第五章 討論與建議
第六節 研究限制與建議
本研究難免有一些研究限制：（1）本研究為橫斷性研究，變項間的因果關聯 難確定，建議未來研究可進行縱貫性研究；（2）研究參與者僅為高中、職學生，
因而無法將研究結果推論到其他年齡，建議未來研究能納入不同年齡層之研究參 與者；（3）本研究利用自陳式量表來測量相關變項，可能受研究參與者是否誠實 填答或相關個人因素影響，造成反應上有所偏誤或誤差，因此建議未來研究可利 用多元衡鑑的方式，例如加入晤談（interview）的方式當作效度檢證，或是加入 如家人或同學/好友等客觀觀察者的資料，以提供更精確的分析；（4）由於本研 究為了檢證述情障礙是否能中介不良家庭功能對自傷行為之影響，因此僅納入家 庭功能與述情障礙等兩個變項，故整體解釋量有限，建議未來能納入更多變項，
以提升整體模式的解釋力。
本研究發現目前臺灣高中、職學生的自傷行為盛行率較國外高，且自傷行為 是自殺行為非常重要的預測因子，因此高中職學生自傷行為之預防、輔導及諮商，
值得教育工作者投注更多的心力。此外，本研究也發現不良家庭功能對自傷行為 有直接影響外，亦部份透過述情障礙來影響自傷行為，因此健全家庭功能，並且 針對高風險家庭或不良家庭功能之家庭的學生，來進行發展行輔導與介入性輔導，
對於自傷行為之防治，將有其良好成效。
依據本研究之發現，研究者建議若能增進與促進：（一）家庭成員間所感受 到的信任感及支持度；（二）家庭成員彼此適當表達情感並了解所表達的情感；（三）
家庭成員間直接表達出個人想法與意見且被瞭解；（四）家庭面對外界新的刺激 挑戰時具備好的因應歷程與適應能力；（五）家庭成員間高的自主性；（六）家庭 成員有其特定的角色並接受與盡其應有的責任；並且，降低：（一）家庭中所表 達出的憤怒、批評、攻擊及衝突；（二）過度的關心、造成彼此的壓力與負擔，
相信將有助於預防與降低臺灣高中職學生述情障礙之傾向以及自傷行為之發 生。
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實務上，有效介入改變高中職學生家庭功能之難度較高，但若能聚焦於改變 高中職學生的述情障礙來進行輔導與諮商，則對於自傷行為之防治，將有其良好 成效。另外，過往研究已發現，正念訓練（mindfulness training）對於述情障礙 的改善具有正面效果（Stasiewicz et al., 2012），因為正念訓練是一種注意力的訓 練，並以非評價的方式，主動地指揮我們的心（Mind）去觀察分分秒秒的心智 活動歷程，包含想法、感受及行為，而後進行討論，因此對於改善述情障礙具有 良好效果。當學生能夠主動辨識、描述個人情緒後，得以習得彈性調節情緒之策 略，進而有機會減少自我傷害行為之發生。
總而言之，本研究結果帶來理論與實務之意涵，可供後續研究者、教育與助 人工作者及家長參考，以協助學生培養良好的情緒調控策略和技巧、健全良好的 家庭功能，以減低自我傷害行為的發生。
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參考文獻
中文部分
王淑惠（2001）。由家庭功能與性格特質探討婦女憂慮焦慮之共病現象。國立成 功大學醫學院行為醫學研究所碩士論文。
林志哲（2014）。感恩、社會支持及幸福感之研究：中介效果模式之驗證。中華 心理衛生學刊，27（3），453-482。
林育臣、陳展航（2006）。綜合醫院非精神科門診病患情感表達不能特質。台灣 精神醫學，20（4），272-278。
林耀盛、李仁宏、吳英璋（2006）。雙親教養態度、家庭功能與青少年憂鬱傾向 關係探討。臨床心理學刊，3（1），35-45。
邱郁雯（2003）。家庭功能、父母管教態度對 4-6 歲學齡前兒童行為與情緒問題 之影響。國立成功大學行為醫學研究所碩士論文。
涂慧慈、鄭其嘉、黃翠咪、林雪蓉、史麗珠（2013）。青少年自殺之流行病學研 究－以台灣北部某縣市為例。澄清醫護管理雜誌，9（4），37-49。
教育部校園安全暨災害防救通報處理中心（2006）。教育部九十四年各級學校校 園統計分析報告。取自教育部校園安全暨災害防救通報處理中心資訊網：
http://140.111.1.166/%E7%9B%B8%E9%97%9C%E7%B6%B2%E9%A0%81
%E9%80%A3%E7%B5%90/94%E5%B9%B4%E5%90%84%E7%B4%9A%E5
%AD%B8%E6%A0%A1%E6%A0%A1%E5%9C%92%E4%BA%8B%E4%BB
%B6%E7%B5%B1%E8%A8%88%E5%88%86%E6%9E%90%E5%A0%B1%E 5%91%8A.pdf，2006 年 12 月。
教育部校園安全暨災害防救通報處理中心（2014）。教育部 101 年各級學校校園
安全及災害事件統計分析報告（簡版）。取自教育部校園安全暨災害防救通
報處理中心資訊網：
63
https://csrc.edu.tw/Content/FileManageFiles/20150213040942-102 年各級學校 校園安全及災害事件統計分析報告（簡版）.pdf，2014 年 12 月。
程炳林（2003）。四向度目標導向模式之研究。師大學報：教育類，48（1），15-40。
劉惠青、劉珣瑛、黃郁心、鍾嫈嫈、方俊凱（2011）。北台灣高中職學生自傷盛 行率及其危險因子之研究。臺灣家庭醫學雜誌，21，27-39。
蕭淑惠、陳若琳（2010）。小高年級學童知覺家庭功能與家庭滿意度之相關研究。
輔仁民生學誌，16，95-110。
蘇宗偉、邱震寰、郭千哲、陳喬琪、李明濱（2005）。自殺之流行病學研究。北 市醫學雜誌，2，6-15。
64
西文部分
Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39, 389-400. doi: 10.1007/s10802-010-9465-3
Alfonso, M. L., & Kaur, R. (2012). Self-Injury among early adolescents: Identifying segments protected and at risk. Journal of School Health, 82, 537-547. doi:
10.1111/j.1746-1561.2012.00734.x
Asgeirsdottir, B. B., Sigfusdottir, I. D., Gudjonsson, G. H., & Sigurdsson, J. F. (2011).
Associations between sexual abuse and family conflict/violence, self-injurious behavior, and substance use: The mediating role of depressed mood and anger.
Child Abuse and Neglect, 35, 210-219. doi: 10.1016/j.chiabu.2010.12.003
Aust, S. Hartwig, E. A., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 225-232. doi: 10.1037/a0027314
Baetens, I., Claes, L., Martin, G., Onghena, P., Grietens, H., Leeuwen, K. V., ...
Griffith J. W. (2014). Is nonsuicidal self-injury associated with parenting and family factors? Journal of Early Adolescence, 34, 387-405. doi:
10.1177/0272431613494006
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical
considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
doi: 10.1037/0022-3514.51.6.1173
Borrilla, J., Foxb, P., Flynna, M., & Roger, D. (2009). Students who self-harm:
coping style, rumination and alexithymia. Counselling Psychology Quarterly, 22,
65
361-372. doi: 10.1080/09515070903334607
Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples:
Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68(4), 609-620. doi: 10.1037/h0080369
Bureau, J., Martin, J., Freynet, N., Poirier, A. A., Lafontaine, M., & Cloutier, P.
(2010). Perceived dimensions of parenting and non-suicidal self-injury in young adults. Journal Youth Adolescence, 39, 484-494. doi:
10.1007/s10964-009-9470-4
Cheung, Y. T. D., Wong, P. W. C., Lee, A. M., Lam, T. H., Fan, Y. S. S., & Yip, P. S.
F. (2013). Non-suicidal self-injury and suicidal behavior: Prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong.
Social Psychiatry and Psychiatric Epidemiology, 48, 1133-1144. doi:
10.1007/s00127-012-0640-4
Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents:
Prevalence and associations with identity formation above and beyond depression. Personality and Individual Differences, 61-62, 101-104. doi:
10.1002/erv.2341
Conterio, K., & Lader, W. (1998). Bodily harm: The breakthrough healing program for self-injurers. New York, NY: Hyperion.
Crowell, S. E., Beauchaine, T. P., McCauley, E., Smith, C. J., Vasilev, C. A., &
Stevens, A. L. (2008). Parent-child interactions, peripheral serotonin, and self-inflicted injury in adolescents. Journal of Consulting and Clinical Psychology, 78, 15–21. doi: 10.1037/0022-006X.76.1.15
Garisch, J. A., & Wilson M. S. (2010). Vulnerabilities to deliberate self-harm among adolescents: The role of alexithymia and victimization. British Journal of Clinical Psychology, 49, 151-162. doi: 10.1348/014466509X441709
66
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, 79, 238–250. doi: 10.1037/0002-9432.76.2.238
Halstead, R. O., Pavkov, T. W., Hecker, L. L., & Seliner, M. M. (2014). Family dynamics and self-injury behaviors: A correlation analysis. Journal of Marital and Family Therapy, 40, 246-259. doi: 10.1111/j.1752-0606.2012.00336.x
Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32, 482-496. doi:
10.1016/j.cpr.2012.05.003
Hsu, Y. F., Chen, P. F., & Lung, F. W. (2013). Parental bonding and personality
characteristics of first episode intention to suicide or deliberate self-harm without a history of mental disorders. BMC Public Health, 13, 1-8. doi:
10.1186/1471-2458-13-421
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55. doi:
10.1080/10705519909540118
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. doi:
10.1080/13811110701247602
Kench, S., & Irwin H. J. (2000). Alexithymia and childhood family environment.
Journal of Clinical Psychology, 56(6), 737-745. doi:
10.1002/(SICI)1097-4679(200006)56:6<737::AID-JCLP4>3.0.CO;2-U
67
King, J. L., & Mallinckrodt, B. (2000) .Family environment and alexithymia in clients and non-clients. Psychotherapy Research, 10, 78-86. doi: 10.1080/713663595 Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between
nonsuicidal self-Injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122, 231-237. doi: 10.1037/a0030278 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. doi: 10.1037/0022-006X.76.1.22
Ko, H. C., Lin, M. P., Liao, L. C., Yu, R. L., Su, L. C., & Chang, E. W. C. (2004). The prevalence and psychosocial risk factors for Internet addiction among college students in Taiwan. Paper presented at the 1st Asia Pacific Institute of Addictions Conference, Singapore.
Lambert, A., & Man, A. F. (2007). Alexithymia, depression, and self-mutilation in adolescent girls. North American Journal of Psychology, 9, 555-566.
Levant, R. F., Allen, P. A., & Lien, M. (2014). Alexithymia in men: How and when do emotional processing deficiencies occur? Psychology of Men and Masculinity, 15, 324–334.
Levant, R. F., Hall, R. J., Williams, C. M., & Hasan, N. T. (2009). Gender differences in alexithymia. Psychology of Men and Masculinity, 10, 190–203. doi:
10.1037/a0015652
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V.
(2002). A comparison of methods to test mediation and other intervening variable effect. Psychological Methods, 7, 83-104. doi: 10.1207/s15327906mbr4001_1 Mallinckrodt, B., King, J. L., & Coble, H. M. (1998). Family dysfunction, alexithymia,
68
and client attachment to therapist. Journal of Counseling Psychology, 45, 497-504. doi: 10.1037/0022-0167.45.4.497
Martens, M. P. (2005). The use of structural equation modeling in counseling psychology research. The Counseling Psychologist, 33, 269-298. doi:
10.1177/0011000004272260
Nixon, M. K., Cloutier , P., & Jansson S. M. (2008). Nonsuicidal self-harm in youth:
A population-based survey. Canadian Medical Association Journal, 178, 306-312. doi: 10.1503/cmaj.061693
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18, 78-83. doi: 10.1111/j.1467-8721.2009.01613.x
Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.
doi: 10.1146/annurev.clinpsy.121208.131258
Nock, M. K., Joiner, T. E., 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. doi:
10.1016/j.psychres.2006.05.010
Nock, M. K., & Mendes, W. B. (2008). Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. Journal of
Consulting and Clinical Psychology, 76, 28-38. doi: 10.1037/0022-006X.76.1.28
Paivio, S. C., & McCulloch, C. R. (2004). Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse and Neglect, 28, 339-354. doi: 10.1016/j.chiabu.2003.11.018
Parker, J. D. A., Talor, G. J., & Bagby, R. M. (2003). The 20-item Toronto Alexithymia Scale III. Reliability and factorial validity in a community population. Journal of Psychosomatic Research, 55, 269-275. doi:
69
10.1016/S0022-3999(02)00578-0
Peters R. M., & Lumley, M. A. (2007). Relationship of alexithymia to cardiovascular disease risk factors among African Americans. Comprehensive Psychiatry, 48, 34-41. doi: 10.1016/j.comppsych.2006.03.007
Pierro, R. D., Sarno, I., Perego, S., Gallucci, M., & Madeddu, F. (2012). Adolescent nonsuicidal self-injury: The effects of personality traits, family relationships and maltreatment on the presenceand severity of behaviours. European Child and Adolescent Psychiatry, 21, 511-520. doi: 10.1007/s00787-012-0289-2
Polk, E., & Liss, M. (2007). Psychological characteristics of self-injurious behavior.
Personality and Individual Differences, 43, 567–577. doi:
10.1016/j.paid.2007.01.003
Scarpazza, C., Pellegrino, G., & Lãdavas, E. (2014). Emotional modulation of touch in alexithymia. Emotion, 14, 602-610. doi: 10.1037/a0035888
Selekman, M. D. (2002). Living on the Razor’s Edge. New York, NY: W.W. Norton &
Company.
Solomon, Y., & Farrand, J. (1996). Why don’t you do it properly: Young women who self-injure. Journal of Adolescence, 19, 111-119. doi: 10.1006/jado.1996.0011 Stasiewicz, P. R., Bradizza, C. M., Gudleski, G. D., Coffey, S. F., Schlauch, R. C.,
Bailey, S. T., ...Gulliver, S. B. (2012). The relationship of alexithymia to
emotional dysregulation within an alcohol dependent treatment sample. Addictive Behaviors, 37, 469-476. doi: 10.1016/j.addbeh.2011.12.011
Spears, M., Montgomery, A. A., Gunnell, D., & Araya, R. (2013). Factors associated with the development of self-harm amongst a socio-economically deprived cohort of adolescents in Santiago, Chile. Social Psychiatry and Psychiatric Epidemiology, 49, 629-637. doi: 10.1007/s00127-013-0767-y
70
Suyemoto, K. L., & MacDonald, M. L. (1995). Self-cutting in female adolescents.
Psychotherapy, 32, 162–171.
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 and Neglect, 36, 572-584. doi: 10.1016/j.chiabu.2012.05.005
Tahir, I., Ghayas, S., & Tahir, W. (2012). Personality traits and family size as the predictors of alexithymia among university undergraduates. Journal of Behavioural Sciences, 22,104-119.
Tang, J., Yu, Y., Wu, Y., Do, Y., Ma, Y., Zhu, H., … Liu, Z. (2011). Association between non-suicidal self-injuries and suicide attempts in Chinese adolescents and college students: A cross-section study. Plos One, 6, 1-6. doi:
10.1371/journal.pone.0017977
Thorberg, F. A., Young, R. McD., Sullivan, K.A., & Lyvers, M. (2011). Parental bonding and alexithymia: A meta-analysis. European Psychiatry, 26, 187-193.
doi: 10.1016/j.eurpsy.2010.09.010
Tominaga, T., Choi, H., Nagoshi, Y., Wada, Y., & Fukui, K. (2014). Relationship between alexithymia and coping strategies in patients with somatoform disorder.
Neuropsychiatric Disease and Treatment, 10, 55-62. doi: 10.2147/NDT.S55956 Victor, E. S., & Klonsky E. D. (2014). Daily emotion on non-suicidal self-injury.
Journal of Clinical Psychology, 70(4), 365-375. doi: 10.1002/jclp.22037
Yates, T. M. (2004). The developmental psychopathology of self-injurious behavior:
Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24, 35-74. doi: 10.1016/j.cpr.2003.10.001
Yates, T. M., Tracy, A. J., & Luthar, S. S. (2008). Nonsuicidal self-injury among
“privileged” youths: Longitudinal and cross-sectional approaches to
71
developmental process. Journal of Consulting and Clinical Psychology, 76, 52-62. doi: 10.1037/0022-006X.76.1.52
You, J., & Leung, F. (2012). The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: A 2-year follow-up study. Journal of Adolescence, 35, 389-395. doi: 10.1016/j.adolescence.2011.07.020
You, J., Leung, F., & Fu, K. (2012). Exploring the reciprocal relations between nonsuicidal self-injury, negative emotions and relationship problems in Chinese adolescents: A longitudinal cross-lag study. Journal of Abnormal Child
Psychology, 40, 829-836. doi: 10.1007/s10802-011-9597-0
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附錄三 自傷行為量表
從 不
一 次
二 次
三 次
四 次
五 次 以 上
1.割傷自己 0 1 2 3 4 5
2.燒傷自己 0 1 2 3 4 5
3.用尖銳物體在皮膚上刻字或圖案以致流血 0 1 2 3 4 5 4.嚴重抓傷自己以致出血或留疤痕 0 1 2 3 4 5 5.將尖銳的物體，如針、鋼釘、訂書釘等插入皮膚或指甲 0 1 2 3 4 5
6.使勁拽頭髮 0 1 2 3 4 5
7.咬傷自己 0 1 2 3 4 5
8.猛烈摩擦皮膚以致流血 0 1 2 3 4 5
9.用酸性液體腐蝕皮膚 0 1 2 3 4 5
10.用漂白劑或清潔劑擦洗皮膚 0 1 2 3 4 5 11.猛烈碰撞頭部或其他身體部位以致瘀傷 0 1 2 3 4 5
12. 拳打自己以致瘀傷 0 1 2 3 4 5