Assessing the Functions of Non-Suicidal Self-Injury: Factor Analysis of Functional Assessment of Self- Mutilation among Adolescents

Non-Suicidal Self-Injury among Adolescents

  • Maryam Izadi Phd student of clinical psychology, shahed university, Tehran, Iran
  • Hamid Yaghubi
  • Pavaneh Mohammadkhani
  • Hamidreza Hassanabadi
Keywords: Adolescent; Assessment; Functional Assessment of Self-Mutilation (FASM); Non Suicidal Self-Injury


Objective: The aim of this cross sectional study was to assess the factor analysis of Functional Assessment of Self-
Mutilation (FASM) among Iranian adolescents with non-suicidal self-injury.
Method: In this study, 646 high school students, with the mean age of 16.55 ± 0.7, were selected using a multistage
cluster sampling method; they completed FASM and the demographic form. Data were analyzed using the descriptive
statistics, chi-square (χ2), independent sample t test, MANOVA, and confirmatory factor analyses (CFA).
Results: Of the participants, 178 reported at least 1 episode of NSSI during the previous year. The mean age of the
participants when they first harmed themselves was 14.64 (±1.71). Most of them reported to engage in NSSI impulsively
(39.32%) and experienced little (31.5%) or moderate physical pain (31.5%) There were no significant differences
between males and females in severity of NSSI, frequency of NSSI, thinking about NSSI prior to engaging in the act, and
age of onset. The results of the confirmatory factor analysis supported the 4-factor model of NSSI functions suggested by
Nock and Prinstine [Χ2/df = 1.84; RMSEA = 0.07; GFI = 0.82; AGFI = 0.77]. The most frequent function for engaging in
NSSI was Automatic Negative Reinforcement .
Conclusion: Findings of this study supported the structural validity of the FASM; thus, this tool can be useful in
treatment and research contexts as a measure of NSSI functions. Moreover, this study found that adolescents engage in
non-suicidal self-injury because of 4 distinct reinforcement processes. The study findings have important implications for
the assessment and treatment of NSSI.


1. Nock MK, Favazza AR. Nonsuicidal self-injury: Definition and classification. In Nock MK. Understanding nonsuicidal self-injury: Origins, assessment, and treatment. American Psychological Association. Washington, DC, US: American Psychological Association; 2009.
2. Klonsky ED. Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions. Psychological medicine. Psychol Med. 2011;41(9):1981-6.
3. Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self‐injury in nonclinical samples: Systematic review, meta‐analysis and meta‐regression. Suicide Life Threat Behav. 2014;44(3):273-303.
4. Gholamrezaei M, Heath N, Panaghi L. Non-suicidal self-injury in a sample of university students in Tehran, Iran: prevalence, characteristics and risk factors. International Journal of Culture and Mental Health. 2017;10(2):136-49.
5. Peivastehgar. M. The rate of deliberate self- harming in girls students and relationship with loneliness &Attachment styles [In Persian]. Psychology Studies.2013;9(3):29-52.
6. Briere J, Gil E. Self‐mutilation in clinical and general population samples: Prevalence, correlates, and functions. Am J Orthopsychiatry. 1998;68(4):609-20.
7. Benjet C, González-Herrera I, Castro-Silva E, Méndez E, Borges G, Casanova L, et al. Non-suicidal self-injury in Mexican young adults: Prevalence, associations with suicidal behavior and psychiatric disorders, and DSM-5 proposed diagnostic criteria. J Affect Disord. 2017;215:1-8.
8. Turner BJ, Austin SB, Chapman AL. Treating nonsuicidal self-injury: a systematic review of psychological and pharmacological interventions. Can J Psychiatry. 2014;59(11):576-85.
9. Nock MK, Joiner Jr TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006 Sep 30;144(1):65-72.
10. Klonsky ED. The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation. Psychiatry Res. 2009;166(2-3):260-8.
11. Asarnow JR, Porta G, Spirito A, Emslie G, Clarke G, Wagner KD, et al. Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. J Am Acad Child Adolesc Psychiatry. 2011;50(8):772-81.
12. Guan K, Fox KR, Prinstein MJ. Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. J Consult Clin Psychol. 2012;80(5):842-9.
13. Klonsky ED, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. J Abnorm Psychol. 2013;122(1):231-237.
14. Herpertz S. Self‐injurious behaviour Psychopathological and nosological characteristics in subtypes of self‐injurers. Acta Psychiatr Scand. 1995;91(1):57-68.
15. Himber J. Blood rituals: Self-cutting in female psychiatric inpatients. Psychotherapy: Theory, Research, Practice, Training. 1994; 31(4):620.
16. Miller F, Bashkin EA. Depersonalization and self-mutilation. Psychoanal Q. 1974;43(4):638-49.
17. Suyemoto KL. The functions of self-mutilation. Clin Psychol Rev. 1998;18(5):531-54.
18. Friedman M, Glasser M, Laufer E, Laufer M. Wohl. M.(1972). Attempted suicide and self-mutilation in adolescence: some observations from a psychoanalytic research project. Int J Psychoanal. 1972;53(2):179-83.
19. Firestone RW, Seiden RH. Suicide and the continuum of self-destructive behavior. Journal of J Am Coll Health. 1990;38(5):207-13.
20. Bentley KH, Nock MK, Barlow DH. The four-function model of nonsuicidal self-injury: key directions for future research. Clinical Psychological Science. 2014;2(5):638-56.
21. Nock MK, Prinstein MJ. A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol. 2004;72(5):885-90.
22. Nock MK, Prinstein MJ. Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol. 2005;114(1):140-6.
23. Nock MK. Self-injury. Annu Rev Clin Psychol. 2010;6:339-63.
24. Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behav Res Ther. 2006;44(3):371-94.
25. Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007;27(2):226-39.
26. Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007;37(8):1183-92.
27. Power J, Smith HP, Beaudette JN. Examining Nock and Prinstein’s four-function model with offenders who self-injure. Personal Disord. 2016;7(3):309-14.
28. Zetterqvist M, Lundh L-G, Dahlström Ö, Svedin CG. Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. J Abnorm Child Psychol. 2013;41(5):759-73.
29. You J, Lin M-P, Leung F. Functions of nonsuicidal self-injury among Chinese community adolescents. J Adolesc. 2013;36(4):737-45.
30. Gholamrezaei M, De Stefano J, Heath NL. Nonsuicidal self‐injury across cultures and ethnic and racial minorities: A review. International journal of psychology. 2017;52(4):316-26
31. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®).Washington, DCLondon, England: American Psychiatric; 2013.
32. Lloyd E, Kelley M, Hope T, editors. Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. annual meeting of the Society for Behavioral Medicine, New Orleans, LA; 1997.
33. Tabachnick BG, Fidell LS. Using multivariate statistics. 6th edition. Pearson education Inc; 2013.
34. Hu LT, Bentler PM.Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus new alternatives. Structural Equation Modeling; 1999;6(9): 9-55.
35. Khanipour H, Borjali A, Falsafi nejad M. Non-suicidal Self-injury in delinquent adolescents and adolescents with history of childhood maltreatment: motivation and suicide probability. Psychology of Exceptional Individuals. 2016; 6(21) : 59-79.
36. Wan Y-H, Hu C-L, Hao J-H, Sun Y, Tao F-B. Deliberate self-harm behaviors in Chinese adolescents and young adults. Eur Child Adolesc Psychiatry. 2011;20(10):517.
37. Liang S, Yan J, Zhang T, Zhu C, Situ M, Du N, et al. Differences between non-suicidal self injury and suicide attempt in Chinese adolescents. Asian J Psychiatr. 2014;8:76-83.
38. Zoroglu SS, Tuzun U, Sar V, Tutkun H, Savaçs HA, Ozturk M, et al. Suicide attempt and self‐mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry Clin Neurosci. 2003;57(1):119-26.
39. You J, Leung F, Fu K, Lai CM. The prevalence of nonsuicidal self-injury and different subgroups of self-injurers in Chinese adolescents. Arch Suicide Res. 2011;15(1):75-86.
40. Ross S, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence. 2002;31(1):67-77.
41. Tang J, Yu Y, Wu Y, Du Y, Ma Y, Zhu H, et al. Association between non-suicidal self-injuries and suicide attempts in Chinese adolescents and college students: a cross-section study. PloS one. 2011;6(4):e17977.
42. Izutsu T, Shimotsu S, Matsumoto T, Okada T, Kikuchi A, Kojimoto M, et al. Deliberate self-harm and childhood hyperactivity in junior high school students. European child & adolescent psychiatry. 2006;15(3):172-6.
43. Serafini G, Canepa G, Adavastro G, Nebbia J, Belvederi Murri M, Erbuto D, Pocai B, Fiorillo A, Pompili M, Flouri E, Amore M. The relationship between childhood maltreatment and non-suicidal self-injury: a systematic review. Frontiers in psychiatry. 2017;8:149.
How to Cite
Izadi M, Yaghubi H, Mohammadkhani P, Hassanabadi H. Assessing the Functions of Non-Suicidal Self-Injury: Factor Analysis of Functional Assessment of Self- Mutilation among Adolescents. Iran J Psychiatry. 14(3):184-191.
Original Article(s)