A.

KULIKOWSKA
1
, M. POKORSKI
1, 2
SELF-INJURIES IN ADOLESCENTS: SOCIAL COMPETENCE,
EMOTIONAL INTELLIGENCE, AND STIGMATIZATION
1
Institute of Psychology, Opole University, Opole, Poland;
2
Medical Research Center,
Polish Academy of Sciences, Warsaw, Poland
Social competence, emotional intelligence, and strategies of coping with stress were
investigated in adolescents who commit acts of self-injury. Furthermore, the extent
to which stigma influences changes in psychological functioning of self-injuring
persons also was examined. The methodology consisted of recognized self-reporting
psychometric tools. Findings revealed substantial disturbances in all of the above-
mentioned psychological aspects of functioning of the self-injured. There were
significant decreases in the level of emotions directed toward the 'self' and in the
components of social competence dealing with intimate relations and assertiveness,
as compared with healthy persons. Emotion-oriented strategy of dealing with stress
became dominant in the self-injured. A decrease in social competence was
appreciably intensified by stigma. Findings, however, failed to reveal changes in
emotions directed toward the 'others', which may help explain good functioning in
social exposure and everyday life situations of the self-injured.
Ke y wor ds : adolescents, career behavior, emotional intelligence, self-injury, social
competence, stigma, stress
INTRODUCTION
Social competence is a set of complex skills, which determine the efficiency
of managing in certain social situations and are gained through social practice (1,
2). Taking into account the type of situation, three elementary components of
social competences may be distinguished - the first determines the effectiveness
of behavior in close interpersonal relationships, the second in conditions of social
exposure, while the third is useful in conditions requiring assertiveness.
JOURNAL OF PHYSIOLOGYAND PHARMACOLOGY 2008, 59, Suppl 6, 383392
www.jpp.krakow.pl
The importance of measuring the level of social competence among persons
inflicting self-injuries is supported by data from the literature showing that
individuals conducting self-injuries have a tendency to choose professional
education that requires intensive contact with other persons, such as cultural
studies, medicine, social sciences, advertising (3, 4) and may achieve
considerable success in their careers. Taking that into account, it can be assumed
that self-injuring individuals will not differ from the control group as far as the
level of social competence plays an important role in career development (5);
meaning the competence determining the effectiveness of behavior in situations
of social exposure.
Facts from the literature accenting that auto-aggressive individuals come from
the families where contacts outside the family system were hindered (6, 7),
pointing to difficult childhood experiences, and data exposing tendencies of such
individuals to suppress their own negative emotions (8) suggest that they may
have a lower level of competence determining the effectiveness in interpersonal
contacts and situations requiring assertiveness.
Emotional intelligence is the ability to understand emotions, accurate
perception and expression of emotions, and the ability to gain access to emotional
processes, which makes it easier to generate feelings when they facilitate the
thinking process (9, 10). It is probable that self-injuring individuals may
demonstrate emotional intelligence disorders, especially with suppressing
negative emotions. Difficulties with reading out and expressing emotions may
also steer dealing with stress toward an emotional approach to stressful situations.
While defining social skills, it is assumed that they are specific behavioral
components of effective social interactions (11). This effectiveness of interaction
between a self-injuring individual and the surrounding environment may be
obstructed when their problem is disclosed. Everything that is within acceptable
socio-cultural norms allows gaining acceptance and a feeling of belonging to a
group, while everything that goes beyond the norm may not be accepted or lead
to exclusion (4).
In our culture, self-injury is far beyond widely understood norms, which
explains negative reactions toward persons performing self-injury. Many authors
point out that a negative reaction towards such persons has a stigmatizing
character (4, 6, 12). Smith (12) has shown that the stigmatization problem of self-
injuring individuals concerns also the psychiatrists, who very often feel the need
of proving the fact that self-injury is caused by mental disorders. The author also
suggests that patients performing self-injuries are more often said to have
borderline personality disorders. This diagnosis leads to sustaining self-
aggressive behavior, because "certain behavior" is demanded from a person with
a "certain diagnosis". At the same time, each next self-injury act becomes a
symptom proving the diagnosis. Smith's (12) research proves that the use of a
broad diagnosis may result from psychiatrists' feeling of helplessness toward the
self-injury phenomenon. It might also be a sign of a pathogenic way of
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understanding an incomprehensible phenomenon, which, at a closer
investigation, deserves to be considered from the salutogenetic point of view,
which many authors agree with (6, 13). A wrong diagnosis might also lead to an
increase of negative attitudes toward self-injuring persons, as well as make their
stigmatizing by the society much easier (12).
The aim of the present paper was to evaluate the psychological functioning
of self-injuring late adolescents. The values assessed were social abilities,
emotional intelligence, and the style of coping with stress. We also tackled the
issue of reluctance toward individuals with self-injury problems by dividing the
studied group into those who, as a result of revealing their problem, met with a
rejection from the society, and those who did not suffer due to the society's
rejection. The aim of such a division was to verify the research question posed
of whether the social stigmatization of self-injuring individuals leads to a
decrease in the level of social abilities.
MATERIALAND METHODS
The study was approved by the Review Board of the Institute of Psychology of Opole
University in Poland. Informed consent was obtained from all participants of this study.
Subjects, pathologies, emotions, and family milieu
Fifty-two late adolescents (32 females and 20 males) of the mean age of 18.2 0.6(SE) years
were enrolled into the study. The subjects had to fulfil the criteria set in the Record of Self-Injuring
Behaviors, an index card designed by the authors for the purpose of this study. This record,
containing 20 questions concerning self-injuring behaviours, enabled the selection of self-injuring
individuals on a moderate level and helped in gathering important information on self-injuries.
The year bracket for the period of self-injuring was between 1 to 8 years, with an average of 3
years. Due to self-injuries, 17 subjects were hospitalized. The most common form of self-injuries
was mutilation with the use of a sharp tool. The second most frequent form was hitting one's body
parts (head, fist, etc.) against hard items (27 subjects). Cauterization was declared by 16 subjects.
In 11 cases, tearing out hair was observed. Over 20 from the 52 studied subjects declared the use of
at least three self-injuring forms. The most commonly injured body parts were arms, wrists, bellies,
thighs, and calves. Fifty percent of the subjects self-injured more than 3 parts of their bodies.
In the studied group, the self-injuring phenomenon corresponded mostly with anxiety disorders
(18 subjects) and depression (20 subjects). Over 1/3 of self-injuring women suffered from nutrition
disorders (7 anorexic and 5 bulimic individuals). Men and women, equally often, declared addiction
to psychoactive substances (in total 19 subjects). Men more often pointed out their problems with
alcohol and women their addiction to soporifics and sedatives. Nine subjects declared drug
problems. Self-injuring individuals showed emotions and feelings, which can be qualified to several
categories. The first group consisted of feelings such as: feeling of guilt, self-anger, shame, etc. It
concerned emotions felt toward oneself. The second group consisted of emotions felt toward other
people (anger towards somebody, etc.) The third category concerned emotions connected with the
dissociation state (a feeling of being in another body, etc.) The fourth group concerned the need of
stimulating oneself (boredom, etc.).
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The most commonly chosen category was emotions felt toward oneself (32 subjects). Emotions
felt toward the surrounding environment were declared by 10 subjects. The category of feelings
indicating the dissociation state - just before self-injuring - was indicated by nine subjects. Only 1
person declared belonging to the group concerning the need of stimulating himself.
Separation of these four categories led to refuting the stereotype saying that young persons
performed self-injuring behavior due mainly to boredom. The domination of motives connected
with showing emotions toward oneself and toward others proves that self-injuring plays roles such
as: emotion regulation, self-punishment and communication function.
In most cases, the studied subjects came from two-parent families (46 subjects), where both
parents were professionally active (32 subjects). Self-injuring persons usually had siblings (39
subjects), though a model of a family with two children dominated. In over 60% of the families, no
serious illnesses could be found. In other cases, the most commonly reported disease was
depression or the parent's alcoholism. Among other reported illnesses we can find: neurosis,
schizophrenia, multiple sclerosis, and dementia.
Twenty-seven persons, due to revealing their problem, faced a negative change of relationship
with the surrounding environment. Twenty-five subjects declared that the surrounding environment
did not change its attitude towards them, when the problem of self-injuring was revealed. According
to the answers given to the question concerning the environment's attitude toward their problem, the
self-injuring subjects were divided into 2 subgroups - the 'marked' (stigmatized) subjects and the
'unmarked' subjects.
Psychometric measures
Social competence was assessed with the Questionnaire of Social Competence (QSC), the 2001
Polish version by Matczak (14). The QSC consists of 90 items that are infinitival qualifications of
different activities. The responder assesses how effectively he would perform a given task. A four-
degree scale is used (distinctly well, well, rather badly, distinctly badly) and the answers are scored
4, 3, 2, or 1 point, respectively. Of the 90 items, 60 concern social competence while the remaining
30 do not have a social character, and, being non-diagnostic, are not considered in the final
assessment f social competence. The questionnaire measures competence in three categories:
competence in interpersonal or intimate relations (IR);
competence in social exposure (SE);
competence in situations requiring assertiveness (A).
Each subscale is scored separately, and the sum score refers to the overall social competence.
The QSC is a sensitive and specific measure of domains of social competence across various age
groups. Validity and test-retest reliability of this tool have been verified Matczak (14).
Emotional intelligence was assessed with the Two-Dimensional Inventory of Emotional
Intelligence - DINEMO designed in a Polish version by Matczak and Jaworowska (15). The tool
consists of two main subscales:
OTHERS scale: studies the ability to recognize, understand, and respect emotions of other people;
ME scale: studies the ability to realize, understand, respect, and express one's emotions.
Strategies of coping with stressful situations were assessed with the Coping Inventory for
Stressful Situations (CISS) according to Endler and Parker (16), in a 2005 Polish modification by
Szczepaniak, Strelau, and Wrzesniewski (17). The questionnaire is a self-reporting toll consisting
of 48 items. The respondent reports, on a 5-degree scale, with what frequency he would undertake
a given action. There are three subscales of coping styles: task-oriented, emotion-oriented, and
avoidance-oriented. The latter is further subdivided into two forms: engagement in substitutive
actions and searching for social contacts.
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The questionnaires were anonymous. The time to fill out the questionnaires was not limited,
and, on average, amounted to 40 min. The control group consisted of 40 subjects (20 females and
20 males) of the mean age of 18.9 0.3 years, who were entirely healthy and never had any
psychological problems. Subjects of the control group fill in the same questionnaires.
Data elaboration
Data are expressed as means SD of raw scores. Levene's test was used to assess the equality of
variance in different samples. Differences between the groups examined were assessed with a paired
or unpaired t-test, as required. P<0.05 was considered to denote statistically significant differences.
RESULTS
Emotional intelligence among self-injuring individuals
A comparison of results concerning changes in emotional intelligence is
shown in Table 1. In the DINEMO test, measuring the total result of emotional
intelligence, the self-injuring individuals obtained a distinctly lower result than
the healthy persons did (P<0.001). Analysis with the DINEMO subscales showed
that the self-injuring persons obtained a statistically lower result in the ME
subscale (P<0.001), whereas in the OTHERS subscale, no differences compared
with the control group were found. Therefore, self-injuring individuals show
difficulties with coping with their own emotions. However, they do not differ
from the control group in regard to recognition, understanding, and respecting
emotions of the others.
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Self-injured Controls
n 52 40
Total score 16.9 4.5* 20.8 5.2
Subscale ME 7.2 2.2* 10.0 2.0
Subscale OTHERS 11.0 3.7 12.0 4.2
Values are means SD of raw score; *P<0.001 denotes significant differences vs. the control group.
Table 1. Scores in the Two-Dimensional Inventory of Emotional Intelligence - DINEMO.
Self-injuring subjects Healthy controls
n 52 40
QSC-Total score 128.4 22.3** 144.6 28.4
Subscale IR 37.9 6.9** 47.4 10.1
Subscale SE 46.3 11.6 48.2 13.4
Subscale A 44.4 9.0* 49.1 10.9
QSC - Questionnaire of Social Competence; IR -interpersonal or intimate relations; SE - Social
exposure; A - assertiveness. Values are means SD of raw score;*P<0.05, **P<0.01 denote
significant differences between the two groups.
Table 2. Summary score of social competence, with divisions into subscales, in the self-injuring and
healthy groups of adolescents.
Social competence in self-injuring adolescents, irrespective of stigmatization
The general level of social competence in the whole group of the self-injuring
individuals, without the division into 'marked' and 'unmarked' persons, compared
with the level of the control group's competence, is shown in Table 2. The study
shows that the self-injuring individuals had a significantly lower general level of
social competence than that in the control group. There were, however,
differences in the particular subscales of social competence. The self-injuring
individuals did not differ from the control group concerning the competence
conditioning the efficiency of behaviors in situations demanding social exposure.
However, they had statistically lower results in the IR subscale, conditioning the
efficiency of behaviors in interpersonal situations, as well as in the A subscale,
measuring the competence concerning assertiveness.
Social competence in self-injuring adolescents with respect to the issue of
stigmatization
After dividing the studied group into 'marked' and 'unmarked' self-injuring
individuals, we found that the adolescents socially 'marked' had a statistically
lower result in general competence than those, who self-injure, but were not
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Self-injured Controls
n 52 40
Task-oriented 46.5 8.9** 52.8 7.4
Emotion-oriented 55.7 .9** 44.9 10.4
Avoidance-oriented:
Avoiding style 33.0 8.9 36.6 10.8
Searching for social contacts 13.3 5.1* 16.1 6.6
Values are means SD of raw score; *P<0.05, **P<0.01 denote significant differences vs. the
control group.
Table 4. Strategies of coping with stressful situations.
Stigmatized Non-stigmatized
n 27 25
QSC-Total score 119.6 23.7** 138.0 16.4
Subscale IR 36.0 6.7* 40.0 6.7
Subscale SE 42.3 12.7** 50.6 8.7
Subscale A 41.5 8.8* 47.4 8.4
QSC - Questionnaire of Social Competence; IR - personal or intimate relations; SE - Social
exposure; A - assertiveness. Values are means SD of raw score; *P<0.05, **P<0.01 denote
significant differences between the two groups.
Table 3. Summary score of social competence, with divisions into subscales, in the self-injuring
adolescents who were stigmatized and non-stigmatized by the surrounding social milieu.
socially 'marked'. Moreover, competence of persons socially stigmatized
decreased dramatically in each subscale, including the social exposure scale
(Table 3), in which no differences were found compared with the control group
while analyzing without including stigmatization (see Table 2 above).
Strategy of coping with stress by self-injuring persons
Strategy of coping with stress was significantly different among the self-
injuring individuals compared with that in the healthy ones. The self-injuring
adolescents usually represented a style of coping with stress, which was
concentrated on emotions (P<0.01). This style was clearly dominating over both
task- and avoidance-oriented styles; the latter was related with searching for social
contacts to ease up the psychological burden of stressful situations (Table 4).
DISCUSSION
In this paper we studied psychological aspects of functioning of self-injuring
adolescents, also including the role of stigmatization of such behaviors in the
psychological disorders. In general, we found significant impairments in
emotional intelligence, social competences, and the strategy of coping with
stressful situations among self-injuring individuals compared with the control
group, consisting of age-matched healthy subjects. It is worthwhile to note,
however, a number of interesting differences that appeared in the subscales of the
studied psychological aspects.
Self-injuring subjects show less efficiency in coping with their own
emotions, which might lead to disorders in perceiving emotions and repressing
negative emotions. Such persons do not differ though from the control group in
the sphere of recognizing, understanding, and respecting emotions of the others,
which might have an important meaning when staying in social contacts. The
general level of social competence of self-injuring individuals turned out to be
significantly lower than the control group's result. The analysis shows that the
studied adolescents differed from the control group in all kinds of competences
but the one conditioning the efficiency of behaviors in situations of social
exposure. Abilities in this sphere were located on an average level for the
healthy population. Therefore, it seems that self-injuring individuals are able to
skillfully adjust their behavior to situational demands and create the desirable
image. That provides an explanation why such persons often thrive in their
professional lives (4, 18).
In case of competence shaping assertiveness or interpersonal relations, in
which usually the major role is played by one's own emotions, self-injuring
persons obtained a significantly lower result than the reference group. The
subjects studied have difficulties in coping with situations that are connected with
talking about the self, which requires involving one's emotions. If assertive
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behavior is to help in an effective 'demanding' of one's rights, no wonder that the
person, whose rights - even in the primary 'social laboratory' such as the family
(19) - are frequently neglected (20) does not have any well developed
competences in this sphere. Low results obtained on the scale of competence
useful for creating close relationships also prove that self-injuring subjects have
problems with building stable, constructive, and happy relationships (20).
The problem of emotional disorders among self-injuring persons also came into
the open in relation to coping with stressful situations, where emotion-oriented
strategy clearly dominated over task- or social interaction-oriented strategies. It
has been found that emotion-oriented coping is closely associated with
neuroticism, esoteric, and isolation tendencies, and often with depressive disorders
(21). These are psychopathological personality traits that can underlie the
propensity for self-injuring acts and can be at play, at least in some of the cases.
The assessment of social competence among self-injuring persons shows that
the more engagement of one's emotions is needed in a certain situation, the worse
such persons cope with it. In case of social exposure, one stays as far as possible
from the others - you can only put a 'mask' on, play your role and no one will
notice that you are far away - not only from the others, but also from yourself.
These situations are not so closely connected with traumatic experiences and the
'pinching' family system (13) as are intimate situations requiring assertiveness,
and, therefore, they may become the favorite form of contact with the world. It is
possible that that indirectly explains why such persons prefer having professions
that require contacts with people and they accomplish professional successes (4).
Entering relationships with people on a professional basis may be a form of
satisfying one's need of intimacy at a safe 'distance'.
Unfortunately, even this kind of contacts may stop being 'safe', when the
problem of self-injuring is revealed and the social environment rejects such a
person. Comparing the competences of persons, who declared that due to self-
injuring they experienced negative reactions from other people, with auto-
aggressive persons, who did not meet with any negative reactions, demonstrates
that subjects socially stigmatized had significantly lower social competence than
the 'unmarked' persons did.
If social stigmatization has a negative influence on functioning of self-
injuring persons, then the efforts, such as, inter alia, Jennifer Muehlenkamp
(22) to single out in DSM-IV the syndrome of 'deliberate self-injuring', become
questionable. Contentiousness of this issue is further shown by a study of Smith
(12), who argues that treating the problem of self-injuring as a category of
serious disorder leads not only to an increase in frequency of the performed acts
by auto-aggressive subjects, but also to their common stigmatization and
mental hurting by other people. Rigorous opponents of stigmatization of self-
injuring subjects are also Babiker and Arnold (6), who opt for creating 'crisis
houses' to which all individuals with self-injuring problems could come in order
to receive help. According to these authors, lack of a patient status gives the
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self-injuring subjects a feeling of safety, which encourages them to undertake
medical treatment. The authors of the present article strongly incline toward
this opinion.
Acknowledgments: Supported by the statutory budget of the Institute of Psychology, Opole
University in Poland.
Conflicts of interest: The authors had no conflicts of interest to declare in relation to this article.
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Re c e i ve d: June 16, 2008
Ac c e pt e d: September 26, 2008
Authors address: M. Pokorski, Medical Research Center, Polish Academy of Sciences,
Pawinskiego 5 St., 02-106 Warsaw, Poland; phone: +48 22 6685416; e-mail: mpokorski@cmdik.pan.pl
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