Co-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review

The impact of childhood emotional abuse on the developmental trajectory of non-suicidal self-injury in adolescents: The mediating role of self-compassion and peer attachment

BACKGROUND

Non-suicidal self-injury (NSSI) is a concerning health problem that afflicts some adolescents, and childhood emotional abuse is an early risk factor for NSSI. However, few studies have focused on identifying specific mediators underlying the relationship between childhood emotional abuse and the developmental trajectory of NSSI. Self-compassion and peer attachment are important intrapersonal and interpersonal factors influencing NSSI. However, it remains unclear whether self-compassion and peer attachment may mediate the relationship between childhood emotional abuse and the developmental trajectory of NSSI.

OBJECTIVE

Based on Nock's integrated theoretical model and the Four-Function Model of self-injury, this study investigates the developmental change of NSSI during one year in adolescence and the mediating roles of self-compassion (as an intrapersonal factor) and peer attachment (as an interpersonal factor) in childhood emotional abuse and the initial level and rate of change of NSSI.

PARTICIPANTS AND METHODS

A total of 1214 Chinese adolescents (M = 15.46, SD = 0.71; 737 boys and 477 girls) were recruited to measure NSSI, childhood emotional abuse, self-compassion, and peer attachment at T1 and then NSSI was assessed again at T2 and T3 within the same calendar year. A latent growth model was used to explore the developmental change of NSSI; structural equation modeling was constructed to explore the mediating role of self-compassion and peer attachment.

RESULTS

The results showed that the frequency of NSSI occurred at a very low level among Chinese adolescents and decreased significantly over the year. Childhood emotional abuse positively predicted the initial level of NSSI and negatively predicted the rate of decline in NSSI. In addition, self-compassion and peer attachment partially mediate between childhood emotional abuse and the initial levels and rate of change in adolescent NSSI.

CONCLUSIONS

The findings suggested a downward trend in adolescent NSSI development over the one-year follow-up, and indicated that childhood emotional abuse is related to the development of NSSI. Additionally, the study suggested that increasing self-compassion and improving peer relationships offer opportunities for prevention and intervention for NSSI in adolescence.

The effects of childhood abuse, depression, and self-compassion on adolescent nonsuicidal self-injury: A moderated mediation model

BACKGROUND

Nonsuicidal self-injury (NSSI) is a widespread public health issue in adolescents. Exploring the risk and protective variables of NSSI is critical for prevention and intervention. Based on the experiential avoidance model (Chapman et al., 2006) and Nock's (2009) integrated model of NSSI, the current study tested a moderated mediation model to examine the impact of two risk factors, childhood abuse and depression, and one protective factor, self-compassion, on NSSI.

METHODS

Self-report measures were conducted among 758 Chinese adolescents (329 females and 429 males, mean age = 14.16 years, SD = 1.92) in Hong Kong, China regarding childhood abuse, depression, self-compassion, and NSSI.

RESULTS

Childhood abuse was found to be positively linked to NSSI, and this connection was mediated by depression. Self-compassion weakened the strength between childhood abuse and NSSI, along with that between childhood abuse and depression.

CONCLUSIONS

These results assist in understanding how NSSI develops and facilitate future studies to investigate how the risk and protective variables for NSSI interact. The clinical application of these findings was also discussed.

A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury

PURPOSE OF REVIEW

Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts.

RECENT FINDINGS

See Fig. 1. See Fig. 1.