Motivations for self-injury in an adolescent inpatient population: development of a self-report measure

Objective: The aim of this study was to develop and pilot an instrument for the assessment of self-injury in adolescent inpatients. Methods: The Self-Injury Motivation Scale was modified for use in adolescents. Thirty-eight consenting adolescent inpatients with a history of self-injury completed the Self-Injury Motivation Scale - Adolescent version (SIMS-A) and the Self-Injury Interview (SII) to collect information about a range of factors associated with self-injury, other clinical variables and demographic details. Results: The SIMS-A was acceptable to this adolescent sample and motivations for self-injury were similar to those of adults using the original SIMS scale. Adolescents were, however, more likely to use self-injury for communicating to/influencing others compared to adults. The participants most frequently reported self-injury by hitting, cutting and burning. The clinical diagnosis most frequently associated with self-injury was major depression. Females reported earlier onset, higher frequency and multiple methods of self-injury compared to males. Distraction from emotional pain was the most common motivation for self-injury in both males and females. Conclusions: This pilot study suggests the SIMS-A is a useful self-report measure to assist clinicians and adolescent patients to understand a behaviour that may be associated with shame, guilt or other difficult emotions for the adolescent. Results also support the contention that there are often multiple and conflicting motivations for self-injury. Self-injury in this population was more common and severe in female adolescents compared to males, while clinical depression was a risk factor for self-injury in both males and females. The small sample size of adolescent inpatients is an important limitation of this pilot study, and research using the SIMS-A in larger samples is warranted.