Patterns of self-harm functions among clinic-referred youth: Associations with treatment outcomes

Theories of self-harm (self-injurious behaviour that may or may not include suicidal intent) include behavioural components such as escape, coping, and reinforcement through emotion regulation. By better understanding the functions (i.e., reasons or anticipated consequences) of self-harm, we may be able to improve treatment outcomes. This is a secondary analysis of data from the Self-Harm Intervention: Family Therapy trial. We used latent class analysis to identify patterns of self-harm functions (e.g., interpersonal, intrapersonal) in adolescents who presented to services due to self-harm. Participants (N = 832, 11-17 years; 89 % female) completed a structured interview to provide information on the presence and functions of self-harm as well as a questionnaire on suicidal ideation. Five latent classes were identified: 1) self-harming to stop feelings of anger and communicate desperation to others ("Anger/Desperation"); 2) self-harming to relieve negative feelings, particularly anxiety, and to receive help ("Anxious/Distressed"); 3) both intrapersonal and interpersonal functions with a desire to receive help ("Mixed Inter-Intrapersonal; "); 4) intrapersonal functions without an interest in seeking help ("Intrapersonal/Internalizing"); and 5) a low probability of intrapersonal and interpersonal functions ("Few Self-Harm Functions"). The Intrapersonal/Internalizing class had significantly higher suicidal ideation at 12-month post-treatment follow-up than the Few Self-Harm Functions class. Both the Anxious/Distressed and Intrapersonal/Internalizing classes were significantly more likely to have engaged in self-harm between baseline and 12-month post-treatment follow-up than the Few Self-Harm Functions class. The results highlight the need to identify effective treatment approaches to intervene on self-harm behaviour based on its functions.