Non-Suicidal Self-Injury in High School Students:
Associations with Identity Processes and Statuses
Koen Luyckx
Amarendra Gandhi
Patricia Bijttebier
Laurence Claes
KU Leuven, Leuven, Belgium
Correspondence should be sent to Koen Luyckx, KU Leuven, Faculty of Psychology and
Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium. E-mail:
Koen.Luyckx@ppw.kuleuven.be.
1
Abstract
Non-suicidal self-injury (NSSI) refers to the direct, deliberate destruction of one’s
body tissue without suicidal intent. Research has highlighted the importance of identity
synthesis versus confusion for NSSI. However, the association with identity processes and
statuses remains unknown. A total of 568 adolescents reported on NSSI, identity, anxiety, and
depression. Although identity processes of identification with commitment (negatively) and
ruminative exploration (positively) were related to NSSI variables, these relationships were
no longer significant when controlling for anxiety and depression. When examining identity
statuses (using cluster analysis), individuals who had engaged in NSSI in the past (but not
currently) were more likely to be in the moratorium cluster and less likely to be in the
achievement cluster. Individuals who were currently engaging in NSSI were more likely to be
in the troubled diffusion cluster. Clinicians should be attentive to the complex interplay
between identity and NSSI when treating adolescents.
2
Identity formation represents a core developmental task for adolescents. Erikson
(1968) viewed identity as a tension between synthesis and confusion, where each individual is
charged with finding a balance that favors synthesis over confusion. The stronger one’s sense
of identity synthesis, the more aware he/she is of his/her uniqueness, strengths, and
weaknesses. Identity confusion, however, is associated with a disorganized or haphazard
sense of self (Schwartz et al., 2011). Past research has accumulated evidence that identity is
related to well-being and distress (Kroger & Marcia, 2011; Schwartz et al., 2011). Recent
research focused on linkages between identity and pathological behaviour as well, with nonsuicidal self-injury (NSSI) being an interesting sample case (Breen, Lewis, & Sutherland,
2013). NSSI tends to emerge during early- to mid-adolescence, the age span when identity
questions also arise. Identity issues have been hypothesized to play an important role in the
emergence and maintenance of NSSI (Breen et al., 2013). Although research has found
significant associations between identity synthesis/confusion and NSSI (r=-.10, p<.05 and
r=.23, p<.001, respectively; Claes, Luyckx, & Bijttebier, 2014), a view on how specific
identity processes and statuses relate to NSSI remains forthcoming.
Identity Processes and Statuses
Based on Erikson (1968), Marcia (1966) defined two identity processes in his status
paradigm. Exploration refers to experimenting with identity alternatives and commitment
signifies adhering to a set of convictions and values. By crossing these dimensions, Marcia
described four statuses: achievement (commitments enacted after exploring alternatives),
foreclosure (commitments enacted without prior exploration), moratorium (exploring
alternatives without current commitments), and diffusion (neither commitments nor
systematic exploration). During the last decade, researchers have proposed refined models in
which exploration and commitment have been unpacked into a larger set of processes.
3
In one such model, Luyckx and colleagues (2006, 2008) distinguished among five
processes subsumed under two complementary cycles. The first cycle builds on Marcia’s
paradigm (1966) and captures the processes through which individuals explore alternatives
and enact commitments. This first cycle may be described in terms of two processes:
exploration in breadth, or the purposeful exploration of various alternatives, and commitment
making, or the adherence to a set of choices. The second identity cycle captures the processes
through which individuals re-evaluate their choices and assess the degree to which they feel
certain about them. This second cycle may also be described in terms of two processes:
exploration in depth, or the evaluation of current commitments, and identification with
commitment, or the degree to which these commitments become integrated in one’s sense of
self. Especially identification with commitments seems to relate to feelings of self-worth and
well-being (for an overview, see Luyckx, Schwartz, Goossens, Beyers, & Missotten, 2011).
Assessing these processes carries the assumption that exploration is helpful to the
person. However, exploration has been linked with anxiety and depression as well (Schwartz,
Zamboanga, Weisskirch, & Rodriguez, 2009). Hence, Luyckx and colleagues (2008)
forwarded a fifth identity process, that is, ruminative exploration, to capture exploration
characterized by worry and indecisiveness. Research has demonstrated that ruminative
exploration was associated with distress and decreased well-being (see Luyckx et al., 2011).
This model allows for a fine-grained analysis of identity status. Through the use of
cluster analysis, identity statuses similar to Marcia’s statuses, along with some new statuses,
have emerged from North American and European research (Crocetti, Luyckx, Scrignaro, &
Sica, 2011; Schwartz et al., 2011). Six identity clusters have been commonly identified (as
displayed in Table 1): achievement, foreclosure, moratorium, carefree diffusion, troubled
diffusion, and undifferentiated.
Both achievement and foreclosure were characterized by high scores on commitment
4
processes and low scores on ruminative exploration. In addition, achievement was
characterized by substantially higher scores on exploration in breadth and exploration in
depth. Although achieved and foreclosed individuals scored similarly on self-esteem and
depressive symptoms (Luyckx, Schwartz, Berzonsky, et al., 2008), achieved individuals
scored higher on meaning in life (Schwartz et al., 2011). This suggests that high commitment
levels are associated with satisfaction and contentment with oneself. However, individuals
who explore before making commitments may be most likely to experience identity synthesis
and to ascribe meaning to their lives. Being identity foreclosed may be less likely to involve
such a sense of personal meaning (Schwartz et al., 2011; Waterman, 2007).
As moratorium is associated with distress and low self-worth, several authors have
questioned whether this status is truly an adaptive step towards identity synthesis. To the
extent that young people are engaged in a “perpetual moratorium”, they may experience
aggravated identity confusion (Côté & Schwartz, 2002; Marcia, 2002). Luyckx and colleagues
(2008) indeed found that individuals in moratorium scored high on ruminative exploration in
addition to exploration in breadth and in depth. Consequently, moratorium might denote a
type of arrested development, blocking individuals from forming commitments (Côté &
Levine, 2002).
With respect to diffusion, Luyckx and colleagues (2008) distinguished troubled
diffusion from carefree diffusion (Archer & Waterman, 1990; Marcia, 1989). Both clusters
were characterized by low scores on commitment processes and limited exploration in breadth
and in depth. However, more so than carefree-diffused individuals, troubled-diffused
individuals attempted to explore identity issues. However, they did so predominantly in a
ruminative manner. Thus, whereas troubled-diffused individuals might be unable to take
proactive steps in identity development, carefree-diffused individuals might be uninterested or
unmotivated to do so (Luyckx, Klimstra, Schwartz, & Duriez, 2013; Schwartz et al., 2011).
5
Finally, an undifferentiated cluster emerged (Luyckx et al., 2008; Schwartz et al., 2011),
consisting of individuals scoring close to the sample means on all identity processes.
Non-Suicidal Self-Injury
NSSI is defined as any socially unaccepted behaviour causing intentional and direct
injury to one’s own body tissue without suicidal intent, such as cutting, skin abrading, or
burning oneself. Further, this behaviour is engaged in to regulate negative internal or
interpersonal states (Claes & Muehlenkamp, 2013; Nock & Favazza, 2009). In community
samples, up to 17% of adolescents and 4% of adults report a history of NSSI (Muehlenkamp,
Claes, Havertape, & Plener, 2012). NSSI is associated with depressive and anxiety symptoms,
and approximately 50%-75% of individuals with a history of NSSI make a suicide attempt at
some point in life (Nock et al., 2006). These negative mental health implications underscore
the need for a better understanding of NSSI (Mullins-Sweat, Lengel, & Grant, 2013).
Identity formation – and especially the inability to pro-actively address this
developmental task – has been forwarded to play an important role in the emergence and
maintenance of NSSI (Breen et al., 2013). NSSI could be symptomatic of identity confusion
or of a lack of identity synthesis and could provide identity-confused individuals with some
sort of a “pseudo-identity”. Claes and colleagues (2014) found in a sample of high school
students that identity confusion was uniquely related to NSSI, after controlling for age,
gender, and internalizing symptoms (Exp(B)=1.13, p<.01). This finding was replicated in a
recent study using the present sample (Exp(B)=3.05, p<.01; Luyckx, Gandhi, Bijttebier, &
Claes, in press). Additional evidence for a link between identity and NSSI has emerged from
qualitative and narrative accounts in community and clinical samples. Through thematic
analyses of online autobiographical accounts of NSSI, Breen and colleagues (2013) found that
NSSI was discussed as a means to counteract feelings of loss of self and, in case of a
dissociative disorder, to create connections among multiple selves.
6
However, previous research has mainly focused on retrospective accounts of lifetime
NSSI and linked it to current identity mechanisms (Claes et al., 2014; Luyckx et al., 2014).
Hence, it could be that not so much identity issues are driving NSSI, but that NSSI acts earlier
on in the lifespan, along with problematic developmental factors causing individuals to
engage in these acts (e.g., Baetens et al., 2011; Nock & Favazza, 2009), might actually
contribute to identity difficulties later on. In the absence of longitudinal data on NSSI and
identity, however, such tenets remain to be investigated. The present cross-sectional study
aims to shed some light on this issue by distinguishing between current and past NSSI and
examining whether both variables are differentially related to current identity processes and
statuses.
The Present Study
The present study had two main objectives. First, we examined whether NSSI would
be related to five identity processes (commitment making, identification with commitment,
exploration in breadth, exploration in depth, and ruminative exploration). In line with research
indicating that identification with commitment and ruminative exploration were respectively
related to psychosocial functioning and ill-being (Luyckx et al., 2008), we expected that
especially these two processes would be related to NSSI. Experienced certainty towards
identity commitments would be negatively related, whereas identity rumination would be
positively related to NSSI.
Second, a differentiated pattern of associations was expected to emerge between
identity statuses (achievement, foreclosure, moratorium, carefree diffusion, troubled
diffusion, and undifferentiated) and NSSI. We expected that identity achievement (high
scores on all identity processes except for ruminative exploration) as an indication of identity
synthesis would be negatively related to NSSI. Troubled diffusion (low to intermediate scores
on all identity processes, except for a high score on ruminative exploration) as an indication
7
of identity confusion would be positively related to NSSI. Similarly, individuals in
moratorium (high scores on exploration processes and low to intermediate scores on
commitment processes) are experiencing an identity crisis which could translate itself in
NSSI. Our expectations were less clear with respect to foreclosure (high scores on
commitment processes and low scores on exploration processes) and carefree diffusion (low
to intermediate scores on all identity processes). Erikson (1968) defined identity synthesis as a
self-directed resolution to the identity task, emphasizing that foreclosure cannot be equated
with identity synthesis (Schwartz et al., 2011). Hence, one would expect that achieved
individuals would engage less in NSSI as compared to foreclosed individuals. Foreclosed
individuals, however, do have strong commitments that seem to protect them against
depressive symptoms much in the same degree as for achieved individuals. As such,
foreclosed individuals may report similarly low levels of NSSI as achieved individuals.
Further, given that carefree-diffused individuals lack strong commitments and are not
engaged in constructive exploration, they might engage more frequently in NSSI. However,
their lack of interest in identity issues and their present-oriented, hedonistic lifestyle could
decrease the need to engage in NSSI as an attempt to cope with their inner emptiness.
In examining both objectives, we also distinguished adolescents who engaged in NSSI
in the past (but not at present) from those adolescents who were currently (still) engaging in
NSSI. We explored whether past versus current NSSI would be differentially related to
identity. If associations would emerge mainly between past NSSI and current identity, these
findings would indicate that NSSI engaged in earlier on in the lifespan (along with the
associated developmental difficulties) might contribute to current identity problems.
However, if associations would emerge mainly between current NSSI and identity (and not so
much between past NSSI and identity), these findings could be in line with the hypothesis that
identity issues contribute to engaging in NSSI1.
8
Finally, given that previous research has found substantial relationships of
internalizing symptoms (e.g., anxiety and depression) with identity and NSSI (Claes, Luyckx,
& Bijttebier, 2014; Luyckx et al., 2008; Nock & Favazza, 2009), we examined whether
identity was related to NSSI above and beyond anxiety and depression. Insight in the added
value of identity towards NSSI could inform prevention and intervention efforts.
Methods
Participants and Procedure
The sample consisted of 568 high school students of 9th to 12th grade (61.8% girls;
98% Belgian nationality) from six high schools in the Flemish speaking part of Belgium2.
Mean age was 16.13 years (SD=1.42). A total of 27.5% were involved in a relationship. A
total of 69% were living in intact households, 18.1% had parents who were divorced, and
8.8% were living in a blended family. Active informed consent letters were distributed to the
parents two weeks before the data-collection. If parents consented for their child to
participate, students completed the questionnaires during regular school hours. Students were
provided with an envelope including assent documents and questionnaires. They returned
completed forms in a sealed envelope.
Measures
Non-suicidal self-injury. We assessed the lifetime prevalence of 7 different forms of
NSSI based on the Self-Injurious Questionnaire-Treatment Related (SIQ-TR; Claes &
Vandereycken, 2007): scratching, carving, cutting, hitting or bruising, burning, pricking with
a sharp object, and head banging. These questions were answered using a no/yes format
(scored as 0/1). Cronbach’s alpha of NSSI behaviors was .73. The total number of NSSI
forms in which participants had ever engaged was summed into a score of NSSI lifetime
versatility (range 0-7). Participants also indicated at which age the NSSI behavior started and
9
whether they needed to seek help for their injuries. Finally, we assessed whether they were
still engaging in NSSI currently (again scored as no/yes).
Identity processes. The Dimensions of Identity Development Scale (DIDS) was used.
This measure has been found to be valid and reliable in Belgian adolescents (Luyckx et al.,
2008). Identity processes were measured by five items each on 5-point Likert-type scales
ranging from 1 (completely disagree) to 5 (completely agree). Sample items read: “I have
decided on the direction I want to follow in my life” (Commitment making), “I sense that the
direction I want to take in my life will really suit me” (Identification with commitment), “I
regularly think over a number of different plans for the future” (Exploration in breadth), “I
regularly talk with other people about the plans for the future I have made for myself”
(Exploration in depth), and “It is hard for me to stop thinking about the direction I want to
follow in my life” (Ruminative exploration). Mean scores were calculated for each dimension.
Cronbach’s alphas were .89, .85, .83, .79, and .82, respectively.
Anxiety and depression. The 14-item Hospital Anxiety and Depression Scale (HADS;
Zigmond & Snaith, 1983) was used, a widely used and valid instrument to screen for anxiety
and depression (7 items each) in community samples (Bjelland, Dahl, Haug, & Neckelmann,
2002). All items were answered on a 4-point Likert scale ranging from 0 to 3, with response
options differing among the items. Sample items for anxiety and depression read: “I feel tense
or wound up” (response options from Most of the time to Not at all) and “I still enjoy the
things I used to enjoy” (response options from Definitely as much to Hardly at all). Sum
scores range between 0 and 21 for each subscale and higher scores indicate more anxiety and
depressive symptoms. Cronbach’s alphas were .81 and .67, respectively.
Results
Descriptive Analyses for NSSI
10
A total of 16.5% of adolescents had ever engaged in NSSI (lifetime presence; 76.6%
girls vs. 23.7% boys; χ²(1)=10.45, p<.001); 4.9% were currently engaging in NSSI. Hence,
11.6% had engaged in NSSI in the past but were no longer doing so. Mean age of onset was
13.56 years (SD=2.01). A total of 4.6% of adolescents had ever engaged in scratching, 8.3%
in carving, 7.5% in cutting, 3.3% in hitting or bruising, 1.9% in burning, 3.7% in pricking
oneself with a sharp object, and 2.8% in head banging. Girls were more likely than boys to
engage in scratching (χ²(1)=6.01, p<.05), carving (χ²(1)=11.79, p<.001), and cutting oneself
(χ²(1)=9.47, p<.01). With respect to NSSI lifetime versatility, a total of 47.9% engaged in one
form of NSSI, 25.5% in two forms of NSSI, 13.8% in three forms of NSSI, and 12.7% in four
or more forms of NSSI. Finally, 6.4% of those ever engaging in NSSI had to seek help due to
injuries caused by NSSI.
Preliminary Mean-Level Analyses
Prior to conducting all analyses, we removed 11 univariate (i.e., values more than 3
SDs below or above the mean) or multivariate outliers (i.e., individuals with high
Mahalanobis distance values) on the identity variables. Outliers have been demonstrated to
influence the number and/or meaning of clusters (Garson, 1998). A multivariate analysis of
variance (MANOVA) pointed to gender differences (F(8, 541)=7.85, p<.001, η²=.10).
Follow-up univariate F-values, η², and pairwise comparisons (using Tukey’s HSD test) shown
in Table 2 indicated that, in line with the findings for NSSI lifetime presence, girls scored
higher than boys on NSSI lifetime versatility. Further, girls scored higher on exploration in
depth and anxiety.
Correlation and Regression Analyses: The Role of Identity Processes
Table 3 presents all correlations. Ruminative exploration, anxiety, and depression
were positively related to all NSSI variables. Identification with commitment was negatively
related to all NSSI variables, except for past NSSI. Hierarchical logistic regression analysis as
11
displayed in Table 4 demonstrated that identity processes did not explain additional variance
in lifetime NSSI in Step 3 above and beyond age, gender, anxiety, and depression. (Separate
analyses for current NSSI and past NSSI past resulted in similar findings, with none of the
identity dimensions explaining additional variance above and beyond age, gender, anxiety,
and depression3). In Step 2, being female, anxiety, and depression were associated with a
significantly greater likelihood of lifetime NSSI [Exp(B)>1]. A hierarchical regression
analysis with NSSI lifetime versatility as dependent variable generated virtually identical
findings, with only anxiety (β=.15, p<.01) and depression (β=.26, p<.001) in Step 2 being
significant.
Cluster Analysis: The Role of Identity Statuses
Cluster analysis on the five identity processes was conducted using a two-step
procedure (Gore, 2000). Three- to six-cluster solutions were evaluated in terms of substantive
interpretability, parsimony, and explanatory power. In the first step, a hierarchical cluster
analysis was carried out using Ward’s method based on squared Euclidian distances. In the
second step, these initial cluster centers were used as non-random starting points in an
iterative k-means clustering procedure. In line with previous research, 6 clusters were
retained. This cluster solution explained between 56% and 64% of the variance in identity
processes. Figure 1 presents the six-cluster solution. The Y-axis represents z-scores: 0.2 SD is
a small effect, 0.5 SD a medium or moderate effect, and 0.8 SD a large effect (Cohen, 1988).
As expected, the achievement cluster scored high on commitment processes,
exploration in breadth and in depth, and low on ruminative exploration (16%). The
foreclosure cluster scored high on commitment processes and moderately low to low on all
exploration processes (9%). The moratorium cluster scored intermediate on commitment
processes, and high on the exploration processes (20%). The carefree diffusion cluster scored
moderately low to low on all identity processes (14%). The troubled diffusion cluster scored
12
low on commitment processes, intermediate on exploration in depth and in breadth, and high
on ruminative exploration (14%). Finally, the undifferentiated cluster scored moderate on all
processes (27%).
As displayed in Table 5, cross-tabulations pointed to significant associations between
cluster membership and lifetime NSSI (χ²(5)=28.45, p<.001), past NSSI (χ²(5)=16.34, p<.01),
and current NSSI (χ²(5)=22.15, p<.001), respectively. A standardized residual lower than -2
or higher than 2 indicates that this cell contributes significantly to the significant χ²
(Haberman, 1973). For lifetime NSSI, standardized residuals indicated that individuals in
moratorium and troubled diffusion were most likely to have ever engaged in NSSI.
Individuals in achievement and carefree diffusion were least likely to have ever engaged in
NSSI. For past NSSI, individuals in moratorium were most likely and individuals in
achievement were least likely to have engaged in it. For current NSSI, individuals in troubled
diffusion were most likely to engage in it.
Further, a MANOVA indicated that these clusters differed substantially on NSSI
lifetime versatility, anxiety, and depression (F(15, 1507)=6.07, p<.001, η²=.05). Follow-up
univariate F-values, η², and pairwise comparisons are shown in Table 6. Significant
differences among the clusters were obtained for all outcome variables. With respect to NSSI
lifetime versatility, individuals in achievement and carefree diffusion scored lower compared
to individuals in troubled diffusion and moratorium. Finally, an analysis of covariance with
anxiety and depression as covariates revealed significant differences among the clusters on
NSSI lifetime versatility (F(5, 546)=2.64, p<.05, η²=.02), much in line with the results
presented in Table 6 (except for that the difference between troubled diffusion and
achievement was marginally significant with p=.057).
Discussion
13
The present study added substantially to a recent research theme in the literature, that
is, establishing empirical linkages between identity and NSSI. Given that NSSI constitutes an
important health issue in adolescents, research contributing to our understanding of how
identity formation is related to NSSI is both timely and needed. Our findings indicated that
not so much identity processes were related uniquely to NSSI in adolescents. Stronger
associations were found between identity statuses (representing multivariate combinations of
identity processes) and NSSI, emphasizing the need for a typological identity approach to
obtain a fine-grained view on these linkages. Further, differential associations were obtained
when distinguishing between current and past NSSI, which might have important implications
for our thinking about the relationship between identity and NSSI.
With respect to the link between identity processes and NSSI, an apparent discrepancy
was observed between correlational and regression analyses. Identification with commitment
(negatively) and ruminative exploration (positively) were found to be correlated to NSSI.
These findings are in line with previous research demonstrating that these two identity
processes have been identified as the strongest correlates of distress and well-being (Luyckx
et al., 2006, 2008). Hence, also with respect to pathological behavior such as NSSI,
experienced certainty towards commitments and identity worry or rumination seem to be
important correlates. However, when additionally controlling for anxiety and depression in
the regression analyses, these significant associations disappeared. These latter findings seem
to suggest that it is not so much the identity process itself that is driving this association but
that accompanying feelings of anxiety and depression might explain the observed associations
between these processes and NSSI (cf. Klonsky, 2007, 2009).
These findings seem to contradict recent studies pointing to significant associations
between identity synthesis/confusion and NSSI (Claes, Luyckx, & Bijttebier, 2014; Luyckx et
al., 2014). However, when looking at the associations between identity clusters and NSSI,
14
significant associations were found, even when controlling for anxiety and depression in the
case of lifetime versatility. Further, these associations substantially extended those obtained
between the Eriksonian measure of identity synthesis versus confusion and NSSI. In other
words, researchers and clinicians need to assess individuals’ overarching identity status
instead of focusing solely on a single identity process of commitment or exploration when
examining linkages with NSSI.
In discussing the relationship between identity status and NSSI, it is important to
distinguish between individuals who engaged in NSSI in the past versus those who are
currently engaging in it. With respect to past NSSI, individuals in moratorium were most
likely and individuals in achievement were least likely to report it. Given that these
individuals did not engage in NSSI anymore at present, these results are in line with the
hypothesis that NSSI is related to identity disturbances later on in the lifespan. Importantly,
no causal conclusions can be drawn given that not so much NSSI in itself but the individual
and contextual developmental factors playing into NSSI (such as temperamental factors or a
profound lack of contextual support; Baetens et al., 2011; Nock & Favazza, 2009) could drive
these identity problems. Nonetheless, the present findings do illustrate that engaging in NSSI
earlier on in the lifespan is related to a potential developmental delay in adolescent identity
formation. These individuals seem to experience an identity crisis (in terms of being in a state
of moratorium) more often and seem less able to arrive at an achieved identity in adolescence.
In other words, they are investing energy in their identity quest but they do not succeed yet in
forming self-endorsed commitments, more so than their peers who have never engaged in
NSSI in the past. Hence, some of these individuals seem to lack the necessary agency and
self-direction to find their own life pathway (Schwartz et al., 2011).
With respect to the high commitment-statuses, only individuals in the achievement
(but not the foreclosure) status reported significantly less past NSSI as could be expected
15
based on sample prevalence rates. Nonetheless, both clusters were characterized by similarly
high scores on commitment processes. What differentiates both clusters, however, is the
elevated scores on exploration in breadth and in depth for achieved but not for foreclosed
individuals. Foreclosure has traditionally been considered as a “less mature” status compared
to achievement (Marcia, 1980). Empirical research has demonstrated that achieved
individuals score higher on identity synthesis and centrality as compared to foreclosed
individuals (Luyckx, Klimstra, Schwartz, & Duriez, 2013; Schwartz et al., 2011). In sum,
engaging in past NSSI does not seem to impede the formation of identity commitments in
itself (as is the case in foreclosure), but especially the formation of personally endorsed
commitments (i.e., after a personalized exploratory search as is the case in achievement).
With respect to present NSSI, especially troubled-diffused individuals were most
likely to engage in it, mirroring previous findings on the link between identity confusion and
NSSI. Individuals in troubled diffusion indeed have been found to score highest on the
Eriksonian measure of identity confusion (Schwartz et al., 2011). The fact that this association
was not found between past NSSI and troubled diffusion seems to suggest that identity
confusion might play into NSSI acts as well. NSSI then could be symptomatic of such identity
uncertainty and could constitute a problematic coping strategy for dealing with identity issues
(cf. Selby, Anestis, Bender, & Joiner, 2009). Several studies have shown that NSSI is driven
by high levels of negative affectivity and low levels of effortful control in both community
and clinical samples (e.g., Baetens et al., 2011; Claes, Norré, Van Assche, & Bijttebier, 2014).
Interestingly, such increased odds for engaging in NSSI were not obtained for
individuals classified in carefree diffusion. What separates carefree-diffused from troubleddiffused individuals is mainly the former individuals’ lack of interest, motivation, or
willingness to invest in identity formation, whereas individuals in troubled diffusion might be
unable to take proactive identity steps (Schwartz et al., 2011). Hence, it is not surprising that
16
carefree-diffused individuals do not feel the need to engage in NSSI to compensate for a lack
of clear and guiding life choices. Such identity issues are simply not that highly placed on
their agenda so to speak due to a general disinterest in these issues (Luyckx, Schwartz,
Klimstra, & Duriez, 2013). On the contrary, they are present-oriented and seem to be reluctant
to settle down and enact adult commitments (Côté, 2000). However, previous research has
pointed to the “dark side” of such a carefree lifestyle in terms of externalizing and health risk
behaviours in some of these individuals (such as using hard drugs and inhalants, injecting
drugs, and misusing prescription drugs; Schwartz et al., 2011).
Although the present data are cross-sectional in nature, they seem to point to
reciprocal mechanisms linking identity to NSSI. However, for such claims to be made,
longitudinal research should investigate whether (a) NSSI in childhood or early adolescence
indeed can lead to developmental delays in identity formation in mid- to late adolescence and
the transition to adulthood; and (b) identity confusion in mid- to late adolescence can actually
lead to engagement in NSSI. Provided that the present findings can be replicated
longitudinally, they have important clinical implications.
First, NSSI could be symptomatic for an inner emptiness or lack of a guiding identity
framework in daily life. The underlying motivation or willingness (not) to engage in identity
work needs to be taken into account. The fact that an individual has no strong commitments
and does not explore pro-actively does not make him or her vulnerable for NSSI acts. Only
when this lack of pro-active identity work signals an underlying vulnerability or incapacity to
do so (in contrast to an underlying disinterest as in the case of carefree-diffused individuals),
individuals seem to be more vulnerable for NSSI. Hence, clinicians should be sensitive
towards these identity issues which could signal the presence of NSSI in some individuals.
Some of these individuals might indeed not have the internal or external resources at their
disposal to interrupt a potentially negative spiral of identity confusion and worry. Facilitating
17
commitment formation and evaluation might help in reducing the risk for NSSI in these
individuals.
Second, clinicians should not only be attentive towards current acts of NSSI in treating
adolescents, as NSSI acts engaged on earlier in life were found to signal a developmental
delay in current identity status. These individuals were more often in a state of identity
moratorium and were less able to make self-explored and self-endorsed identity commitments
(resulting in a genuine sense of identity synthesis). In sum, future research should examine
whether a vicious circle can be at work in some individuals. Past NSSI could lead to a
developmental delay in identity which can result in identity confusion, again giving rise to
NSSI. The support of self-determined choices constitutes an important feature of the
treatment of NSSI and might help in breaking such a cycle. A recent study has showed that
eating disordered patients with NSSI reported higher levels of well-being when they
autonomously decided to get rid of their symptoms compared to patients who were externally
driven to give up their symptoms (Vansteenkiste, Claes, Soenens, & Verstuyf, 2013). The
mere introjection of choices proposed by significant others seems not sufficient in alleviating
or preventing NSSI.
Limitations and Suggestions for Future Research
The present study was characterized by several limitations. First, we relied on selfreported measures which might artificially inflate correlations among constructs. However,
for identity, self-reports are the only reliable source, as the construct is thought to represent an
individual’s own sense of commitment and exploration (Erikson, 1968). Relatedly, the present
findings cannot be generalized beyond the identity model used. The present study focused on
very specific components of identity, that is, commitment and exploration processes. Future
research should do well to examine identity from a narrative viewpoint as well. The coherence
of the narrative that one constructs might be taken as an index of the coherence or
18
functionality of one’s sense of identity (McAdams, 2011). This conceptualization of identity
is consistent with Erikson’s (1968) view of identity synthesis, in which one’s various life
roles and commitments fit well together and tell a coherent story. Second, as noted, the crosssectional design prevents us from drawing conclusions about directionality of effects and
developmental changes. Long-term longitudinal research is needed to uncover the
developmental mechanisms linking identity processes and statuses to NSSI.
19
Footnotes
1. We would like to thank an anonymous reviewer for this suggestion.
2. The present sample was also used by Luyckx, Gandhi, Bijttebier, and Claes (2014) in
which NSSI was linked to identity synthesis and confusion.
3. All results can be obtained from the first author.
20
References
Archer, S. L., & Waterman, A. S. (1990). Varieties of identity diffusions and foreclosures: An
exploration of subcategories of the identity statuses. Journal of Adolescent Research, 5,
96-111.
Baetens, I., Claes, L., Willem, L., Muehlenkamp, J.J., & Bijttebier, P. (2011). The
relationship between non-suicidal self-injury and temperament in male and female
adolescents based on child- and parent-report. Personality and Individual Differences,
50, 527-530.
Bjelland, I., Dahl, A.A., Haug, T.T., & Neckelmann, D.D. (2002). The validity of the Hospital
Anxiety and Depression Scale – An updated literature review. Journal of
Psychosomatic Research, 52, 69-77.
Breen, A.V., Lewis, S. P., & Sutherland, O. (2013). Brief report: Non-suicidal self-injury in
the context of self and identity development. Journal of Adult Development, 20, 57-62.
Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents:
Prevalence and associations with identity formation above and beyond depression.
Personality and Individual Differences, 61-62, 101-104.
Claes, L., & Muehlenkamp, J. J. (2013). The relationship between the UPPS-P impulsivity
dimensions and non-suicidal self-injury characteristics in male and female high school
students. Psychiatry Journal, Article ID 654847.
Claes, L., Norré, J., Van Assche, L., & Bijttebier, P. (2014). Non-suicidal self-injury
(functions) in eating disorders: associations with reactive and regulative temperament.
Personality and Individual Differences, 57, 65-69.
Claes, L., & Vandereycken, W. (2007). The Self-Injury Questionnaire-Treatment Related
(SIQ-TR): Construction, reliability, and validity in a sample of female eating disorder
21
patients. In P.M. Goldfarb (Ed.), Psychological Tests and Testing Research Trends
(pp. 111-139). New York: Nova Science Publishers.
Cohen, J. (1988). Statistical power analyses for the behavioral sciences (2nd edition).
Hillsdale, NJ: Erlbaum.
Côté, J. E. (2000). Arrested adulthood: The changing nature of maturity and identity. New
York: New York University Press.
Côté, J. E., & Levine, C. G. (2002). Identity formation, agency, and culture: A social
psychological synthesis. Mahwah, NJ: Erlbaum.
Côté, J. E., & Schwartz, S. J. (2002). Comparing psychological and sociological approaches
to identity: Identity status, identity capital, and the individualization process. Journal
of Adolescence, 25, 571-586.
Crocetti, E., Luyckx, K., Scrignaro, M., & Sica, L. S. (2011). Identity formation in Italian
emerging adults: A cluster-analytic approach and associations with psychosocial
functioning. European Journal of Developmental Psychology, 8, 558-572.
Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.
Garson, D. G. (1998). Cluster analysis. In Statnotes: Topics in multivariate analysis.
Retrieved April 20, 2006, from http://www2.chass.ncsu.edu/garson/PA765/cluster.htm
Gore, P.A. Jr. (2000). Cluster analysis. In H. E. A. Tinsley & S. D. Brown (Eds.), Handbook
of applied multivariate statistics and mathematical modeling (pp. 297-321). San
Diego, CA: Academic Press.
Haberman, S. J. (1973). Analysis of residuals in cross-classified tables. Biometrics, 29, 205220.
Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence.
Clinical Psychology Review, 27, 226-239.
22
Klonsky, E.D. (2009). The functions of self-injury in young adults who cut themselves:
Clarifying the evidence for affect-regulation. Psychiatry Research, 166, 260-268.
Kroger, J., & Marcia, J. E. (2011). The Identity statuses: Origins, meanings, and
interpretations. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of
identity theory and research (pp. 31-54). New York: Springer.
Luyckx, K., Gandhi, A., Bijttebier, P., & Claes, L. (in press). Non-suicidal self-injury among
Female adolescents and psychiatric patients: A replication and extension of the role of
identity formation. Personality and Individual Differences.
Luyckx, K., Goossens, L., & Soenens, B. (2006). A developmental contextual perspective on
identity construction in emerging adulthood: Change dynamics in commitment
formation and commitment evaluation. Developmental Psychology, 42, 366-380.
Luyckx, K., Goossens, L., Soenens, B., & Beyers, W. (2006). Unpacking commitment and
exploration: Validation of an integrative model of adolescent identity formation.
Journal of Adolescence, 29, 361-378.
Luyckx, K., Klimstra, T. A., Schwartz, S. J., & Duriez, B. (2013). Personal identity in college
and the work context: Developmental trajectories and psychosocial functioning.
European Journal of Personality, 27, 222-237.
Luyckx, K., Schwartz, S. J., Berzonsky, M. D., Soenens, B., Vansteenkiste, M., Smits, I., &
Goossens, L. (2008). Capturing ruminative exploration: Extending the fourdimensional model of identity formation in late adolescence. Journal of Research in
Personality, 42, 58-82.
Luyckx, K., Schwartz, S. J., Goossens, L., Beyers, W., & Missotten, L. (2011). Processes of
personal identity formation and evaluation. In S. J. Schwartz, K. Luyckx, & V. L.
Vignoles (Eds.), Handbook of identity theory and research (pp. 77-98). New York:
Springer.
23
Marcia, J. E. (1966). Development and validation of ego-identity status. Journal of
Personality and Social Psychology, 3, 551-558.
Marcia, J. E. (1980). Identity in adolescence. In J. Adelson (Ed.), Handbook of adolescent
psychology (pp. 159-186). New York: Wiley.
Marcia, J. E. (1989). Identity diffusion differentiated. In M. A. Luszcz & T. Nettelbeck (Eds.),
Psychological development: Perspectives across the life-span (pp. 123-137). Dordrecht,
The Netherlands: Elsevier.
Marcia, J. E. (2002). Identity and psychosocial development in adulthood. Identity: An
International Journal of Theory and Research, 2, 7-28.
McAdams, D. P. (2011). Narrative identity. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles
(Eds.), Handbook of identity theory and research (pp. 99-116). New York: Springer.
Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence
of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent
Psychiatry and Mental Health, 6, 10.
Mullins-Sweat, S. N., Lengel, G. J., & Grant, D. M. (2013). Non-suicidal self-injury: The
contribution of general personality functioning. Personality and Mental Health, 7, 5668.
Nock, M. K., & Favazza, A. R. (2009). Non-suicidal self-injury: Origins, assessment, and
treatment. Washington, DC: American Psychological Association.
Nock, M. K., Joiner Jr., T. E., Gordon, K., Lloyd-Richardson, E., & Prinstein, M. J. (2006).
Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to
suicide attempts. Psychiatry Research, 144, 65-72.
Schwartz, S. J., Beyers, W., Luyckx, K., Soenens, B., Zamboanga, B. L., Forthun, L. F.,
Hardy, S. A., Vazsonyi, A. T., Ham, L. S., Kim, S. Y., Whitbourne, S. K., &
Waterman, A. S. (2011). Examining the light and dark sides of emerging adults’
24
identity: A study of identity status differences in positive and negative psychosocial
functioning. Journal of Youth and Adolescence, 40, 839-859.
Schwartz, S. J., Zamboanga, B. L., Weisskirch, R. S., & Rodriguez, L. (2009). The
relationships of personal and ethnic identity exploration to indices of adaptive and
maladaptive psychosocial functioning. International Journal of Behavioral
Development, 33, 131-144.
Selby, E. A., Anestis, M. D., Bender, T. W., & Joiner, T. E. (2009). An exploration of the
emotional cascade model in borderline personality disorder. Journal of Abnormal
Psychology, 118, 375-387.
Vansteenkiste, M., Claes, L., Soenens, B., & Verstuyf, J. (2013). Motivational dynamics
among eating-disordered patients with and without non-suicidal self-injury: A SelfDetermination Theory Approach. European Eating Disorders Review, 21, 209-214.
Waterman, A. S. (2007). Doing well: The relationship of identity status to three conceptions of
well-being. Identity: An International Journal of Theory and Research, 7, 289-307.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta
Psychiatrica Scandinavica, 67, 361-370.
25
Table 1
Identity Statuses Based on Five Identity Processes
Identity statuses
Commitment making
Achievement
Foreclosure
Moratorium
High
High
Low/
Carefree Diffusion
Troubled Diffusion
Undifferentiated
Low
Low
Moderate
Low
Low
Moderate
Low
Low/
Moderate
Moderate
Identification w commitment
High
High
Low/
Moderate
Exploration in breadth
High
Low
High
Moderate
Exploration in depth
High
Low
High
Low
Low/
Moderate
Moderate
Ruminative exploration
Low
Low
High
Low
High
Moderate
26
Table 2
Follow-up Univariate ANOVAs, Means, and F-Values for Gender
Total sample
Variable
F-value (η²)
Gender
Boys
Girls
Commitment making
3.39 (0.85)
3.39 (0.87)
3.38 (0.83)
0.01 (.00)
Identification w commitment
3.41 (0.75)
3.45 (0.73)
3.39 (0.77)
0.67 (.00)
Exploration in breadth
3.45 (0.75)
3.39 (0.80)
3.48 (0.72)
1.80 (.00)
Exploration in depth
3.15 (0.80)
3.06 (0.77)
3.21 (0.81)
5.12* (.01)
Ruminative exploration
2.60 (0.88)
2.53 (0.84)
2.64 (0.90)
1.92 (.00)
NSSI lifetime versatility
0.31 (0.88)
0.19 (0.73)
0.39 (0.95)
6.86** (.01)
Anxiety
7.63 (3.81)
6.44 (3.57)
8.35 (3.78)
34.56*** (.06)
Depression
4.23 (2.95)
4.38 (2.83)
4.13 (3.02)
0.93 (.00)
Note. Standard deviations in parentheses.
*p < .05. ** p < .01. *** p < .001.
27
Table 3
Pearson Correlations Among the Study Variables
Variables
1.Commitment making
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
.71***
.26***
.36***
-.41***
-.03
-.15***
-.05
-.01
-.07
-.03
.33***
.40***
-.43***
-.18***
-.29***
-.13**
-.06
-.14**
-.11*
.53***
.17***
.12**
-.08
-.01
-.01
-.01
.02
.09*
.11*
-.08
.04
.03
.02
.04
.40***
.32***
.20***
.13**
.15***
.19***
.47***
.31***
.19***
.24***
.31***
.33***
.17***
.31***
.34***
.81***
.51***
.82***
-.08
.62***
2.Identification w commitment
3.Exploration in breadth
4.Exploration in depth
5.Ruminative exploration
6.Anxiety
7.Depression
8.NSSI lifetime presence
9. NSSI past presence
10.NSSI current presence
11.NSSI lifetime versatility
.50***
--
Note. NSSI = Non-Suicidal Self-Injury.
*p < .05. **p < .01. ***p < .001.
28
Table 4
Hierarchical Logistic Regression Analysis with Lifetime Presence/Absence of NSSI as Dependent Variable and Age, Gender, Depression,
Anxiety, and Identity Processes as Independent Variables
S.E.
0.086
0.266
Wald
0.627
7.174**
Exp(B)
0.934
2.038
Χ²
9.288**
Nagelkerke R²
.028
Step 1
Age
Gender
B
-0.068
0.712
Step 2
Age
Gender
Anxiety
Depression
-0.044
0.591
0.124
0.201
0.0936
0.296
0.038
0.045
0.220
3.992*
10.875**
19.803***
0.957
1.806
1.132
1.222
74.105***
.214
-0.076
0.558
0.107
0.190
0.134
-0.133
-0.236
0.258
0.218
0.097
0.300
0.040
0.047
0.216
0.269
0.221
0.217
0.185
0.604
3.465
7.024**
16.221***
0.382
0.243
1.135
1.413
1.380
0.927
1.748
1.112
1.209
1.143
0.876
0.790
1.294
1.243
77.987***
.225
Step 3
Age
Gender
Anxiety
Depression
Commitment making
Identification w commitment
Exploration in breadth
Exploration in depth
Ruminative exploration
*p < .05. **p < .01. ***p < .001.
29
Table 5
Cross-Tabulations Between Six Identity Clusters and Presence/Absence of NSSI
Identity clusters
Achievement
Foreclosure
Moratorium
Carefree Diffusion
Troubled Diffusion
Undifferentiated
Total N
Lifetime NSSI
Absent
85 (1.0)
45 (0.3)
79 (-1.2)
73 (0.9)
55 (-1.1)
127 (0.1)
464
Expected count
76.2
42.7
90.4
65.3
63.6
125.5
Present
6 (-0.8)
23 (-0.3)
90
6 (-2.3)
29 (2.7)
5 (-2.2)
21 (2.4)
Expected count
8.3
24.5
14.8
17.6
12.7
12.4
Past NSSI
Absent
87 (0.7)
45 (0.0)
86 (-1.0)
74 (0.6)
66 (-0.2)
133 (0.0)
491
Expected count
80.7
45.2
95.7
69.1
67.4
132.9
Present
6 (0.1)
4 (-1.6)
10 (0.5)
17 (0.0)
63
4 (-2.0)
22 (2.8)
Expected count
5.8
8.9
8.6
17.1
10.3
12.3
Current NSSI
Absent
89 (0.3)
51 (0.4)
101 (-0.2)
77 (0.3)
65 (-0.9)
144 (0.1)
527
Expected count
86.6
48.5
102.7
74.2
72.3
142.7
Present
2 (-1.2)
0 (-1.6)
7 (0.8)
1 (-1.4)
6 (-0.5)
27
11 (3.8)
Expected count
4.4
2.5
5.3
3.8
7.3
3.7
Total N
91
51
108
78
76
150
554
Note. Standardized residuals between parentheses. NSSI = Non-Suicidal Self-Injury. Cells in bold have in standardized residuals equalling or
exceeding |2.0|.
30
Table 6
Follow-up Univariate ANOVA’s and Post-hoc Cluster Comparisons Based upon Tukey HSD Tests for the Six Identity Clusters
Variables
Clusters
Achievement
Foreclosure
Moratorium
NSSI lifetime versatility
a
0.09 (0.32)
0.22 (0.73)
b
Anxiety
7.19 (3.49)ab
Depression
3.02 (2.53)a
F-value
η²
Carefree
Troubled
Undiffe-
0.57 (1.23)
Diffusion
0.10 (0.41)a
Diffusion
0.61 (1.24)b
rentiated
0.25 (0.70)
6.29***
.05
6.22 (2.96)a
8.80 (3.74)bc
6.55 (3.58)a
9.38 (4.42)c
7.16 (3.57)a
9.25***
.08
3.12 (1.80)a
4.77 (3.03)bc
4.54 (3.01)bc
5.64 (3.55)c
4.02 (2.64)ab
9.78***
.08
Note. Standard deviations in parentheses. Cluster means differ significantly from one another if they have different superscripts; cluster means
without superscripts do not differ from other cluster means for the respective variable.
*p < .05. **p < .01. ***p < .001.
31
Figure 1
Final six cluster-solution for the identity variables. Z-scores for commitment making (CM),
identification with commitment (IC), exploration in breadth (EB), exploration in depth (ED),
and ruminative exploration (RE).
32
Achievement
Troubled
diffusion
1.5
Foreclosure
1
0.5
0
Moratorium
Carefree
diffusion
Undifferentiated
CM
IC
EB
ED
-0.5
RE
-1
-1.5
-2
33