Antecedents and Consequences of Self-harm

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543Suicide and Life-Threatening Behavior 37(5) October 2007© 2007 The American Association of Suicidology

Emotional Antecedents and Consequences of Deliberate Self-Harm and Suicide Attempts

Alexander L. Chapman, PhD, and Katherine L. Dixon-Gordon, BS

Emotional experiences immediately prior to (emotional antecedents) andfollowing (emotional consequences) deliberate self-harm and suicide attempts infemale inmates ( N = 63) were examined. Anger was the antecedent emotion re-ported by the largest proportion of individuals who had engaged in deliberateself-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts(30%). Relief and other positive emotional shifts were more common in deliberateself-harm (41.94%) (involving no intent to die) than in suicide attempts or ambiv-alent suicide attempts, particularly for persons with borderline personality disor-der. These findings underscore the utility of discriminating between deliberateself-harm and suicidal behavior and highlight the potential role of anger in trig-gering such behaviors.

Behaviors that involve direct and intentional & Johnstone, 1999; Joiner et al., 2005; see alsoBoardman, Grimbaldeston, Handley, Jones,self-harm, often called parasuicidal behaviors,

have received increased attention from re- & Willmott, 1999; Brown, Beck, Steer, &Grisham, 2000; Esposito, Spirito, Boergers,searchers in recent years (Brown, Comtois, &

Linehan, 2002; Chapman, Specht, & Cel- & Donaldson, 2003).Unfortunately, there has been suchlucci, 2005a, 2005b; Favazza, 1998; Gratz,

Conrad, & Roemer, 2002; Nock & Prinstein, ambiguity in the definitions of these behav-iors that it is unclear how to interpret some2004) and represent serious and potentially

life-threatening clinical problems. Indeed, of the research findings (Linehan, 2000).Linehan has suggested that the presence orseveral studies have indicated that repeated,

deliberate self-harm is perhaps the most ro- absence of the intent to die during self-harmis a critical yet often neglected factor that canbust and potent predictor of suicide attempts

(van Egmond & Diekstra, 1989) and com- be reliably assessed in research. For the pur-poses of the present paper, we define deliber-pleted suicide (Gunnell & Frankel, 1994),

even after controlling for important covari- ate self-harm (DSH) as the deliberate, direct destruction or alteration of body tissue with-ates such as presence and severity of mental

disorder, gender, and age (Cavanagh, Owens, out conscious suicidal intent (Chapman,Gratz, & Brown, 2006; Gratz, 2003; Klonsky,Oltmanns, & Turkheimer, 2003). In contrast

with DSH, suicide attempts (SA) involve con- Alexander Chapman and Katherinescious intent to die, and ambivalent suicide at-Dixon-Gordon are with the Department of Psy-tempts (ASA) involve ambivalence regardingchology at Simon Fraser University in Burnaby,

BC, Canada. the intent to die. Address correspondence to Alexander L. Accumulating evidence suggests that

Chapman, Department of Psychology (RCB DSH differs from SA in clinically important 5246), Simon Fraser University, 8888 University

ways (Brown et al., 2002; Chapman et al.,Drive, Burnaby, BC, Canada V5A 1S6; E-mail:2006; Gratz, 2003). For instance, Brown et [email protected]



544 Emotions, Deliberate Self-Harm, and Suicide Attempts

al. examined the reasons endorsed by 75 also have highlighted the potentially impor-tant role of emotions. For instance, Brown women diagnosed with borderline personal-

ity disorder (BPD) for engaging in recent et al.’s (2002) study on woman with BPD in-

dicated support for the notion that emotionalacts of DSH or SA. Emotional relief was themost common reason given for both SA and relief is a key motivation for both DSH andSA and suggested a potentially stronger roleDSH; however, reasons for SA were more

likely to involve “making others better off” for anger in DSH versus SA. Individuals whoengage in DSH typically report that the be-(reducing burden on others), while reasons

for DSH more often included “feeling gener- havior quickly relieves unendurable anxiety/ tension (Kemperman, Russ, & Shearin, 1997;ation,” “anger expression,” and “distraction.”

Another study of the reasons for engaging in Michel, Valach, & Waeber, 1994; Simeon et al., 1992; Wilkins & Coid, 1991). Otherparasuicidal behavior found that the reason

“wish to die” loaded negatively on a factor studies have found that some individuals re-port that DSH temporarily reduces anger,consisting of reasons that involve temporary

escape from emotions, suggesting that the anxiety, sadness, depression, and shame (Kem-perman et al., 1997).motivation to escape is more closely aligned

with behavior involving lower intent to die Further research is needed to examine whether particular emotional experiences may (Hjelmeland et al., 2002). In addition, al-

though DSH confers a heightened risk for trigger or reinforce DSH or SA. It also wouldbe clinically useful to know whether emo-SA and eventual suicide completion, not ev-

eryone who engages in DSH is suicidal or tional triggers and consequences differ basedon the type of behavior (DSH, ASA, SA) in-has attempted suicide (Kessler, Borges, &

Walters, 1999; Velamoor & Cernovsky, 1992). volved. For example, if anger were morelikely to precede DSH than SA, then clinicalFurther studies are needed to clarify

the distinction between SA and DSH. One interventions targeting DSH would morestrongly emphasize strategies to reduce orimportant distinguishing factor may be the

emotional experiences surrounding these be- regulate anger. A couple of studies havefound that imagery associated with episodeshaviors. Several theories have emphasized the

role of emotional experiences in either trig- of DSH led to reductions in physiological

measures of emotional arousal in male pris-gering or reinforcing DSH or SA. For in-stance, the experiential avoidance model oners (Haines, Williams, Brain, & Wilson,

1995) and in parasuicidal women with BPD(EAM; Chapman et al., 2006) poses that DSH is maintained through negative rein- (Shaw-Welch, Kuo, Sylvers, Chittams, & Line-

han, 2003); however, these studies did not ex-forcement in the form of reduction or escapefrom unwanted emotional arousal. Baumeis- amine differences between DSH and SA.

The primary purpose of the present ter’s (1990) escape model of suicidal behaviorsuggests that suicidal behavior often occurs study was to examine differences in the emo-

tional antecedents and consequences of in response to aversive, self-focused emo-tional states that lead to a breakdown in cog- DSH, ASA, and SA among female inmates, a

population for which these behaviors arenition and problem solving. In addition, Joiner’s (2002) theory of suicidal behavior quite prevalent and clinically important (see

Chapman et al., 2005a, 2005b; Dolan &posits that repeated experience with DSH re-

duces the aversive aspects of the behavior Mitchell, 1994; Wilkins & Coid, 1991). Wehypothesized that participants would be(shame, unwanted scars), while simultane-

ously heightening the reinforcing aspects, in- more likely to report negative (e.g., anger,guilt) rather than positive or neutral anteced-cluding reductions in unwanted or intolera-

ble emotions. ent emotions, and positive or neutral emo-tional consequences rather than negative emo-Studies of reasons people provide for

engaging in self-harm and suicidal behavior tional consequences [(e.g., relief, calmness,



Chapman and Dixon-Gordon 545

indifference)]. We also explored differences in (74.6%), Native American (11.1%), Hispanic(9.5%), and African American (1.6%); 3.2%emotional antecedents and consequences

among DSH, ASA, and SA. Our study fo- marked “other” or did not indicate.

cused on female inmates but also examinedthe influence of borderline personality disor- Procedureder on the findings, a disorder that is quiteprevalent among female inmates (Chapman et All participants were given a descrip-

tion of the project and signed a written in-al., 2005a, 2005b; Coid, 1992; Dolan & Mitchell, 1994). According to Linehan’s (1993) formed consent form that specified that par-

ticipation (or refusal to participate) in thisbiosocial theory, BPD involves marked defi-cits in the skills necessary to regulate emo- study would in no way influence their treat-

ment or privileges in prison. Participantstions; consequently, persons with BPD useimpulsive, self-destructive strategies to es- completed various assessment measures over

the course of two sessions (separated by acape unwanted emotions. We examined thehypothesis that, among persons with BPD mean of 4.74 days): Session 1 involved com-

pleting self-report questionnaires; Session 2(compared with non-BPD participants),

DSH and SA (particularly DSH) would be involved individual interviews administeredby a doctoral student in clinical psychology more strongly associated with emotional

consequences involving relief or escape from or a licensed psychologist. All interviewers were trained in the SCID-II by the first au-distressing emotions.thor, who had conducted or rated over 100SCID-II interviews. Interview ratings were

METHODdiscussed during lab meetings to ensure that the basis for ratings was consistent across in- Participants terviewers. Questionable ratings were scoredbased on team consensus. This study received IRB approval prior

to data collection. One hundred and seven- Borderline Personality Disorder Assess-ment. The SCID-II (First et al., 1997) wasteen female inmates ( M age = 33.90, SD = 8.52)

from a multilevel women’s prison volun- used for diagnostic evaluation of BPD. The

SCID-II has demonstrated good psychomet-teered to participate after receiving a brief description of the study. Exclusionary criteria ric properties in several studies (Farmer &

Chapman, 2002; First et al., 1995; Maffei et included a current manic or psychotic epi-sode or serious reading difficulties that pre- al., 1997). The SCID-II-Personality Ques-

tionnaire (SCID-II-PQ) was administered ascluded completing questionnaires. Two par-ticipants were excluded, one because of reading a screening measure; interviewers queried

only those items rated “true” on the SCID-difficulties and the other due to frank confu-sion. Ten participants completed question- II-PQ. Given the prevalence of substance use

among female prisoners, ratings were madenaires but were transferred to another facility before completing the interviews. Of the re- based on instances when the inmate was not

actively using substances.maining 105 individuals, 63 (60%) reporteda history of DSH, ASA, or SA and were in- Lifetime Parasuicide Count-2. The Life-

time Parasuicide Count-2 (LPC-2; Linehancluded in the analyses for this study. Of these

63 individuals, 32 (50.79%) were diagnosed & Comtois, 1996) is a structured interview designed to assess lifetime frequency of with borderline personality disorder, using

the Structured Clinical Interview for DSM- DSH, ASA, and SA. Questions inquire about the frequency of various methods of DSH, IV personality disorders (SCID-II; First,

Gibbon, Spitzer, Williams, & Benjamin, SA, and ASA (e.g., cutting, burning, overdos-ing). An act of DSH was defined as a single1997). The ethnic composition of these indi-

viduals ( M age = 30.30, SD = 8.57) was: White instance of direct, intentional self-harm with




TABLE 1no intent to die; ASA acts involved ambiva-lence regarding the intent to die; and SA in- Emotional Antecedents to Deliberate Self-Harm,

Ambivalent Self-Harm, and Suicide Attempts volved clear intent to die. The LPC-2 in-

quired about participants’ very first, most Emotion DSH ASA SA χ2recent, and most severe instances of self-harm behaviors. Given the potential memory Anger 45.16% 30% 40.90% 0.74biases associated with recalling distal acts of Anxiety 16.13% 0% 0% 7.54*DSH, ASA, or SA, we focused on partici- Tension 9.68% 10.00% 0.00% 3.58pants’ most recent act (following Brown et Guilt 6.45% 30.00% 18.00% 3.76

Sadness 9.68% 30.00% 18.00% 2.34al., 2002). Participants were asked to identify Boredom 12.90% 0.00% 0.00% 5.95*the most prominent emotion before and afterIndifference 0.00% 0.00% 13.60% 6.60*the most recent act of DSH, ASA, or SA Relief 0.00% 0.00% 4.54% 2.13from a standard list of nine emotions: anger,Calmness 0.00% 0.00% 4.54% 2.13sadness, anxiety, guilt, tension, boredom, in-

difference, relief, and calmness. Note. DSH = deliberate self-harm; ASA =ambivalent suicide attempt; SA = suicide attempt.

* p < .05RESULTS

Characteristics of Recent Acts of DSH, (n = 31), the largest percentage of individualsreported that they felt angry immediately ASA, and SAprior to engaging in that behavior. Overall,all participants reported a negative emotion The most recent act of DSH, ASA, or

SA occurred a median of 3.0 years ago, with prior to DSH; no participant reported feelingindifferent, relieved, or calm. Similarly, all of almost 30% of participants (28.6%) report-

ing one of these behaviors in the past year. the ASA participants reported a negativeemotion preceding ASA, with the most com-In terms of DSH, the most common form

was cutting (38.7%), followed by banging mon negative emotions consisting of anger,guilt, and sadness. In terms of participantshead or hitting self (22.6%), intentionally

overdosing on drugs (12.90%), burning who reported a SA (n = 22), the largest pro-portion reported that they felt angry prior to(12.90%), and other (12.90%). The most

common forms of ASA included intentionally the SA; nobody reported that boredom oranxiety preceded SA. Unlike ASA and DSH,overdosing on drugs (60%), cutting (30%),

and attempting to strangle or hang oneself some SA participants reported relief, indif-ference, and calmness prior to engaging in SA.(10%). In contrast, the most common form

of SA was intentionally overdosing on drugs Differences in Antecedents Across DSH, ASA, and SA. Compared with persons who(54.50%), followed by cutting (18.20%), other

(13.60%), jumping from a high place reported ASA (0%) and SA (0%), a signifi-cantly larger proportion of persons who re-(4.50%), self-shooting (4.50%), and self-

asphyxiating (4.50%). Across DSH, ASA, and ported DSH reported that they felt boredomprior to engaging in DSH (12.90%), χ2 likeli-SA, the “other” category largely consisted of

punching objects, self-starvation, and getting hood ratio = 5.95, p < .05. In addition, a larger

number of SA participants reported indiffer-into a car wreck.ence (13.60%), compared with DSH (0%)and ASA (0%) participants, χ2 likelihood ra- Emotional Antecedents tio = 6.60, p < .05 (see Table 1). When wecollapsed analyses across all negative emo- Table 1 displays the percentages of in-

dividuals who reported each emotion preced- tions, significant differences emerged in theproportions of DSH (100%), ASA (100%),ing recent acts of DSH, ASA, and SA. Across

all participants who had engaged in DSH and SA (77.27%) individuals who reported




negative antecedent emotions, χ2 likelihood reported that they felt guilty immediately following ASA. No participant reportedratio = 11.35, p < .01.1

boredom, indifference, or anxiety following

ASA. Finally, in terms of SA participants (n = Emotional Consequences 22), the largest proportion reported that they felt angry following SA, and nobody reported Table 2 displays the percentages of in-

dividuals who reported each emotion follow- boredom or tension following SA.ing recent acts of DSH, ASA, and SA. Acrossall participants who had engaged in DSH Differences in Consequences across DSH,

ASA, and SA(n = 31), the largest proportion of individualsreported that they felt relieved immediately following DSH. No participant reported Compared with persons who reported

ASA (10%) or DSH (6.45%), a significantly boredom following DSH. In terms of ASA participants (n = 10), the largest proportion larger proportion of persons who reported

SA also reported anger as an emotional con-sequence (31.8%), χ2 likelihood ratio = 6.28,

TABLE 2 p < .05. In addition, there was a trend for Emotional Consequences of Deliberate guilt to be a more common consequence to

Self-Harm, Ambivalent Self-Harm, ASA (40%), compared with DSH (9.68%),and Suicide Attempts and SA (27%), and also for calmness to be

most common following DSH (16.13%) (seeEmotion DSH ASA SA χ

2

Table 2). When analyses collapsed across allnegative emotions, significant differences Anger 6.45% 10.00% 31.8% 6.28*emerged in the proportions of DSH Anxiety 9.68% 0.00% 4.54% 1.95

Tension 6.45% 10.00% 0.00% 2.79 (45.16%), ASA (70%), and SA (77.27%) indi-Guilt 9.68% 40.00% 27.00% 5.19a

viduals who reported negative consequent Sadness 12.90% 10.00% 13.60% .09 emotions, χ2 likelihood ratio = 6.15, p < .05.Boredom 0.00% 0.00% 0.00% N/A When collapsed across all positive emotions,Indifference 9.68% 0.00% 9.00% 2.38 it appeared that positive emotional conse-

Relief 25.80% 20.00% 13.63% 1.21 quences were more likely among DSH indi-Calmness 16.13% 10.00% 0.00% 5.73 a

viduals (41.94%) than ASA (30%) and SA (13.63%), but this effect was a trend, χ2 like- Note. DSH = deliberate self-harm; ASA =

ambivalent suicide attempt; SA = suicide attempt. lihood ratio = 5.23, p = .07.a p < .10; * p < .05

Emotional Shifts from Antecedents to Consequences

1. For these analyses, we used the standardα cutoff of .05 and did not implement a correction

Although examining particular typesfor cumulative Type-I error. The analyses wereand valences of emotional consequences may largely exploratory, and correcting for Type-I er-

ror would have resulted in an unacceptable bal- suggest reinforcing effects of DSH, ASA, orance between Type I and Type II errors. For in- SA, data that show shifts from negative ante-stance, Cohen and colleagues (Cohen, Cohen, cedent emotions to neutral or positive emo-

West, & Aiken, 2003, p. 183) have suggested that tions would be more convincing. Thus, weone of the key tasks in statistical inference is main-examined the association of DSH, ASA, andtaining a low rate of Type I errors without a sub-

stantially elevated risk of Type II errors. Because SA with changes in participants’ reports of this research is exploratory, and the sample sizes emotions prior to (antecedents) and follow-

were relatively small for some groups (particu- ing (consequences) the behavior by comput-larly, the ASA group, n = 10), we concluded that

ing a change score (CS) in the followingapplying blanket corrections for Type I errormanner: We coded the antecedent and con- would have resulted in an unacceptably large like-

lihood of Type II errors. sequence emotions 1 ( present ) versus 0 (ab-




sent ). If the change from antecedent to conse- dividuals in the non-BPD group (n = 31),finding a nonsignificant result. Subsequently,quence was from the presence of a negative

emotion to its absence, or from the absence we repeated this analysis with individuals in

the BPD group. Among persons with BPD,of a positive emotion to its presence, CS = 1.If the change was from the absence of a nega- those in the DSH group (68.75%) were morelikely to report a positive emotional shift,tive emotion to its presence, or from the

presence of a positive emotion to its absence, compared with the ASA (0%) and SA (15.38%)groups ( p < .01). Thus, it appeared that thereCS = −1. If a participant had a change in the

type of emotion, but not in the valence of the was an interaction of BPD with behavior type(DSH, ASA, SA), such that the higher likeli-emotion, CS = .5. Alternatively, if a partici-

pant had no change in the valence of emotion hood of a positive emotional shift with DSHonly occurred among participants with BPD.reported prior to and following the behavior,

the CS = 0. We examined the association of intent

with change, using a 4 (CS levels −1, 0.50, 0, DISCUSSION

and 1) × 3 (DSH, ASA, SA) chi-square analy-

sis, χ2

(6) = 18.33, p < .01. Among the SA The primary purpose of this study wasto examine the emotional antecedents andgroup, 18.18% reported a negative emotional

shift following SA, compared with 0% for consequences of deliberate self-harm and sui-cide attempts. Overall, participants reportedboth the DSH and the ASA group. Fifty-five

percent of the DSH group received a positive negative antecedent emotions, and relative toother emotions, anger was a common ante-CS, compared with only 30% of the ASA

group and 22.72% of the SA group. To ex- cedent to DSH, ASA, and SA. Future re-search might examine whether particularamine whether those with more experience

with DSH were more likely to experience a types of anger precede DSH. For instance,some theorists pose that anger directed in-positive emotional shift, we examined the

correlation between the total lifetime fre- ward, involving self-blame and self-loathingfor perceived social transgressions, may pre-quency of DSH and the CS (where lower val-

ues = more negative shifts), and found that cede DSH (Krasser, Rossmann, & Zapotoc-

zky, 2003; van Elderen, Verkes, Arkesteijn, &higher lifetime frequency of DSH was associ-ated with more a more positive emotional Komproe, 1996). In this case, the individual

engages in DSH as a form of self-punish-shift, Spearman’s ρ = .28, p = .026. In con-trast, lifetime frequency of ASA (Spearman’s ment, which relieves anger and self-loathing.

In other cases, individuals who cannot regu-ρ = .085, ns ) and SA (Spearman’s ρ = −.16, ns ) were not significantly associated with CS. late or effectively express their anger or navi-

gate their social environment in a way that reduces anger cues may resort to DSH to Emotional Shifts from Antecedents

to Consequences: The Effects achieve relief. Ultimately, future treatment development might involve strategies to helpof Borderline Personality Disorder female inmates who engage in DSH or SA tocope with or regulate anger.Using the CS described above, we also

examined whether the association of the type The finding that boredom was a more

common antecedent to DSH than to ASA orof behavior (DSH vs. ASA vs. SA) with changedepended on the presence of BPD. It is pos- SA provided some support for the notion

that DSH sometimes involves an attempt tosible that persons with BPD are more likely to use DSH as an emotion regulation or ex- alleviate boredom and emotional numbness.

Indeed, nobody reported boredom followingperiential avoidance strategy, compared withpersons who do not have BPD. First, we con- DSH. Some theorists have suggested that in-

dividuals who engage in DSH experience in-ducted a 4 (CS levels −1, 0.50, 0, 1) × 3(DSH, ASA, SA) Fisher’s Exact Test with increased activity in the opiate system in re-




sponse to stress (see Saxe, Chowla, & van der BPD (Linehan, 1993), a majority of BPD in-dividuals reported a positive emotional shift Kolk, 2002), which leads to an uncomfortable

state of dissociation and numbness. The following DSH (68.75%), but not following

SA or ASA. In addition, DSH was not associ-physical stimulation involved with DSH in-terferes with dissociation and awakens the in- ated with positive emotional shifts (compared with ASA or SA) among non-BPD individu-dividual from the dissociative state (Simpson,

1975). Boredom may have some similarities als. Joiner’s (2002) theory suggests that per-sons who engage in DSH more frequently with dissociation or numbness, but studies

have not yet explored this possibility, and the are more likely to experience heightened re-inforcing consequences; thus, it was possibledata on the role of opiates in DSH have been

inconclusive (Russ, 1992). that this link between BPD and positiveemotional shifts following DSH was relatedRelief was the most common conse-

quence to DSH, whereas guilt and anger to the fact that individuals with BPD simply have had more experience engaging in this were the most common consequences to ASA

and SA, respectively. Guilt was most com- behavior. Indeed, another study based on thissample found a positive association of BPDmon in ASA, and anger was most common in

SA. Over 45% of individuals who engaged in with number of lifetime acts of DSH (Chap-man et al., 2005a). Further research might DSH reported anger prior to the behavior,

but only 6.45% reported anger following explore whether the association of BPD withrelief/positive emotional shifts followingDSH, suggesting that anger may play a role

in triggering DSH; the reduction of anger or DSH is attributable to frequency of engage-ment in DSH.2stimuli that elicit anger may be involved in

reinforcing DSH. In contrast, anger was a Several limitations are relevant to thisstudy. First, past acts of DSH were based oncommon antecedent and consequence of SA.

If the SA occurred with unambiguous intent self-report; thus, there is no way to verify theoccurrence of DSH, or the occurrence of to die, participants may have felt angry about

failing in their suicide attempts. In contrast, specific emotional experiences that precededor followed DSH. The median number of DSH may be more of an attempt to regulate

emotions, with anger persisting only when years since the most recent act of DSH, ASA,

or SA was 3 years. Although the self-reportsthis attempt is unsuccessful. The findings regarding shifts in emo- may be biased or inaccurate, the way in

which participants recall these behaviors istional experiences further suggest that DSH,unlike SA and ASA, is more likely to serve an potentially quite significant. For instance, if

an individual recalls that an act of DSH oc-emotion regulatory function. Compared with ASA and SA, a larger proportion of individu- curred in the presence of anger and was fol-

lowed by relief, he or she may be likely toals who engaged in DSH reported a shift toward a more neutral or positive emotion. engage in DSH again in the future (i.e., to

regulate anger), even if the details recalledHowever it is also noteworthy that a signifi-cantly greater proportion of persons engaged were somewhat inaccurate. Indeed, our data

indicated that greater reported positive emo-in DSH. In addition, a higher frequency of DSH (but not ASA or SA) predicted a more tional shifts were associated with greater fre-

quency of DSH.positive emotional shift. These data support

the experiential avoidance model (EAM; Second, the word prompts for partici-pants’ emotion ratings were not exhaustive;Chapman et al., 2006) of DSH, tentatively

suggesting that shifts away from negative thus, we may have excluded some important emotions and toward neutral or positiveemotions may play a role in maintaining

2. For the present study, these data wereDSH (however, the presence of BPD moder- available, but the sample sizes would have beenated this effect). too small to permit a methodologically sound in-

vestigation of this hypothesis.Consistent with the biosocial theory of




emotional antecedents or consequences from gests that suicidal behavior differs in impor-tant ways from DSH. It is also noteworthy the list. Third, a rating of relief or indiffer-

ence does not preclude the presence of a dis- that a significant proportion of individuals re-

ported that their predominant emotional ex-tressing emotion, given that we asked partici-pants to report the most predominant emotional perience following DSH was negative, most notably including sadness. Further researchexperience preceding and following DSH,

rather than all of the emotions they experi- might examine differences between individu-als who experience negative emotional se-enced. Fourth, it is not clear to what extent

the intensity of distressing emotions declined quelae following DSH and those persons who are more likely to experience relief or(if at all) following DSH; however, it was

noteworthy that only a small proportion of positive emotions. Our findings suggest that persons with BPD are more likely to fallindividuals reported a negative emotion as

their predominant emotion following DSH. within the latter group. Further research alsois needed to examine the association of angerFifth, the analyses relied on a relatively small

sample size, particularly for the ASA group with SA and DSH. The present study represents an inno-(n = 10), which may have limited the power

or external validity of the study. Finally, it is vation in methodology (gathering informa-tion on emotions surrounding self-destruc-important to note that the emotions a person

has prior to (or after) engaging in a behavior tive behaviors) to be built upon in futureresearch. Although studies examining re-do not necessarily correspond to specific mo-

tives (or reasons) for engaging in the behav- ported reasons for engaging in DSH or SA clearly yield valuable data (e.g., Brown et al.,ior. Also, emotional states may be the result

of deciding to engage in a behavior, rather 2002), the reasons or expectations an individ-ual has about DSH or SA may or may not than the cause. Therefore, we cannot infer

whether the motivations for engaging in the correspond with the actual emotional trig-gers and sequelae of these behaviors. Futurebehavior differ between DSH and SA.

Notwithstanding, findings from this studies might employ ambulatory monitoringmethods to examine the real-time associa-study have important ramifications for the

conceptualization of DSH and SA in female tions of emotional experiences with urges to

engage in DSH and SA. We hope that thisinmates generally, and in BPD female in-mates specifically. Perhaps most importantly, study will contribute to research that ulti-

mately leads to refinements in the conceptu-the findings further underscore the impor-tance of distinguishing between DSH and alization and treatment of self-destructive be-

haviors.SA. Based on this and other studies (e.g.,Brown et al., 2002), emerging evidence sug-

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