High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents

A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

Childhood maltreatment and non-suicidal self-injury in adolescent population: A systematic review and meta-analysis

BACKGROUND

Non-suicidal self-injury (NSSI) is highly prevalent among adolescents. However, knowledge about the possible factors that might precede and influence its development remains scarce.

OBJECTIVE

Our goal is to examine the impact of adverse childhood events, and more specifically of different types of childhood maltreatment (CM) in adolescent NSSI. This involves performing a systematic review and meta-analysis of the different CM subtypes (physical and emotional neglect, physical and emotional abuse, sexual abuse) in clinical and non-clinical samples of adolescents with NSSI.

PARTICIPANTS AND METHODS

A digital search of the PsycInfo, PubMed and Web of Science platforms for articles published up to June 2022 was performed. The search terms were "self harm", "non-suicidal self-injury", "childhood maltreatment" and "adolescents".

RESULTS

Forty-six articles that fit the research objectives were included in the study, which covered a total of 1,505,430 adolescents, of whom 560,337 belonged to the NSSI group, while 945,093 were in the control group. The results describe strong positive associations between all CM subtypes and NSSI, especially with emotional abuse (odds ratio [OR] 2.91, 95 % CI 2.37-3.56) and sexual abuse (OR 2.72, 95 % CI 2.12-3.48), in clinical and non-clinical samples of adolescents.

CONCLUSIONS

The experience of CM, and especially emotional and/or sexual abuse, seems to be associated with a greater risk of developing NSSI in adolescence. Therefore, early identification and detection of children who have suffered or are suffering these forms of CM are of vital importance for instigating psychotherapeutic treatments that can minimize the risk of developing NSSI in adolescence.

Effect of Parenting Style, attachment to parents and self-compassion on the occurrence and recovery motivation for non-suicidal self-injury in adolescents

Background

Non-suicidal self-injury (NSSI) is a worldwide mental health problem that deserves thorough investigation. This study aims to explore the effect of parenting styles, attachment to parents, and self-compassion on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents and whether these factors influence their recovery motivation.

Methods

A total of 132 adolescents who had engaged in NSSI within the last year and 72 adolescents who had never engaged in NSSI were recruited from the Shenzhen Kangning Hospital and from primary and secondary schools and communities. Differences in the Hamilton Depression Scale (HAMD), Inventory of Parent and Peer Attachment (IPPA), Egma Minn av. Bardndosnauppforstran (EMBU), and Self-Compassion Scale (SCS) of participants were compared. A binary logistic model was established to measure the odds ratios of these variables on the occurrence of NSSI. In the NSSI adolescent sample, separate binary logistic models were created with NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation as dependent variables and with parenting styles, attachment to parents, and self-compassion as independent variables.

Results

Compared with adolescents with no NSSI behavior, those who had engaged in NSSI within the past year had higher scores on the HAMD, as well as higher EMBU-negative father parental behavior (punishment, excessive interference, rejection, and overprotection), EMBU-negative mother parental behavior (excessive interference, rejection, and punishment), and SCS negative self-compassion scores. Moreover, adolescents with NSSI had lower EMBU-father emotional warmth, EMBU-mother emotional warmth, IPPA-attachment to father, IPPA-attachment to mother, and SCS positive self-compassion scores. Current depressive symptoms and maternal punishment are risk factors for NSSI in adolescents, while positive self-compassion was a protective factor. Positive self-compassion can positively predict NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation. However, we unexpectedly found that the father's emotional warmth negatively predicts NSSI resistance activity.

Conclusion

This study found that positive self-compassion has a significant impact on the prevention of and recovery from NSSI behavior in adolescents.

Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults

BACKGROUND

Non-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement.

METHODS

We characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18-30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image.

RESULTS

TGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific.

LIMITATIONS

The OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups.

CONCLUSIONS

Interventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

Does Bullying Victimization Accelerate Adolescents' Non-suicidal Self-injury? The Mediating Role of Negation Emotions and The Moderating Role of Submissive Behavior

Based on general strain theory, the current study examined whether bullying victimization was significantly related to adolescents' non-suicidal self-injury and whether negation emotions mediated this association and submissive behavior moderated this mediation process. A total of 1,984 adolescents completed a series of anonymous questionnaires regarding bullying victimization, negative emotions, non-suicidal self-injury, and submissive behavior. Results showed that bullying victimization was significantly and positively associated with non-suicidal self-injury and this relation was partially mediated by negative emotions. Submissive behavior moderated the relation between bullying victimization and non-suicidal self-injury as well as negation emotions and non-suicidal self-injury. Specifically, the victims of bullying with high submissive behavior were more likely to develop non-suicidal self-injury. Adolescents who had higher negative emotions were at greater risk of engaging in non-suicidal self-injury when they also had high submissive behavior. The positive association between negative emotions and non-suicidal self-injury was stronger in females than males.

Emotional and interpersonal states following dialectical behavioral therapy in adolescent borderline personality disorder: A proof-of-concept ecological momentary assessment outcome study

Objective: The effects of Dialectical Behavioral Therapy for Adolescents (DBT-A) on emotional and interpersonal instability were explored in adolescents exhibiting Borderline Personality Disorder (BPD) features, using ecological momentary assessment (EMA) to reduce recall bias.Method: N = 28 help-seeking female adolescents were enrolled, meeting ≥ 3 DSM-IV BPD criteria. BPD criteria, non-suicidal self-injury (NSSI), and depressive symptoms were examined pre- and post-DBT-A treatment (mean duration: 42.74 weeks, SD = 7.46). Participants maintained e-diaries pre- and post-treatment, hourly rating momentary affect, attachment to mother and best friend, and self-injury urges.Results: Interview-rated BPD symptoms decreased (χ²(1) = 5.66, p = .017), alongside reduced self-rated depression severity (χ²(1) = 9.61, p = .002). EMA data showed decreased NSSI urges (χ²(1) = 9.05, p = .003) and increased mother attachment (χ²(1) = 6.03, p = .014). However, mean affect, affective instability, mean attachment to the best friend, and attachment instability showed no significant change over time.Conclusion: DBT-A yielded limited evidence for altering momentary affective states and instability in adolescents based on EMA. Nevertheless, significant effects were observed in reducing NSSI urges and enhancing interpersonal dynamics during treatment, as assessed via EMA.

The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis

Background & Aims

Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis.

Methods

The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary.

Conclusion

This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.

Diurnal variation of cardiac autonomic activity in adolescent non-suicidal self-injury

Heart rate (HR) and vagally mediated heart rate variability (HRV) are two distinct biomarkers of cardiac autonomic activity. Decreased cardiac vagal activity (or decreased HRV) in particular has been linked with impairments in the functional flexibility of the central autonomic network (CAN), resulting in impaired stress and emotion regulatory capacities. Decreased HRV is widely used as trait marker of psychopathology. Repetitive engagement in non-suicidal self-injury (NSSI) in adolescence correlates with both deficits in stress and emotion regulation, as well as decreased HRV. Existing research has, however, focused on short-term recordings of HR and HRV under resting and phasic conditions. In this study, we examined whether diurnal variation of cardiac autonomic activity, indexed by cosinor parameters of HR and HRV derived from 48 h of ambulatory ECG recording under natural conditions over a weekend, are altered in female adolescents with NSSI disorder compared to controls (HC; N = 30 per study group). Several important confounds, including physical activity, were controlled for. Female adolescents with NSSI show higher rhythm-adjusted 24 h mean levels and greater respective amplitude of HR, as well as lower rhythm-adjusted 24 h mean levels and smaller respective amplitude of HRV. Peak levels in both HR and HRV in the NSSI group were reached approximately 1 h later compared to HC. Severity of exposure to early life maltreatment might be linked with altered amplitudes of 24 h HR and HRV. Diurnal rhythms of cardiac autonomic activity might hold promise as objective indicators of disordered stress and emotion regulation in developmental psychopathology, and as such should be investigated in future studies with rigorous assessment and control of potential confounds.

Testing Suicide Ideation-to-Action Theory Differences Among Those With Nonsuicidal Self-Injury

OBJECTIVE

Individuals with recent nonsuicidal self-injury (NSSI) are at elevated risk for suicide but our understanding of the factors that impact the emergence of suicidal ideation and/or suicide attempts in this group is limited. The current study aimed to evaluate whether the processes identified by existing ideation-to-action theories of suicide apply within this subgroup.

METHOD

A sample of 362 university students (77.9% female, 88.5% White) who reported past year engagement in NSSI completed an anonymous online questionnaire assessing past year NSSI, suicidal ideation, and suicide attempts as well as hopelessness, interpersonal, and acquired capability/volitional variables. Participants were divided into NSSI only (controls), NSSI + Ideation, and NSSI + Suicide Attempt groups.

RESULTS

A one-way ANOVA evaluated group differences on the theoretical factors. There were significant differences between NSSI controls and both the ideation and attempt groups, who did not differ from each other, on hopelessness and interpersonal factors. No significant differences were observed across groups for the volitional factors except for impulsivity, which differed between the NSSI controls and ideation group.

CONCLUSION

Results suggest suicide ideation-to-action theories may have applicability to understanding the presence of suicide ideation among those with NSSI but may lack specificity for understanding risk for suicide attempts.

Assessing affect in adolescents with e-diaries: multilevel confirmatory factor analyses of different factor models

In the last two decades, e-diary studies have gained increasing interest, with a dominant focus on mood and affect. Although requested in current guidelines, psychometric properties are rarely reported, and methodological investigations of factor structure, model fit, and the reliability of mood and affect assessment are limited. We used a seven-day e-diary dataset of 189 adolescent participants (12-17  years). The e-diary affect assessments revealed a considerable portion of within-person variance. The six-factor model showed the best model fit compared to the less complex models. Factor loadings also improved with the complexity of the models. Accordingly, we recommend that future e-diary studies of adolescents use the six-factor model of affect as well as reporting psychometric properties and model fit. For future e-diary scale development, we recommend using a minimum of three items per scale to enable the use of confirmatory multilevel factor analyses.

Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis

BACKGROUND

Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person's overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person's daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated.

OBJECTIVE

This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD.

METHODS

A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features.

RESULTS

In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates.

CONCLUSIONS

Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.

Does Being Ignored on WhatsApp Hurt? A Pilot Study on the Effect of a Newly Developed Ostracism Task for Adolescents

(1) Background: Many studies have used a well-known social exclusion task, namely Cyberball, to assess the psychophysiological reactions to ostracism in laboratory settings. However, this task has been recently criticized for its lack of realism. Instant messaging communication platforms are currently central communication channels where adolescents conduct their social life. These should be considered when recreating the emotional experiences that fuel the development of negative emotions. To overcome this limitation, a new ostracism task, namely SOLO (Simulated On-Line Ostracism), recreating hostile interactions (i.e., exclusion and rejection) over WhatsApp was developed. The aim of this manuscript is to compare adolescents' self-reported negative and positive affect, as well as physiological reactivity (i.e., heat rate, HR; heart rate variability, HRV) exhibited during SOLO to Cyberball. (2) Method: A total of 35 participants (Mage = 15.16; SD = 1.48; 24 females) took part in the study. The first group (n = 23; transdiagnostic group), recruited at an inpatient and outpatient unit of a clinic for children and adolescent psychiatry, psychotherapy, and psychosomatic therapy in Baden-Württemberg (Germany), reported clinical diagnoses linked with emotional dysregulation (e.g., self-injury and depression). The second group (n = 12; control group), recruited in the district of Bavaria and Baden-Württemberg, had no pre-existing clinical diagnoses. (3) Results: The transdiagnostic group showed higher HR (b = 4.62, p < 0.05) and lower HRV (b = 10.20, p < 0.01) in SOLO than in Cyberball. They also reported increased negative affect (interaction b = -0.5, p < 0.01) after SOLO but not after Cyberball. In the control group, no differences in either HR (p = 0.34) or HRV (p = 0.08) between tasks were found. In addition, no difference in negative affect after either task (p = 0.83) was found. (4) Conclusion: SOLO could be an ecologically valid alternative to Cyberball when assessing reactions to ostracism in adolescents with emotional dysregulation.

Does self-harm have the desired effect? Comparing non-suicidal self-injury to high-urge moments in an ambulatory assessment design

All theoretical models of non-suicidal self-injury (NSSI) posit that regulation of negative affect (NA) is a central motive for NSSI, and cross-sectional work supports this. However, previous ambulatory assessment (AA) studies that examined NSSI found mixed results. We investigated the affect regulation function of NSSI in 51 women with DSM-5 NSSI disorder in a 15-day AA study with five random daily prompts and self-initiated NSSI prompts. We extend previous work by i) comparing NSSI moments to moments of a high-urge for NSSI, ii) adding high-frequency sampling following NSSI and high-urge moments, and iii) including tension as a dependent variable. We hypothesized that NA and tension would show a steeper decrease following NSSI than following high-urge moments, if NSSI was effective in reducing NA and tension. Results showed that the significant linear NA decline following NSSI was not steeper than that following high-urge moments. For aversive tension, we found that NSSI was associated with a significant linear decrease in tension, whereas resisting an urge was not. High-urge moments were better described by an inverted U-shaped pattern, likewise leading to decreased NA and tension following the reported urge. In exploratory analyses, we provide visualized clustering of the NA and tension trajectories surrounding NSSI using k-means and relate these to participants' self-rated effectiveness of the NSSI events. Findings indicate that resisting an urge may also be effective in managing NA and tension and underline the utility of interventions such as urge-surfing.

Early Intervention for Personality Disorder

Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.

Emotional Reactivity and Inhibitory Control in Nonsuicidal Self-Injury Adolescence: Divergence Between Positive and Negative Emotions

Nonsuicidal self-injury (NSSI) is prevalent in adolescents and is often linked to emotion dysregulation. However, it remains unknown which specific processes of emotion regulation and under what emotional context these processes are related to the risk for NSSI in samples of community-based adolescents. This study used two laboratory tasks to examine whether adolescents with a history of NSSI displayed difficulties in emotional reactivity and inhibitory control in response to negative and positive emotions. In Study 1, adolescents with/without a history of NSSI (N = 64; M_Age = 13.45 ± 0.50; 53% female) completed a picture perception task in which they were asked to judge the valence and arousal of images. In Study 2, adolescents with/without a history of NSSI (N = 74; M_Age = 13.49 ± 0.80; 50% female) were given a two-choice emotional oddball task that required them to differentially respond to frequent stimuli (images of an object) and infrequent stimuli (affective images). The results showed that adolescents with a history of NSSI showed decreased emotional sensitivity and lower levels of inhibitory control in response to images depicting negative emotional content but not to those depicting positive emotional content. Furthermore, affective inhibitory control problems were significantly positively related to the severity of NSSI, especially in the context of negative emotions. These findings suggest that there is a divergence between positive and negative emotions in both emotional reactivity and affective inhibitory control processes on NSSI. Specifically, relative to adolescents with no history of NSSI, adolescents with a history of NSSI showed lower emotional awareness and behavioral inhibitory control when processing negative emotions, but these distinctions were not found in contexts involving positive emotions. Additionally, the results suggest that affective inhibitory control deficits specific for negative emotions may result in vulnerability to increased NSSI severity.

Affective states and nonsuicidal self-injury (NSSI): Results from an ecological momentary assessment study of veterans with NSSI disorder

BACKGROUND

The affective states most strongly associated with nonsuicidal self-injury (NSSI) remain poorly understood, particularly among veterans. This study used ecological momentary assessment (EMA) to examine relationships between affect ratings and NSSI urges and behaviors among veterans with NSSI disorder.

METHODS

Participants (N = 40) completed EMA entries via mobile phone for 28 days (3722 total entries). Entries included intensity ratings for five basic affective states, as well as NSSI urges and behaviors, during the past 4 hours.

RESULTS

Bivariate analyses indicated that each affect variable was significantly associated with both NSSI urges and behaviors. Angry/hostile and sad were most strongly associated with both NSSI urges and behaviors. A multivariate regression revealed that angry/hostile, disgusted with self, and happy (inversely related) were contemporaneously (within the same period) associated with NSSI behaviors, whereas all five basic affective states were contemporaneously associated with NSSI urges. In a lagged model, angry/hostile and sad were associated with subsequent NSSI urges but not behaviors.

CONCLUSIONS

Findings highlight the relevance of particular affective states to NSSI and the potential utility of targeting anger in treatments for NSSI among veterans. There is a need for future EMA research study to further investigate temporal relationships between these variables.

[A Multidimensional Assessment of Emotion Regulation in Adolescent Non-Suicidal Self-Injury]

The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility

Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

A test of the interpersonal function of non-suicidal self-injury in daily life

Theoretical models of non-suicidal self-injury (NSSI) posit that individuals use NSSI to influence others, but this remains largely untested. We used ambulatory assessment to test the interpersonal function of NSSI in the daily lives of 51 women with DSM-5 NSSI disorder. Participants reported NSSI events, urges, motives, and positive/negative interpersonal events (IPEs) for 14 days, providing five semi-random daily assessments and event-related NSSI reports. We analyzed 3,498 data-points, including 155 NSSI events, using multilevel models. We observed a positive concurrent association between the number of negative IPEs and NSSI engagement. Additionally, perceived distress of negative IPEs was positively associated with concurrent NSSI events and urges, and predicted later events. We saw no reduction in negative or increase in positive IPEs following NSSI. In a trait-level interview, participants endorsed interpersonal motives only minimally, but indicated that others often trigger NSSI. In daily life, participants rarely endorsed the motive 'get help/attention'. The results suggest that negative IPEs trigger NSSI, but that individuals in this sample rarely used NSSI for interpersonal motives and did not experience interpersonal reinforcement of NSSI. We discuss limitations of and possible solutions for under-reporting of interpersonal motives and benefits of studying interpersonal triggers (rather than outcomes) in future studies.

Self-harm in the context of borderline personality disorder

The present article gives a selective overview of recent studies on the role of nonsuicidal self-injury (NSSI) and suicidal behavior in the context of borderline personality disorder (BPD). Previous research found self-harming behavior, particularly NSSI, to constitute an easily accessible marker in the early detection of individuals at risk of development of BPD. The review further summarizes studies that investigated inter-relations between BPD features and self-harming behavior over time. Mainly, affective instability has been shown to play a role in the maintenance of NSSI and the increased risk of suicidal behavior among individuals with BPD. Finally, results about the effectiveness of treatment programs on the reduction of self-harming behavior among individuals with BPD are presented.

A pilot study on ecological momentary assessment in asylum-seeking children and adolescents resettled to Germany: Investigating compliance, post-migration factors, and the relation between daily mood, sleep patterns, and mental health

Background

Asylum-seeking children and adolescents (ASCs) resettled to western countries show elevated levels of psychological distress. While research on the mental health of ASCs is increasing, less is known about their day-to-day living experiences such as their daily mood, sleep patterns, and post-migration factors. Moreover, no examination in situ, using smartphone-assisted ecological momentary assessment (EMA), has been conducted up to now among ASCs. Furthermore, we do not know if screening measures succeed in reflecting the daily mood of ASCs experienced in everyday life.

Methods

We undertook a smartphone-assisted EMA study over a two-week period with 3 measurements a day. Participants were N = 40 ASCs from 10 different countries who had resettled to Germany. They completed standardized questionnaires screening for history of trauma and clinical symptoms (post-traumatic stress symptoms, depression, and anxiety) that were carried out in interview-like settings, and they participated in the subsequent EMA where they rated mood, sleep parameters, and post-migration factors on a daily basis. Multilevel models of clinical symptoms, daily mood, and sleep parameters were computed based on a total of 680 measurements.

Results

The multiply traumatized and highly distressed participants reported different levels of discrimination, and various social activities and contacts in the EMA. The overall compliance rate was shown to be 40.5%. Higher PTSS and anxiety scores were associated with lower levels of daily mood and poorer outcomes of some sleep parameters. Depression scores were not associated with any of the variables assessed in the EMA.

Conclusions

Smartphone-assisted EMA among ASCs resettled to Germany proved to be implementable despite a rather low compliance rate. Not only do ASCs show high symptom levels, they are also affected by these symptoms in their daily lives. The results emphasize the need for concise screenings and psychological treatment for this high-risk population. Limitations include the convenient nature of the sample and the lack of a comparison group.