Korean Clinical Psychology Association
[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 41, No. 1, pp.24-31
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 28 Feb 2022
Received 30 Aug 2021 Revised 12 Jan 2022 Accepted 27 Jan 2022
DOI: https://doi.org/10.15842/kjcp.2022.41.1.003

Moderating Effect of Psychological Flexibility in the Relationship between Neuroticism and Self-Harm

Chowon Park ; Myoung-Ho Hyun
Department of Psychology, Chung-Ang University, Seoul, Korea

Correspondence to: Myoung-Ho Hyun, Department of Psychology, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Korea; E-mail: hyunmh@cau.ac.kr This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that there exists no conflict of interest.

© 2022 Korean Clinical Psychology Association


Many people seek professional help because of self-harm, signaling a crisis in domestic mental health issues. Neuroticism significantly predicts self-harm through experiential avoidance as a coping strategy in response to negative stimuli. However, despite neurotic tendencies, a person with a high level of psychological flexibility may have the capacity to respond constructively to unpleasant situations or emotions. The current study measured neuroticism (K-IPIP-NEO-120), self-harm (K-SHI), and psychological flexibility (K-AAQ-II) in 551 South Korean adults (M=271, F=280, age range: 20–59 years). Results showed that psychological flexibility moderated the relationship between neuroticism and self-harm. Neuroticism significantly predicted self-harming behaviors when psychological flexibility was low or moderate, whereas high psychological flexibility prevented the risk of a connection between neuroticism and self-harm. Psychological flexibility may need to be addressed in clinical interventions and in self-harm prevention.


neuroticism, self-harm, self-injury, psychological flexibility, experiential avoidance model, escape theory

Author contributions statement

CP, a graduate student at Chung-Ang University, conceptualized the research, collected and analyzed the data, and wrote the draft of the manuscript. MHH, professor at Chung-Ang University, supervised the research process and reviewed the manuscript. All the authors provided critical feedback, participated in the revision of the manuscript, and approved the final submission.


  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing. [https://doi.org/10.1176/appi.books.9780890425596]
  • Anderson, N. L., & Crowther, J. H. (2012). Using the experiential avoidance model of non-suicidal self-injury: Understanding who stops and who continues. Archives of Suicide Research, 16, 124-134. [https://doi.org/10.1080/13811118.2012.667329]
  • Angelakis, I., & Gooding, P. (2021). Experiential avoidance in non‐suicidal self‐injury and suicide experiences: A systematic review and meta‐analysis. Suicide and Life‐Threatening Behavior, 51, 978-992. [https://doi.org/10.1111/sltb.12784]
  • Barrocas, A. L., Giletta, M., Hankin, B. L., Prinstein, M. J., & Abela, J. R. (2015). Nonsuicidal self-injury in adolescence: Longitudinal course, trajectories, and intrapersonal predictors. Journal of Abnormal Child Psychology, 43, 369-380. [https://doi.org/10.1007/s10802-014-9895-4]
  • Baumeister, R. F. (1990). Suicide as escape from the self. Psychological Review, 97, 90-113. [https://doi.org/10.1037/0033-295X.97.1.90]
  • Beckman, K., Mittendorfer-Rutz, E., Lichtenstein, P., Larsson, H., Almqvist, C., Runeson, B., & Dahlin, M. (2016). Mental illness and suicide after self-harm among young adults: Long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort. Psychological Medicine, 46, 3397-3405. [https://doi.org/10.1017/S0033291716002282]
  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., . . . Zettle, R. D. (2011). Preliminary psychometric properties of the acceptance and action questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676-688. [https://doi.org/10.1016/j.beth.2011.03.007]
  • Boyes, M. E., & French, D. J. (2009). Having a Cyberball: Using a ball-throwing game as an experimental social stressor to examine the relationship between neuroticism and coping. Personality and Individual Differences, 47, 396-401. [https://doi.org/10.1016/j.paid.2009.04.005]
  • Callahan, K. E., Stori, S. A., & Donahue, J. J. (2021). Psychological inflexibility processes and nonsuicidal self‐injury: Concurrent and prospective associations. Journal of Clinical Psychology, 77, 1394-1411. [https://doi.org/10.1002/jclp.23086]
  • Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394. [https://doi.org/10.1016/j.brat.2005.03.005]
  • Cho, Y., & Seo, D. G. (2017). Application of factor analyses and the polytomous item response theory for the acceptance and action questionnaire-II in a Korean sample of community-dwelling old adults. Korean Journal of Clinical Psychology, 36, 402-417. [https://doi.org/10.15842/kjcp.2017.36.3.010]
  • Dutra, S. J., & Sadeh, N. (2018). Psychological flexibility mitigates effects of PTSD symptoms and negative urgency on aggressive behavior in trauma-exposed veterans. Personality Disorders: Theory, Research, and Treatment, 9, 315-323. [https://doi.org/10.1037/per0000251]
  • Favaro, A., Santonastaso, P., Monteleone, P., Bellodi, L., Mauri, M., Rotondo, A., . . . Maj, M. (2008). Self-injurious behavior and attempted suicide in purging and bulimia nervosa: Associations with psychiatric comorbidity. Journal of Affective Disorders, 105, 285-289. [https://doi.org/10.1016/j.jad.2007.05.010]
  • Feng, C., Wang, H., Lu, N., Chen, T., He, H., Lu, Y., & Tu, X. M. (2014). Log-transformation and its implications for data analysis. Shanghai Archives of Psychiatry, 26, 105-109.
  • Goldberg, L. R. (1999). A broad-bandwidth, public domain, personality inventory measuring the lower-level facets of several five-factor models. Personality Psychology in Europe, 7, 7-28.
  • Gunthert, K. C., Cohen, L. H., & Armeli, S. (1999). The role of neuroticism in daily stress and coping. Journal of Personality and Social Psychology, 77, 1087-1100. [https://doi.org/10.1037/0022-3514.77.5.1087]
  • Hafferty, J. D., Navrady, L. B., Adams, M. J., Howard, D. M., Campbell, A. I., Whalley, H. C., . . . McIntosh, A. M. (2019). The role of neuroticism in self-harm and suicidal ideation: Results from two UK population-based cohorts. Social Psychiatry and Psychiatric Epidemiology, 54, 1505-1518. [https://doi.org/10.1007/s00127-019-01725-7]
  • Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E., & Bond, A. (2003). Deliberate self-harm in Oxford, 1990–2000: A time of change in patient characteristics. Psychological Medicine, 33, 987-995. [https://doi.org/10.1017/S0033291703007943]
  • Hayes, S. C., Luoma, J. B., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. [https://doi.org/10.1016/j.brat.2005.06.006]
  • Jahng, S. (2018). Development and validation of the Korean version of IPIP-NEO-300 scale and the brief version of IPIP-NEO scale [Unpublished Manuscript]. Sungkyunkwan University, Seoul, Korea.
  • Johnson, J. A. (2014). Measuring thirty facets of the five factor model with a 120-item public domain inventory: Development of the IPIP-NEO-120. Journal of Research in Personality, 51, 78-89. [https://doi.org/10.1016/j.jrp.2014.05.003]
  • Jung, G. H. (2020). 2019 National Emergency Department Information System (NEDIS) Statistical Annual Report (Report No. 7). Seoul: National Emergency Medical Center. Retrieved from https://www.e-gen.or.kr/nemc/statistics_annual_report.do
  • Kendler, K. S., Myers, J., & Reichborn‐Kjennerud, T. (2011). Borderline personality disorder traits and their relationship with dimensions of normative personality: A web‐based cohort and twin study. Acta Psychiatrica Scandinavica, 123, 349-359. [https://doi.org/10.1111/j.1600-0447.2010.01653.x]
  • Kim, S. (2017). A review of the risk and protection factors of non-suicidal self-injury. Korean Journal of Youth Studies, 24, 31-53. [https://doi.org/10.21509/KJYS.2017.]
  • Kim, S., Woo, S., Koo, H., & Lee, J. (2019). Validation of the Korean version of the self-harm inventory (K-SHI). Cognitive Behavior Therapy in Korea, 19, 205-228. [https://doi.org/10.33703/cbtk.2019.19.2.205]
  • Kline, R. B. (2015). Principles and Practice of Structural Equation Modeling (4th ed.). New York, NY: Guilford Publications.
  • Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41, 1981-1986. [https://doi.org/10.1017/S0033291710002497]
  • Kokkonen, M., & Pulkkinen, L. (2001). Extraversion and neuroticism as antecedents of emotion regulation and dysregulation in adulthood. European Journal of Personality, 15, 407-424. [https://doi.org/10.1002/per.425]
  • Krafft, J., Hicks, E. T., Mack, S. A., & Levin, M. E. (2019). Psychological inflexibility predicts suicidality over time in college students. Suicide and Life‐Threatening Behavior, 49, 1488-1496. [https://doi.org/10.1111/sltb.12533]
  • Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64, 241-256. [https://doi.org/10.1037/a0015309]
  • Landrault, H., Jaafari, N., Amine, M., Malka, G., Selimbegović, L., & Chatard, A. (2020). Suicidal ideation in elite schools: A test of the interpersonal theory and the escape theory of suicide. Suicide and Life‐Threatening Behavior, 50, 201-210. [https://doi.org/10.1111/sltb.12578]
  • Lee, K. S. (2019). Youth self-harm: Not for ‘death,’ but for ‘SOS’!! Youth Counseling Issue Paper (Report No. 2). Busan: Korea Youth Counseling and Welfare Institute. Retrieved from https://www.kyci.or.kr/fileup/issuepaper/IssuePaper_201902.pdf
  • Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3, 155-163. [https://doi.org/10.1016/j.jcbs.2014.06.003]
  • Lucas, J. J., & Moore, K. A. (2020). Psychological flexibility: Positive implications for mental health and life satisfaction. Health Promotion International, 35, 312-320. [https://doi.org/10.1093/heapro/daz036]
  • 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. [https://doi.org/10.1016/j.paid.2010.05.019]
  • Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2005). The relationship between the five-factor model of personality and symptoms of clinical disorders: A meta-analysis. Journal of Psychopathology and Behavioral Assessment, 27, 101-114. [https://doi.org/10.1007/s10862-005-5384-y]
  • McCracken, L. M., Badinlou, F., Buhrman, M., & Brocki, K. C. (2021). The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. Journal of Contextual Behavioral Science, 19, 28-35. [https://doi.org/10.1016/j.jcbs.2020.11.003]
  • McGrae, R. R., & John, O. P. (1992). An Introduction to the five‐factor model and its applications. Journal of Personality, 60, 175-215. [https://doi.org/10.1111/j.1467-6494.1992.tb00970.x]
  • Nielsen, E., Sayal, K., & Townsend, E. (2016). Exploring the relationship between experiential avoidance, coping functions and the recency and frequency of self‐harm. PLoS ONE, 11, 1-20. [https://doi.org/10.1371/journal.pone.0159854]
  • Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363. [https://doi.org/10.1146/annurev.clinpsy.121208.131258]
  • Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118, 816-827. [https://doi.org/10.1037/a0016948]
  • Paulus, D. J., Vanwoerden, S., Norton, P. J., & Sharp, C. (2016). Emotion dysregulation, psychological inflexibility, and shame as explanatory factors between neuroticism and depression. Journal of Affective Disorders, 190, 376-385. [https://doi.org/10.1016/j.jad.2015.10.014]
  • Plener, P. L., Schumacher, T. S., Munz, L. M., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation, 2, 1-11. [https://doi.org/10.1186/s40479-014-0024-3]
  • 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. [https://doi.org/10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H]
  • Spidel, A., Lecomte, T., Kealy, D., & Daigneault, I. (2018). Acceptance and commitment therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychology and Psychotherapy: Theory, Research and Practice, 91, 248-261. [https://doi.org/10.1111/papt.12159]
  • Suls, J., & Martin, R. (2005). The daily life of the garden‐variety neurotic: Reactivity, stressor exposure, mood spillover, and maladaptive coping. Journal of Personality, 73, 1485-1510. [https://doi.org/10.1111/j.1467-6494.2005.00356.x]
  • Suominen, K., Isometsä, E., Suokas, J., Haukka, J., Achte, K., & Lönnqvist, J. (2004). Completed suicide after a suicide attempt: A 37-year follow-up study. American Journal of Psychiatry, 161, 562-563. [https://doi.org/10.1176/appi.ajp.161.3.562]
  • Suyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18, 531-554. [https://doi.org/10.1016/S0272-7358(97)00105-0]
  • Tighe, J., Nicholas, J., Shand, F., & Christensen, H. (2018). Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: Systematic review. JMIR Mental Health, 5, e10732. [https://doi.org/10.2196/10732]
  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600. [https://doi.org/10.1037/a0018697]
  • Watson, D., Clark, L. A., & Harkness, A. R. (1994). Structures of personality and their relevance to psychopathology. Journal of Abnormal Psychology, 103, 18-31. [https://doi.org/10.1037/0021-843X.103.1.18]
  • Willoughby, T., Heffer, T., & Hamza, C. A. (2015). The link between nonsuicidal self-injury and acquired capability for suicide: A longitudinal study. Journal of Abnormal Psychology, 124, 1110-1115. [https://doi.org/10.1037/abn0000104]
  • Zubrick, S. R., Hafekost, J., Johnson, S. E., Sawyer, M. G., Patton, G., & Lawrence, D. (2017). The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12–17. Journal of Affective Disorders, 220, 49-56. [https://doi.org/10.1016/j.jad.2017.05.050]