5 - (IOP 8) Exploring the Prevalence & Predictors of Sex as Self-injury

The study of self-injurious behavior is an area of clinical and scientific interest that has been well developed (Swannell et al., 2014). One area of recent interest is the consideration of sex as self-injury (SASI), a newly emerging form of non-suicidal self-injury (NSSI) defined as the use of sexual behaviors and interactions to voluntarily inflict physical and/or psychological damage to the self (Fredlund et al., 2020). As this construct is being formulated, it is relevant to consider sex as self-injury that may take either a direct form of NSSI through physical damage, an indirect form of NSSI through psychological damage, or both depending on the variety and severity. Behavioral expressions of non-suicidal self-injury and sex as self-injury have additionally been described as “interchangeable” by individuals who utilize both behaviors (Fredlund & Jonsson, 2022). SASI and NSSI share a central function of emotion regulation, a key consideration in any discussion of where/how SASI may fit as a sub-type, or on the spectrum of, NSSI (Jonsson et al., 2022). Whereas previous studies of this construct have occurred primarily in Sweden (Fredlund et al., 2022; Fredlund et al., 2020; Fredlund et al., 2017), the purpose of this study was to examine the prevalence of SASI behaviors in the United States population as well as the extent to which predictive factors of non-suicidal self-injury and NSSI behaviors themselves are predictive of sex as self-injury. Measures of depression (PHQ9), childhood trauma (CTQ), emotion dysregulation (DERS-sf), borderline personality disorder characteristics (MSI-BPD), sexual attitudes (SAS), interoceptive awareness (MAIA), direct and indirect NSSI, and SASI behaviors were administered to participants as an anonymous online survey. Participants were recruited using Prolific, an online research recruitment platform. Predictive variables that were hypothesized to have the strongest relationship with sex as self-injury were indirect NSSI behaviors and difficulties in emotion regulation. Preliminary data analysis was conducted on a sample of n=375 and indicated that 108 out of 375 participants (28%) endorsed over 6 forms or functions of sex as self-injury. Structural equation modeling analysis yielded fit indices indicating the hypothesized model was an adequate fit (CFI=0.86, SRMR=0.062, RMSEA=0.169, x2= < 0.001). The results indicated a significant direct effect of depression on SASI (ꞵ=0.738, p= < 0.001), emotion dysregulation on SASI (ꞵ=0.778, p= < 0.001), childhood trauma on SASI (ꞵ=0.789, p= < 0.001), BPD characteristics on SASI ((ꞵ=0.892, p= < 0.001), direct NSSI on SASI (ꞵ=0.649, p= < 0.001), and indirect NSSI on SASI (ꞵ=0.710, p= < 0.001). Results indicated that variables included within the model accounted for 51% of variance in SASI (R2=0.507). These results suggest a strong relationship between constructs that have been established to be associated with NSSI may also have a strong relationship with SASI. These findings are novel in the consideration of SASI, concerning both theoretical implications and clinical practice.