Investigating the Functions and Psychological Correlates of Sexual Activity to Self-Injure (SASI) in Post-Secondary Students

Abstract Background Sexual activity as self-injury (SASI) is an emerging and underexplored concept in current research. Literature suggests that sexual behaviours may serve a function like non-suicidal self-injury (NSSI). However, there is an ongoing debate regarding SASI categorization as either a direct or indirect form of self-injury. Currently, SASI literature predominantly focuses on adolescent populations over emerging adults. Specifically, post-secondary students may be particularly prone to SASI due to increased mental health challenges and expectations of sexual exploration. Moreover, histories of sexual and physical abuse is a known risk factor for self-injurious behaviours, therefore, understanding how these factors interact with SASI can aid in developing more effective interventions. The present study aims to address the gap in literature by exploring SASI prevalence and self-reported functions in post-secondary students. Methods An anonymous cross-sectional survey was completed by 190 post-secondary students, aged 17–25, who were currently or previously sexually active. The survey included an investigator-designed SASI questionnaire, standardized measures of NSSI, abuse, self-esteem, depression, and anxiety. Participants were categorized into four groups: NSSI+SASI (n = 77), NSSI only (n = 64), SASI only (n = 26), and neither (n = 23). Analyses included descriptive statistics, one-way ANOVA and MANOVA, McNemar’s test, Spearman correlations, logistic regression, and chi-squared tests. Results Results indicate that students are significantly more likely to engage in SASI for indirect functions, such as emotional regulation, rather than direct functions ( p = .001). Abuse history was critically prevalent in SASI-reporting groups; 100% of the SASI-only group reported a history of both sexual and physical abuse. Logistic regression identified depression (OR = 1.13) and abuse (OR = 1.60) as significant predictors of SASI engagement. Conclusion This work fills a critical gap in understanding how sexual behaviours may serve self-injurious functions among emerging adults. Findings suggest that emotional distress and trauma history are primary correlates of SASI in university populations. The strong association between SASI and prior abuse highlights the need for trauma-informed mental health supports. Future research should utilize longitudinal designs and validated psychometric tools to refine the conceptualization of SASI and develop effective early-intervention strategies. Trial Registration : The study protocol and analysis plan were preregistered at (10.17605/OSF.IO/BJ3T7).