Curr Psychol (2012) 31:49–64

DOI 10.1007/s12144-012-9130-9

Predictors of Deliberate Self-Harm Behavior

Among Emerging Adolescents: An Initial Test
of a Self-Punitiveness Model

Gordon L. Flett & Abby L. Goldstein &

Paul L. Hewitt & Christine Wekerle

Published online: 12 February 2012

# Springer Science+Business Media, LLC 2012

Abstract The current study examined the extent to which an expanded self-
punitiveness model could be applied to deliberate self-harm (DSH) among students
making the transition to university. Specific components of the self-punitiveness
model included perfectionism, overgeneralization, self-criticism, and shame. A sample
of 319 university students completed a measure of deliberate self-harm as well as two
multidimensional perfectionism measures and measures of self-criticism, overgeneral-
ization, and shame. Correlational analyses found few significant associations among
deliberate self-harm and the self-punitiveness factors among men. In contrast, among
women, deliberate self-harm was associated with dimensions of trait perfectionism such
as parental criticism and socially prescribed perfectionism, as well as with overgener-
alization, self-criticism, and both characterological shame and bodily shame with the
strongest associations found with shame. Supplementary analyses found a strong link

Funding for this project was provided by a grant from the Canadian Auto Workers. Support for this study
was also provided by a Canada Research Chair in Personality and Health to Gordon Flett, a Canadian
Institutes of Health Research New Emerging Team award from the Violence, Gender, and Health Program
to Christine Wekerle (Principal Investigator) and Gordon Flett (Co-Investigator), and a Career Award from
the Ontario Women’s Health Council/CIHR Institute of Gender and Health Joint Program to Christine
Wekerle. We would like to thank Simon Sherry for his helpful comments and suggestions.
G. L. Flett
York University, Toronto, ON, Canada

A. L. Goldstein
Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada

P. L. Hewitt
University of British Columbia, Vancouver, BC, Canada

C. Wekerle
McMaster University, Hamilton, ON, Canada

G. L. Flett (*)
Department of Psychology, York University, 4700 Keele Street, Toronto, ON, Canada M3J 1P3
e-mail: gflett@yorku.ca
50 Curr Psychol (2012) 31:49–64

between overgeneralization and shame and an association between self-criticism and

shame among women. The results support the contention that particularly among young
women making the transition to university, deliberate self-harm behavior is a reflection
of a self-punitive personality orientation with multiple facets and a sense of shame
associated with an overgeneralized sense of failing to meet social expectations.

Keywords Self-harm . Perfectionism . Self-criticism . Overgeneralization .

Parental criticism

The phenomenon of deliberate self-harm is receiving increasing attention, both in terms of

researchers and in terms of the general public. Deliberate self-harm (DSH) is defined as
intentional self-injury without suicidal intent and represents a significant risk for serious
injury, including a risk for future suicide attempts (Cooper et al. 2005; Stanley et al.
2001). Although DSH can and should be distinguished from suicidal behavior, there
is ample evidence indicating that DSH predicts subsequent suicide attempts and
completions (Dulit et al. 1994; Stanley et al. 1992) and evidence suggests that
nonsuicidal self-harm is part of a continuum that includes attempted suicide (see
Larsson and Sund 2008; Muehlenkamp and Gutierrez 2007). While it is believed that
DSH is designed to provide temporary relief of tension, engaging in DSH often results in
shame and guilt and the perpetuation of a cycle of positive reinforcement, punishment,
and escape-avoidance behaviors. The sequence of negative affect reduction and
negative affect induction may contribute to persistent DSH (see Chapman et al. 2006).
Individual difference factors reflecting dysfunctional personality styles are likely
involved in the tendency to engage in deliberate self-harm. The current paper describes
the results of a study that investigated whether a modified self-punitiveness model with
elements of perfectionism, overgeneralization, and a pervasive sense of shame could be
applied to DSH. The guiding premise of this work is that certain individuals are highly
sensitive to the negative self-worth implications of failure and the possibility of failure,
and the deliberate self-harm behaviors expressed by these people stem from a need or
desire for self-punishment. The general appropriateness of a self-punitiveness model is
suggested by evidence of the self-punishment function of DSH (see Brown et al. 2002;
Klonsky 2007; Nock 2009). For instance, a recent study of eating disorder patients
found not surprisingly that the vast majority of self-injurious acts reflect a very salient
self-punishment motive (Claes et al. 2005) and a desire for self-punitiveness is
included as one of the functions on the intrapersonal functions subscale of a new
measure assessing statements about self-injury (Klonsky and Glenn 2009). Other
research indicates that youths who engage in self-harm endorse such explanations as
“I was angry at myself” and “I felt like a failure,” and “I wanted to punish myself”
(Laye-Gindhu and Schonert-Reichl 2005).
The general framework used in the current study is derived from Carver and
Ganellen’s (1983) three-factor self-punitiveness model applied to the study of depres-
sion. They created a measure known as the Attitudes Toward Self Scale. This scale
was designed to assess three factors—high standards, self-criticism, and over-
generalization. The high standards component was defined as the tendency to
have excessive, unattainable goals and thus ensure exposure to failure experiences.
Self-criticism was described as the tendency to react strongly against the self when there
Curr Psychol (2012) 31:49–64 51

is a discrepancy perceived between the actual and ideal self. Finally, overgeneralization
is the cognitive tendency to perceive that one failure experience represents more
universal negative aspects of the self. The tendency to overgeneralize a single failure
to all aspects of the self was first identified by Beck (1967) in his original work of the
cognitive manifestations of depression. Empirical research has provided general
support for the model with overgeneralization showing the most consistent associa-
tion with depression (see Carver 1998; Flett et al. 1991) and overgeneralization
predicts negative orientations to the self in specific contexts (Kernis et al. 1989).
Hayes et al. (2004) found that overgeneralization was linked with the presence of a
core defectiveness schema, greater self-esteem variability, and a lifetime history of
depressive symptoms.
Given the apparent role of self-punishment in deliberate self-injury (Klonsky
2007), one interpretation of DSH is that for certain individuals it is a behavioral
manifestation of a process or orientation that stems from a high level of self-
punitiveness. If so, then it follows that the various elements of self-punitiveness
should be implicated to some degree in DSH. Existing evidence is limited but is
consistent with this possibility. For instance, research on DSH has found a link
between DSH and self-criticism (Glassman et al. 2007).
As for perfectionism, various dimensions should be associated with deliberate self-
harm in light of recent evidence suggesting that striving to avoid feelings of inferiority is
associated with deliberate self-harm (Gilbert et al. 2009), and the Adlerian view of
perfectionism is that it is a form of overcompensation motivated by feelings of
inferiority. Mental health counsellors have identified the pressure to be perfect that
comes from the self (self-oriented perfectionism) and the pressure to be perfect that
comes from family members (a form of socially prescribed perfectionism) as reasons
for acts of nonsuidical self-injury (Whitlock et al. 2009).
A possible link between perfectionism and deliberate self-harm is also suggested
by one team of investigators who observed that “… most people who self-injure tend
to be perfectionists, are unable to handle intense feelings, and unable to express their
emotions verbally, have dislike for themselves and their bodies, and can experience
severe mood swings (Bolognini et al. 2003, p. 247). These observations are in
keeping with the deleterious effects of perfectionism (see Flett and Hewitt 2006).
Regarding empirical research on perfectionism, Nock and Prinstein (2005) examined
perfectionism and features and functions of self-mutilation in adolescent psychiatric
patients. Self-oriented perfectionism was not associated with the behavioral functions
of self-mutilation. However, socially prescribed perfectionism in adolescents was
associated with engaging in self-mutilation for social positive reinforcement and
social negative reinforcement. This informative study by Nock and Prinstein (2005)
did not compare those who did or did not engage in self-mutilation so it did not
address the extent to which perfectionism was associated with self-mutilation.
Unfortunately, there is not extensive research on perfectionism and DSH, but results
suggest that particular aspects of the perfectionism construct may be relevant.
O’Connor et al. (2010) found small but significant links between self-harm and
indices of self-oriented and socially prescribed perfectionism in a large sample of
adolescents.
Another recent investigation of non-suicidal self-injury in high school students
found no association when perfectionism was assessed as a unidimensional construct
52 Curr Psychol (2012) 31:49–64

with the Eating Disorder Inventory perfectionism scale (Ross et al. 2009). In contrast,
Yates et al. (2008) assessed perfectionism as a multidimensional construct and they
did show a link between nonsuicidal self-injury and parental criticism as measured by
a subscale of the Frost Multidimensional Perfectionism Scale (see Frost et al. 1990).
The Yates et al. (2008) investigation had both cross-sectional and longitudinal phases
and they further established that parental criticism reported by youths in high school
was associated with increased self-injury over time. Unfortunately, other dimensions
of perfectionism were not assessed by Yates et al. (2008). Still, this link with parental
criticism is intriguing in light of another recent investigation which found that
adolescents with a history of DSH tend to be exposed to greater parental criticism,
as determined by analyses of 5 min assessments of parental speech samples (Wedig
and Nock 2007). Thus, in the current study, we expected perfectionism in the form of
parental criticism to be associated with self-harm.
Although intentional self-injury and suicidal urges must be distinguished, it is also
reasonable to infer from past research on perfectionism and suicide that dimensions of
perfectionism such as socially prescribed perfectionism and excessive concern over
mistakes could also play a role in deliberate self-harm. An association between
socially prescribed perfectionism and deliberate self-harm would be in keeping with
extensive investigation of perfectionism and suicide (for reviews, see Hewitt et al.
2006; O’Connor 2007) and other data indicating that those who engage in deliberate
self-harm are susceptible to social influence (Muehlenkamp et al. 2008).
As for overgeneralization, to our knowledge, research has not been conducted to
evaluate the link between overgeneralization and DSH, but overgeneralization may
be quite relevant given that it has been linked with various forms of maladjustment.
Overgeneralization has been linked with suicidal tendencies (Prezant and Neimeyer
1988) and this too points to a possible role for overgeneralization in DSH. Clearly, a
tendency toward self-harm should be amplified to the extent that an individual tends
to make sweeping, negative self-assessments that seemingly reflect pervasive
deficiencies in the self.
The self-punitiveness model as described by Carver and Ganellen (1983) was
extended in the current research by also including a focus on the link between DSH
and a sense of self-shame. Internal shame is self-focused and involves a provide sense
and awareness of the self as deficient, especially in terms of the ability to meet social
expectations and obligations (Gilbert and Procter 2006). There are numerous
accounts of the sense of shame that often follows DSH acts (see Milligan and
Andrews 2005). For instance, Miller and Smith (2008) described the case study of
an adolescent girl who engaged in self-harm behavior that was triggered by the shame
and self-loathing that was experienced when her father accused her of only caring
about herself because she wanted to see her boyfriend instead of thinking about her
cancer-stricken mother.
One possibility is that perceptions of shame that stem from relatively permanent
aspects of the self such as one’s character and physical appearance could constitute
both an antecedent and a byproduct of DSH. Shame can be conceptualized as a self-
conscious emotion that arises from a chronic sense that one has failed to live up to
important social standards (Orth et al. 2006; Tangney 2002) and empirical work has
confirmed the link between personal failure experiences and shame (McGregor and
Elliot 2005). If an individual is prone to engage in self-punitiveness, the experience of
Curr Psychol (2012) 31:49–64 53

shame can serve as an affective signal that the self is deficient and self-punishment is
warranted, perhaps in the form of DSH. Moreover, a link between DSH and shame
should be evident when shame is in the form of bodily shame (see Andrews 2002).
The link between DSH and bodily shame may be more evident among females given
the greater importance of physical appearance among females (Pliner et al. 1990) and
recent data indicating that deliberate self-injury and low body esteem are associated
in adolescent girls but not in adolescent boys (Bjärehed and Lundh 2008).
The role of shame in self-harm behavior has not been extensively investigated.
However, some support for the role of shame in self-harm was provided by Milligan
and Andrews (2005). They examined shame and self-harm in a sample of 89 women
prisoners. A total of 33 women reported engaging in self-harm on two or more
occasions. Participants in this study completed the Experience of Shame Scale
(Andrews et al. 2002). This inventory provides an overall shame score, as well as
subscale measures of characterogical shame, behavioral shame, and bodily shame.
Comparisons of those who did versus did not engage in self-harm found that the self-
harming women were significantly higher on all of the shame measures (see Milligan
and Andrews 2005). This same measure was included in our current study in order to
examine shame and DSH in university students. It was hypothesized that all aspects
of shame as well as the various elements of the self-punitiveness model such as
overgeneralization, perfectionistic standards, and self-criticism would be associated
significantly with a history of DSH.
The issues outlined above were examined in a sample of first-year university
students who were participants in the York University Collegiate Health Study, which
was designed to focus on the well-being of students making the transition from high
school to university. Initial analyses of the data from our sample established that
deliberate self-harm was associated with personality variables such as sensation
seeking and openness to experience, as well as with emotional abuse and illicit drug
use (Goldstein et al. 2009). The current study is our initial assessment of the self-
punitiveness measures administered in this investigation. We report the results
separately for women versus men in light of evidence suggesting that females
are more likely to endorse self-punishment as a factor contributing to intentional self-
injury (see Lloyd-Richardson et al. 2007).

Method

Participants

The participants were 319 university students (112 men, 207 women) who
volunteered to complete a questionnaire after being approached by a female
research assistant. Participants were paid $10 for their involvement in the study.
The average age of participants was 18.89 years (SD02.30). The majority of the
sample had just completed high school (67.8%) and was living with their parents
(64.5%). The sample was equally split between Canadian-born (50.0%) and foreign-
born students.
Many of our participants were approached about taking part immediately after
their final advising prior to beginning university. Other students were recruited at the
54 Curr Psychol (2012) 31:49–64

beginning of the fall term from common areas for students near cafeteria and library
services.
Questionnaire booklets were also administered to small groups of participants
during scheduled research sessions. Participants were provided with a list of relevant
community resources upon completion of the questionnaire.

Measures

The Multidimensional Perfectionism Scale (MPS; Hewitt and Flett 1991) The MPS
was used to measure trait perfectionism. This is a self-report measure that assesses
levels of self-oriented (“I strive to be as perfect as I can be”), other-oriented (“The
people who matter to me should never let me down”) and socially prescribed
perfectionism (“I find it difficult to meet others’ expectations of me”.) The MPS
contains 45 items, which are assessed on a 7-point Likert scale. Participants are asked
to indicate their answer from 1 (“disagree”) to 7 (“agree.”) The reliability for self-
oriented perfectionism is .90, other-oriented perfectionism is .96, and socially pre-
scribed perfectionism is 87. The MPS has been shown to have high validity and
reliability throughout many studies (Hewitt and Flett 1991, 2004).

The Frost Multidimensional Perfectionism Scale (MPS-F; Frost et al. 1990) The
MPS-F assesses six dimensions of perfectionism including Personal Standards (“I set
higher goals than most people”), Concern over Mistakes (“The fewer mistakes I make,
the more people will like me”), Parental Expectations (“My parents have expected
excellence from me”) Parental Criticism (“My parents never tried to understand my
mistakes”) Doubting of Actions (“I usually have doubts about the simple everyday things
I do”) and Organization (“neatness is very important to me.”) The original MPS-F has 35
items arranged on a five-point Likert scale. We administered a version that did not include
the organization factor in the current study in keeping with the decision made by other
researchers (see Kawamura et al. 2001) to exclude the organization factor because
empirical research has shown that it is not correlated with other perfectionism
dimensions. Participants are asked to indicate their answer from 1 (“strongly disagree”)
to 5 (“strongly agree”). The scale has excellent internal consistency and has been found
to be a both reliable and valid measure (Frost et al. 1990; Frost et al. 1993).

Attitudes Towards Self Scale (ATS; Carver and Ganellen 1983) The ATS is an 18-item
Likert-type scale measuring varying degrees of Overgeneralization (“How I feel about
myself overall is easily influenced by a single mistake”), High Standards (“I expect a lot
from myself”) and Self-Criticism (“I am not satisfied with anything less than what I
expected of myself”). Participants are asked to indicate their answer from 1 (“extremely
untrue”) to 5 (“extremely true.”) Adequate internal validity and test-retest reliability
have been demonstrated (Carver and Ganellen 1983; Carver et al. 1985).

Experience of Shame Scale (ESS; Andrews et al. 2002) The ESS is a 25-item self-
report measure which assesses varying degrees of characterological shame, behav-
ioral shame, and bodily shame. Items for each shame area address experiential,
cognitive and behavioral components. Participants are asked to indicate their answer
on a 4-point Likert-scale from 1 (“not at all”) to 4 (“very much.”) The ESS has been
Curr Psychol (2012) 31:49–64 55

shown to have high levels of internal consistency, test-retest reliability as well as

concurrent validity in terms of its association with other shame measures (Andrews et
al. 2002).

Self-Harm Inventory (SHI) Participants were asked to indicate (by circling “yes” or
“no”) whether they have intentionally engaged in 22-item self-harm behaviors (for
example, “burned yourself, cut yourself, scratched yourself to the extent that scarring
or bleeding occurred”). The instructions explicitly indicated that the respondent
should respond yes only if the behavior was intentional and on purpose in order to
hurt themselves. Behaviors were drawn from Gratz’s (2001) 17-item Deliberate Self-
Harm Inventory. Scores on this instrument are linked with single-item measures of
self-harm (Gratz 2001). We also included items that assessed a broader range of DSH
acts. These additional items assessed behaviors where the intention was to cause
harm, even if no actual harm resulted (for example, “deliberately put self in danger-
ous situations, abused substances beyond point of known tolerance”). Items were
taken from the Self-Harm Inventory by Sansone et al. (1998). The SHI has been used
in several studies and its validity has been demonstrated (see Gilbert et al. 2009;
Sansone et al. 1998; Sansone et al. 2000).

Results

The data for men and women were analyzed separately in the present study in light of
extant sex differences in levels and correlates of DSH, especially among college
students (Gratz et al. 2002). Overall, a total of 94 participants (29.5%) reported ever
engaging in at least one act of self-harm. Those involved in self-harm reported an
average of 3.11 (SD02.69) types of DSH behavior which is below the cut-off for
borderline personality disorder of five or more (see Sansone et al. 1998). In total, only
21.3% of those engaging in DSH met the borderline personality disorder cut-off
(n020). Therefore, the majority of undergraduates engaging in DSH did so to
subclinical degrees. Descriptive statistics for all variables of interest are presented
in Table 1. The mean scores on the ESS and its subscales were slightly lower when
compared with norms (overall M of 51.96 versus M of 55.58 reported by Andrews et
al. (2002)) but the mean score for characterological shame was virtually identical to
the norm. Levels of perfectionism as assessed by the Hewitt and Flett MPS were
comparable to the existing norms for university students (see Hewitt and Flett 2004)
with slight elevations in the current sample in terms of levels of other-oriented and
socially prescribed perfectionism.
Table 2 contains the correlations with self-harm. Note that the correlations are
modest at best in magnitude, similar to what was found and reported in Goldstein et
al. (2009); the associations were influenced in part by the absence of any form of self-
harm in the majority of our participants. As illustrated in Table 2, correlational
analyses revealed that increased self-harm in men was related to other-oriented
perfectionism only. Men who had engaged in increased self-harm behaviors tended
to be have lower perfectionistic expectations of others.
Self-harm in women was significantly related to measures of perfectionism, as
evidenced by both the MPS-F and the MPS. Specifically, increased levels of self-
56 Curr Psychol (2012) 31:49–64

Table 1 Descriptive characteristics

Variable Men Women
of the sample
Gender [n (%)] 112 (35.1) 207 (64.9)
Age [M (SD)] 19.56 (3.21) 18.53 (1.49)
Self-Harm Inventory 0.67 (1.61) 1.05 (2.22)
MPS
Self-Oriented Perfectionism 67.54 (15.09) 69.19 (14.94)
Other-Oriented Perfectionism 59.67 (10.24) 59.29 (10.03)
Socially Prescribed Perfectionism 57.85 (11.55) 56.15 (11.67)
MPS-F
Personal Standards 21.18 (5.31) 21.30 (5.21)
Concern Over Mistakes 23.17 (7.38) 22.08 (7.15)
Doubts About Actions 10.83 (3.26) 10.62 (3.60)
Parental Criticism 10.13 (3.73) 9.49 (3.74)
Parental Expectations 16.54 (4.39) 16.45 (4.63)
ATS: Attitudes Towards Self Scale
Overgeneralization 14.78 (7.04) 15.12 (5.16)
High Standards 13.21 (3.52) 13.94 (3.62)
Self-Criticism 12.57 (3.50) 13.43 (3.60)
Standard deviations are in ESS: Experience of Shame Scale
parentheses. The following
Characterological Shame 24.29 (8.20) 23.23 (8.73)
abbreviations were used: MPS
(Multidimensional Bodily Shame 8.02 (3.18) 8.79 (3.59)
Perfectionism Scale), and Behavioral Shame 19.66 (6.21) 20.03 (6.58)
MPS-F (Frost Multidimensional Total 51.96 (15.68) 51.97 (16.76)
Perfectionism Scale)

harm in women were related to higher levels of parental criticism. Thus, women with
highly critical parents tended to engage in more self-harm behaviors. Similar to men,
increased self-harm activity in women was related to lower levels of other-oriented
perfectionism.
Self-harm in women was also found to be related to self-punitive attitudes. For
instance, women who were more likely to generalize failure to overall self-worth
tended to engage in more self-harm behaviors. Furthermore, women who were highly
self-critical tended to exhibit more self-harm. Finally, self-harm in women had
significant associations with characterological shame and bodily shame (see Table 2).
Thus, women who were ashamed of their personal habits, manner with others,
personal abilities and general sense of self tended to engage in more deliberate self-
harm behaviors. Similarly, women who were ashamed of their body also tended to
have higher instances of self-harm.
Although it was not our main objective, we thought it important to report the
associations that the ATSS self-punitiveness factors had with the other personality
variables. These results are displayed in Table 3. It can be seen that overall shame
scores were associated significantly with high standards, self-criticism, and overgen-
eralization for both men and women and the associations were more robust among
women. This is in keeping with the interpretation that shame is an affective mani-
festation of self-punitiveness.
Curr Psychol (2012) 31:49–64 57

Table 2 Correlations of self-harm

Self-Harm
with all other measures for men
and women
Men Women

MPS
Self-Oriented Perfectionism −.14 −.02
Other-Oriented Perfectionism −.40** −.03
Socially Prescribed Perfectionism −.15 .16*
MPS-F
Personal Standards .01 .03
Concern over Mistakes −.05 .12
Parental Criticism .06 .20**
Parental Expectations .10 −.07
Doubt about Actions .05 .09
Attitudes Toward Self Scale
Overgeneralization −.03 .23**
High Standards −.15 .14
Self-Criticism .05 .15**
Experience of Shame Scale
*p<.05, **p<.01. The following
Characterological .14 .28**
abbreviations were used: MPS
(Multidimensional Behavioural .15 .11
Perfectionism Scale), and Bodily .18 .28**
MPS-F (Frost Multidimensional Total .17 .25**
Perfectionism Scale)

Table 3 also contains the correlations between self-punitiveness and the two
perfectionism inventories. The association between the ATS and the MPS has been
reported previously (see Hewitt et al. 1991), but to our knowledge, the possible
association between self-punitiveness and the dimensions on the Frost MPS has not
been evaluated. Not surprisingly, the ATSS high standards scale was correlated
significantly with all of the perfectionism measures. In addition, it was found that
the ATSS self-criticism factor was associated significantly with all of the perfection-
ism measures. As for overgeneralization, this element of self-punitiveness was
correlated significantly with self-oriented, other-oriented, and socially prescribed
perfectionism in women but not in men. The particularly maladaptive forms of
perfectionism assessed by the Frost MPS (that is, concern over mistakes, doubts
about actions, parental criticism) were associated significantly with overgeneraliza-
tion in both men and women, but once again, the associations tended to be more
robust among women.

Discussion

The purpose of the present study was to test the applicability of an expanded self-
punitiveness model to the phenomenon of deliberate self-harm in university students,
and the overarching premise that deliberate self-harm is likely among individuals who
are highly sensitive to the negative self-worth implications of failure. To our
58 Curr Psychol (2012) 31:49–64

Table 3 Correlations with ATSS self-punitiveness measures for men and women

ATSS Measure

High Standards Self-Criticism Overgeneralization

Men Women Men Women Men Women

ESS-Total
Total .19* .27** .29** .46** .20* .50**
MPS
Self .61** .60** .49** .38** .06 .24**
Other .30** .32** .29** .23** −.01 .19**
Social .29** .28** .34** .36** .15 .45**
MPS-F
Personal Standards .63** .66** .44** .40** .08 .22**
Concern over Mistakes .39** .43** .38** .48** .25** .57**
Parental Criticism .22** .17* .25** .31** .23** .34**
Parental Expectations .41** .29** .33** .16* .21* .12
Doubt about Actions .19* .23** .28** .42** .19* .57**

*p<.05, **p<.01. The following abbreviations were used: ESS (Experience of Shame Scale), MPS
(Multidimensional Perfectionism Scale), MPS-F (Frost Multidimensional Perfectionism Scale), Self
(Self-Oriented Perfectionism), Other (Other-Oriented Perfectionism), and Social (Socially Prescribed
Perfectionism)

knowledge, this study represents the first empirical attempt to apply the self-
punitiveness model to the phenomenon of deliberate self-harm. Some support for
the self-punitiveness model was obtained, but the results varied substantially for men
versus women. Clearly, there were few significant correlations between the person-
ality variables and DSH for men. The only significant association for men was a
negative link between other-oriented perfectionism and DSH; this finding presum-
ably reflects the potentially positive benefits of redirecting self-focused attention
outward toward other people and away from the self. In any event, it is clear that
the current results are in keeping with other research with university students suggest-
ing the need to differentiate the correlates of self-harm in men versus women (see
Gratz et al. 2002).
In contrast, DHS in women was correlated significantly with overgeneralization
and high evaluative standards in terms of socially prescribed perfectionism and
parental criticism. Analyses of the data from the women in our study also found
evidence of a weak positive association between self-criticism and DSH, along with a
much stronger association between shame and DSH.
The association between DSH and overgeneralization is potentially revealing in
several respects. As noted earlier, research has found consistently that overgeneral-
ization is a predictor of depression and other forms of maladjustment. To our
knowledge, this is the first empirical test of a possible link between DSH and
overgeneralization. Our findings suggest that a tendency to make sweeping negative
judgements of the self may facilitate acts of deliberate self-harm. That is, certain
Curr Psychol (2012) 31:49–64 59

young women may be prone to distress and engage in deliberate self-injury because
they tend to perceive a global negative self when specific self-limitations are identi-
fied, and this broad tendency to negatively appraise the self may trigger the type of
destructive cognitive processes that Baumeister (1990) described in his model of
suicide and self-destruction as a form of escaping the self. Overgeneralization may
facilitate this process via its linked with reduced mindfulness; recent data suggest that
overgeneralizers are characterized by relatively low mindfulness (Feldman et al.
2007) and perhaps this low mindfulness is a defensive strategy to minimize the
impact of aversive self-awareness.
As indicated above, the tendency toward global negative self-evaluations was also
evident in terms of the pattern of results emerging from analyses of the ESS. We
found in the current study that DSH was associated with overall shame scores, and
with elevated levels of both characterological shame and bodily shame among young
women but not among young men. There are several noteworthy aspects of these
findings. First, we found that the pattern of obtained associations among young
women was such that shame had the strongest correlation with DSH. Second, the
finding that DSH was linked with bodily shame but only for young women is in
keeping with evidence linking self-injury and low appearance self-esteem in adoles-
cent girls (Bjärehed and Lundh 2008). However, in the current study, DSH in women
was not associated with behavioral shame. Thus, the elements of shame that were
involved were the ones that were less controllable and more reflecting of enduring
attributes, including sweeping negative self-assessments of bodily attributes. This is
in keeping with accounts that highlight the role of dislike of one’s body in DSH (see
Bolognini et al. 2003). If viewed from another perspective, many of the findings that
emerged from data provided by the young women in this study are in keeping with
the link between self-injury and eating disorders among women (see Svirko and
Hawton 2007) and it is quite possible that self-punitive tendencies are applicable to
both phenomena. Finally, supplementary analyses indicating that there is a substantial
association between overgeneralization and shame in young women, and this asso-
ciation is stronger than was found among young men. This link merits further
investigation because it may reflect a broader tendency for aspects of self-
punitiveness to be linked with a sense of shame among women. Young women with
these attributes may be ashamed about their entire self in a manner that could possibly
decrease the likelihood of seeking help despite experiencing significant distress. This
overgeneralized shame could also account for secretive forms of self-harm.
The analyses involving the perfectionism measures found limited evidence of an
association between perfectionism and DSH. While it is tempting to conclude that
perfectionism may be more relevant to suicide ideation and suicidal tendencies rather
than to DSH (see Hewitt et al. 2006), two dimensions of perfectionism (socially
prescribed perfectionism and parental criticism) were associated with DSH in our
study. It is also possible that perfectionism needs to be examined within the context of
particular stressors, in keeping with diathesis-stress accounts of the various in ways
that perfectionism is linked with psychological distress (see Hewitt and Flett 2002),
and O’Connor et al. (2010) did establish that life stress moderated the association
between socially prescribed perfectionism and self-harm.
Our results linking parental criticism and DSH are intriguing in that they replicate
other recent findings of an association between deliberate self-injury and perceived
60 Curr Psychol (2012) 31:49–64

parental criticism in adolescents (Wedig and Nock 2007; Yates et al. 2008). Collec-
tively, these findings accord with numerous other studies that attest to the role of
parental criticism in various forms of maladjustment (Frye and Garber 2005; Pineda
et al. 2007). An important issue for further investigation is the extent to which the
replicated association between DSH and reported parental criticism reflects veridical
reports of parental criticism. The findings of Wedig and Nock (2007) are illuminating
because their results were based on analyses of speech samples that go beyond the
reliance on self-report questionnaires. A related issue is the extent to which perceived
parental criticism fosters other forms of self-punitiveness. While it is difficult to argue
that parental criticism per se is a form of self-punitiveness, it certainly can contribute
to a general tendency to be self-punitive.
Our analyses also yielded evidence of a weak positive association between deliberate
self-harm and the measure of self-criticism among women. Perhaps a stronger link was
not found because we did not use a more commonly used measure of self-criticism from
a measure such as the Depressive Experiences Questionnaire. Alternatively, perhaps a
domain-specific measure tapping criticism of one’s appearance (including bodily
characteristics) would have been more relevant in this particular context. Still, the
association found in the current study does accord with some other recent evidence of
an association between trait self-criticism and DSH (see Glassman et al. 2007). The fact
that overgeneralization was more predictive than was self-criticism is in keeping with
earlier research on self-punitiveness; other research tends to find that overgenerali-
zation is more deleterious than either self-criticism or perfectionistic standards and it
seems to be the key element in self-punitiveness (see Flett et al. 1991).
While the current results represent general support for an individual differences
approach that involves a self-punitiveness model of DSH, it must be acknowledged
that most statistically significant correlations obtained in the current study were
relatively low in magnitude. There are several factors that likely operate here. First,
we noted earlier that the majority of our participants did not engage in any DSH and
range restriction may have limited the magnitude of the obtained correlations.
Second, people engage in DSH for various reasons that go beyond a desire for self-
punishment; it is quite conceivable that the self-punitiveness model applies only to a
distinguishable subset of individuals who engage in DSH and it will not apply to
others who engage in DSH as a result of other factors; there is some evidence, for
instance, of DSH stemming from sensation seeking (see Klonsky 2007) as well as
from desires for social reinforcement (Nock 2008).
As we alluded to above, it is also possible that self-punitive tendencies become
more relevant within the context of significant life stressors. Indeed, it has been
suggested in the perfectionism literature that perfectionism is best viewed as a
diathesis factor that requires the experience of significant life setbacks in order for
distress to be experienced (see Hewitt and Flett 2002). Life stressors that are seen as
being uncontrollable yet still a source of self-blame, a phenomenon referred to as the
depressive paradox, would seem particularly relevant to a possible link between
perfectionism and individual acts of deliberate self-harm. Finally, research is needed
to examine why some people high in self-punitiveness are willing to harm themselves,
but others with comparable levels of self-punitiveness do not harm themselves.
Although it was not our main focus, we also examined the extent to which the
shame and perfectionism measures were associated with the ATSS self-punitiveness
Curr Psychol (2012) 31:49–64 61

subscales. These analyses confirmed that shame was linked with the various indices
of self-punitiveness for both women and men. Also, in keeping with previous
research on self-oriented, other-oriented, and socially prescribed perfectionism
(Hewitt et al. 1991), the self-punitiveness measures were also linked with trait
perfectionism. However, the analyses also suggested that the associations with the
self-punitiveness measures were stronger for women than men, and this is intriguing
because it was found similarly by Hewitt et al. (1991) in a clinical sample that the
association between self-oriented perfectionism and both self-criticism and overgen-
eralization was more robust in women than in men. Given the more general evidence
in the current study that self-punitiveness and self-harm were associated in women
but not in men, it is readily apparent that there is a need for further examination of
possible sex differences in the correlates of self-punitiveness. If these differences can
be confirmed, there may also be associated differences in related cognitive processes
such as rumination.
It is evident that the current results have some clear treatment implications. Recent
evidence indicates that cognitive-behavioral therapy and dialectical behavior therapy
are effective in reducing rates of deliberate self-harm (see Slee et al. 2008; Stanley et
al. 2007). Our findings suggest that it is important to address self-punitiveness in the
form of overgeneralization and negative self-evaluative tendencies that foster a
pervasive sense of shame among young women who engage in self-injury behavior.
The role of parental criticism in contributing to these tendencies also merits consid-
eration among those who are highly sensitive to interpersonal feedback.

Limitations of the Current Study

The current findings must be interpreted within the context of certain limitations.
First, and foremost, the findings are correlational so it cannot be ascertain that self-
punitiveness caused DSH. Indeed, we alluded above to the possible issues involving
the causal sequence when it was noted earlier that shame may be both an antecedent
and a consequence of deliberate self-harm. Second, there is always a concern about
social desirability bias when relying on self-report measures, and this concern may be
relevant in the current study.
Future research should explore individual differences in self-punitiveness and delib-
erate self-harm in clinical samples. Equally important will be research that examines
whether aspects of self-punitiveness and shame (or situations that foster a sense of
shame) combine interactively with each other to predict DSH, as well as the related
possibility that the components of self-punitiveness combine with other factors (for
instance, life stress, hopelessness) to precipitate acts of self-harm. Finally, it is essential
to establish whether the greater link between self-punitiveness and DSH in females that
was detected in the current study is a finding that can be replicated in other populations.
In summary, the current study found some support for an expanded self-
punitiveness model of self-harm, but this was limited to women rather than men.
Our results in a sample of university students found that women with a history of self-
harm had elevated levels of overgeneralization, certain elements of perfectionism,
self-criticism, and shame. These data suggest that acts of DSH are a reflection of a
pre-existing orientation toward self-punitiveness and an important goal for future
research will be to identify other factors that combine with self-punitiveness and
62 Curr Psychol (2012) 31:49–64

associated deficits in self-regulation to actually facilitate self-harm behaviors. Clearly,

not all individuals who are highly self-punitive engage in DSH, so it will be important
to not only replicate the current findings, but also extend them by identifying factors
that are protective versus those factors that make an act of self-harm more likely to
take place.

References

Andrews, B. (2002). Bodily shame and abuse in childhood. In P. Gilbert & J. Miles (Eds.), Bodily shame:
Conceptualization, research, and treatment (pp. 256–283). New York: Brunner-Routledge.
Andrews, B., Qian, M., & Valentine, J. D. (2002). Predicting depressive symptoms with a new measure of
shame: the experience of shame scale. British Journal of Clinical Psychology, 41, 29–42.
Baumeister, R. F. (1990). Suicide as escape from the self. Psychological Review, 97, 90–113.
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper and
Row.
Bjärehed, J., & Lundh, L.-G. (2008). Deliberate self-harm in 14-year-old adolescents: how frequent is it,
and how is it associated with psychopathology, relationship variables, and styles of emotional
regulation. Cognitive Behavior Therapy, 37, 26–37.
Bolognini, M., Plancherel, B., Laget, J., Stephan, P., & Halfon, O. (2003). Adolescents’ self-mutilation –
Relationship with dependent behaviour. Swiss Journal of Psychology, 62, 241–249.
Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal
self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–
202.
Carver, C. S. (1998). Generalization, adverse events, and development of depressive symptoms. Journal of
Personality, 66, 607–619.
Carver, C. S., & Ganellen, R. J. (1983). Depression and components of self-punitiveness: high standards,
self-criticism, and overgeneralization. Journal of Abnormal Psychology, 92, 330–337.
Carver, C. S., Ganellen, R. J., & Behar-Mitrani, V. (1985). Depression and cognitive style: comparisons
between measures. Journal of Personality and Social Psychology, 49, 722–728.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: the
experiential avoidance model. Behaviour Research and Therapy, 44, 371–394.
Claes, L., Vandereycken, W., & Vertommen, H. (2005). Self-care versus self-harm: piercing, tattooing, and
self-injuring in eating disorders. European Eating Disorder Review, 13, 11–18.
Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., et al. (2005). Suicide after
deliberate self-harm: a 4-year cohort study. The American Journal of Psychiatry, 162, 297–303.
Dulit, R. A., Fryer, M. R., Leon, A. C., Brodsky, B. S., & Fances, A. J. (1994). Clinical correlates of self-
mutilation in borderline personality disorder. The American Journal of Psychiatry, 4, 149–155.
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P. (2007). Mindfulness and emotion
regulation: the development and initial validation of the Cognitive and Affective Mindfulness Scale-
Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29, 177–190.
Flett, G. L., & Hewitt, P. L. (2006). Positive versus negative perfectionism in psychopathology: a comment
on Slade and Owen’s dual process model. Behavior Modification, 30, 472–495.
Flett, G. L., Hewitt, P. L., & Mittelstaedt, W. M. (1991). Dysphoria and components of self-punitiveness: a
re-analysis. Cognitive Therapy and Research, 15, 201–219.
Frost, R., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive
Therapy and Research, 14, 449–468.
Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A comparison of two
measures of perfectionism. Personality and Individual Differences, 14, 119–126.
Frye, A., & Garber, J. (2005). The relations among maternal depression, maternal criticism, and adolescents’
externalizing and internalizing symptoms. Journal of Abnormal Child Psychology, 33, 1–11.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism:
overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13, 353–
379.
Gilbert, P., McEwan, K., Bellew, R., Mills, A., & Gale, C. (2009). The dark side of competition: how
competitive behaviour and striving to avoid inferiority are linked to depression, anxiety, stress, and
self-harm. Psychology and Psychotherapy: Theory, Research and Practice, 82, 123–136.
Curr Psychol (2012) 31:49–64 63

Glassman, L. H., Weierich, M. R., Hooley, J. M., Deliberto, T. L., & Nock, M. K. (2007). Child
maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Behaviour Research
and Therapy, 45, 2483–2490.
Goldstein, A. L., Flett, G. L., Wekerle, C., & Wall, A.-M. (2009). Personality, child maltreatment, and
substance use: examining correlates of deliberate self-harm among university students. Canadian
Journal of Behavioural Science, 41, 241–251.
Gratz, K. L. (2001). Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm
Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253–263.
Gratz, C. K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college
students. The American Journal of Orthopsychiatry, 72, 128–140.
Hayes, A. M., Harris, M. S., & Carver, C. S. (2004). Predictors of self-esteem variability. Cognitive
Therapy and Research, 28, 369–385.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: conceptualization,
assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60,
456–470.
Hewitt, P. L., & Flett, G. L. (2002). Perfectionism and stress processes in psychopathology. In G. L. Flett &
P. L. Hewitt (Eds.), Perfectionism: theory, research and treatment. Washington: APA.
Hewitt, P. L., & Flett, G. L. (2004). The multidimensional perfectionism scale: Technical manual. Toronto:
Multi-Health Systems Inc.
Hewitt, P. L., Flett, G. L., Turnbull-Donovan, W., & Mikail, S. F. (1991). The multidimensional perfec-
tionism scale: reliability, validity, and psychometric properties in psychiatric samples. Psychological
Assessment, 3, 464–468.
Hewitt, P. L., Flett, G. L., Sherry, S. B., & Caelian, C. (2006). Trait perfectionism dimensions and suicidal
behavior. In T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 215–235).
Washington: American Psychological Association.
Kawamura, K. Y., Hunt, S. L., Frost, R. O., & DiBartolo, P. M. (2001). Perfectionism, anxiety, and
depression: are the relationships independent? Cognitive Therapy and Research, 25, 291–301.
Kernis, M. H., Brockner, J., & Frankel, B. S. (1989). Self-esteem and reactions to failure: the mediating role
of overgeneralization. Journal of Personality and Social Psychology, 57, 707–714.
Klonsky, E. D. (2007). The functions of deliberate self-injury: a review of the evidence. Clinical Psychology
Review, 27, 226–239.
Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: psychometric
properties of the Inventory About Self-Injury (ISAS). Journal of Psychopathology and Behavioral
Assessment, 31, 215–219.
Larsson, B., & Sund, A. M. (2008). Prevalence, course, incidence, and 1-year prediction of deliberate self-
harm and suicide attempts in early Norwegian school adolescents. Suicide & Life-Threatening Behavior,
38, 152–165.
Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents:
understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34, 447–457.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of
non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37, 1183–
1192.
McGregor, H. A., & Elliot, A. J. (2005). The shame of failure: examining the link between fear of failure
and shame. Personality and Social Psychology Bulletin, 31, 218–231.
Miller, A. L., & Smith, H. L. (2008). Adolescent non-suicidal self-injurious behaviour: the latest epidemic
to assess and treat. Applied and Preventive Psychology, 12, 178–188.
Milligan, R.-J., & Andrews, B. (2005). Suicidal and other self-harming behaviour in offender women: the
role of shame, anger, and childhood abuse. Legal and Criminological Psychology, 10, 13–25.
Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts among adolescents who engage in
non-suicidal self-injury. Archives of Suicide Research, 11, 69–82.
Muehlenkamp, J. J., Hoff, E. R., Licht, J.-G., Azure, J. A., & Hasenzahl, S. J. (2008). Rates of non-suicidal
self-injury: a cross-sectional analysis of exposure. Current Psychology, 27, 234–241.
Nock, M. K. (2008). Actions speak louder than words: an elaborated theoretical model of the social
functions of self-injury and other harmful behaviors. Applied and Preventive Psychology, 12, 159–
168.
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature of functions of self-
injury. Current Directions in Psychological Science, 18, 78–83.
Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation
among adolescents. Journal of Abnormal Psychology, 114, 140–146.
64 Curr Psychol (2012) 31:49–64

O’Connor, R. C. (2007). The relations between perfectionism and suicidality: a systematic review. Suicide
& Life-Threatening Behavior, 37, 698–714.
O’Connor, R. C., Rasmussen, S., & Hawton, K. (2010). Predicting depression, anxiety, and self-harm in
adolescents: the role of perfectionism and acute life stress. Behaviour Research and Therapy, 48, 52–59.
Orth, U., Berking, M., & Burkhardt, S. (2006). Self-conscious emotions and depression: rumination
explains why shame but not guilt is maladaptive. Personality and Social Psychology Bulletin, 32,
1608–1619.
Pineda, A. Q., Cole, D. A., & Bruce, A. E. (2007). Mother-adolescent interactions and adolescent
depressive symptoms: a sequential analysis. Journal of Social and Personal Relationships, 24, 5–19.
Pliner, P., Chaiken, S., & Flett, G. L. (1990). Gender differences in concern with body weight and physical
appearance over the lifespan. Personality and Social Psychology Bulletin, 16, 263–273.
Prezant, D. W., & Neimeyer, R. A. (1988). Cognitive predictors of depression and suicide ideation. Suicide
& Life-Threatening Behavior, 18, 259–264.
Ross, S., Heath, N. L., & Toste, J. R. (2009). Non-suicidal self-injury and eating pathology in high school
students. The American Journal of Orthopsychiatry, 79, 83–92.
Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). The Self-Harm Inventory (SHI): develop-
ment of a measure for identifying self-harm behaviors and borderline personality disorder. Journal of
Clinical Psychology, 54, 973–983.
Sansone, R. A., Wiederman, M. W., Sansone, L. A., & Monteith, D. (2000). Patterns of self-harm
behaviour among women with borderline personality symptomatology: psychiatic versus primary care
samples. General Hospital Psychiatry, 22, 174–178.
Slee, N., Garnefski, N., van der Leeden, R., Arensman, E., & Spinhoven, P. (2008). Cognitive-behavioural
intervention for self-harm: randomized control trial. The British Journal of Psychiatry, 192, 202–211.
Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for
suicidal behaviour and non-suicidal self-injury. Archives of Suicide Research, 11, 337–341.
Stanley, B., Gameroff, M. J., Michalsen, V., & Mann, J. J. (2001). Are suicide attempters who self-mutilate
a unique population? The American Journal of Psychiatry, 158, 427–432.
Stanley, B., Winchel, R., Molcho, A., Simeon, D., & Stanley, M. (1992). Suicide and the self-harm
continuum: phenomenological and biochemical evidence. International Review of Psychiatry, 4,
149–155.
Svirko, E., & Hawton, K. (2007). Self-injurious behaviour and eating disorders: the extent and nature of the
association. Suicide and Life-Threatening Behaviors, 37, 409–421.
Tangney, J. P. (2002). Perfectionism and the self-conscious emotions: Shame, guilt, embarrassment, and
pride. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 199–
215). Washington: American Psychological Association.
Wedig, M. M., & Nock, M. K. (2007). Parental expressed emotion and adolescent self-injury. Journal of the
American Academy of Child and Adolescent Psychiatry, 46, 1171–1178.
Whitlock, J., Eells, G., Cummings, N., & Purington, A. (2009). Nonsuicidal self-injury in college
populations: mental health provider assessment of prevalence and need. Journal of College Student
Psychotherapy, 23, 172–183.
Yates, T. M., Tracy, A. J., & Luthar, S. S. (2008). Nonsuicidal self-injury among “privileged” youths:
longitudinal and cross-sectional approaches to developmental processes. Journal of Consulting and
Clinical Psychology, 76, 52–62.