation for the development of effective treatments that focus on the intrapersonal and interpersonal regulating functions of the behavior but have failed to consider other mechanisms that may facilitate the initiation and maintenance of the self-injury. This article presents a theoretical argument that body disregard is a necessary factor to include in etiological conceptualizations of nonsuicidal self-injurious behavior as well as within treatment approaches. Empirical literature is reviewed to provide a solid basis for the tenant that body disregard facilitates self-injury. Suggestions for incorporating treatment strategies that address body-related factors are offered along with some directions for future research.

Keywords: nonsuicidal self-injury; body image; body regard; self-harm; treatment

Nonsuicidal self-injury (NSSI) continues to be a problem among adolescents and young adults (Nock, 2010; Rodham & Hawton, 2009), presenting a growing challenge for clinicians. Research into the phenomenon of NSSI is advancing current understanding of various risk and maintenance factors associated with the behavior as well as suggests potentially effective treatment interventions (Klonsky, Muehlenkamp, Lewis, & Walsh, 2011; Muehlenkamp, 2006; Nixon & Heath, 2009; Walsh, 2006). In addition, theoretical models have been proposed that attempt to explain how both distal (e.g., abuse, family hostility, genetics) and proximal (e.g., stressful event, pain analgesia) risk factors influence the development of NSSI (Nock, 2010). Other models have been offered that help to explain the maintenance and reinforcing properties of NSSI (see Chapman, Gratz, & Brown, 2006; Nock, 2009; Nock & Prinstein, 2004). Despite these advances, the current models tend to focus predominantly on the psychosocial and physiological regulating properties of the behavior. However, this requires a person to have engaged in NSSI at least once. What the models fail to address are mechanisms that explain why NSSI is first chosen and then continued, when other behaviors such as substance abuse, behavioral acting out, and disordered eating show similar patterns of risk, motivation, and reinforcement (Feil & Hasking, 2008; Hasking, 2006; Muehlenkamp, Claes, Smits, Peat, & Vandereycken, 2011; Svirko & Hawton, 2007) yet do not involve such blatant and direct harm to the body. To fully comprehend and adequately treat NSSI behaviors, it is essential to identify the mechanisms through which NSSI becomes an attractive and viable behavioral coping tool.

Given that NSSI represents a direct, intentional, physical attack on the body, how one perceives, cares for, and experiences the body (e.g., body regard) may be a key piece to include in etiological models and to address within treatment. Within the suicide literature, theories (e.g., Baumeister, 1990; Orbach, 1996) have proposed that negative attitudes toward and/or experiences of the body are among the key pieces to understanding a person's ability to enact lethal self-harm. Although NSSI is distinct from suicidal behavior, particularly in its intent, motivations, and lethality (Muehlenkamp, in press), both behaviors do represent intentional harm to the physical health and safety of the body. Furthermore, NSSI and suicidal behaviors tend to co-occur at high rates and share some risk factors (Muehlenkamp & Kerr, 2010; Skegg, 2005), suggesting that they may share some similar etiological processes. Thus, it is possible that the suicide-based theories about the importance of the body may have some relevance to NSSI. As Walsh (2006) notes, to suggest that individuals who engage in NSSI have "compromised relationships with their bodies" (p. 167) may seem obvious, but the dominant theoretical models and treatment approaches for NSSI do not include this piece. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.