Molly Adrian

Date of Award


Level of Access Assigned by Author

Campus-Only Thesis

Degree Name

Doctor of Philosophy (PhD)




Janice L. Zeman

Second Committee Member

Cynthia A. Erdley

Third Committee Member

Douglas W. Nangle


The primary purpose of this study was to examine a model of factors that place psychiatrically distressed adolescents at risk for non-suicidal self-injury (NSSI). Specifically, the role of familial invalidation, peer invalidation, and emotional dysregulation in predicting NSSI behaviors was explored. Furthermore, gender differences in risk factors and NSSI were examined. Participants were 139 adolescents, 99 girls and 40 boys, from ages 13 to 18, who were psychiatrically hospitalized at the Mayo Clinic in Rochester, MN. Participants completed measures that assessed self-reported family environment and family emotion socialization; relational and overt victimization; friendship quality; emotion regulation patterns, skills, and experiences; NSSI; and psychological symptoms. The participants' parents were also asked to complete questionnaires regarding family environment, emotion socialization, and their adolescent's psychological symptoms. Results indicated that girls engaged in NSSI behaviors more frequently than boys. Girls and boys appeared to experience the same levels of the risk factors that were hypothesized to predict NSSI; however the relationships between variables differed by gender. Findings suggest that emotional dysregulation serves as an underlying process placing adolescents at risk for NSSI and mediating the influence of contextual invalidation through the family and peer contexts. Specifically, adolescents who endorsed intense emotional experiences, lack emotional awareness, and had few adaptive strategies for managing their intense emotions were at risk for this behavior. Further, peers and family influenced emotion regulation abilities such that when these relationships are characterized by invalidation and lack of support for managing emotions, adolescents reported more dysregulated emotional management. Unique for girls was the finding that family invalidation was directly and indirectly, through emotional dysregulation, related to NSSI. However, for both boys and girls the indirect processes of peer invalidation, through emotional dysregulation, predicted NSSI. The findings suggest that the process by which invalidation results in NSSI is complex, and is at least partially dependent on both the form of victimization and gender of the adolescent. Many questions remain about the underlying processes that result in the development of NSSI for adolescents experiencing psychological distress. Future research is needed to examine the complicated relations among proximal and distal risk factors, gender, and outcomes to better understand the pathways by which adolescents become reliant on NSSI.