Past and Recent Deliberate Self-Harm:

Emotion and Coping Strategy Differences

䊲

Seth A. Brown and Kelly Williams

University of Northern Iowa
䊲

Amanda Collins
University of Nebraska

Only limited information on nonsuicidal deliberate self-harm behavior among

nonclinical populations is available, and it is unclear whether coping and
emotional difficulties remain among those with a past history of self-harm
behavior. The purpose of this study is to examine emotions and coping
strategies among three nonclinical groups with a recent, past, and no
history of nonsuicidal deliberate self-harm behavior. College students com-
pleted self-report measures of self-harm behavior, suicidal thoughts, emo-
tional dispositions, and coping strategies. Contrary to expectations, there
were few differences in coping strategies among the three groups ( p ⬎
.0033). Those with a recent history (n ⫽ 23; in the last 12 months) and
past history (n ⫽ 32; more than 12 months ago) of self-harm behavior
reported greater levels of negative emotion (e.g., hostility, guilt, sadness)
than those who have never self-harmed (n ⫽ 161; p ⬍ .0045). This indi-
cates that although self-harm behavior had discontinued (⬎12 months
ago), negative emotion differences were present, and both recent and
past self-harmers merit concern in managing their negative emotions to
lower their risk for future difficulties. © 2007 Wiley Periodicals, Inc. J Clin
Psychol 63: 791–803, 2007.

Keywords: self-harm; emotion; coping; nonclinical

Numerous hypotheses have been developed and evaluated throughout the years in an
attempt to explain the functions of nonsuicidal deliberate self-harm behaviors (Muehlen-
kamp, 2005; Suyemoto, 1998). More recently, research has focused on the negative emo-
tions and coping strategies of individuals who self-harm, particularly those in psychiatric

Correspondence concerning this article should be addressed to: Seth A. Brown, Department of Psychology,
Baker Hall 334, University of Northern Iowa, Cedar Falls, IA 50614–0505; e-mail: seth.brown@uni.edu

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 63(9), 791–803 (2007) © 2007 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20380
792 Journal of Clinical Psychology, September 2007

and prison populations (Dear, Slattery, & Hillan, 2001; Dear, Thomson, Hall, & Hall,
1998; Gratz, 2003; Haines & Williams, 2003; Muehlenkamp, 2005; Nock & Prinstein,
2004). The current focus on negative emotions appears to follow from the affect regula-
tion model, which states that individuals self-harm in an attempt to express or control
emotions they feel they have no other way of expressing (Suyemoto, 1998). Consistent
with the affect regulation model, a number of studies have shown an association between
negative emotion states and nonsuicidal deliberate self-harm behaviors (Muehlenkamp,
2005; Williams & Hassanyeh, 1983). In fact, research has indicated that self-harm behav-
iors may serve one of the following functions for individuals experiencing negative emo-
tions: (a) expressing negative emotions (Brown, Comtois, & Linehan, 2002; Gratz, 2003;
Nock & Prinstein, 2004), (b) decreasing negative affect (Briere & Gil, 1998), or (c)
avoiding unpleasant emotions (Briere & Gil, 1998; Gratz, 2003).
Acknowledging that negative emotion is likely a core factor in deliberate self-harm
behavior, Chapman, Gratz, and Brown (2006) formulated a theoretical framework, the
Experiential Avoidance Model (EAM), to guide future research on nonsuicidal deliberate
self-harm (DSH). According to Chapman et al.:
. . . DSH is a behavior that is negatively reinforced through the reduction of unwanted internal
experiences, particularly emotional responses. According to the EAM, individuals who engage
in DSH have strong experiential avoidance repertoires or response tendencies, possibly stem-
ming from more intense emotional responses, poor distress tolerance, deficits in emotion
regulation skills, and/or difficulties implementing alternative coping strategies when emotion-
ally aroused. (p. 384)

As summarized by Chapman et al., individuals report high levels of negative emotions

both during the self-harm event as well as in general. This latter finding suggests that
differences in emotional dispositions may exist among those who self-harm.
Since self-harm behaviors are associated with negative emotions, it would appear
that effective coping strategies would be extremely important. In the context of the EAM
model, Chapman et al. (2006) proposed that individuals who self-harm fail to implement
more skillful coping strategies and are more apt to utilize avoidance/escape strategies.
Research examining self-harm behavior and coping has been documented within a prison
population. Among Australian prisoners, self-harmers utilized less acceptance strategies,
direct-action strategies, and positive reinterpretation. Moreover, self-harming prisoners
reported an increased use of avoidance behaviors and less perceived control over prob-
lem solving (Dear et al., 2001; Dear et al., 1998; Haines & Williams, 2003). As opposed
to having ineffective coping strategies, Haines and Williams (2003) speculated that indi-
viduals engage in nonsuicidal DSH when they have no alternative coping strategies.
The research findings and conclusions outlined earlier are drawn primarily from
psychiatric and prison populations. Recent evidence has documented frequent self-harm
behavior among nonclinical populations as well. For example, among a stratified, ran-
domized U.S. community sample of registered automobile owners with listed telephone
numbers, 4% reported self-harm behavior in the previous 6 months (Briere & Gil, 1998).
Similarly, a 4% prevalence rate also was found among military recruits (Klonsky, Olt-
manns, & Turkheimer, 2003). Furthermore, among college students, prevalence esti-
mates of DSH range from 12 to 38% (Favazza, DeRosear, & Conterio, 1989; Gratz,
Conrad, & Roemer, 2002; Whitlock, Eckenrode, & Silverman, 2006). In the largest sam-
ple collected to date (N ⫽ 2,875), Whitlock et al. (2006) found a lifetime rate of 17.0%
and a 12-month prevalence rate of 9.7% of DSH among college students. Moreover, in
this sample, only one fourth of those with a history of self-harm behavior disclosed this
information to a medical or mental health professional. The notable prevalence among
Journal of Clinical Psychology DOI 10.1002/jclp
 Self-Harm Behavior 793

the nonclinical population coupled with the absence of professional help underscore the
importance of examining self-harm behavior in this population.
Beyond the prevalence data, only limited research has been conducted on the emo-
tional status among nonclinical populations who engage in self-harm behavior. In one of
the few studies among nonclinical samples (i.e., college women), Gratz (2006) found
those who self-harmed did not report higher levels of negative affect, but they did report
lower levels of positive affect. Klonsky et al. (2003) also examined a nonclinical popu-
lation (i.e., military recruits) and found self-harmers scored higher than did non-self-
harmers on negative temperament but found no difference on positive temperament.
Whitlock et al. (2006) found elevated levels of distress and suicidal ideation/attempts
among those with a history of DSH behavior. To date, no published research has been
done on coping strategies among nonclinical self-harmers.
Although the high rates are alarming, fortunately, many who engage in nonsuicidal
DSH will discontinue across time (Muehlenkamp, 2005). Among college students, 40%
reported discontinuing self-harm behavior in 1 year, and 80% discontinued within a 5-year
period (Whitlock et al., 2006). However, the majority of self-harm research examines
those with any history of self-harm behavior, and does not frequently consider the time
elapsed since the last self-harm behavior. This distinction is critical, as research has
shown that those with a history of other psychological difficulties have varied long-term
outcomes, even in the context of a full symptom remission.
Long-term outcomes of individuals have been documented among the more well-
researched psychiatric disorders (e.g., depression, anxiety). For example, among those
who have recovered from depression, a certain proportion of individuals do not return to
their premorbid status. Psychosocial impairment has been noted despite the remission of
depression symptoms at the end of treatment (Hirschfeld et al., 2002) and following a
2-year remission period (Coryell et al., 1993). In the latter study, many formerly depressed
patients had decreased job status (57%), dissatisfaction with sexual relationships (25%),
and poor overall satisfaction (37%). Longitudinal research on depression suggests two
possible explanations: (a) continuing premorbid traits or (b) ongoing residual symptoms
of a previous depression episode (Ormel, Oldehinkel, Nolen, & Vollebergh, 2004; Ormel,
Oldehinkel, & Vollebergh, 2004).
Unfortunately, long-term outcomes have been sparsely researched on those with a
history of self-harm behavior. Among those in the general population who had received
medical attention for self-harm behavior, an elevated lifetime risk for future self-harm
behavior and suicide was documented (de Moore & Robertson, 1998; Hawton, Zahl, &
Weatherall, 2003; Zahl & Hawton, 2004). At this time, little is known about whether
other difficulties such as emotional distress or ineffective coping strategies persist or
discontinue following the cessation of self-harm behavior.
The purpose of this study is to examine emotion and coping strategy differences
among a nonclinical population (i.e., college students) including those with no history of
self-harm, a past history of self-harm (over 12 months ago), and recent self-harm (up to
12 months ago). Informed by both the clinical and nonclinical research to date, we hypoth-
esized that the highest negative emotions (i.e., fear, hostility, guilt, and anger) would be
found among those in the recent self-harm category, followed by those with a past history
of self-harm. The lowest frequency of adaptive coping strategies (i.e., positive reinter-
pretation, active coping, and acceptance) and highest frequency of maladaptive coping
strategies (i.e., behavioral disengagement, substance use, mental disengagement, and denial)
also would be found among those who recently engaged in self-harm, followed by those
with a past history. Those with a past history would demonstrate differences in emotions
and coping strategies as compared to those with no history of self-harm, although at a
Journal of Clinical Psychology DOI 10.1002/jclp
794 Journal of Clinical Psychology, September 2007

lower level than those with recent self-harm behavior. This pattern would be suggestive
of the idea that emotion and coping strategy differences persist beyond active self-harm
behavior periods.

Method
Participants

Following Institutional Board approval, 223 participants were recruited from introduc-
tory psychology courses at a Midwestern university and offered course credit for their
participation. Participants were given the opportunity to select from a number of unrelated
research studies. Of those who signed up and appeared for this study, all participants
consented and completed the study. The average age of these participants was 19.4 years
(SD ⫽ 2.1). A large majority of the participants were female (76.2%), Caucasian (94.2%),
and never married (94.6%). Most of the participants were freshmen (65.6%) and sopho-
mores (16.7%), followed by a smaller number of juniors (9.5%) and seniors (8.2%). As
participants were intended to represent a typical college population (who usually encom-
pass a certain level of psychological disorders), participants were not screened for
psychopathology.

Measures
Self-harm behavior. The Deliberate Self-Harm Inventory (DSHI; Gratz, 2001) is a
self-report questionnaire which was designed to measure nonsuicidal DSH behavior. The
author operationalized self-harm behavior as the destruction of body tissue which is
deliberate and direct, nonsuicidal, and severe enough to cause tissue damage such as
scarring. The DSHI measures the age of onset, frequency, date of last occurrence, dura-
tion, and severity of 17 types of self-harm behavior. The DSHI has adequate internal
consistency (Cronbach’s a ⫽ .82), test-retest reliability (r ⫽ .92), and validity (Gratz,
2001). For purposes of this study, the date of last occurrence of any DSH behavior was
utilized to assign membership into three groups: recent self-harmers (up to 12 months),
past self-harmers (more than 12 months ago), and never self-harmers.1

Suicide screen. To monitor the safety of participants, the Suicidal Behaviors

Questionnaire-Revised (SBQ-R; Osman et al., 2001) was used to assess the risk of sui-
cide. This measure includes four self-report items, and assesses different dimensions of
suicidality and has acceptable validity (Osman et al., 2001). In this study, we compared
the frequency of suicidal thoughts in the past year (Item 2) among the three groups.

Emotions. The Positive and Negative Affect Schedule-Expanded Form (PANAS-X;

Watson & Clark, 1994) is a 60-item self-report measure designed to assess 11 specific
types of emotions. The PANAS-X can be administered to suit numerous time frames; in
this study, participants were asked about how they “generally” experience emotion states
(more temporally stable). Each item is rated on a Likert scale ranging from 1 (very
slightly or not at all ) to 5 (extremely). Among college students, the 11 subscales had

1
Currently, there is no standard in this field in regard to what constitutes “recent” or “past” DSH behavior. The
Whitlock et al. (2006) epidemiological study calculated DSH behavior for lifetime and 12-month prevalence
rates. Given a lack of a standard guideline, an arbitrary 12-month cutoff was adopted to classify recent and past
DSH behavior.

Journal of Clinical Psychology DOI 10.1002/jclp

 Self-Harm Behavior 795

good internal consistency (a ⫽ .73–.93), fair test-retest reliability (r ⫽ .51–.71), and

acceptable validity (Watson & Clark, 1994). In this sample, internal consistency was
acceptable (a ⬎ .70) for all but the surprise subscale (a ⫽ .68). Items on the 11 specific
emotion subscales were summed to represent an individual’s disposition to experience
specific emotion states.

Coping strategies. The COPE (Carver, Scheier, & Weintraub, 1989) is a 60-item
self-report inventory used to assess an individual’s use of specific coping strategies. Each
item is rated on a Likert scale ranging from 1 (I usually don’t do this at all ) to 4 (I usually
do this a lot). Based on a theoretical approach, 15 subscales were constructed based on
four items, each with higher scores indicating greater endorsement of the coping strategy.
Among college students, the COPE subscales have been found to have poor to good
internal consistency (a ⫽ .45–.92), poor to good test-retest reliability (r ⫽ .46–.89), and
acceptable validity (Carver et al., 1989). In this sample, internal consistency was accept-
able (a ⬎ .70) for 11 of the 15 scales. The following scales had poor to fair internal
consistency: Active Coping (a ⫽ .66), Suppressing Activities (a ⫽ .57), Restraint (a ⫽
.60), and Mental Disengagement (a ⫽ .44).

Data Analysis

Descriptive information on self-harm behavior was presented first. Next, differences on

suicidal thoughts and gender were examined among the three groups using a one-way
ANOVA and chi-square, respectively. One-way ANOVAs on emotions and coping strat-
egies also were conducted, followed by Tukey’s honestly significant difference group
comparisons.2 To address Type I errors, Bonferroni-adjusted significance levels were
adopted for the 11 emotions ( p ⬍ .0045) and 15 coping strategies ( p ⬍ .0033) ANOVAs.
Finally, effect sizes for the emotions and coping comparisons were computed using
Cohen’s d.

Results
Self-Harm Behavior

In this college sample (N ⫽ 223), 10.3% (n ⫽ 23) engaged in self-harm behavior in the
last 12 months, and 17.5% (n ⫽ 39) engaged in self-harm behavior over 12 months ago.
The overall prevalence rate (27.8%) was within the range found among other college
samples (e.g., Gratz, 2006). The last self-harm behavior occurred approximately 6 months
ago (M ⫽ 5.6 months, SD ⫽ 5.2) in the recent group and occurred approximately 5 _12 years
ago (M ⫽ 69.2 months, SD ⫽ 39.2) in the past group. No significant differences in
number of methods of self-harm behavior were noted between the recent (M ⫽ 1.9, SD ⫽
1.2) and past (M ⫽ 1.9, SD ⫽ 1.1) self-harm behavior groups, t(60) ⫽ 0.2, p ⬎ .05. The
most frequent methods of self-harm behavior were sticking oneself with sharp objects,
scratching oneself, head banging, carving words and marks into skin, preventing healing,
and cutting oneself (see Table 1). Only 3% of participants (n ⫽ 2) reported seeking

2
With multiple analyses, the implementation of an omnibus MANOVA and subsequent “protected F tests”
(univariate ANOVAs) is common practice to address experiment-wise Type I errors; however, with the excep-
tion of rare circumstances (which is not the case here), statisticians consider this approach to be fallacious and
do not control Type I errors. Although statistically conservative, Bonferroni adjustments were implemented to
limit Type I error (for more information, see Kellow, 2000).

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796 Journal of Clinical Psychology, September 2007

Table 1
Percentage of Self-Harm Behaviors Between the Two
Self-Harming Groups

%Recent %Past
Type of Self-Harm Behavior (n ⫽ 23) (n ⫽ 39)

Sticking sharp objects 27 25

Scratching self 19 27
Banged head 19 7
Carved words into skin 19 17
Cut self 19 47
Carved marks into skin 16 7
Punched self 12 17
Prevented healing 12 20
Burn self with flame 9 13
Burn self with cigarette 6 10
Bit self 3 3
Used cleanser on skin 0 3
Other (not listed) 25 10

medical attention for their self-harm behavior. Those who reported recently engaging in
self-harm behavior had, on average, twice as many (M ⫽ 11.9, SD ⫽ 12.6) self-harm
behavior incidents than those with a past history of self-harm behavior (M ⫽ 5.9, SD ⫽
7.0), t(54) ⫽ 2.3, p ⬍ .05.3

Suicidal Thoughts

During the past year, a majority of those with recent self-harm behavior reported suicidal
thoughts (56%), followed not far behind by those with a past history of self-harm behav-
ior (41%). A smaller proportion (16%) of those with no history of self-harm behavior
reported suicidal thoughts in the past year. Examining the frequency of thoughts about
killing oneself in the past year on a 5-point Likert scale (Item 2 of the SBQ-R), there were
significant differences among the self-harm behavior groups, F(2,219) ⫽ 12.98, p ⬍ .05.
Both recent (M ⫽ 1.8, SD ⫽ 1.0) and past (M ⫽ 1.8, SD ⫽ 1.1) self-harmers reported
suicidal thoughts much more frequently than did those who had never self-harmed (M ⫽
1.2, SD ⫽ 0.6; p ⬍ .05). No significant differences were noted between recent and past
self-harmers ( p ⬎ .05).

Gender Differences

Few gender differences were noted across a number of measures. Men and women were
not significantly different in proportion of history of self-harm behavior, x 2 (2, N ⫽
223) ⫽ 3.5, p ⬎ .05. Furthermore, no statistically significant differences on number of
self-harm behavior incidents were noted between men (M ⫽ 3.2, SD ⫽ 7.1) and women

3
Post hoc analyses among those ever engaging in self-harm behavior revealed no sizable correlations between
number of self-harm behavior incidents and emotions/coping strategies. Furthermore, a statistical comparison
of those with only one incident versus multiple incidents revealed no differences in emotions and coping
strategies.

Journal of Clinical Psychology DOI 10.1002/jclp

 Self-Harm Behavior 797

(M ⫽ 1.7, SD ⫽ 5.6), t(215) ⫽ 1.65, p ⬎ .05. In terms of suicidal thoughts, no differences

were found between men (M ⫽ 1.4, SD ⫽ 0.9) and women (M ⫽ 1.4, SD ⫽ 0.8), t(220) ⫽
0.7, p ⬎ .05. In terms of emotions, men had significantly higher levels of serenity (M ⫽
10.3, SD ⫽ 2.5) than did the women (M ⫽ 9.0, SD ⫽ 2.2), t(220) ⫽ 3.49, p ⬍ .0045.
Women reported higher levels of seeking out social support (M ⫽ 11.8, SD ⫽ 3.2) than
did the men (M ⫽ 10.0, SD ⫽ 3.0), t(221) ⫽ 3.53, p ⬍ .0033. No other differences were
noted for emotions and coping strategies between men and women.

Emotions
Individual ANOVAs were conducted on each of the 11 emotion subscales to identify
differences among the three groups (see Table 2). Statistically significant differences
were found on all four negative emotion scales ( p ⬍ .0045; Fear, Hostility, Guilt, and
Sadness) and one of the three positive emotion scales ( p ⬍ .0045; Joviality). None of the
remaining two positive and four miscellaneous emotion scales had statistically signifi-
cant differences among the three groups ( p ⬎ .0045).
Using Tukey’s HSD pairwise comparisons, the differences among the three groups
were examined (see Table 2). Recent self-harmers were noted to report significantly
higher levels of fear than did never self-harmers. On hostility, guilt, and sadness, recent
self-harmers were significantly higher than both past and never self-harmers. Further-
more, past self-harmers also were significantly higher than never self-harmers on these
three emotions. Finally, on joviality, recent and past self-harmers were significantly lower
than never self-harmers.

Coping Strategies
Individual ANOVAs were conducted on each of the 15 coping subscales to identify dif-
ferences among the three groups. Statistical significant differences were found for only

Table 2
Group Comparisons on Emotions

Recent (R) Past (P) Never (N) Significant Comparisons

Emotion (n ⫽ 23) (n ⫽ 39) (n ⫽ 161) F p (d )

Negative emotion subscales

Fear 14.0 (4.2) 11.9 (4.0) 10.7 (3.4) 9.2 .0001 R⬎N (.86)
Hostility 14.3 (3.9) 12.2 (3.5) 10.4 (3.2) 15.9 .0001 R⬎P (.66); P⬎N (.51); R⬎N (1.10)
Guilt 15.5 (6.1) 12.5 (5.8) 9.8 (4.0) 18.3 .0001 R⬎P (.49); P⬎N (.56); R⬎N (1.12)
Sadness 13.6 (4.6) 11.2 (4.2) 9.0 (3.5) 17.8 .0001 R⬎P (.55); P⬎N (.56); R⬎N (1.12)
Positive emotion subscales
Joviality 23.1 (5.5) 25.6 (6.8) 28.2 (6.0) 8.5 .0001 P⬍N (.41); R⬍N (.89)
Self-Assurance 15.6 (4.0) 17.5 (4.2) 18.4 (4.0) 5.2 .006
Attentiveness 11.7 (2.5) 13.2 (2.6) 13.5 (2.6) 4.8 .009
Other emotion subscales
Shyness 10.1 (3.4) 8.4 (4.0) 8.0 (3.1) 4.1 .017
Fatigue 12.0 (3.5) 10.8 (2.9) 10.2 (3.2) 3.5 .033
Serenity 8.4 (2.8) 9.1 (3.0) 9.5 (2.1) 2.3 .102
Surprise 7.2 (2.3) 6.6 (2.3) 6.8 (2.1) 0.5 .580

Note. Means (SDs); between-group df ⫽ 2; within-group df ⫽ 218–220; comparisons used Tukey’s HSD test.

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798 Journal of Clinical Psychology, September 2007

Table 3
Group Comparisons on Coping Strategies

Recent (R) Past (P) Never (N) Significant Comparisons

Coping Strategy (n ⫽ 23) (n ⫽ 39) (n ⫽ 161) F p (d )

Maladaptive
Behavioral disengagement 7.1 (1.7) 7.0 (2.0) 6.0 (1.9) 7.1 .001 P⬎N (.54); R⬎N (.61)
Substance use 7.0 (3.7) 7.4 (3.9) 5.4 (2.7) 7.6 .001 P⬎N (.58)
Mental disengagement 10.6 (2.1) 10.6 (2.4) 9.8 (2.3) 2.5 .084
Denial 7.0 (2.5) 5.8 (2.0) 5.7 (2.1) 3.5 .031
Restraint 8.8 (2.2) 9.1 (2.6) 9.2 (2.0) 0.4 .660
Suppress activities 8.4 (1.7) 8.8 (2.0) 9.0 (2.1) 1.0 .376
Adaptive
Positive reinterpretation 11.0 (2.0) 11.8 (2.8) 12.3 (2.5) 3.2 .042
Venting emotions 11.0 (3.6) 10.3 (3.3) 9.9 (2.8) 1.5 .233
Instrumental support 10.8 (3.3) 10.6 (2.9) 11.1 (2.7) 0.5 .622
Active coping 9.7 (2.0) 10.3 (2.6) 10.7 (2.0) 2.7 .069
Religious 10.6 (4.4) 9.5 (4.1) 10.6 (4.0) 1.1 .350
Humor 7.7 (3.4) 9.4 (3.3) 8.8 (3.3) 1.8 .175
Emotional support 10.4 (4.2) 11.0 (3.5) 11.6 (3.0) 1.6 .210
Acceptance 9.5 (2.2) 10.7 (2.8) 11.1 (2.4) 4.4 .014
Planning 10.3 (1.9) 10.8 (2.9) 11.7 (2.4) 4.4 .014

Note. Means (SDs); between-group df ⫽ 2; within-group df ⫽ 218–220; comparisons used Tukey’s HSD test.

the behavioral disengagement and substance use subscales ( p ⬍ .0033). Using Tukey’s
HSD pairwise comparisons, the pattern of differences among the three groups on these
two coping strategies were examined (see Table 3). Recent and past self-harmers were
noted to report significantly higher levels of behavioral disengagement than did never
self-harmers. Past self-harmers reported greater levels of substance use strategies than
did never self-harmers.

Discussion

Utilizing a conservative statistical approach, the results clearly indicate emotion differ-
ences among recent nonsuicidal deliberate, past, and never self-harmers. All four nega-
tive emotion dispositions were significantly greater among recent self-harmers than among
never self-harmers, with large effect sizes.4 With the exception of fear, past self-harmers
also reported significantly greater negative emotions than did never self-harmers, but
with medium effect sizes. The tendency to experience greater negative emotions among
those who engage in self-harm behavior and those who have never done so are not sur-
prising. Previous research has hypothesized that individuals engage in self-harm behav-
iors as a strategy to manage negative emotions and has documented an association between
these two phenomena among psychiatric, prison, and military populations; however, these
findings were in contrast with Gratz (2006), who found no differences in negative affect
among college women. The difference in results among these college samples could be
due to a number of factors including different measures of affect (Affect Intensity Measure

4
Effect size interpretations were based on Cohen’s (1988) guidelines: small (d ⫽ .20–.49), medium (d ⫽
.50–.79), and large (d ⫽ .80⫹).

Journal of Clinical Psychology DOI 10.1002/jclp

 Self-Harm Behavior 799

vs. PANAS) or sample differences (racially diverse urban sample vs. predominantly Cau-
casian rural sample).
The most interesting findings were the differences found between past and recent
self-harmers. When comparing recent and past self-harmers, levels among three of the
four negative emotion states (i.e., hostility, guilt, and sadness) were significantly lower in
past self-harmers, with medium effect sizes. In sum, those with a past history of self-harm
behavior have an intermediary level of negative emotions—lower than those who have
recently engaged in self-harm behavior, but higher than those with no history of self-
harm behavior. One could speculate that hostility, guilt, and sadness persist due to pre-
vious behaviors and interactions with others that may have been never completely resolved
or forgiven (e.g., fight with parents) whereas, emotions such as fear may be more con-
tingent on immediate circumstances.
Joviality was found to be greater among never self-harmers than both recent and past
self-harmers, with large and small effect sizes, respectively. These findings were consis-
tent with those of Gratz (2006), who documented lower positive affect among self-
harming college women. Given the number of potential difficulties associated with
self-harming individuals (e.g., disruptions in relationships), it was not surprising to find
diminished enjoyment. No differences were noted on the two remaining positive emotion
scales, self-assurance and attentiveness. Similarly, on the remaining four emotion scales
of the PANAS, no differences among the three groups were found. For three of the four
scales, the lack of differences was not surprising given the seemingly irrelevant content:
shyness, fatigue, and surprise; however, we expected to find differences in serenity, which
one would speculate to be associated with self-harm behavior. The three items incorpo-
rated in this scale (i.e., calm, relaxed, at ease) would appear to be relevant to those having
difficulty modulating their emotions.
Although self-harm behavior is not a current issue for past self-harmers, emotion
differences from never self-harmers may bring about other difficulties among these indi-
viduals. Past research has indicated that in addition to self-harm behavior, psychological
consequences and disruptions in interpersonal relationships have been noted among those
with a history of self-harm behavior (Gratz et al., 2002). In this study, the intensity of
negative emotions was not as high as for recent self-harmers, but still significantly higher
than that for never self-harmers. These results were consistent with previous research that
demonstrated continuing difficulties beyond general remission of a psychological prob-
lem (e.g., depression). These difficulties could be potential targets of interventions, as
significantly higher levels of negative emotions may lead to elevated distress, diminished
social/occupational functioning, or perhaps suicidal thoughts/behaviors (discussed later).
Across the 15 specific coping strategies assessed, no significant differences were
found on almost all (n ⫽ 13) subscales among the three groups. These findings were
inconsistent with our expectations as well as with past research that demonstrated greater
utilization of poorer coping strategies among self-harmers. For example, self-harming
prisoners reported less acceptance strategies and positive reinterpretation strategies (Dear
et al., 2001; Dear et al., 1998; Haines & Williams, 2003), but no differences were noted
in this nonclinical sample. These differences in findings could be accounted for by con-
text. Incarcerated individuals may not have full access to a wide array of coping strat-
egies, such as utilizing prosocial peers to help them engage in adaptive coping strategies.
Given that poor coping has been associated with psychopathology (e.g., Sherbourne,
Hays, & Wells, 1995), the differences in research findings also could be accounted for by
the mental health or demographic disparities between a prison population and a college
sample. Previous research has illuminated differences in coping strategies among those
with particular mental disorders and demographic variables. More than half of those in a
Journal of Clinical Psychology DOI 10.1002/jclp
800 Journal of Clinical Psychology, September 2007

U.S. prison or jail have a mental disorder (James & Glaze, 2006), which is substantially
higher than a U.S. college population (American College Health Association, 2006).
Furthermore, those incarcerated differ from college students on demographic character-
istics such as educational attainment (Only 32% of state inmates had a high school diploma;
Harlow, 2003.)
Two maladaptive coping strategies were found to be different among the three groups.
Both recent and past self-harmers reported using behavioral disengagement strategies
more often than did never self-harmers, with medium effect sizes. This generally indi-
cates that those with a history of self-harm will be more likely to quit, give up, or put in
less effort when confronted with a challenging situation. This finding was consistent with
previous research that found self-harming prisoners used more avoidance behaviors (Haines
& Williams, 2003) as well as the EAM which advocates that “individuals who engage in
DSH have strong experiential avoidance repertoires or response tendencies” (Chapman
et al., 2006, p. 384). Curiously, substance use coping strategies were reported as the
highest among the past self-harmers. There were significant differences in substance use
coping strategies between past and never self-harmers groups, with a medium effect size.
No significant difference was noted between recent self-harmers and the two other groups.
One may speculate that previous self-harmers may have adopted alcohol and drug use as
an alternative to self-harm behavior. In sum, these findings suggest that only a few select
coping strategies of self-harming individuals differ from those with no history of self-
harm behavior.
Although not the specific focus of this study, there were two additional findings in
this study that were noteworthy. The high rates of suicidal thoughts in the past year
among both recent and past self-harmers are alarming. Utilizing the occurrence of sui-
cidal thoughts among those with no history of self-harm behavior as a base rate (16%),
the odds ratio of having suicidal thoughts was 3.5 times among those with recent self-
harm behavior (56%) and 2.5 times among those with past self-harm behavior (41%).
This suggests that both samples are at elevated risk for future suicidal thoughts/
behaviors. A second finding was that the differences in suicide and negative emotions
among the past self-harm group were present despite an average time lapse of 5 _12 years
since the last incident. This not only documents that fundamental differences between
never and past self-harmer exists but also suggests a high-risk period for the initiation of
self-harm behavior. Although only longitudinal studies can definitively identify this pat-
tern, considering the average age (19.4 years old) of the participant coupled with the
average time since last incident (69.2 months ago) in this study, the average age that the
past self-harmer discontinued the last self-harm behavior was fairly young (13.6 years
old). These results suggest that self-harm behavior begins, on average, during early ado-
lescence (or younger) for the general population.
A number of research limitations were inherent in this study. First, given that poten-
tial participants were forewarned about the content of the study, the study sample may not
be fully representative of the groups in this study. The participants had alternate study
choices, and individuals, particularly those with a history of self-harm, either could have
been drawn to or repelled from this study. Second, our participants were restricted in
variability of age, ethnicity, sex, and geographical location. This sample was predomi-
nantly young Caucasian females from a Midwestern university. It is likely that differ-
ences in self-harm behavior as well as emotion and coping differences exist across
demographic variables. In addition, psychopathology was not assessed in this college
sample, and this likely would play an important influence. A recent survey of college
students documented moderate 12-month prevalence rates of mental disorders such as
depression (20.9%) and anxiety disorders (13.5%; American College Health Association,
Journal of Clinical Psychology DOI 10.1002/jclp
 Self-Harm Behavior 801

2006). Disorders such as these have been associated with poor coping and emotional
difficulties in the research literature (e.g., Sherbourne et al., 1995). Third, this study
relied heavily on self-report. It is feasible that participants underreported self-harm behav-
ior due to privacy concerns or recall problems, and some of our never self-harmers could
be misclassified. Similarly, self-reports of coping strategies and emotionality also could
be misreported. Furthermore, a few of the subscales demonstrated poor to fair internal
reliability (most importantly, the Active Coping and Mental Disengagement subscales),
which may have undermined accurate measurement of those purported constructs. A
moderate size sample coupled with a conservative statistical approach diminished statis-
tical power to detect small differences. Several findings were well below the conven-
tional statistical level (.05), but not considered significant due to concern about Type I
errors. Finally and importantly, the use of a correlational cross-sectional research design
limited the ability to infer causal or longitudinal associations among the variables. Spe-
cific to this study, we cannot determine whether the intermediary levels of negative emo-
tion found in the past self-harmers group indicates (a) a modest decrease in negative
emotions from previous higher active self-harm periods (an ongoing residual symptom)
or (b) a long-term stable pattern in negative emotions which reflects a subgroup of self-
harmers who do discontinue self-harm behavior over time (continuing premorbid trait).
The results of this study delineate emotion differences among those with no, a past,
and a recent history of self-harm behavior in a nonclinical population. This research
suggests that these findings are not mere artifacts of psychiatric symptoms or incarcera-
tion, but were found among those in a nonclinical population who were attending a
university. Not surprisingly, recent self-harmers (in the last 12 months) were of most
concern. A novel finding in this study was that those with a past history of self-harm
behavior (over 12 months ago) also exhibited heightened negative emotions compared to
those with no history of self-harm behavior. These results are consistent with the EAM,
which theorizes that negative emotions are a crucial aspect of self-harm behavior. Although
few differences in coping strategies were noted, these findings are somewhat consistent
with the EAM, which emphasizes emotional regulation and distress tolerance problems
as opposed to the more traditional coping strategies (e.g., seeking instrumental support)
measured here.
These findings strongly support the notion that interventions with recent self-
harmers should not only focus on the prevention of self-harm behaviors but also work to
address negative emotion states. In addition, those with a past history of self-harm behav-
ior should be assisted to handle negative emotions, which may place them at risk for
future problems. Compared to their peers with no history of self-harm behavior, tradi-
tional coping strategies did not appear to be compromised among those with a recent or
past history of self-harm behavior. As suggested by the EAM, the examination of emo-
tional regulation and distress tolerance would be valuable in understanding how self-
harmers manage their heightened negative emotions. If this line of research supports
differences in the aforementioned abilities, facilitating emotional regulation and distress
tolerance skills among self-harm individuals may prove to be a more fruitful intervention
than bolstering traditional coping strategies.

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