ZELFVERWONDEND GEDRAG BIJ ADOLESCENTEN: De relatie met persoonlijkheid, stress en coping

Glenn Kiekens
Persbericht

ZELFVERWONDEND GEDRAG BIJ ADOLESCENTEN: De relatie met persoonlijkheid, stress en coping

In een recente studie bij Vlaamse en Nederlandse adolescenten gaf 1 op 4 aan zichzelf ooit opzettelijk te hebben verwond. Adolescenten die zichzelf verwonden verschillen van hun leeftijdsgenoten qua persoonlijkheidskenmerken, ervaren stress en de manier waarop ze omgaan met stressvolle gebeurtenissen.

Zelfverwondend gedrag wordt gedefinieerd als “sociaal onacceptabel gedrag waarbij een fysiek letsel opzettelijk en op een directe manier wordt toegebracht zonder een aanwezige intentie tot zelfdoding”. Vaak voorkomende voorbeelden zijn zichzelf krassen, snijden, slaan, branden, hoofdbonken en wonden verhinderen te genezen.

Hoe vaak komt zelfverwonding voor? In een recente studie (i.s.m. de Universiteit van Nijmegen) bevroegen we 1013 Vlaamse en Nederlandse adolescenten tussen 12 en 19 jaar en kwamen tot de vaststelling dat bijna één op vier rapporteert zichzelf ooit te hebben verwond. Vlaanderen en Nederland zijn geen uitzondering met deze alarmerende cijfers, internationaal worden immers gelijkaardige bevindingen gerapporteerd. Nederlandse adolescenten starten ongeveer twee jaar vroeger dan hun Belgische leeftijdsgenoten. Hoewel er in het voorkomen geen geslachtsverschillen aanwezig waren, constateerden we wel verschillen qua methoden. Zo werd hoofdbonken meer gehanteerd door jongens dan meisjes, terwijl het omgekeerde gold voor zichzelf snijden of krassen. Gemiddeld genomen gaven jongeren aan twee verschillende methoden te hanteren.

Waarom zelfverwondend gedrag?Uit onderzoek blijkt dat zelfverwondend gedrag het vaakst gehanteerd wordt als een manier om met negatieve gevoelens of stress om te gaan. Daarnaast zijn andere vaak voorkomende functies: een gevoel van controle krijgen, ontsnappen aan eisen uit de sociale omgeving en het gebruik omwille van het verkrijgen van aandacht. Zelfverwonding heeft op korte termijn dus positieve gevolgen voor de adolescent. Op middellange termijn steken negatieve gevoelens als schaamte de kop op, waarna jongeren zichzelf dan mogelijks terug verwonden om met deze negatieve gevoelens om te gaan. Zo kan dit leiden tot een gevaarlijke negatieve bekrachtigende cyclus.

OorzakenDit gedrag ontwikkelt zich meestal tijdens de adolescentie en komt in deze periode dan ook het frequentst voor. In onze onderzoeksgroep gaf meer dan de helft aan zichzelf voor de eerste maal te hebben verwond tussen de leeftijd van 12 en 15 jaar. Het is in onderzoek naar zelfverwonding belangrijk om te beseffen dat één risicofactor nooit aanleiding zal geven tot dit gedrag, het is veelal zo dat een aanwezigheid van verschillende risicofactoren aan de grondslag liggen. Deze risicofactoren zijn omgevingsgebonden, bijvoorbeeld verwaarlozing, misbruik, moeilijkheden in seksuele oriëntatie, gepest worden, etc. Daarnaast kunnen ze ook persoonsgebonden zijn zoals bijvoorbeeld de mate van impulsiviteit.

Mogelijke factoren die wij onderzocht hebben zijn persoonlijkheid, stress en de manier waarop er met stress wordt omgegaan. We stelden onder andere vast dat jongeren met zelfverwondend gedrag een grotere neiging hebben om negatieve emoties te ervaren en zich in een sociale context meer terughoudend en angstig opstellen. Daarnaast scoren adolescenten die zichzelf verwonden lager op persoonlijkheidstrekken zoals optimisme, vriendelijkheid en gewetensvolheid. Verder beschouwen ze hun leven meer onvoorspelbaar en oncontroleerbaar, en ervaren ze dus meer stress dan leeftijdsgenoten zonder dergelijk gedrag. Daarenboven blijken adolescenten met zelfverwondend gedrag eveneens anders om te gaan met stressvolle gebeurtenissen in hun leven. Zo zullen zij bijvoorbeeld minder sociale steun zoeken of geruststellende gedachten ervaren, en zullen ze meer depressief reageren of hun emoties en boosheid uiten.

Het verwerven van inzicht in de ontstaansmechanismen van zelfverwonding is belangrijk. Zo kunnen we leren hoe persoonlijkheidskenmerken of andere factoren kunnen leiden tot een verhoogd of net verlaagd risico op het ontstaan en continueren van zelfverwondend gedrag. We hebben onder andere vastgesteld dat persoonlijkheidsfactoren iemand kwetsbaar kunnen maken voor zelfverwonding via de mate van het ervaren stressniveau, en de manier waarop ze hiermee omgaan. Dit impliceert dat stressregulatie en de manier waarop met stressvolle gebeurtenissen wordt omgegaan twee belangrijke therapeutische thema’s zijn.

Gevolgen op lange termijnHelaas is er voorlopig nog weinig geweten over de impact van zelfverwondend gedrag op langere termijn voor andere levensdomeinen. Zoals de invloed op sociaal leven, academische prestaties, mentale gezondheid, etc. Zo toont onderzoek bijvoorbeeld duidelijk een link aan met suïcidale gedragingen. Echter, gefundeerd inzicht over welke zelfverwondende jongeren later een verhoogd risico lopen suïcidale gedragingen te ontwikkelen vraagt complexer en tijdsintensiever onderzoek. Een financiële investering die maatschappelijk verantwoordbaar en nodig is.

Personalia

Glenn Kiekens schreef zijn masterproef aan de onderzoeksgroep Klinische Psychologie van de Faculteit Psychologie en Pedagogie KU Leuven. Glenn is momenteel doctoraatsstudent aan de onderzoeksgroep Psychiatrie van de Faculteit Geneeskunde KU Leuven, waar hij zelfverwonding bij Leuvense universiteitsstudenten zal onderzoeken. 

Bibliografie

Aguinis, H., & Stone-Romero, E. F. (1997). Methodological artifacts in moderated multiple regression and their effects on statistical power. Journal of Applied Psychology, 82, 192-206.

American Psychiatric Association. (2010). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychological Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychological Association.

Amirkhan, J. H. (1990). A factor analytically derived measure of coping: The Coping Strategy Indicator. Journal of Personality and Social Psychology, 59, 1066–1074

Andover, M. S., & Pepper, C. M. (2002). Frequency of Activities Scale. Unpublished measure, Binghamton University.

Andover, M. S., Pepper, C. M., & Gibb, B. E. (2007). Self‐Mutilation and coping strategies in a college sample. Suicide and Life-Threatening Behavior, 37, 238-243.

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 and Life-Threatening Behavior, 35, 581-591.

Andover, M. S., Primack, J. M., Gibb, B. E., & Pepper, C. M. (2010). An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics? Archives of Suicide Research, 14 (1), 79-88.

Asendorpf, J. B., & Wilpers, S. (1998). Personality effects on social relationships. Journal of Personality and Social Psychology, 74, 1531-1544.

Avia, M. D., Sanz, J., Sánchez-Bernardos, M. L., Martínez-Arias, M. R., Silva, F., & Graña, J. L. (1995). The five-factor model—II. Relations of the NEO-PI with other personality variables. Personality and Individual Differences, 19 (1), 81-97.

Babiker, G., & Arnold, L. (1997). The language of injury: Comprehending self-mutilation. Leicester, Engeland: The British Psychological Society.

Baetens, I., Claes, L., Muehlenkamp, J., Grietens, H., & Onghena, P. (2011). Non-suicidal self-injurious behavior among Flemish adolescents: A web survey. Archives of Suicide Research, 15, 55-67.

Baetens, I., Claes, L., Willem, L., Muehlenkamp, J., & Bijttebier, P. (2011). The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child-and parent-report. Personality and Individual Differences, 50, 527-530.

Bennum, I. (1983). Depression and hostility in self-mutilation. Suicide and Life Threatening Behavior, 13, 71-84.

Bijstra, J. O., Jackson, S., & Bosma, H. A. (1994). De Utrechtse Coping Lijst voor Adolescenten. Kind en Adolescent, 15, 67-74.

Bland, J. M., & Altman, D. G. (1995). Multiple significance tests: The Bonferroni method.. British Medical Journal, 310, 170.

Bohus, M., Limberger, M., Ebner, E., Glocker, F. X., Schwarz, B., Wernz, M., & Lieb, K. (2000). Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Research, 95, 251-260.

Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicidal attempts in adolescents. Journal of Youth and Adolescence, 39, 233-242.

Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates and functions. American Journal of Orthopsychiatry, 68, 609-620.

Britton, A. R., Sliter, M. T., & Jex, S. M. (2012). Is the glass really half-full? The reverse-buffering effect of optimism on undermining behavior. Personality and Individual Differences, 52, 712-717.

Brown, S. A. (2009). Personality and non-suicidal deliberate self-harm: Trait differences among a non-clinical population. Psychiatry Research, 169, 28-32.

Brown, S. A., Williams, K., & Collins, A. (2007). Past and recent deliberate self‐harm: Emotion and coping strategy differences. Journal of Clinical Psychology, 63, 791-803.

Bruck, C. S., & Allen, T. D. (2003). The relationship between Big Five personality traits, negative affectivity, type A behavior, and work–family conflict. Journal of Vocational Behavior, 63, 457-472.

Button, K. S., Ioannidis, J. P., Mokrysz, C., Nosek, B. A., Flint, J., Robinson, E. S., & Munafò, M. R. (2013). Power failure: Why small sample size undermines the reliability of neuroscience. Nature Reviews Neuroscience, 14, 365-376.

Cannon, W. (1932). Wisdom of the body. New York, NY: W. W. Norton.

Carver, C. S., & Connor-Smith, J. (2010). Personality and coping. Annual Review of Psychology, 61, 679-704.

Carver, C. S., Scheier, M. F., & Segerstrom, S. C. (2010). Optimism. Clinical Psychology Review, 30, 879-889.

Carver, C. S., Scheier, M. F., & Weintraub, J. K. ( 1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.

Caspi, A., Roberts, B. W., & Shiner, R. L. (2005). Personality development: Stability and change. Annual Review of Psychology, 56, 453–484.

Cawood, C. D., & Huprich, S. K. (2011). Late adolescent nonsuicidal self-injury: The roles of coping style, self-esteem, and personality pathology. Journal of Personality Disorders, 25, 765-781.

Cerutti, R., Presaghi, F., Manca, M., & Gratz, K. L. (2012). Deliberate self-harm behavior among Italian young adults: Correlations with clinical and nonclinical dimensions of personality. American Journal of Orthopsychiatry, 82, 298-308.

Chang, E. C. (1998). Does dispositional optimism moderate the relation between perceived stress and psychological well-being? A preliminary investigation. Personality and Individual Differences, 25, 233-240.

Chang, E. C. (2001). Introduction: Optimism and pessimism and moving beyond the most fundamental question. In E. C. Chang (Red.), Optimism and pessimism: Implications for theory, research, and practice (pp. 3-13). Washington, DC: American Psychological Association.

Claes, L. (2004). Self-injury in eating disorders (Niet gepubliceerd doctoraal proefschrift). Katholieke Universiteit Leuven, Faculteit Psychologie en Pedagogische wetenschappen.

Claes, L., Muehlenkamp, J., Vandereycken, W., Hamelinck, L., Martens, H., & Claes, S. (2010). Comparison of non-suicdal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit. Personality and Individual Differences, 48, 83-87.

Claes, S., & Van Den Eede, F. (2010). De stressrespons bij de depressieve stoornis en bij CVS. In B. Van Houdenhove, P. Luyten, & J. Vandenberghe, Luisteren naar het lichaam: Het dualisme voorbij (pp. 155-162). Leuven, België: Lannoo Campus

Claes, L., & Vandereycken, W. (2007). Self-injurious behaviour: Differential diagnosis and functional differentiation. Comprehensive Psychiatry, 48 137-144.

Claes, L., & Vandereycken, W. (2007). The Self-Injury Questionnaire-Treatment Related (SIQ-TR): Construction, reliability, and validity in a sample of female eating disorder patients. In P. M. Goldfarb (Red.), Psychological tests and testing research trends (pp. 111-139). New York, NY: Nova Science Publishers.

Claes, L., & Vandereycken, W. (2007). Zelfverwonding: Hoe ga je ermee om? Tielt, België: Lannoo.

Claes, L., Vandereycken, W., & Vertommen, H. (2004). Personality traits in eating disordered patients with and without self-injurious behaviors. Journal of Personality Disorders, 18, 199-404.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 358-396.

Cohen, S., Kessler, R. C., & Gordon, L. U. (1995). Measuring stress. New York, NY: Oxford University Press.

Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological bulletin, 127 (1), 87-127.

Connor-Smith, J. K., Compas, B. E., Wadsworth, M. E., Thomsen, A. H., & Saltzman, H. (2000). Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology, 68, 976.

Connor-Smith, J. K., & Flachsbart, C. (2007). Relations between personality and coping: A meta-analysis. Journal of Personality and Social Psychology, 93, 1080-1107.

Costa, P. T., & McCrae, R. R. (1992). Revised neo personality inventory (neo pi-r) and neo five-factor inventory (neo-ffi). Odessa, FL: Psychological Assessment Resources.

Costa, P. T., & McCrae, R. R. (1992). Trait psychology comes of age. In T. B. Sonderegger (Red.), Nebraska symposium on motivation: Psychology and aging (pp. 169-204). Lincoln, NE: University of Nebraska Press.

Darche, M. A. (1990). Psychological factors differentiating self-mutilating and nonself-mutulating adolescent inpatient females. Psychiatric Hospital, 21, 31-35.

Deliberto, T., L. & Nock, M. K. (2008). An exploratory study of correlates, onset, and offset of nonsuicidal self-injury. Archives of Suicide Research, 12, 219-231.

Denollet, J. (2000). Type D personality: A potential risk factor refined. Journal of Psychosomatic Research, 49, 255-266.

Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and type D personality. Psychosomatic Medicine, 67, 89-97.

Di Pierro, R., Sarno, I., Perego, S., Galluci, M., & Madeddu, F. (2012). Adolescent nonsuicidal self-injury: The effects of personality traits, family relationships and maltreatment on the presence and severity of behaviors. European Child and Adolescent Psychiatry, 21, 511-520.

D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy. Handbook of cognitive-behavioral therapies, 3, 197-225. In K. S. Dobson (Red.), Handbook of cognitive-behavioral therapies (3th ed.) (pp. 197-225). New York, NY: Guilford Press.

Eberhart, N. K., & Hammen, C. L. (2010). Interpersonal style, stress, and depression: An examination of transactional and diathesis-stress models. Journal of Social and Clinical Psychology, 29, 23-38.

Engelen, I., & Coosemans, I. (2003). Tieners in de knoei. Gids voor het begeleiden van jongeren. Tielt, België: Lannoo.

Evans, E., Hawton, K., & Rodham, K. (2005). In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? Journal of Adolescence, 28, 573-587.

Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental Disease, 186, 259-268.

Favazza, A. R., & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Psychiatric Services, 44, 134-140.

Ferguson, E., Williams, L., O’Connor, R. C., Howard, S., Hughes, B. M., Johnston, D. W., ... O’Carroll, R. E. (2009). A taxometric analysis of type-D personality. Psychosomatic Medicine, 71, 981-986.

Fisher, R. J. (1993). Social desirability bias and the validity of indirect questioning. Journal of Consumer Research, 20, 303-315.

Fliege, H., Kocalevent, R. D., Walter, O. B., Beck, S., Gratz, K. L., Gutierrez, P. M., & Klapp, B. F. (2006). Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates. Journal of Psychosomatic Research, 61, 113-121.

Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology, 30, 1010-1016.

Frydenberg, E., & Lewis, R. (1993). The adolescent coping scale: Practitioners manual. Australian Council for Educational Research.

Giletta, M., Scholte, R. H., Engels, R. C., Ciairano, S., & Prinstein, M. J. (2012). Adolescent non-suicidal self-injury: A cross-national study of community samples from Italy, the Netherlands and the United States. Psychiatry research, 197, 66-72.

Glassman, L. H., Weierich, M. R., Hooley, J. M., Deliberto, T. L., & Nock, M. K. (2007). Child maltreatment, nonsuicidal self-injury, and the mediating role of self-criticism. Behavior Research and Therapy Journal, 45, 2483-2490.

Glenn, C. R., & Klonsky, E. D. (2009). Social context during non-suicidal self-injury indicates suicide risk. Personality and Individual Differences, 46 (1), 25-29.

Glenn, C. R., & Klonsky, E. D. (2010). A multimethod analysis of impulsivity in nonsuicidal self-injury. Personality Disorders: Theory, Research, and Treatment, 1, 67-75.

Glenn, C. R., & Klonsky, E. D. (2011). One-year test-retest reliability of the inventory of statements about self-injury (ISAS). Assessment, 18, 375-378.

Goldberg, L. R., Johnson, J. A., Eber, H. W., Hogan, R., Ashton, M. C., Cloninger, C. R., & Gough, H. G. (2006). The international personality item pool and the future of public-domain personality measures. Journal of Research in Personality, 40 (1), 84-96.

Goldberg, D., & Williams, P. (2000). General health questionnaire (GHQ). Swindon, Wiltshire, UK: nferNelson.

Goldstein, A. L., Flett, G. L., Wekerle, C., & Wall, A. M. (2009). Personality, child maltreatment, and substance use: Examining correlates of deliberate self-harm among university students. Canadian Journal of Behavioural Science, 41, 241-251.

Gollust, S. E., Eisenberg, D., & Golberstein, E. (2008). Prevalence and correlates of self-injury among university students. Journal of American College Health, 56, 491–498.

Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A very brief measure of the big-five personality domains. Journal of Research in Personality, 37, 504-528.

Grant, K. E., Compas, B. E., Stuhlmacher, A. F., Thurm, A. E., McMahon, S. D., & Halpert, J. A. (2003). Stressors and child and adolescent psychopathology: moving from markers to mechanisms of risk. Psychological Bulletin, 129, 447.

Grant S, Lagan-Fox J. (2007) Personality and the occupational stressor-strain relationship: The role of the Big Five traits. Personality and Individual Differences, 41, 719-732.

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.

Gratz, K. L. (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity\reactivity. American Journal of Orthopsychiatry, 76, 238-250.

Grynberg, D., Gidron, Y., Denollet, J., & Luminet, O. (2012). Evidence for a cognitive bias of interpretation toward threat in individuals with a Type D personality. Journal of Behavioral Medicine, 35 (1), 95-102.

Hammen, C. (2006). Stress generation in depression: Reflections on origins, research, and future directions. Journal of Clinical Psychology, 62, 1065-1082.

Hamza, C. A., & Willoughby, T. (in press). A longitudinal person-centered examination of nonsuicidal self-injury among university students. Journal of Youth and Adolescence, 1-15. Advance online publication. doi: 10.1007/s10964-013-9991-8.

Hankin, B. L., & Abela, J. R. (2011). Nonsuicidal self-injury in adolescence: Prospective rates and risk factors in a 2 ½year longitudinal study. Psychiatry Research, 186, 65-70.

Hankin, B. L., Kassel, J. D., & Abela, J. R. (2005). Adult attachment dimensions and specificity of emotional distress symptoms: Prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality and Social Psychology Bulletin, 31, 136-151

Hasking, P. A. (2006). Reinforcement sensitivity, coping, disordered eating and drinking behaviour in adolescents. Personality and Individual Differences, 40, 677-688.

Hasking, P. A., Coric, S. J., Swannel, S., Martin, G., Thompson, H. K., & Frost, A. D. J. (2010). Brief report: Emotion regulation and coping as moderators in the relationship between personality and self-injury. Journal of Adolescence, 33, 767-773.

Hasking, P., Momeni, R., Swannell, S., & Chia, S. (2008). The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults. Archives of Suicide Research, 12, 208-218.

Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: Self report survey in schools in England. British Medical Journal, 325, 1207-1211.

Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74, 797816.

Herpetz, S. (1995). Self-injurious behavior. Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatrica Scandinavica, 91, 57-68

Hilt, L. M., Cha, C. B., & Nolen-Hoeksema, S. (2008). Nonsuicidal self-injury in young adolescent girls: Moderators of distress-function relationship. Journal of Consulting and Clinical Psychology, 76, 63-71.

Hilt, L. M., Nock, M. K., Llyod-Richardson, E., & Prinstein, M. J. (2008) Longitudinal study of nonsuicidal self-injury among young adolescents: Rates, correlates and preliminary test of an interpersonal model. Journal Early Adolescence, 28, 455-469.

Hoff, E. R., & Muehlenkamp, J. J. (2009). Nonsuicidal self-injury in college students: The role of perfectionism and rumination. Suicide and Life-Threatening Behavior, 39, 576-587.

Huan, V. S., Yeo, L. S., Ang, R. P., & Chong, W. H. (2006). The influence of dispositional optimism and gender on adolescents' perception of academic stress. Adolescence, 41, 533-546.

In-Albon, T., Ruf, C., & Schmid, M. (2013). Proposed diagnostic criteria for the DSM-5 of nonsuicidal self-injury in female adolescents: Diagnostic and clinical correlates. Psychiatry Journal. doi:10.1155/2013/159208

Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11, 129-147.

Jacobson, C. M., Muehlenkamp, J. J., Miller, A. L., & Turner, J. B. (2008). Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. Journal of Clinical Child & Adolescent Psychology, 37, 363-375.

Kaess, M., Hille, M., Parzer, P., Maser-Gluth, C., Resch, F., & Brunner, R. (2012). Alterations in the neuroendocrinological stress response to acute psychosocial stress in adolescents engaging in nonsuicidal self-injury. Psychoneuroendocrinology, 37, 157-161.

Jerusalem, M. (1993). Personal resources, environmental constraints, and adaptational processes: The predictive power of a theoretical stress model. Personality and Individual Differences, 14, 15-24.

Kahan, J., & Pattison, E. M. (1984). Proposal for a distinctive diagnosis: The deliberate self-harm syndrome. Suicide and Life Threatening Behavior, 14 (1), 17-35.

Kaplan, D. E., & Dubro, A. (2012). Yakuza: Japan's criminal underworld. Londen, Engeland: University of California Press.

Kaufman, J., & Charney, D. (2001). Effects of early stress on brain structure and function: implications for understanding the relationship between child maltreatment and depression. Developmental Psychopathology, 13, 451-471.

Kemperman, I., Russ, M. J., Clark, W. C., Kakuma, T., Zanine, E., & Harrison, K. (1997). Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Research, 70, 175–83.

Kerby, D. S. (2003). CART analysis with unit-weighted regression to predict suicidal ideation from Big Five traits. Personality and Individual Differences, 35, 249-261.

Klingman, A., & Hochdorf, Z. (1993). Coping with distress and self-harm: The impact of a primary prevention program among adolescents. Journal of Adolescence, 16, 121-140.

Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226-239.

Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41, 1981-1986.

Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76, 22-27.

Knoll, N., Rieckmann, N., & Schwarzer, R. (2005). Coping as a mediator between personality and stress outcomes: A longitudinal study with cataract surgery patients. European Journal of Personality, 19, 229-247.

Kraemer, H. C., Kazdin, A. E., Offord, D. R., Kessler, R. C., Jensen, P. S., & Kupfer, D. J. (1997). Coming to terms with the terms of risk. Archives of general psychiatry, 54, 337-344.

Krohne, H. W. (2003). Individual differences in emotional reactions and coping. In R.J. Davidson, H.H. Goldsmith, K.R. Scherer (Eds.), Handbook of affective sciences (pp. 698–725). New York, NY: Oxford University Press.

Krohne, H. W., & Hock, M. (2011). Anxiety, coping strategies, and the processing of threatening information: Investigations with cognitive-experimental paradigms. Personality and Individual Differences, 50, 916-925.

Larsen, R. J., & Buss, D. M. (2010). Personality psychology: Domains of knowledge about human nature (4th ed.). New York, NY: McGraw-Hill.

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, 447-457.

Lazarus, R. S. (1991). Emotion and adaptation. Oxford, Engeland Oxford University Press.

Lazarus, R. S. (2006). Emotions and interpersonal relationships: Toward a person‐centered conceptualization of emotions and coping. Journal of Personality, 74 (1), 9-46.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer.

Lerner, R. M., & Galambos, N. L. (1998). Adolescent development: challeneges and opportunities for research, programs, and policies. In J. T. Spence (Red.), Annual Review of Psychology (pp. 413-446). Palo Alto, CA: Annual Reviews.

Lewis, D. A. (1997). Development of the prefrontal cortex during adolescence: insights into vulnerable neural circuits in schizophrenia. Neuropsychopharmacology, 16, 385-398.

Lundh, L. G., Karim, J., & Quilisch, E. V. A. (2007). Deliberate self‐harm in 15‐year‐old adolescents: A pilot study with a modified version of the Deliberate Self‐Harm Inventory. Scandinavian Journal of Psychology, 48 (1), 33-41.

Lundh, L. G., Wångby-Lundh, M., Ingesson, S., & Bjärehed, J. (2010). Depressive symptoms and deliberate self-harm in a community sample of adolescents: A prospective study. Depression research and treatment, 2011. doi: 10.1155/2011/935871

Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434-445.

Luyten, P., Bruffaerts, R., Bonnewwyn, A., & Demyttenaere K. (2011). Vroege negatieve levenservaringen als risicofactoren voor psychische stoornissen doorheen de levensloop. In R. Bruffaerts , A. Bonnewyn en K. Demyttenaere (Red.), Kan geestelijke gezondheid worden gemeten?: Psychische stoornissen bij de Belgische bevolking (109-121). Leuven, België: Acco.

MacLaren, V. V., & Best, L. A. (2010). Nonsuicidal self-injury, potentially addictive behaviors, and the Five Factor Model in undergraduates. Personality and Individual Differences, 49, 521-525.

Madge, N., Hawton, K., McMahon, E. M., Corcoran, P., De Leo, D., de Wilde, E. J., ... Arensman, E. (2011). Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European Child & Adolescent Psychiatry, 20, 499-508.

Madge, N., Hewitt, A., Hawton, K., De Wilde, E., Corcoran, P., Fekete, S., … Ysgaard, M. (2008). Deliberate self-harm within an international community sample of young people: Comparative findings from the Child & Adolescents Self-harm in Europe (CASE) Study. Child Psychology and Psychiatry, 49, 667.

Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12 (1), 23-44.

McAndrew, F. T., & Garrison, A. J. (2007). Beliefs about gender differences in methods and causes of suicide. Archives of Suicide Research, 11, 271-279.

McCrae, R. R., & Costa, P. T. (2008). The five factor theory of personality. In O. P. John, R. W. Robins, & L. A. Pervin (Red.), Personality: Theory and research (pp.159-181). New York, NY: Guilford Press.

McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153, 2093-2101.

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

Messerli-Bürgy, N., Barth, J., von Känel, R., Schmid, J. P., Saner, H., & Znoj, H. (2012). Maladaptive emotion regulation is related to distressed personalities in cardiac patients. Stress and Health 28, 347-352.

Michal, M., Wiltink, J., Till, Y., Wild, P. S., Münzel, T., Blankenberg, S., & Beutel M. E. (2010). Type-D personality and depersonalization are associated with suicidal ideation in the German general population aged 35–74: Results from then Gutenberg Heart Study. Journal of Affective Disorders, 125, 227-233.

Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133, 25-45.

Mischel, W., & Shoda, Y. (1995). A cognitive-affective system theory of personality: reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological review, 102, 246-268.

Morgan H. G. (1979). Death wishes? The understanding and management of deliberate self-harm. London, Engeland: Wiley.

Muehlenkamp, J. J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28, 166-185.

Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent nonsuicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6:10.

Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self‐injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behavior, 34, 12-23.

Muehlenkamp, J. J., Kerr, P. L., Bradley, A. R., & Larsen, M. A. (2010). Abuse subtypes and nonsuicidal self-injury: Preliminary evidence of complex emotion regulation patterns. The Journal of Nervous and Mental Disease, 198, 258-263.

Muehlenkamp, J. J., Williams, K. L., Gutierrez, P. M., & Claes, L. (2009). Rates of non-suicidal self-injury in high school students across five years. Archives of Suicide Research, 13, 317-329.

Myers, R. H. (1990). Classical and modern regression with applications (2th ed.). Belmont, CA: Duxbury Press.

Najimi, S., Wegner, D. M., & Nock, M. K. (2007). Thought suppression and self-injurious thoughts and behaviors. Behaviour Research and Therapy Journal, 45, 1957-1965.

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 & Adolescent Psychiatry, 41, 1333-1341.

Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Nonsuicidal self-harm in youth: A population-based survey. Canadian Medical Association, 178, 306-312.

Nixon, M. K., & Health, N. L. (2009). Self-injury in youth: The essential guide to assessment and intervention. New York, NY: Taylor and Francis Group.

Nock, M. K. (2008). Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors. Applied Preventive Psychology, 12, 159-168.

Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and function of self-injury. Current Directions in Psychological Science, 18, 78-83

Nock, M. K. (2010). Self-injury. Annual Review Clinical Psychology, 6, 339-363.

Nock, M. K., & Banaji, M. R. (2007). Assessment of self-injurious thoughts using a behavioral test. American Journal of Psychiatry, 164, 820-823.

Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., ... Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192, 98-105.

Nock, M. K., & Cha C. B. (2009). Psychological models of nonsuicidal self-injury. In M. K. Nock (Red.), Understanding non-suicidal self-injury: Origins, assessment and treatment (pp.65-77). Washington, DC: American Psychological Association.

Nock, M. K., & Favazza, A. (2009). Nonsuicidal self-injury: definition and classification. In M. K. Nock (Red.), Understanding non-suicidal self-injury: Origins, assessment and treatment (pp.9-18). Washington, DC: American Psychological Association.

Nock, M. K., Joiner, T. E. Jr., 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, 65–72.

Nock, M. K. & Mendes, W. B. (2008). Psychological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76, 28-38.

Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885-890.

Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140-146.

Nock, M. K., Wedig, M. M., Holmberg E. B., & Hooley J. M. (2008). The emotion reactivity scale: development, evaluation, and reaction to self-injurious thoughts and behaviors. Behavioral Therapy, 39, 107-116

Norem, J. K., & Chang, E. C. (2002). The positive psychology of negative thinking. Journal of Clinical Psychology, 58, 993-1001.

O’Connor, R. C., Rasmussen, S., Miles, J., & Hawton, K. (2009). Self-harm in adolescents: Self-report survey in schools in Scotland. The British Journal of Psychiatry, 194, 68-72.

Pattison, E. M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.

Patton, G. C., Hemphill, S. A., Beyers, J. M., Bond, L., Toumbourou, J. W., McMorris, B. J., & Catalano, R. F. (2007). Pubertal stage and deliberate self-harm in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 508-514.

Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49, 1373-1379.

Penley, J. A., Tomaka, J., & Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review. Journal of Behavioral Medicine, 25, 551-603.

Perugini, M., & Di Blass, L. (2002). The Big Five Marker Scales (BFMS) and the Italian AB5C taxonomy: analyses from an emic-ethic perspective. In B. De Raad & M. Perugini (Red.), Big Five assessment (pp. 153-165). Gottingen, Duitsland: Hogrefe & Huber Publishers.

Peterson, C. (2000). The future of optimism. American Psychologist, 55, 44-55.

Plener, P. L., Libal, G., Keller, F., Fegert, J. M., & Muehlenkamp, J. J. (2009). An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychological Medicine, 39, 1549-1558.

Polman, R., Borkoles, E., & Nicholls, A R. (2010). Type D personality, stress and symptoms of burnout: The influence of avoidance coping and social support. British Journal of Health Psychology, 15, 681-696.

Portzky, G., De Wilde, E. J., & van Heeringen, K. (2008). Deliberate self-harm in young people: Differences in prevalence and risk factors between The Netherlands and Belgium. European Child & Adolescent Psychiatry, 17, 179-186.

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891.

Presaghi, F., & Ercolani, A. P. (2005, September). Validazione Italiana del Cognitive Emotion Regulation Questionnaire. Paper presented at the meeting of the national congress of Italian Association of Psychology, Experimental Psychology Session, Cagliari, Italy.

Rodham, K., & Hawton, K. (2009). Epidemiology and phenomenology of non-suicidal self-injury. In M. Nock (Red.) Understanding nonsuicidal self-injury: Origins, assessment, and treatment. Washington, DC: American Psychological Association.

Roger, D., Jarvis, G., & Najarian, B. (1993). Detachment and coping: The construction and validation of a new scale for measuring coping strategies. Personality and Individual Differences, 15, 619-626.

Romans, S. E., Martin, J. M., Gendall, K., & Herbison, G. P. (2003). Age of menarche: The role of some psychosocial factors. Psychological Medicine, 33, 933-939.

Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31 (1), 67-77.

Russ, M. J., Campbell, S. S., Kakuma, T., Harrison, K., & Zanine, E. (1999). EEG theta activity and pain insensitivity in self-injurious borderline patients. Psychiatry Research, 89, 201–214.

Sachsse, U., Von Der Heyde, S., & Huether, G. (2002). Stress regulation and self-mutilation. American Journal of Psychiatry, 159, 672-672.

Sanchez, M. M., Ladd, C. O., & Plotsky, P. M. (2001). Early adverse experience as a developmental risk factor for later psychopathology: Evidence from rodent and primate models. Developmental Psychopathology, 13, 419-449.

Sansone, R. A., Songer, D. A., & Sellbom, M. (2006). The relationship between suicide attempts and low-lethal self-harm behavior among psychiatric inpatients. Journal of Psychiatric Practice, 12, 148-152.

Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). The Self-Harm Inventory (SHI): Development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54, 973-983.

Samuel, D. B., & Widiger, T. A. (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis. Clinical Psychology Review, 28, 1326-1342.

Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219-247.

Scheier, M. F., & Carver, C. S. (1992). Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cognitive Therapy and Research, 16, 201-228.

Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063-1078.

Schreurs, P. J. G., Van de Willige, G., Brosschot, J. F., Tellegen, B., & Graus, G. M. H. (1993). De Utrechtse Coping Lijst: UCL [The Utrecht coping list: UCL]. Lisse, Nederland: Swets & Zeitlinger

Sharpe, J. P., Martin, N. R., & Roth, K. A. (2011). Optimism and the Big Five factors of personality: Beyond Neuroticism and Extraversion. Personality and Individual Differences, 51, 946-951.

Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129, 216-269.

Solberg N. L. & Segerstrom, S. C. (2006). Dispositional optimism and coping: A meta-analytic review. Personality and Social Psychology Review, 10, 235-251.

Stanford, S., & Jones, M. P. (2009). Psychological subtyping finds pathological impulsive, and ‘normal’ groups among adolescents who self-harm. Journal of Child Psychology and Psychiatry, 50, 807-815.

Svansdottir, E., van den Broek, K. C., Karlsson, H. D., Olason, D. T., Thorgilsson, H., & Denollet, J. (2013). The distressed (type D) and Five-Factor Models of personality in young, healthy adults and their association with emotional inhibition and distress. Personality and Individual Differences55, 123-128.

Swannell, S., Martin, G., Page, A., Hasking, P., Hazell, P., Taylor, A., & Protani, M. (2012). Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame. Child Abuse & Neglect, 36, 572-584.

Sweeny, K., & Shepperd, J. A. (2010). The cost of optimism and the benefits of pessimism. Emotion, 10, 750-753.

Tait, R. J., French, D. J., & Hulse, G. K. (2003). Validity and psychometric properties of the General Health Questionnaire‐12 in young Australian adolescents. Australian and New Zealand Journal of Psychiatry, 37, 374-381.

Tanner, A. K., Hasking, P., & Martin, G. (in press). Effects of rumination and optimism on the relationship between psychological distress and non-suicidal self-injury. Prevention Science, 1-9. Advance online publication. doi: 10.1007/s11121-013-0444-0

Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience Biobehavioral Review, 27, 33–44.

Thompson, P. M., Giedd, J. N., Woods, R. P., MacDonald, D., Evans, A. C., & Toga, A. W. (2000). Growth patterns in the developing brain detected by using continuum mechanical tensor maps. Nature, 404, 190-193.

Tsoh, J., Chiu, H. F., Duberstein, P. R., Chan, S. S., Chi, I., Yip, P. S., & Conwell, Y. (2005). Attempted suicide in elderly Chinese persons: A multi-group, controlled study. The American Journal of Geriatric Psychiatry, 13, 562-571.

Turner, B. J., Chapman, A. L., & Layden, B. K. (2012). Intrapersonal and interpersonal functions of non suicidal self‐injury: Associations with emotional and social functioning. Suicide and Life-Threatening Behavior, 42(1), 36-55.

Tyler, K., Melander, L., & Almazan, E. (2010). Self-injurious behavior among homeless young adults: A social stress analysis. Social Science & Medicine, 70, 269-276.

Vanderlinden, J., & Vandereycken, W. (1997). Trauma, dissociation, and impulse dyscontrol in eating disorders. Philadelphia, PA: Brunner\Mazel.

Vermulst, A. A., & Gerris, J. R. M. (2005). QBF: Quick Big Five Persoonlijkheidstest Handleiding [quick Big Five personality test manual]. Leeuwarden, The Netherlands: LDC Publications.

Vollrath, M. (2001). Personality and stress. Scandinavian Journal of Psychology, 42, 335-347.

Watson, P. D., Denny, S. J., Adair, V., Ameratunga, S. N., Clark, T. C., Crengle, S. M., ...  Sporle, A. A. (2001). Adolescents' perceptions of a health survey using multimedia computer‐assisted self‐administered interview. Australian and New Zealand Journal of Public Health25, 520-524.

Wedig, M. M., & Nock, M. K. (2007). Parental expressed emotion and adolescent self-injury. Journal. Journal of the American Child and Adolescent Psychiatry, 46, 1171-1178.

Weierich, M. R., & Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76, 39-44.

Whitlock, J., Eckenrode, J., & Silvermand, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939-1948.        

Whitlock, J., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child & Adolescent Psychology, 37, 725-735.

Whitlock, J., Muehlenkamp J. J., Purington, A., Eckenrode, J., Barreira, P., Abrams, G. B., … Knox, K. (2011). Nonsuicidal self-injury in a college population: General trends and sex differences. Journal of American College Health, 59, 691-698.

Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2011). Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42, 717-726.

Williams, L., O'Connor, R. C., Howard, S., Hughes, B. M., Johnston, D. W., Hay, J. L., & O'Carroll, R. E. (2008). Type-D personality mechanisms of effect: The role of health-related behavior and social support. Journal of Psychosomatic Research, 64 (1), 63-69.

Williams, L., & Wingate A. (2012). Type D personality, physical symptoms and subjective stress: The mediating effects of coping and social support. Psychology and Health, 27, 1075-1085.

Winnubst, J. A. M. (1996). Stressbestendigheid vereist: Feiten en fabels over stress. Deventer, Nederland: Kluwer Bedrijfwetenschappen.

World Health Organization (2010). ICD-10: International statistical classification of diseases and related health problems (10th ed.). Genève, Zwitserland: World Health Organization.

Xia, L. X., Ding, C., Hollon, S. D., & Wan, L. (2013). Self-supporting personality and psychological symptoms: The mediating effects of stress and social support. Personality and Individual Differences, 54, 408-413.

Zabin, S., Emerson, M/ R., & Rowland D. L. (2005). Childhood sexual abuse and early menarche: The direction of their relationship and its implications. Journal of Adolescent Health, 36, 393-400.

Zlotnick, C., Donaldson, D., Spirito, A., & Pearlstein, T. (1997). Affect regulation and suicide attempts in adolescent inpatients. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 793-798.

 

Universiteit of Hogeschool
Klinische en Gezondheidspsychologie
Publicatiejaar
2014
Kernwoorden
Gkiekens
Share this on: