Date of Graduation

Summer 2026

Document Type

Dissertation

Degree Name

Doctor of Clinical Psychology (PsyD)

Department

Psychology

Committee Chairperson

Deanne Zotter, PhD

Committee Member

Lauri Hyers, PhD

Committee Member

Michael Roche, PhD

Committee Member

Kelsey Blum, PsyD

Abstract

The investigation of nonsuicidal self-injury (NSSI) and eating disorders (EDs) is important for the field of clinical psychology to clearly conceptualize and treat self-destructive behaviors. The present study aimed first to understand experiences of NSSI and ED behaviors and then to determine the best way to conceptualize indirect versus direct self-harm behaviors to inform treatment. Four research questions focused on (1) experiences of the behaviors, (2) functions of the behaviors, (3) conceptualization of direct/indirect self-harm, and (4) descriptions of treatment experiences. Interviews were conducted with nine people (eight women, one nonbinary) with a mean age of 31 years old. Participants engaged in an average of five types of NSSI and two types of ED behaviors in their lifetime. Reflexive thematic analyses based on research questions led to the development of main themes and subthemes. Themes described NSSI as more dynamic than EDs with emphasis on change over time and EDs were described with clearer and more pervasive consequences, especially in social functioning. Both NSSI and EDs involved emotions and need for control, but intention to cause harm was not clearly defined for any behavior. Participants described direct harm as physical damage and indirect harm as consequences and had not made the distinction previously. Participants indicated that clinicians have attitudes toward NSSI that impact how treatment is provided and received. Implications for clinical practice include expanded assessment of behaviors, clinician professional development, and treatment emphasis on emotion regulation to address all behaviors.

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