Skip to main content

Advertisement

SpringerLink
Log in

The Difficulties in Emotion Regulation Scale: Factor Structure and Association with Nonsuicidal Self-Injury in Adolescent Inpatients

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

Research suggests that difficulties in emotion regulation are an important correlate of nonsuicidal self-injury (NSSI) in adults. Research examining this link in adolescents is limited by the lack of comprehensive instruments to assess difficulties in emotion regulation. Against this background, the aims of the current study were to (a) confirm the six-factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263, 2004) in a sample of adolescent inpatients (N = 218); (b) explore the relation between different aspects of emotion dysregulation and lifetime NSSI while controlling for psychopathology and sex; and (c) assess the clinical utility of the DERS in detecting lifetime NSSI status. Fit indices obtained through Confirmatory Factor Analysis indicated that the six-factor structure of the DERS fit the data adequately and that most items loaded strongly on their respective latent factor. All six latent factors were significantly correlated with each other, with the exception of lack of emotional awareness and difficulties engaging in goal-directed behavioral when distressed. Regression analyses revealed that only the limited access to emotion regulation strategies subscale accounted for a significant portion of the variance in NSSI when controlling for other aspects of emotion dysregulation, sex, and psychopathology. Receiver Operating Characteristic analysis indicated that the DERS limited access to emotion regulation strategies subscale score has moderate diagnostic accuracy in detecting the presence of NSSI. The optimal cut-off score was 21.5 when detecting NSSI among inpatient adolescents. Results provide further support for the relation between emotion regulation difficulties and NSSI. The DERS appears to be a useful measure of detecting NSSI in clinical samples of adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2010). Emotion dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology. doi:10.1007/s10802-010-9465-3.

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park: Sage.

    Google Scholar 

  • Andover, M. S., Pepper, C. M., Ryabchenko, K. A., Orrico, E. G., & Gibb, B. E. (2005). Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder. Suicide & Life-Threatening Behavior, 35(5), 581–591. doi:10.1521/suli.2005.35.5.581.

    Article  Google Scholar 

  • Brain, K. L., Haines, J., & Williams, C. L. (1998). The psychophysiology of self-mutilation: evidence of tension reduction. Archives of Suicide Research, 4(3), 227–242. doi:10.1023/A:1009692507987.

    Google Scholar 

  • Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39(3), 233–242. doi:10.1007/s10964-009-9482-0.

    Article  PubMed  Google Scholar 

  • Bresin, K., & Gordon, K. H. (2011). Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personality Disorders: Theory, Research, and Treatment. doi:10.1037/a0025736.

  • Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: Guilford Press.

    Google Scholar 

  • Brown, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills: Sage.

    Google Scholar 

  • Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–202. doi:10.1037/0021-843X.111.1.198.

    Article  PubMed  Google Scholar 

  • Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behaviour Research and Therapy, 44, 371–394. doi:10.1016/j.brat.2005.03.005.

    Article  PubMed  Google Scholar 

  • DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 735–739. doi:10.1016/S0890-8567(10)80007-3.

    PubMed  Google Scholar 

  • Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491. doi:10.1037/1082-989X.9.4.466.

    Article  PubMed  Google Scholar 

  • Fombonne, E. (1991). The use of questionnaires in child psychiatry research: measuring their performance and choosing an optimal cut-off. Journal of Child Psychology and Psychiatry, 32(4), 677–693. doi:10.1111/j.1469-7610.1991.tb00343.x.

    Article  PubMed  Google Scholar 

  • Franklin, J. C., Hessel, E. T., Aaron, R. V., Arthur, M. S., Heilbron, N., & Prinstein, M. J. (2010). The functions of nonsuicidal self-injury: support for cognitive–affective regulation and opponent processes from a novel psychophysiological paradigm. Journal of Abnormal Psychology. doi:10.1037/a0020896.

  • Gratz, K. (2001). Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. doi:10.1023/A:1012779403943.

    Article  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. doi:10.1023/b:joba.0000007455.08539.94.

    Article  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37(1), 14–25. doi:10.1080/16506070701819524.

    Article  PubMed  Google Scholar 

  • Gratz, K. L., & Tull, M. T. (2010). The relationship between emotion dysregulation and deliberate self-harm among inpatients with substance use disorders. Cognitive Therapy and Research, 34(6), 544–553. doi:10.1007/s10608-009-9268-4.

    Article  PubMed  Google Scholar 

  • Haines, J., Williams, C. L., Brain, K. L., & Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104, 471–489. doi:10.1037/0021-843X.104.3.471.

    Article  PubMed  Google Scholar 

  • Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143, 29–36. http://radiology.rsna.org/.

  • Hawton, K., & Harriss, L. (2008). The changing gender ratio in occurrence of deliberate self-harm across the lifecycle. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(1), 4–10. doi:10.1027/0227-5910.29.1.4.

    Article  Google Scholar 

  • Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. doi:10.1093/jpepsy/27.1.87.

    Article  PubMed  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118.

    Article  Google Scholar 

  • Klonsky, E. D. (2007). The functions of deliberate self-injury. A review of the evidence. Clinical Psychology Review, 27, 226–239. doi:10.1016/j.cpr.2006.08.002.

    Article  PubMed  Google Scholar 

  • Kumar, G., Pepe, D., & Steer, R. A. (2004). Adolescent psychiatric inpatients’ self-reported reasons for cutting themselves. The Journal of Nervous and Mental Disease, 192(12), 830–836. doi:10.1097/01.nmd.0000146737.18053.d2.

    Article  PubMed  Google Scholar 

  • Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34(5), 447–457. doi:10.1007/s10964-005-7262-z.

    Article  Google Scholar 

  • Lewczyk, C. M., Garland, A. F., Hurlburt, M. S., Gearity, J., & Hough, R. L. (2003). Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 349–356. doi:10.1097/00004583-200303000-00016.

    Article  Google Scholar 

  • Linehan, M. M. (1993). Cognitive-behavioral treatment for borderline personality disorder. New York: Guildford Press.

    Google Scholar 

  • Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristic and functions on non-suicidal self-injury in a community sample of adolescents. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(8), 1183–1192. doi:10.1017/s003329170700027x.

    Article  Google Scholar 

  • MacDermott, S. T., Gullone, E., Allen, J., King, N. J., & Tonge, B. (2010). The emotion regulation index for children and adolescents (ERICA): a psychometric investigation. Journal of Psychopathology and Behavioral Assessment, 32(3), 301–314. doi:10.1007/s10862-009-9154-0.

    Article  Google Scholar 

  • Menard, S. (1995). Applied logistic regression analysis. Sage university paper series on quantitative applications in the social sciences (pp. 7–106). Thousand Oaks: Sage.

    Google Scholar 

  • Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302. doi:10.1016/j.beth.2006.09.001.

    Article  PubMed  Google Scholar 

  • Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: the protective role of trait emotional intelligence. British Journal of Clinical Psychology, 48(2), 181–193. doi:10.1348/014466508x386027.

    Article  PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998–2010). Mplus users’ guide (Sixth Edition). Los Angeles, CA: Muthén & Muthén.

  • Myers, R. (1990). Classical and modern regression with applications. Pacific Grove: Duxbury Press.

    Google Scholar 

  • Neumann, A., van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the Difficulties in Emotion Regulation Scale. Assessment, 17(1), 138–149. doi:10.1177/1073191109349579.

    Article  PubMed  Google Scholar 

  • Nixon, M. K., Cloutier, P. F., & Aggarwal, S. (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(11), 1333–1341. doi:10.1097/00004583-200211000-00015.

    Article  PubMed  Google Scholar 

  • Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6339–363. doi: 10.1146/annurev.clinpsy.121208.131258

  • Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior in adolescents. Journal of Consulting and Clinical Psychology, 72, 885–890. doi:10.1037/0022-006X.72.5.885.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. doi:10.1016/j.psychres.2006.05.010.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2010). Revealing the form and function of self-injurious thoughts and behaviors: a real-time ecological assessment study among adolescents and young adults. Psychology of Violence, 1(S), 36–52. doi:10.1037/2152-0828.1.S.36.

    Article  Google Scholar 

  • Penn, J. V., Esposito, C. L., Schaeffer, L. E., Fritz, G. K., & Spirito, A. (2003). Suicide attempts and self-mutilative behavior in a juvenile correctional facility. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 762–769. doi:10.1097/01.CHI.0000046869.56865.46.

    Article  PubMed  Google Scholar 

  • Penza-Clyve, S., & Zeman, J. (2002). Initial validation of the Emotion Expression Scale for Children (EESC). Journal of Clinical Child and Adolescent Psychology, 31(4), 540–547. doi:10.1207/153744202320802205.

    PubMed  Google Scholar 

  • Phillips, K. V., & Power, M. J. (2007). A new self-report measure of emotion regulation in adolescents: the regulation of emotions questionnaire. Clinical Psychology & Psychotherapy, 14(2), 145–156. doi:10.1002/cpp.523.

    Article  Google Scholar 

  • Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 80–87. doi:10.1097/00004583-200401000-00017.

    Article  PubMed  Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39(1), 28–38. doi:10.1097/00004583-200001000-00014.

    Article  PubMed  Google Scholar 

  • Sharp, C., Goodyer, I. M., & Croudace, T. J. (2006). The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of children aged 7 through 11. Journal of Abnormal Child Psychology, 34(3), 365–377. doi:10.1007/s10802-006-9027-x.

    Article  Google Scholar 

  • Sim, L., Adrian, M., Zeman, J., Cassano, M., & Friedrich, W. N. (2009). Adolescent deliberate self-harm: linkages to emotion regulation and family emotional climate. Journal of Research on Adolescence, 19(1), 75–91. doi:10.1111/j.1532-7795.2009.00582.x.

    Article  Google Scholar 

  • Sourander, A., Aromaa, M., Pihlakoski, L., Haavisto, A., Rautava, P., Helenius, H., & Sillanpää, M. (2006). Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15. Journal of Affective Disorders, 93(1–3), 87–96. doi:10.1016/j.jad.2006.02.015.

    Article  PubMed  Google Scholar 

  • SPSS for Windows, Rel. 17.0.3. (2009). Chicago: SPSS, Inc.

  • Suyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18, 531–554. doi:10.1016/S0272-7358(97)00105-0.

    Article  PubMed  Google Scholar 

  • Swets, J. A., & Pickett, R. M. (1982). Evaluation of diagnostic systems: Methods from signal detection theory. Orlando: Academic.

    Google Scholar 

  • Thapar, A., & McGuffin, P. (1998). Validity of the shortened Mood and Feelings Questionnaire in a community sample of children and adolescents: a preliminary research note. Psychiatry Research, 81(2), 259–268. doi:10.1016/s0165-1781(98)00073-0.

    Article  PubMed  Google Scholar 

  • Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621. doi:10.1037/a0016669.

    Article  PubMed  Google Scholar 

  • Zeman, J., Shipman, K., & Penza-Clyve, S. (2001). Development and initial validation of the Children’s Sadness Management Scale. Journal of Nonverbal Behavior, 25(3), 187–205. doi:10.1023/A:1010623226626.

    Article  Google Scholar 

  • Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental and Behavioral Pediatrics, 27(2), 155–168. doi:10.1097/00004703-200604000-00014.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, The University of Houston, 126 Heyne Building, Houston, TX, 77024, USA

    Jose Perez, Amanda Venta, Sarah Garnaat & Carla Sharp

Authors
  1. Jose Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda Venta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah Garnaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carla Sharp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carla Sharp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Perez, J., Venta, A., Garnaat, S. et al. The Difficulties in Emotion Regulation Scale: Factor Structure and Association with Nonsuicidal Self-Injury in Adolescent Inpatients. J Psychopathol Behav Assess 34, 393–404 (2012). https://doi.org/10.1007/s10862-012-9292-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-012-9292-7

Keywords

Search

Navigation