Understanding the Link between Direct and Indirect Self-Injurious Behavior

Abstract In this chapter, the authors examine the factors that might explain why individuals who engage in direct self-injurious behavior (SIB) have a higher likelihood of also engaging in indirect SIB, and vice versa. As there are no general models to describe a transdiagnostic understanding of the potential underlying mechanisms of both direct and indirect SIB, the authors rely on a modified version of the “Conceptual model of interactive risk factors for both NSSI and ED” to describe the etiological factors underlying direct and indirect SIB more broadly. The model distinguishes between distal risk factors (e.g., temperament, family environment, and traumatic experiences) and proximal risk factors (e.g., emotional dysregulation, body disregard, and psychiatric disorders) and their mutual interaction. In both direct and indirect SIB, the motivation to self-injure is related to the function (benefits) of the behaviors. Hence, the behaviors are largely controlled by events that immediately precede and follow them (i.e., antecedents and consequences). In the authors’ review of the shared functions and functional equivalence of direct and indirect SIB, they find that they often serve the same purpose (e.g., affect regulation) and thus may replace or stand in for one another (symptom shifting). Although the two forms of the behavior largely share etiology and functions, the authors still find it useful to maintain the separation between the two phenomena.