The Influence of Parental Rejection on the Development of Maladaptive Schemas, Rumination, and Motivations for Self-Injury

Early maladaptive schemas, distress tolerance and self-injury in Iranian adolescents: serial mediation model of transdiagnostic factors

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent behaviour among adolescents. Although there are different etiological models of NSSI, there is a general lack of evidence-based, comprehensive and transdiagnostic models of NSSI in adolescents.

AIMS

The aim of this study was to investigate a model of transdiagnostic factors of NSSI in adolescents, testing a serial mediation model of the relationship between early maladaptive schemas (EMS), distress tolerance and NSSI through experiential avoidance and rumination.

METHOD

A community sample was identified of 1014 adolescents aged 13-17, of whom 425 had a history of NSSI. A serial mediation path analytic method was utilised to examine the relationships between NSSI and its associated functions as criterion variables, EMS and distress tolerance as predictors, experiential avoidance as the first mediator and rumination as the second mediator.

RESULTS

The path analytic model fit indices were good (X2/d.f. = 2.25, goodness of fit index = 0.98, normed fit index = 0.97, comparative fit index = 0.98, root mean square error of approximation = 0.054, standardised root mean squared residual = 0.028). Rumination significantly mediated the relationship between schemas of 'vulnerability to harm', 'emotional deprivation', 'social isolation', 'insufficient self-control', and NSSI frequency and intrapersonal functions. In serial fashion, experiential avoidance mediated the role of rumination in the relationship between social isolation, and insufficient self-control and NSSI frequency and intrapersonal functions. All indirect effects were significant.

CONCLUSIONS

Key indirect effects were found linking maladaptive schemas and distress tolerance to NSSI frequency, and NSSI intrapersonal functions via experiential avoidance and rumination. Thus, it is important to address these transdiagnostic factors with particular emphasis on the sequential mediating role of experiential avoidance and rumination in conceptualisation and therapeutic interventions for NSSI.

Perceived parental warmth attenuates the link between perceived parental rejection and rumination in Chinese early adolescents: two conditional moderation models

Background

Prior studies have explored the association between perceived parental rejection-warmth and adolescents' rumination, but it is unclear whether the interaction between perceived parental rejection and warmth can predict adolescents' rumination in a Chinese context and whether this interaction varies by children's gender during the post-COVID-19 era.

Objective

This study aimed to address these issues in Chinese early adolescents from a family system perspective.

Methods

A total of 910 adolescents (M age = 13.63, 48.50% female) from two middle schools in Chongqing and Changsha, China participated in the survey, answering measures for demographics, perceived parental rejection-warmth, and rumination.

Results

The results show that adolescents' rumination was positively related to perceived paternal rejection (r = 0.326, p <.001) and maternal rejection (r = 0.343, p <.001), and negatively related to perceived paternal warmth (r = -.184, p <.001) and maternal warmth (r = -0.125, p <.001). Moreover, perceived maternal warmth significantly moderated the link between perceived paternal rejection and adolescents' rumination (boot effect = -0.066, 95CI% = [-0.124, -0.010]), but this moderating effect is only presented in boys not in girls (boot effect = -0.063, 95CI% = [-0.015, 0.140]). However, perceived paternal warmth moderated the link between perceived maternal rejection and rumination in adolescents (boot effect = -0.052, 95CI% = [-0.103, -0.001]), and this interaction varied by adolescents' gender (boot effect = 0.103, 95CI% = [0.029, 0.177]).

Conclusions

Perceived Parental rejection and parental warmth co-exist in the Chinese family system, and they exert an interactive effect on adolescents' rumination depending on their gender. It implies that both parents should be more accepting, caring, considerate, and warm toward their daughters, and it is also in line with the tradition and status quo of parenting in Chinese families. These findings have implications for Chinese parental co-parenting practices in families with adolescents and adolescence mental health counseling work.

Early maladaptive schemas are associated with self-injury thoughts and behavior in adolescents

BACKGROUND

Early maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care.

METHODS

The participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants' EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs' associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff's Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression.

RESULTS

The differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs.

CONCLUSIONS

The present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.

Separation-individuation from the community among religious Jewish teens in Israel

We wished to understand the contribution of personal, family, and community factors to the risky behaviors (RBs) of religious Jewish teens in Israel, and whether sense of community belonging mediated the religious estrangement/RB association. A convenience sample comprised 645 adolescents aged 14-19 (420 female/225 male) from Israel's national-religious sector was used in this study. Sociodemographic characteristics, self-esteem, future orientation, degree of religious estrangement, perceived parental acceptance, and sense of community belonging were reported. Being a male, older, and living in a rural community were associated with more RBs, as were higher religious estrangement and less acceptance from the mother. Sense of community was found to partially mediate the religious estrangement/RB association. We extended Blos's conceptualization of adolescence as a second separation-individuation from the parents to include a parallel process of separation-individuation from the community. The results may help in designing interventions for adolescents in religious communities.

Nonsuicidal self-injury and rumination: A meta-analysis

Trait rumination is the tendency to overthink and focus on negative emotions and events and is related to a number of psychological disorders and maladaptive behaviors including nonsuicidal self-injury (NSSI). The purpose of this study was to conduct a meta-analysis of the relationship between trait rumination and NSSI behaviors. Results from 60 samples showed small effect sizes between trait rumination and NSSI engagement, NSSI frequency, and the number of methods used to self-injure in cross-sectional samples. Results from 13 samples showed small effect sizes between trait rumination and NSSI engagement and NSSI frequency in longitudinal samples. Moderator analyses indicated that this relationship is similar whether the type of rumination is depressive or not and is generally consistent across different ages, genders, and ethnicities. These results help clarify the role of trait rumination as a risk factor for NSSI.

Depressive Symptoms, Perceived Stress, Self-Compassion and Nonsuicidal Self-Injury Among Emerging Adults: An Examination of the Between and Within-Person Associations Over Time

Many emerging adults report experiencing mental health challenges (e.g., depressive symptoms and perceived stress) during the transition to university. These mental health challenges often coincide with increased engagement in nonsuicidal self-injury (NSSI; e.g., self-cutting or burning without lethal intent), but longitudinal research exploring the nature of the associations among depressive symptoms, perceived stress, and NSSI are lacking. In the present study, it was examined whether depressive symptoms and perceived stress predicted increased risk for NSSI over time (or the reverse), and whether these effects were mediated or moderated by self-compassion. The sample consisted of 1,125 university students (Mage = 17.96 years, 74% female), who completed an online survey three times in first year university. A random intercept cross-lagged panel model revealed that higher depressive symptoms, perceived stress, NSSI, and lower self-compassion often co-occurred, but only NSSI predicted increased perceived stress over time. Theoretical and practical implications are discussed.

The relationship between rumination and NSSI: A systematic review and meta-analysis

BACKGROUND

Rumination is a cognitive process that has been implicated in the onset and maintenance of a variety of psychological difficulties. The purpose of this review and meta-analysis was to examine the nature and strength of the relationship between rumination and non-suicidal self-injury (NSSI).

METHODS

The protocol for this review was pre-registered (CRD42019148186). A literature search of electronic databases PsycINFO, CINAHL, MEDLINE, and Web of Science was performed from the earliest date available to March 2020. Thirty-nine eligible papers were identified. An additional seven papers were identified from a search conducted in September 2021, resulting in a total of 46 papers. Separate meta-analyses were undertaken for NSSI frequency and NSSI history, with studies grouped by rumination type (depressive, transdiagnostic, anger, brooding, reflection, catastrophising, overall). Moderator analyses were also conducted along with a narrative synthesis of adjusted associations and longitudinal studies.

RESULTS

Rumination had a positive small association with NSSI frequency and a positive moderate association with NSSI history. The adjusted associations yielded mixed findings and most longitudinal research found rumination to be associated with prospective NSSI.

LIMITATIONS

Most included studies had a moderate risk of bias and used a student sample. A limitation of this review was that only English language papers were included.

CONCLUSIONS

Findings indicate that rumination is associated with NSSI, but more so the likelihood of engaging in NSSI overall than the frequency. Rumination-focused techniques for NSSI may therefore be of benefit. Further research is needed to understand this association, particularly with longitudinal studies that focus on state rumination rather than stable trait rumination.

PRACTITIONER POINTS

Rumination was found to have a small to moderate association with NSSI. Some individuals who engage in NSSI may benefit from psychological techniques that target rumination. Most of the studies included had a moderate risk of bias.

Disentangling acculturation and enculturation intergenerational gaps: Examining mother-youth value discrepancies and mental health among Mexican-descent college students

OBJECTIVE

To test the acculturation gap hypothesis by examining mother-youth value discrepancies (both acculturative and enculturative) and their association with mother-youth acculturative conflict and youth mental health outcomes.

METHOD

Participants were 273 Mexican descent college students attending a large, public, Hispanic Serving Institution (HSI) in West Texas (72% women). The participants' ages ranged 18-25 years (M = 19.33 years; SD = 1.54 years).

RESULTS

Three models assessed the relationship between mother-youth value discrepancies and mental health outcomes (suicidal ideation, non-suicidal self-injury, and depressive symptoms) as mediated by mother-youth acculturative conflict. Consistently, Mexican heritage cultural values were related to mental health outcomes while American cultural values were not.

CONCLUSIONS

The study found that increased mother-youth discrepancies on Mexican cultural values were associated with increased negative mental health outcomes. Our findings suggest that adopting or learning new mainstream American values does not substitute for the Mexican cultural values that protect against negative outcomes.

Early maladaptive schemas in young people who self-injure

BACKGROUND

There is emerging evidence that early maladaptive schemas (EMS) may be a cognitive vulnerability factor in nonsuicidal self-injury (NSSI). The current study sought to examine the relationship between EMS and NSSI history, and whether this is moderated by gender, in a community youth sample.

METHOD

Participants were 403 Australian secondary and university students aged between 16 and 25 years, who completed a survey of NSSI history, EMS, and general emotional distress.

RESULTS

Logistic regression analysis indicated that being female, depression, and EMS scores were useful for differentiating between youth reporting NSSI history and those who did not. High levels of Defectiveness/Shame and Abandonment/Instability schema scores, and low levels of Emotional Inhibition schema scores, were associated with NSSI history. Gender did not moderate the relationships between these EMS scores and NSSI history.

CONCLUSIONS

Present results suggest that aspects of the schema domain of Disconnection and Rejection are important for identifying NSSI history beyond young people's emotional distress. This provides researchers and clinicians with an opportunity to better target key EMS, especially beliefs about self-defectiveness and feelings of shame, that may be driving the regulatory function of self-injury among youth.

Rejection sensitivity and adolescent non-suicidal self-injury: Mediation through depressive symptoms and moderation by fear of self-compassion

OBJECTIVES

Rejection sensitivity is a risk trait that contributes to the relationships between rejection experiences in various domains and non-suicidal self-injury (NSSI). However, research about the association between rejection sensitivity and NSSI has still been understudied. This study sought to examine the mediating role of depressive symptoms and the moderating role of fear of self-compassion in the association between rejection sensitivity and adolescent NSSI.

DESIGN

A cross-sectional correlational design was employed through which rejection sensitivity, depressive symptoms, fear of self-compassion, and NSSI experiences in the past year were measured.

METHODS

Seven-hundred twenty-eight Chinese secondary school students (51.1% females; mean age = 14.07, SD = 0.75) were included by convenient sampling.

RESULTS

Regression analyses revealed that depressive symptoms worked as a mediator in the association between rejection sensitivity and NSSI. It was also found that fear of self-compassion acted as a moderator, such that a higher level of fear of self-compassion strengthened the link between rejection sensitivity and depressive symptoms and the direct link between rejection sensitivity and NSSI.

CONCLUSIONS

These findings highlight the need to address adolescents' rejection sensitivity, depressive symptoms, and fear of self-compassion in preventing and intervening NSSI.

PRACTITIONER POINTS

Focusing on rejection sensitivity might help understand the relationships between intra- and interpersonal distress and NSSI. The findings of this study evidenced the risk effect of adolescents' rejection sensitivity on NSSI and the partial mediation of depressive symptoms in the link. Targeting adolescents' rejection sensitivity will be beneficial in developing NSSI-related prevention and intervention programs. This study also found that adolescents' fear of self-compassion magnified the associations between rejection sensitivity, depressive symptoms, and NSSI. It suggests that targeting adolescent's fear of self-compassion will also be beneficial.

Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis

BACKGROUND

Schema Therapy is based on the theory that trauma and neglect in childhood lead to early maladaptive schemas and psychopathology in adulthood. The aim of this review was to evaluate support for this theory by synthesizing the literature on childhood adversity and schemas.

METHODS

A systematic review and meta-analysis were completed in compliance with PRISMA. PsycInfo, CINAHL and PubMed were searched to identify eligible studies that reported unadjusted association(s) between adverse childhood events and schema scores when participants were 18 years or older. Meta-analyses were conducted to estimate the pooled effect size of associations between schemas and experiences of childhood adversity.

RESULTS

A total of 33 studies met inclusion criteria and provided sufficient data for meta-analyses on childhood experiences relating to toxic frustration of needs (emotional neglect and physical neglect) and trauma and victimization (emotional abuse, physical abuse and sexual abuse). Of the 124 meta-analyses, 65 indicated that schemas show small to large correlations with emotional neglect (range: r = .16 [Failure] to r = .51 [Emotional Deprivation]); small to moderate correlations with emotional abuse (range: r = .20 [Vulnerability to Harm] to r = .44 [Emotional Deprivation]); and small correlations with physical neglect, physical abuse and sexual abuse (range: r = .16 [Vulnerability to Harm] to .26 [Emotional Deprivation and Social Isolation]).

CONCLUSIONS

Of the 33 included studies, only one used a longitudinal design. However, based on the correlational studies available, early maladaptive schemas in adulthood are associated with a history of childhood abuse and neglect.

Distinguishing people with current, past, and no history of non-suicidal self-injury: Shame, social comparison, and self-concept integration

OBJECTIVE

Non-Suicidal Self-Injury (NSSI) can have a major impact on the lives of individuals and those around them. The way in which a person feels about and perceives themselves (i.e. self-concept) appears central to understanding NSSI. The current study investigates three variables linked to self-concept: shame, social comparison, and self-concept integration. We examine how well these variables differentiate people who report past NSSI, people who report current NSSI, and people who have never engaged in NSSI.

DESIGN

Cross-sectional.

METHOD

Individuals reporting NSSI in the past year (n = 51), individuals with a history of NSSI but none in the past year (n = 44), and individuals with no history of NSSI (n = 110) were compared on measures of shame, social comparison, and self-concept integration.

RESULTS

Shame was elevated in people with a history of NSSI but did not distinguish between past and current NSSI when other variables were controlled for. Self-concept integration was poorer in people reporting current NSSI than people reporting past NSSI, even when controlling for other variables.

CONCLUSIONS

The results support the role of shame as a general marker for NSSI risk, but suggest self-concept integration may fluctuate more dynamically in relation to the recency of NSSI. The study is limited by a non-matched student control group.

What is the relationship between rejection and self-harm or suicidality in adulthood?

BACKGROUND

Rejection is an adverse experience that may help explain the heightened risk of self-harm and suicide amongst many societal groups. The aim of this systematic review was to determine the relationship between rejection experiences and self-harm and suicidal ideation.

METHOD

The databases PsychINFO, CINAHL, Medline and Web of Science were searched from inception until May 2017 using key search terms. Quantitative studies were included if they were; (i) mean sample age over 18; (ii) in the English language; (iii) and had a measure of self-harm or suicidal behaviour and a measure of rejection. The results were synthesised narratively.

RESULTS

Eighteen studies were identified for the review. Fifteen out of the eighteen studies found a significant positive association between rejection and self-harm. This association was identified within several marginalised groups known to be at risk of self-harm, including those from lesbian, gay or bisexual sexuality or those who identify as transgender.

LIMITATIONS

Heterogeneity between the measures of self-harm, suicidal behaviour and rejection, as well as the lack of longitudinal analyses made it difficult to draw firm conclusions.

CONCLUSION

Perceived rejection may leave some individuals at risk of self-harm and might account for the elevated risk in marginalised societal groups. Interventions focused on modifying rejection experiences may help reduce the risk of self-harm in this population.

Shame and Non-suicidal Self-injury: Conceptualization and Preliminary Test of a Novel Developmental Model among Emerging Adults

Non-suicidal self-injury (NSSI) is particularly prevalent during adolescence and emerging adulthood. The salience of shame during these developmental periods suggests that shame may be inherently linked to NSSI, and at least partially explain the high rates of NSSI observed among youth. In this article, a theoretical developmental model relating shame and NSSI is proposed, and results from a preliminary test of a sub-set of cross-sectional relationships in this model is presented. In the model tested, it was hypothesized that adverse caregiving experiences in prior development (i.e., childhood to late adolescence) like parental invalidation and child maltreatment, established predictors of NSSI, would be linked to proximal episodes of NSSI (i.e., past year) through current shame-proneness (i.e., experiencing shame in a trait-like manner) and internalizing shame-coping (i.e., responding to shame through attacking one's self and withdrawing). It was also hypothesized that some key proximal predictors of NSSI during youth development, such as low body esteem, increased loneliness and heightened psychological distress, would be linked to proximal NSSI via shame-proneness and internalizing shame-coping. Using structural equation modelling, it was observed that data, obtained via self-reports completed by 573 emerging adults (age in years: M = 20.7, SD= 2.20, 69.1% female, NSSI history: n = 220, where most recent NSSI episode was within a year of study participation) recruited throughout Australia between June 2013 and June 2014, fit the hypothesized model well. Tests of indirect effects indicated that current shame-proneness and internalizing shame-coping significantly linked perceived parental invalidation and prior experiences of child maltreatment to proximal NSSI, though this relationship was, unexpectedly, an inverse one in relation to child maltreatment. Current shame-proneness was also linked to proximal NSSI via internalizing shame-coping, current loneliness, and current psychological distress, but not through current body esteem. Finally, proximal self-evaluations of body esteem, loneliness and increased psychological distress were linked to recent NSSI through internalizing shame-coping. The theory and findings presented in this article contribute to a deeper developmental understanding of NSSI among youth, highlight crucial pathways between adverse caregiving experiences and NSSI, and illuminate important shame-based mechanisms that potentially warrant clinical attention for at-risk individuals. Future research directions and clinical recommendations are discussed.

Elucidating DSM-5 and ICD-11 Diagnostic Features of Borderline Personality Disorder Using Schemas and Modes

BACKGROUND

Borderline personality disorder (BPD) comprises a heterogeneous constellation of problems operationalized in the DSM-5 and the forthcoming ICD-11. In schema therapy, schemas and modes are employed to conceptualize and treat these problems.

AIM

The current study investigated whether the 9 diagnostic BPD features are associated with schemas and modes.

METHOD

Psychiatric outpatients with predominant BPD features (n = 142; 68% females) were administered the Structured Clinical Interview for DSM-IV Axis II (SCID-II) and self-report inventories for schemas and modes. Associations were investigated by means of bivariate point-biserial correlations and multiple logistic regression analysis.

RESULTS

BPD features were largely associated with conceptually related schemas and modes. Consistent with the schema therapy literature and previous research, we found schemas of Abandonment/Instability and Mistrust/Abuse along with modes of Angry/Enraged Child, (internalized) Punitive Parent, and Impulsive Child to uniquely predict thematically related BPD features including fear of abandonment, self-destructiveness, feelings of emptiness, stress-related paranoid ideation, inappropriate anger, and impulsivity.

CONCLUSION

Most of the 9 BPD features were related to conceptually meaningful schemas/modes, suggesting that BPD is composed of dormant themes along with salient affective-behavioral responses. Consequently, individual BPD features may be differentially conceptualized and targeted in therapy by means of schemas and modes.

Preoccupied but not dismissing attachment states of mind are associated with nonsuicidal self-injury

In this investigation the factor structure of the Adult Attachment Interview was studied in a partially at-risk sample of 120 young adults. More specifically, 60 participants had engaged in nonsuicidal self-injury (NSSI; 53 females, M age = 20.38 years), and 60 were non-self-injuring controls matched by age and sex. Theoretically anticipated differential associations between preoccupied (but not dismissing) states of mind and NSSI were then examined. Exploratory factor analyses identified evidence for two weakly correlated state of mind dimensions (i.e., dismissing and preoccupied) consistently identified in factor analyses of normative-risk samples. As hypothesized, results further showed that preoccupied (but not dismissing) states of mind were associated with NSSI behavior. Findings support existing arguments suggesting that the regulatory strategy adults adopt when discussing attachment-related experiences with primary caregivers, particularly passive, angry, or unresolved discourse patterns, is uniquely correlated with NSSI.