Suicide and Life-Threatening Behavior 37(5) October 2007

2007 The American Association of Suicidology

543

Emotional Antecedents and Consequences of

Deliberate Self-Harm and Suicide Attempts
Alexander L. Chapman, PhD, and Katherine L. Dixon-Gordon, BS

Emotional experiences immediately prior to (emotional antecedents) and

following (emotional consequences) deliberate self-harm and suicide attempts in
female inmates (N = 63) were examined. Anger was the antecedent emotion reported by the largest proportion of individuals who had engaged in deliberate
self-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts
(30%). Relief and other positive emotional shifts were more common in deliberate
self-harm (41.94%) (involving no intent to die) than in suicide attempts or ambivalent suicide attempts, particularly for persons with borderline personality disorder. These findings underscore the utility of discriminating between deliberate
self-harm and suicidal behavior and highlight the potential role of anger in triggering such behaviors.

Behaviors that involve direct and intentional

self-harm, often called parasuicidal behaviors,
have received increased attention from researchers in recent years (Brown, Comtois, &
Linehan, 2002; Chapman, Specht, & Cellucci, 2005a, 2005b; Favazza, 1998; Gratz,
Conrad, & Roemer, 2002; Nock & Prinstein,
2004) and represent serious and potentially
life-threatening clinical problems. Indeed,
several studies have indicated that repeated,
deliberate self-harm is perhaps the most robust and potent predictor of suicide attempts
(van Egmond & Diekstra, 1989) and completed suicide (Gunnell & Frankel, 1994),
even after controlling for important covariates such as presence and severity of mental
disorder, gender, and age (Cavanagh, Owens,

Alexander Chapman and Katherine

Dixon-Gordon are with the Department of Psychology at Simon Fraser University in Burnaby,
BC, Canada.
Address correspondence to Alexander L.
Chapman, Department of Psychology (RCB
5246), Simon Fraser University, 8888 University
Drive, Burnaby, BC, Canada V5A 1S6; E-mail:
alchapma@sfu.ca

& Johnstone, 1999; Joiner et al., 2005; see also

Boardman, Grimbaldeston, Handley, Jones,
& Willmott, 1999; Brown, Beck, Steer, &
Grisham, 2000; Esposito, Spirito, Boergers,
& Donaldson, 2003).
Unfortunately, there has been such
ambiguity in the definitions of these behaviors that it is unclear how to interpret some
of the research findings (Linehan, 2000).
Linehan has suggested that the presence or
absence of the intent to die during self-harm
is a critical yet often neglected factor that can
be reliably assessed in research. For the purposes of the present paper, we define deliberate self-harm (DSH) as the deliberate, direct
destruction or alteration of body tissue without conscious suicidal intent (Chapman,
Gratz, & Brown, 2006; Gratz, 2003; Klonsky,
Oltmanns, & Turkheimer, 2003). In contrast
with DSH, suicide attempts (SA) involve conscious intent to die, and ambivalent suicide attempts (ASA) involve ambivalence regarding
the intent to die.
Accumulating evidence suggests that
DSH differs from SA in clinically important
ways (Brown et al., 2002; Chapman et al.,
2006; Gratz, 2003). For instance, Brown et

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Emotions, Deliberate Self-Harm, and Suicide Attempts

al. examined the reasons endorsed by 75

women diagnosed with borderline personality disorder (BPD) for engaging in recent
acts of DSH or SA. Emotional relief was the
most common reason given for both SA and
DSH; however, reasons for SA were more
likely to involve making others better off
(reducing burden on others), while reasons
for DSH more often included feeling generation, anger expression, and distraction.
Another study of the reasons for engaging in
parasuicidal behavior found that the reason
wish to die loaded negatively on a factor
consisting of reasons that involve temporary
escape from emotions, suggesting that the
motivation to escape is more closely aligned
with behavior involving lower intent to die
(Hjelmeland et al., 2002). In addition, although DSH confers a heightened risk for
SA and eventual suicide completion, not everyone who engages in DSH is suicidal or
has attempted suicide (Kessler, Borges, &
Walters, 1999; Velamoor & Cernovsky, 1992).
Further studies are needed to clarify
the distinction between SA and DSH. One
important distinguishing factor may be the
emotional experiences surrounding these behaviors. Several theories have emphasized the
role of emotional experiences in either triggering or reinforcing DSH or SA. For instance, the experiential avoidance model
(EAM; Chapman et al., 2006) poses that
DSH is maintained through negative reinforcement in the form of reduction or escape
from unwanted emotional arousal. Baumeisters (1990) escape model of suicidal behavior
suggests that suicidal behavior often occurs
in response to aversive, self-focused emotional states that lead to a breakdown in cognition and problem solving. In addition,
Joiners (2002) theory of suicidal behavior
posits that repeated experience with DSH reduces the aversive aspects of the behavior
(shame, unwanted scars), while simultaneously heightening the reinforcing aspects, including reductions in unwanted or intolerable emotions.
Studies of reasons people provide for
engaging in self-harm and suicidal behavior

also have highlighted the potentially important role of emotions. For instance, Brown
et al.s (2002) study on woman with BPD indicated support for the notion that emotional
relief is a key motivation for both DSH and
SA and suggested a potentially stronger role
for anger in DSH versus SA. Individuals who
engage in DSH typically report that the behavior quickly relieves unendurable anxiety/
tension (Kemperman, Russ, & Shearin, 1997;
Michel, Valach, & Waeber, 1994; Simeon et
al., 1992; Wilkins & Coid, 1991). Other
studies have found that some individuals report that DSH temporarily reduces anger,
anxiety, sadness, depression, and shame (Kemperman et al., 1997).
Further research is needed to examine
whether particular emotional experiences may
trigger or reinforce DSH or SA. It also would
be clinically useful to know whether emotional triggers and consequences differ based
on the type of behavior (DSH, ASA, SA) involved. For example, if anger were more
likely to precede DSH than SA, then clinical
interventions targeting DSH would more
strongly emphasize strategies to reduce or
regulate anger. A couple of studies have
found that imagery associated with episodes
of DSH led to reductions in physiological
measures of emotional arousal in male prisoners (Haines, Williams, Brain, & Wilson,
1995) and in parasuicidal women with BPD
(Shaw-Welch, Kuo, Sylvers, Chittams, & Linehan, 2003); however, these studies did not examine differences between DSH and SA.
The primary purpose of the present
study was to examine differences in the emotional antecedents and consequences of
DSH, ASA, and SA among female inmates, a
population for which these behaviors are
quite prevalent and clinically important (see
Chapman et al., 2005a, 2005b; Dolan &
Mitchell, 1994; Wilkins & Coid, 1991). We
hypothesized that participants would be
more likely to report negative (e.g., anger,
guilt) rather than positive or neutral antecedent emotions, and positive or neutral emotional consequences rather than negative emotional consequences [(e.g., relief, calmness,

Chapman and Dixon-Gordon

indifference)]. We also explored differences in
emotional antecedents and consequences
among DSH, ASA, and SA. Our study focused on female inmates but also examined
the influence of borderline personality disorder on the findings, a disorder that is quite
prevalent among female inmates (Chapman et
al., 2005a, 2005b; Coid, 1992; Dolan &
Mitchell, 1994). According to Linehans (1993)
biosocial theory, BPD involves marked deficits in the skills necessary to regulate emotions; consequently, persons with BPD use
impulsive, self-destructive strategies to escape unwanted emotions. We examined the
hypothesis that, among persons with BPD
(compared with non-BPD participants),
DSH and SA (particularly DSH) would be
more strongly associated with emotional
consequences involving relief or escape from
distressing emotions.
METHOD

Participants
This study received IRB approval prior
to data collection. One hundred and seventeen female inmates (Mage = 33.90, SD = 8.52)
from a multilevel womens prison volunteered to participate after receiving a brief
description of the study. Exclusionary criteria
included a current manic or psychotic episode or serious reading difficulties that precluded completing questionnaires. Two participants were excluded, one because of reading
difficulties and the other due to frank confusion. Ten participants completed questionnaires but were transferred to another facility
before completing the interviews. Of the remaining 105 individuals, 63 (60%) reported
a history of DSH, ASA, or SA and were included in the analyses for this study. Of these
63 individuals, 32 (50.79%) were diagnosed
with borderline personality disorder, using
the Structured Clinical Interview for DSMIV personality disorders (SCID-II; First,
Gibbon, Spitzer, Williams, & Benjamin,
1997). The ethnic composition of these individuals (Mage = 30.30, SD = 8.57) was: White

545
(74.6%), Native American (11.1%), Hispanic
(9.5%), and African American (1.6%); 3.2%
marked other or did not indicate.
Procedure
All participants were given a description of the project and signed a written informed consent form that specified that participation (or refusal to participate) in this
study would in no way influence their treatment or privileges in prison. Participants
completed various assessment measures over
the course of two sessions (separated by a
mean of 4.74 days): Session 1 involved completing self-report questionnaires; Session 2
involved individual interviews administered
by a doctoral student in clinical psychology
or a licensed psychologist. All interviewers
were trained in the SCID-II by the first author, who had conducted or rated over 100
SCID-II interviews. Interview ratings were
discussed during lab meetings to ensure that
the basis for ratings was consistent across interviewers. Questionable ratings were scored
based on team consensus.
Borderline Personality Disorder Assessment. The SCID-II (First et al., 1997) was
used for diagnostic evaluation of BPD. The
SCID-II has demonstrated good psychometric properties in several studies (Farmer &
Chapman, 2002; First et al., 1995; Maffei et
al., 1997). The SCID-II-Personality Questionnaire (SCID-II-PQ) was administered as
a screening measure; interviewers queried
only those items rated true on the SCIDII-PQ. Given the prevalence of substance use
among female prisoners, ratings were made
based on instances when the inmate was not
actively using substances.
Lifetime Parasuicide Count-2. The Lifetime Parasuicide Count-2 (LPC-2; Linehan
& Comtois, 1996) is a structured interview
designed to assess lifetime frequency of
DSH, ASA, and SA. Questions inquire about
the frequency of various methods of DSH,
SA, and ASA (e.g., cutting, burning, overdosing). An act of DSH was defined as a single
instance of direct, intentional self-harm with

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Emotions, Deliberate Self-Harm, and Suicide Attempts

no intent to die; ASA acts involved ambivalence regarding the intent to die; and SA involved clear intent to die. The LPC-2 inquired about participants very first, most
recent, and most severe instances of selfharm behaviors. Given the potential memory
biases associated with recalling distal acts of
DSH, ASA, or SA, we focused on participants most recent act (following Brown et
al., 2002). Participants were asked to identify
the most prominent emotion before and after
the most recent act of DSH, ASA, or SA
from a standard list of nine emotions: anger,
sadness, anxiety, guilt, tension, boredom, indifference, relief, and calmness.

TABLE 1

Emotional Antecedents to Deliberate Self-Harm,

Ambivalent Self-Harm, and Suicide Attempts
Emotion
Anger
Anxiety
Tension
Guilt
Sadness
Boredom
Indifference
Relief
Calmness

DSH

ASA

SA

45.16%
16.13%
9.68%
6.45%
9.68%
12.90%
0.00%
0.00%
0.00%

30%
0%
10.00%
30.00%
30.00%
0.00%
0.00%
0.00%
0.00%

40.90%
0%
0.00%
18.00%
18.00%
0.00%
13.60%
4.54%
4.54%

0.74
7.54*
3.58
3.76
2.34
5.95*
6.60*
2.13
2.13

Note. DSH = deliberate self-harm; ASA =

ambivalent suicide attempt; SA = suicide attempt.
*p < .05

RESULTS

Characteristics of Recent Acts of DSH,

ASA, and SA
The most recent act of DSH, ASA, or
SA occurred a median of 3.0 years ago, with
almost 30% of participants (28.6%) reporting one of these behaviors in the past year.
In terms of DSH, the most common form
was cutting (38.7%), followed by banging
head or hitting self (22.6%), intentionally
overdosing on drugs (12.90%), burning
(12.90%), and other (12.90%). The most
common forms of ASA included intentionally
overdosing on drugs (60%), cutting (30%),
and attempting to strangle or hang oneself
(10%). In contrast, the most common form
of SA was intentionally overdosing on drugs
(54.50%), followed by cutting (18.20%), other
(13.60%), jumping from a high place
(4.50%), self-shooting (4.50%), and selfasphyxiating (4.50%). Across DSH, ASA, and
SA, the other category largely consisted of
punching objects, self-starvation, and getting
into a car wreck.
Emotional Antecedents
Table 1 displays the percentages of individuals who reported each emotion preceding recent acts of DSH, ASA, and SA. Across
all participants who had engaged in DSH

(n = 31), the largest percentage of individuals

reported that they felt angry immediately
prior to engaging in that behavior. Overall,
all participants reported a negative emotion
prior to DSH; no participant reported feeling
indifferent, relieved, or calm. Similarly, all of
the ASA participants reported a negative
emotion preceding ASA, with the most common negative emotions consisting of anger,
guilt, and sadness. In terms of participants
who reported a SA (n = 22), the largest proportion reported that they felt angry prior to
the SA; nobody reported that boredom or
anxiety preceded SA. Unlike ASA and DSH,
some SA participants reported relief, indifference, and calmness prior to engaging in SA.
Differences in Antecedents Across DSH,
ASA, and SA. Compared with persons who
reported ASA (0%) and SA (0%), a significantly larger proportion of persons who reported DSH reported that they felt boredom
prior to engaging in DSH (12.90%), 2 likelihood ratio = 5.95, p < .05. In addition, a larger
number of SA participants reported indifference (13.60%), compared with DSH (0%)
and ASA (0%) participants, 2 likelihood ratio = 6.60, p < .05 (see Table 1). When we
collapsed analyses across all negative emotions, significant differences emerged in the
proportions of DSH (100%), ASA (100%),
and SA (77.27%) individuals who reported

Chapman and Dixon-Gordon

547

negative antecedent emotions, 2 likelihood

ratio = 11.35, p < .01.1
Emotional Consequences
Table 2 displays the percentages of individuals who reported each emotion following recent acts of DSH, ASA, and SA. Across
all participants who had engaged in DSH
(n = 31), the largest proportion of individuals
reported that they felt relieved immediately
following DSH. No participant reported
boredom following DSH. In terms of ASA
participants (n = 10), the largest proportion
TABLE 2

Emotional Consequences of Deliberate

Self-Harm, Ambivalent Self-Harm,
and Suicide Attempts
Emotion
Anger
Anxiety
Tension
Guilt
Sadness
Boredom
Indifference
Relief
Calmness

DSH

ASA

SA

6.45%
9.68%
6.45%
9.68%
12.90%
0.00%
9.68%
25.80%
16.13%

10.00%
0.00%
10.00%
40.00%
10.00%
0.00%
0.00%
20.00%
10.00%

31.8%
4.54%
0.00%
27.00%
13.60%
0.00%
9.00%
13.63%
0.00%

2
6.28*
1.95
2.79
5.19a
.09
N/A
2.38
1.21
5.73 a

Note. DSH = deliberate self-harm; ASA =

ambivalent suicide attempt; SA = suicide attempt.
a
p < .10; *p < .05

1. For these analyses, we used the standard

cutoff of .05 and did not implement a correction
for cumulative Type-I error. The analyses were
largely exploratory, and correcting for Type-I error would have resulted in an unacceptable balance between Type I and Type II errors. For instance, Cohen and colleagues (Cohen, Cohen,
West, & Aiken, 2003, p. 183) have suggested that
one of the key tasks in statistical inference is maintaining a low rate of Type I errors without a substantially elevated risk of Type II errors. Because
this research is exploratory, and the sample sizes
were relatively small for some groups (particularly, the ASA group, n = 10), we concluded that
applying blanket corrections for Type I error
would have resulted in an unacceptably large likelihood of Type II errors.

reported that they felt guilty immediately

following ASA. No participant reported
boredom, indifference, or anxiety following
ASA. Finally, in terms of SA participants (n =
22), the largest proportion reported that they
felt angry following SA, and nobody reported
boredom or tension following SA.
Differences in Consequences across DSH,
ASA, and SA
Compared with persons who reported
ASA (10%) or DSH (6.45%), a significantly
larger proportion of persons who reported
SA also reported anger as an emotional consequence (31.8%), 2 likelihood ratio = 6.28,
p < .05. In addition, there was a trend for
guilt to be a more common consequence to
ASA (40%), compared with DSH (9.68%),
and SA (27%), and also for calmness to be
most common following DSH (16.13%) (see
Table 2). When analyses collapsed across all
negative emotions, significant differences
emerged in the proportions of DSH
(45.16%), ASA (70%), and SA (77.27%) individuals who reported negative consequent
emotions, 2 likelihood ratio = 6.15, p < .05.
When collapsed across all positive emotions,
it appeared that positive emotional consequences were more likely among DSH individuals (41.94%) than ASA (30%) and SA
(13.63%), but this effect was a trend, 2 likelihood ratio = 5.23, p = .07.
Emotional Shifts from Antecedents
to Consequences
Although examining particular types
and valences of emotional consequences may
suggest reinforcing effects of DSH, ASA, or
SA, data that show shifts from negative antecedent emotions to neutral or positive emotions would be more convincing. Thus, we
examined the association of DSH, ASA, and
SA with changes in participants reports of
emotions prior to (antecedents) and following (consequences) the behavior by computing a change score (CS) in the following
manner: We coded the antecedent and consequence emotions 1 (present) versus 0 (ab-

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Emotions, Deliberate Self-Harm, and Suicide Attempts

sent). If the change from antecedent to consequence was from the presence of a negative
emotion to its absence, or from the absence
of a positive emotion to its presence, CS = 1.
If the change was from the absence of a negative emotion to its presence, or from the
presence of a positive emotion to its absence,
CS = 1. If a participant had a change in the
type of emotion, but not in the valence of the
emotion, CS = .5. Alternatively, if a participant had no change in the valence of emotion
reported prior to and following the behavior,
the CS = 0.
We examined the association of intent
with change, using a 4 (CS levels 1, 0.50, 0,
and 1) 3 (DSH, ASA, SA) chi-square analysis, 2 (6) = 18.33, p < .01. Among the SA
group, 18.18% reported a negative emotional
shift following SA, compared with 0% for
both the DSH and the ASA group. Fifty-five
percent of the DSH group received a positive
CS, compared with only 30% of the ASA
group and 22.72% of the SA group. To examine whether those with more experience
with DSH were more likely to experience a
positive emotional shift, we examined the
correlation between the total lifetime frequency of DSH and the CS (where lower values = more negative shifts), and found that
higher lifetime frequency of DSH was associated with more a more positive emotional
shift, Spearmans = .28, p = .026. In contrast, lifetime frequency of ASA (Spearmans
= .085, ns) and SA (Spearmans = .16, ns)
were not significantly associated with CS.
Emotional Shifts from Antecedents
to Consequences: The Effects
of Borderline Personality Disorder
Using the CS described above, we also
examined whether the association of the type
of behavior (DSH vs. ASA vs. SA) with change
depended on the presence of BPD. It is possible that persons with BPD are more likely
to use DSH as an emotion regulation or experiential avoidance strategy, compared with
persons who do not have BPD. First, we conducted a 4 (CS levels 1, 0.50, 0, 1) 3
(DSH, ASA, SA) Fishers Exact Test with in-

dividuals in the non-BPD group (n = 31),

finding a nonsignificant result. Subsequently,
we repeated this analysis with individuals in
the BPD group. Among persons with BPD,
those in the DSH group (68.75%) were more
likely to report a positive emotional shift,
compared with the ASA (0%) and SA (15.38%)
groups (p < .01). Thus, it appeared that there
was an interaction of BPD with behavior type
(DSH, ASA, SA), such that the higher likelihood of a positive emotional shift with DSH
only occurred among participants with BPD.

DISCUSSION

The primary purpose of this study was

to examine the emotional antecedents and
consequences of deliberate self-harm and suicide attempts. Overall, participants reported
negative antecedent emotions, and relative to
other emotions, anger was a common antecedent to DSH, ASA, and SA. Future research might examine whether particular
types of anger precede DSH. For instance,
some theorists pose that anger directed inward, involving self-blame and self-loathing
for perceived social transgressions, may precede DSH (Krasser, Rossmann, & Zapotoczky, 2003; van Elderen, Verkes, Arkesteijn, &
Komproe, 1996). In this case, the individual
engages in DSH as a form of self-punishment, which relieves anger and self-loathing.
In other cases, individuals who cannot regulate or effectively express their anger or navigate their social environment in a way that
reduces anger cues may resort to DSH to
achieve relief. Ultimately, future treatment
development might involve strategies to help
female inmates who engage in DSH or SA to
cope with or regulate anger.
The finding that boredom was a more
common antecedent to DSH than to ASA or
SA provided some support for the notion
that DSH sometimes involves an attempt to
alleviate boredom and emotional numbness.
Indeed, nobody reported boredom following
DSH. Some theorists have suggested that individuals who engage in DSH experience increased activity in the opiate system in re-

Chapman and Dixon-Gordon

sponse to stress (see Saxe, Chowla, & van der
Kolk, 2002), which leads to an uncomfortable
state of dissociation and numbness. The
physical stimulation involved with DSH interferes with dissociation and awakens the individual from the dissociative state (Simpson,
1975). Boredom may have some similarities
with dissociation or numbness, but studies
have not yet explored this possibility, and the
data on the role of opiates in DSH have been
inconclusive (Russ, 1992).
Relief was the most common consequence to DSH, whereas guilt and anger
were the most common consequences to ASA
and SA, respectively. Guilt was most common in ASA, and anger was most common in
SA. Over 45% of individuals who engaged in
DSH reported anger prior to the behavior,
but only 6.45% reported anger following
DSH, suggesting that anger may play a role
in triggering DSH; the reduction of anger or
stimuli that elicit anger may be involved in
reinforcing DSH. In contrast, anger was a
common antecedent and consequence of SA.
If the SA occurred with unambiguous intent
to die, participants may have felt angry about
failing in their suicide attempts. In contrast,
DSH may be more of an attempt to regulate
emotions, with anger persisting only when
this attempt is unsuccessful.
The findings regarding shifts in emotional experiences further suggest that DSH,
unlike SA and ASA, is more likely to serve an
emotion regulatory function. Compared with
ASA and SA, a larger proportion of individuals who engaged in DSH reported a shift toward a more neutral or positive emotion.
However it is also noteworthy that a significantly greater proportion of persons engaged
in DSH. In addition, a higher frequency of
DSH (but not ASA or SA) predicted a more
positive emotional shift. These data support
the experiential avoidance model (EAM;
Chapman et al., 2006) of DSH, tentatively
suggesting that shifts away from negative
emotions and toward neutral or positive
emotions may play a role in maintaining
DSH (however, the presence of BPD moderated this effect).
Consistent with the biosocial theory of

549
BPD (Linehan, 1993), a majority of BPD individuals reported a positive emotional shift
following DSH (68.75%), but not following
SA or ASA. In addition, DSH was not associated with positive emotional shifts (compared
with ASA or SA) among non-BPD individuals. Joiners (2002) theory suggests that persons who engage in DSH more frequently
are more likely to experience heightened reinforcing consequences; thus, it was possible
that this link between BPD and positive
emotional shifts following DSH was related
to the fact that individuals with BPD simply
have had more experience engaging in this
behavior. Indeed, another study based on this
sample found a positive association of BPD
with number of lifetime acts of DSH (Chapman et al., 2005a). Further research might
explore whether the association of BPD with
relief/positive emotional shifts following
DSH is attributable to frequency of engagement in DSH.2
Several limitations are relevant to this
study. First, past acts of DSH were based on
self-report; thus, there is no way to verify the
occurrence of DSH, or the occurrence of
specific emotional experiences that preceded
or followed DSH. The median number of
years since the most recent act of DSH, ASA,
or SA was 3 years. Although the self-reports
may be biased or inaccurate, the way in
which participants recall these behaviors is
potentially quite significant. For instance, if
an individual recalls that an act of DSH occurred in the presence of anger and was followed by relief, he or she may be likely to
engage in DSH again in the future (i.e., to
regulate anger), even if the details recalled
were somewhat inaccurate. Indeed, our data
indicated that greater reported positive emotional shifts were associated with greater frequency of DSH.
Second, the word prompts for participants emotion ratings were not exhaustive;
thus, we may have excluded some important
2. For the present study, these data were
available, but the sample sizes would have been
too small to permit a methodologically sound investigation of this hypothesis.

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Emotions, Deliberate Self-Harm, and Suicide Attempts

emotional antecedents or consequences from

the list. Third, a rating of relief or indifference does not preclude the presence of a distressing emotion, given that we asked participants to report the most predominant emotional
experience preceding and following DSH,
rather than all of the emotions they experienced. Fourth, it is not clear to what extent
the intensity of distressing emotions declined
(if at all) following DSH; however, it was
noteworthy that only a small proportion of
individuals reported a negative emotion as
their predominant emotion following DSH.
Fifth, the analyses relied on a relatively small
sample size, particularly for the ASA group
(n = 10), which may have limited the power
or external validity of the study. Finally, it is
important to note that the emotions a person
has prior to (or after) engaging in a behavior
do not necessarily correspond to specific motives (or reasons) for engaging in the behavior. Also, emotional states may be the result
of deciding to engage in a behavior, rather
than the cause. Therefore, we cannot infer
whether the motivations for engaging in the
behavior differ between DSH and SA.
Notwithstanding, findings from this
study have important ramifications for the
conceptualization of DSH and SA in female
inmates generally, and in BPD female inmates specifically. Perhaps most importantly,
the findings further underscore the importance of distinguishing between DSH and
SA. Based on this and other studies (e.g.,
Brown et al., 2002), emerging evidence sug-

gests that suicidal behavior differs in important ways from DSH. It is also noteworthy
that a significant proportion of individuals reported that their predominant emotional experience following DSH was negative, most
notably including sadness. Further research
might examine differences between individuals who experience negative emotional sequelae following DSH and those persons
who are more likely to experience relief or
positive emotions. Our findings suggest that
persons with BPD are more likely to fall
within the latter group. Further research also
is needed to examine the association of anger
with SA and DSH.
The present study represents an innovation in methodology (gathering information on emotions surrounding self-destructive behaviors) to be built upon in future
research. Although studies examining reported reasons for engaging in DSH or SA
clearly yield valuable data (e.g., Brown et al.,
2002), the reasons or expectations an individual has about DSH or SA may or may not
correspond with the actual emotional triggers and sequelae of these behaviors. Future
studies might employ ambulatory monitoring
methods to examine the real-time associations of emotional experiences with urges to
engage in DSH and SA. We hope that this
study will contribute to research that ultimately leads to refinements in the conceptualization and treatment of self-destructive behaviors.

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Manuscript Received: June 2, 2006
Revision Accepted: December 330, 2006