TPC Journal Volume 11 Issue 2

The Professional Counselor | Volume 11, Issue 2 219 both intrapersonal and interpersonal factors relate to ambivalent SIB given that both are relevant to suicidal and nonsuicidal SIB. Furthermore, individuals who engage in SIB often report multiple intents behind their past SIB (Andover et al., 2012; Klonsky & Olino, 2008). Because of these similarities and the clinical significance of each, we examined intrapersonal (i.e., psychological distress) and interpersonal (i.e., social functioning) predictors of SIB in the current study. Predicting SIB With Psychosocial Functioning The relations between psychological distress and SIB are well established in the literature. Researchers have found positive associations between SIB and depression (Andover et al., 2005; Kirkcaldy et al., 2007), anxiety (Andover et al., 2005; Klonsky & Olino, 2008), obsessive-compulsion (Kirkcaldy et al., 2007), and interpersonal sensitivity (Kim et al., 2015; Kirkcaldy et al., 2007). These studies and others examined specific experiences of psychological distress as it relates to SIB in adults and adolescents and in community and inpatient samples. Previous studies have also demonstrated relations between social functioning and SIB. For instance, SIB is associated with less social support from family and friends (Rotolone & Martin, 2012; Tuisku et al., 2014). Similarly, SIB is related to more negative interactions or negative relational dynamics with family (Halstead et al., 2014; Van Orden et al., 2010) and friends (Adrian et al., 2011). Predicting SIB in Different Populations Some individuals may be at greater risk for developing SIB. In particular, SIB is especially prevalent in individuals with borderline personality disorder (BPD). According to the American Psychiatric Association (2013), BPD is characterized by “marked impulsivity” along with “a pervasive pattern of instability of interpersonal relationships, self-image, and affects” (p. 663). Notably, one diagnostic criterion of BPD is “recurrent suicidal behavior, gestures, threats, or self-mutilating behavior” (p. 663). Additionally, some risk factors for developing BPD (e.g., high emotion dysregulation, trauma exposure, etc.; Crowell et al., 2009) are also risk factors for engaging in SIB (Nock, 2009, 2010). Although lifetime rates of SIB in individuals with BPD vary, one study found that 92.2% of individuals who sought outpatient treatment for symptoms of BPD had engaged in nonsuicidal SIB within the past 2 months (Andión et al., 2012). Additionally, up to 75% of individuals with BPD reported at least one instance of suicidal SIB (Black et al., 2004). Furthermore, there appear to be differences in SIB engagement when comparing individuals with BPD to a community sample. For example, adults with BPD reported engaging in nonsuicidal SIB more recently and frequently, using more varied methods, and causing more physically severe injuries that require medical attention, compared to individuals without BPD who engaged in nonsuicidal SIB (Turner et al., 2015). Although the rates and severity of SIB are higher in individuals with BPD than in the general population (Bentley et al., 2015), SIB is considered relatively common in other populations, including nonsuicidal SIB among college students (e.g., Whitlock et al., 2006, 2013). College students are thought to engage in SIB more than the general population (as suggested by Wilcox et al., 2012) with approximately 17%–41% of college students participating in nonsuicidal SIB (Whitlock et al., 2006) compared to 5.9% of adults in the general population (Klonsky, 2011). Most college students are also in the highest risk age group for nonsuicidal SIB (Rodham & Hawton, 2009), and suicide is the second leading cause of death during this period (18–25 years old; Centers for Disease Control and Prevention, 2017). Notably, college students and non–college students of the same age (i.e., 16–24 years old) do not appear to differ in rates of SIB (McManus & Gunnell, 2020).