Risk factors for deliberate self-harm among female college students: the role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity

Negative and Positive Emotional Reactivity in Women With and Without a History of Self-Injury

In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (M_age = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (M_age = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η² = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ² (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.

The relationship between child maltreatment and social anxiety: A meta-analysis

BACKGROUND

Globally, child maltreatment has become a serious problem, affecting individuals' physical and mental health. This meta-analysis aimed to explore the association between child maltreatment and social anxiety.

METHODS

MEDLINE, PsycINFO, EMBASE, Scopus, and Web of Science were searched for articles published by October 2021. Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of studies. Maltreatment type, sample setting, age, country and measurement instruments were analyzed as moderators.

RESULTS

Twenty-nine studies met the inclusion criteria. Child maltreatment was positively correlated with social anxiety (r = 0.201, 95 % CI [0.171, 0.230]). The moderating effect of maltreatment subtypes was significant whether divided into three types (Q_b = 12.152, p = .002), or five types (Q_b = 11.574, p = .021). Specifically, emotional maltreatment (r = 0.251, 95 % CI [0.201, 0.298]) had a stronger relationship with social anxiety than physical (r = 0.138, 95 % CI [0.085, 0.191]; Q_b = 9.312, p = .002) and sexual maltreatment (r = 0.153, 95 % CI [0.108, 0.197]; Q_b = 9.197, p = .002). However, there was no significant difference in the effect size between physical and sexual maltreatment (Q_b = 0.096, p = .757). Other variables (age, sample setting and country) were not significant moderators.

LIMITATIONS

Only twenty-nine studies were included, and there was high heterogeneity among the studies, the interpretation of the results should be cautious.

CONCLUSIONS

This meta-analysis confirmed the relationship between child maltreatment and social anxiety, especially highlight the harmfulness of emotional maltreatment.

Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients

BACKGROUND

Exposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals' health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients.

METHODS

The current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose-response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression.

RESULTS

In file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI.

CONCLUSIONS

We report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

Incidence and Correlates of Emergency Department Visits for Deliberate Self-Harm Among Asian American Youth

PURPOSE

This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors.

METHODS

We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs.

RESULTS

Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients.

DISCUSSION

Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.

Key factors selection on adolescents with non-suicidal self-injury: A support vector machine based approach

Comparing a family structure to a company, one can often think of parents as leaders and adolescents as employees. Stressful family environments and anxiety levels, depression levels, personality disorders, emotional regulation difficulties, and childhood trauma may all contribute to non-suicidal self-injury (NSSI) behaviors. We presented a support vector machine (SVM) based method for discovering the key factors among mazy candidates that affected NSSI in adolescents. Using SVM as the base learner, and the binary dragonfly algorithm was used to find the feature combination that minimized the objective function, which took into account both the prediction error and the number of selected variables. Unlike univariate model analysis, we used a multivariate model to explore the risk factors, which better revealed the interactions between factors. Our research showed that adolescent education level, anxiety and depression level, borderline and avoidant personality traits, as well as emotional abuse and physical neglect in childhood, were associated with mood disorders in adolescents. Furthermore, gender, adolescent education level, physical abuse in childhood, non-acceptance of emotional responses, as well as paranoid, borderline, and histrionic personality traits, were associated with an increased risk of NSSI. These findings can help us make better use of artificial intelligence technology to extract potential factors leading to NSSI in adolescents from massive data, and provide theoretical support for the prevention and intervention of NSSI in adolescents.

The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis

BACKGROUND

Previous research has suggested that depressive symptoms, emotional competence, and posttraumatic stress symptoms (PTSS) may mediate the association between family functioning and non-suicidal self-injury (NSSI). Therefore, this study aimed to evaluate the mediation effects of depressive symptoms, emotional competence, and COVID-related PTSS on the relationship between family functioning and NSSI in adolescents.

METHOD

A sample of 5854 adolescents was recruited from June 16 to July 8, 2020. The data for family functioning, depressive symptoms, emotional competence, COVID-related PTSS, and NSSI behavior of adolescents were collected via self-reported questionnaires. A structural equation model was constructed to examine the relationship, and a bootstrap analysis was conducted to evaluate the mediation effects.

RESULTS

The reporting rate of adolescent NSSI was 30.2%. The poor family functioning was positively associated with adolescent NSSI (β = 0.130, 95% CI = 0.093-0.182), which was mediated by depression with effect size of 0.231 (95% CI = 0.201-0.257). The pathway coefficients between emotional competence and NSSI, and depression, COVID-related PTSS and NSSI, though statistically significant were unlikely to be clinically meaning with values of 0.057 and 0.015. There was no mediating effect by COVID-related PTSS. The pathways initially constructed between family functioning and COVID-related PTSS, emotional capacity and COVID-related PTSS were not been verified.

LIMITATIONS

It was unclear whether this mediational effect would be supported in a longitudinal design. The application and extension of this model toward other regions and countries, and different ages need to be further explored.

CONCLUSION

The interventions of adolescent NSSI should focus on both the family level and individual levels. Improving family environment, screening depressive symptoms, enhancing emotional competence and lessening COVID-related PTSS may reduce NSSI.

Cognitive and Emotional Processes and Life Satisfaction of Korean Adults With Childhood Abuse Experience According to the Level of Emotional Expressiveness

This study evaluates a hypothesized model describing the cognitive and emotional processes of childhood abuse and its influence on life satisfaction and explores the moderating effect of emotional expressivity in Korean young adults. The mediating roles of early maladaptive schema and state anxiety are explored, and the level of life satisfaction is compared according to the emotional expressivity level. A total of 550 young adults completed self-reported questionnaires, including Childhood Trauma Questionnaire (CTQ-SF), Young Schema Questionnaire (YSQ-SF), State-Trait Anxiety Inventory (STAI-Y), Satisfaction With Life Scale (SWLS), and Emotional Expressivity Scale (EES). The mediating roles of early maladaptive schema and state anxiety between childhood abuse and life satisfaction are confirmed. In the low emotional expressivity group, the double-mediation effect of early maladaptive schema and state anxiety is confirmed, whereas for the high emotional expressivity group, the mediating roles of each early maladaptive schema and state anxiety are confirmed, as well as the double-mediation effect. Moreover, the high emotional expressivity group showed higher life satisfaction. The study results imply that even though expressing emotions does not result in immediate mood elevation, but eventually leads to higher life satisfaction. The implications, limitations, and suggestions are discussed.

Perceived vs. Actual Emotion Reactivity and Regulation in Individuals With and Without a History of NSSI

Non-suicidal self-injury (NSSI) has consistently been associated with self-reported difficulties in emotion reactivity and the regulation of negative emotions; however, less is known about the accuracy of these self-reports or the reactivity and regulation of positive emotions. The present study sought to investigate differences between women with and without a history of NSSI on: (a) self-reported general tendencies of negative and positive emotion reactivity, (b) self-reported general tendencies of negative and positive emotion regulation, and (c) emotion regulation reported in response to a positive and negative mood induction. The sample consisted of 36 women with a recent history of NSSI within the last 2 years (Mage = 20.06; SD = 1.51) and a comparison group with no history of NSSI (n = 34; Mage = 20.15; SD = 1.54). Participants completed self-report measures of negative and positive emotion reactivity and regulation. In a separate session, participants underwent both a negative and positive mood induction using a counterbalanced design and reported their experienced emotions. Results from two-way MANOVAs and ANOVAs revealed those with a history of NSSI reported significantly greater difficulties in negative emotion reactivity and regulation than the no-NSSI comparison group; however, no group differences emerged in self-reported reactivity or regulation of positive emotions. In contrast, repeated measures ANOVAs on data from the mood induction task found no group differences in reactivity or regulation for either negative or positive emotions. These findings highlight the possibility that although individuals with a history of NSSI evaluate their ability to manage negative emotions as significantly worse than individuals with no history of self-injury, this may not reflect their actual emotion regulatory processes.

[Pain perception and nonsuicidal self-injurious behavior]

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

The psychometric properties and clinical utility of the Norwegian versions of the deliberate self-harm inventory and the inventory of statements about self-injury

Deliberate self-harm (DSH) is a widespread transdiagnostic health problem with increasing prevalence among adolescences, and young adults. It is therefore essential to effectively chart the epidemiology of DSH, as well as to assess the efficacy of interventions designed to modify this behavior. The aim was to translate and analyze the psychometric properties of the Norwegian versions of two instruments designed to assess DSH: the Deliberate Self-harm Inventory (DSHI) and the Inventory of Statements About Self-Injury (ISAS), as well as to assess the prevalence of DSH within a nonclinical Norwegian adult population. Of the 402 participants who completed a questionnaire packet comprising the DSHI, ISAS, general questions about DSH, and other related measures, 30.6% reported some form of DSH. Those with a history of DSH reported greater difficulties with emotion regulation than those without. Participants with and without a history of DSH did not differ in unrelated constructs, including social desirability. The frequency of specific DSH behaviors was in accordance with previous research, with cutting being the most frequent. The factor structure of DSH functions in the Norwegian ISAS was generally comparable to the factor structure of the English version. Overall, results indicate that: a) the Norwegian versions of the DSHI and ISAS behave as expected and in accordance with prior research in other languages and other populations, and b) both the DSHI and ISAS have high internal consistency and adequate construct, convergent, and discriminant validity, and may be applied to evaluate DSH in adult Norwegian populations.

Nonsuicidal Self-Injury Among African American and Hispanic Adolescents and Young Adults: a Systematic Review

While African American and Hispanic adolescents and young adults living in the USA are exposed to myriad stressors that may increase their risk for mental health difficulties, few studies have examined nonsuicidal self-injury (NSSI) among these youth. The purpose of this systematic review was to critically examine and synthesize current literature on NSSI among these understudied youth. Using multiple search terms related to NSSI, race/ethnicity, and developmental stage, electronic literature searches of PubMed, PsychINFO, and Google Scholar databases retrieved 3036 relevant articles published in the English language between 2000 and 2018; manual reference checks yielded an additional 17 articles. Ultimately, a total of 52 full-text studies were assessed for eligibility, and 15 articles were included in the present review. Although the majority of studies reported higher prevalence of NSSI among non-Hispanic White youth, evidence suggests that African American males are also at high risk of engaging in self-harm. Emotional dysregulation emerged as a common risk factor, while social support and feelings of connection were protective for some African American and Hispanic youth. Although racism and discrimination were not linked to NSSI in the reviewed studies, this remains an important area of future research for prevention and intervention efforts.

Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm during adolescence and young adulthood, especially among females. Yet little is known about the developmental trajectories or childhood predictors/moderators of self-harm in women with and without childhood histories of ADHD. We characterized lifetime risk for nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), comparing female participants with (n = 140) and without (n = 88) childhood ADHD. We examined theory-informed childhood predictors and moderators of lifetime risk via baseline measures from childhood. First, regarding developmental patterns, most females with positive histories of lifetime self-harm engaged in such behaviors in adolescence yet desisted by adulthood. Females with positive histories of self-harm by late adolescence emanated largely from the ADHD-C group. Second, we found that predictors of NSSI were early externalizing symptoms, overall executive functioning, and father's negative parenting; predictors of SI were adverse childhood experiences and low self-esteem; and predictors of SA were early externalizing symptoms, adverse childhood experiences, and low self-esteem. Third, receiver operating characteristics analyses helped to ascertain interactive sets of predictors. Findings indicate that pathways to self-harm are multifaceted for females with ADHD. Understanding early childhood predictors and moderators of self-harm can inform both risk assessment and intervention strategies.

Nonsuicidal Self-Injury and Suicide: Differences Between Those With and Without Borderline Personality Disorder

Nonsuicidal self-injury (NSSI) is associated with borderline personality disorder (BPD), but it also occurs in nonclinical samples (Briere & Gil, 1998), inflicting serious harm and serving as a precursor to suicide attempts (Klonsky, May, & Glenn, 2013). Therefore, the DSM-5 proposed a nonsuicidal self-injury disorder (NSSID) and suicidal behavior disorder. Because this addition requires reconciliation with current BPD criteria, the authors' study evaluated type and frequency of NSSI and suicide attempts in 3,795 outpatients. Both were found in those without BPD, although the behaviors increased when some symptoms and full criteria for BPD were met. Wound/skin picking, scratching, and hitting were most common. Cutting was the fifth most common self-injury for those with BPD and the eighth most common for those without the disorder. Therefore, increased clinical attention is warranted for such self-injury, which may go unnoticed but indicate significant distress. Findings suggest that NSSID/suicidal behavior disorder may account for self-injury outside of BPD.

The social life of self-injury: exploring the communicative dimension of a very personal practice

This article makes the case for a sociological focus on the communicative, relational and interactional dimensions of nonsuicidal self-injury. While current research tends to be dominated by highly individual and intrapsychic models, it is increasingly observed that such models leave a social dimension to the practice unexplained. A burgeoning sociological literature has begun to address this paradox of the social in self-injury; however, we argue that the role of the social must be considered beyond the issues of aetiology, social learning and social construal/construction that are typically covered in this literature. Specifically, we argue that, since the lived meanings of self-injury directly implicate the interactional along with the intrapsychic, a more systematic focus on the role of social relations and social communication is vital. To illustrate this conceptual argument and embed it in the lived experiences of self-injury, we draw on two case studies taken from pilot research conducted by the authors. The more thoroughly sociological approach to self-injury that we present here offers an important compliment to the existing evidence base by reframing the absent presence of social communication contained within it, and suggesting important future directions for research.

Self-Injurious Behaviors and Adult Attachment: A Review of the Literature

Self-injurious behaviors (SIB) continue to afflict a significant segment of the clinical and general population, sometimes with fatal consequences. The development of SIB seems to share developmental pathways and mechanisms similar to attachment insecurity. To date, no reviews have explored their relationship. A search of publication databases PubMed and PsychInfo from 1969 through April 2018 was conducted and 17 papers met inclusion criteria. Of the 17 articles identified, 13 reported a positive relationship and 1 reported a negative relationship between attachment insecurity and SIB. Both attachment anxiety and avoidance seem to play a role in the risk for SIB, possibly through different mechanisms and likely with different impacts on the choice for either self-harm or suicide attempts.

Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system

BACKGROUND

Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation.

METHODS

Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14-18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable.

RESULTS

About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation.

LIMITATIONS

The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation.

CONCLUSIONS

Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.

Nonsuicidal self-injury among adolescents and young adults with prolonged exposure to violence: The effect of post-traumatic stress symptoms

Less is known about nonsuicidal self-injury (NSSI) among adolescents and young adults living in areas under prolonged political violence. This study aims to explore the frequencies of NSSI as well as the severity of post-traumatic stress symptoms (PTSS), depression, anxiety, and sleep problems among 889 Palestinian adolescents and young adults. The participants completed self-report questionnaires assessing NSSI, PTSS, depression, anxiety symptoms, and sleep difficulties. The results found that 13.8% of the total sample are frequently engaging in some form of NSSI behavior. Moreover, 43.1% exhibited severe symptoms of PTSD, and almost one-third of the sample reported severe symptoms of depression (30.1%); more than two-thirds of the sample (68.4%) experience sleep difficulties. Those who engage in NSSI were found to be at higher risk for sleep problems, depression, and PTSS. Avoidance/numbing, as well as hyperarousal symptoms clusters of PTSS, were significantly associated with NSSI above and beyond depressive symptoms. These results suggest that NSSI is frequently a sequelae of prolonged exposure to trauma and violence, and highlight the importance of routine assessment of this behavior. It is crucial to be familiar with the association between PTSS, sleep difficulties, and NSSI in a clinical setting to implement programs focusing on preventing these domains.

Community and Clinical Epidemiology of Borderline Personality Disorder

Several studies of the prevalence of borderline personality disorder in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, the prevalence is around 10% to 12% in outpatient psychiatric clinics and 20% to 22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of borderline personality disorder in other clinical settings (eg, primary care) and to investigate the impact of demographic variables on borderline personality disorder prevalence.

Is the association of deliberate self-harm with emotional relief stable or dependent on emotional context?

BACKGROUND AND OBJECTIVES

Despite strong support for the role of emotional relief in deliberate self-harm (DSH), no research has examined the impact of emotional distress on the strength of the DSH-relief association. Thus, it remains unclear whether the association of DSH with emotional relief is stable across emotional contexts or context-dependent. This study aimed to examine if the implicit DSH-relief association is stronger in the context of emotional distress (relative to a neutral emotional context).

METHODS

Young adult women with (n = 60) and without (n = 60) a history of recent recurrent DSH were randomly assigned to complete a novel version of the Implicit Association Test (IAT) assessing the DSH-relief association at baseline (following an initial neutral emotion induction) and again following either a neutral or negative (i.e., social rejection) emotion induction.

RESULTS

Consistent with hypotheses, the DSH-relief association was stronger among women with recent recurrent DSH (vs. those without DSH) at baseline. Contrary to hypotheses, however, whereas the DSH-relief association remained stable following both the neutral and negative emotion inductions among participants with DSH, it became stronger across both conditions for participants without DSH.

LIMITATIONS

The use of a community sample of young adult women may limit generalizability to other relevant populations (e.g., clinical populations, young men, adolescents). Additionally, the negative emotion induction may not have been powerful enough to affect the strength of the learned DSH-relief association among individuals with a repeated history of DSH.

CONCLUSIONS

Findings suggest that the repeated use of DSH to bring about emotional relief may engender associations of DSH with relief that are relatively insensitive to emotional context.

Paranoia and maladaptive behaviours in homelessness: The mediating role of emotion regulation

OBJECTIVES

Current research has implicated a role for cognitive and emotional processes in the pathways to becoming homeless. Evidence implicates three risk factors, which are often associated with an increased incidence of homelessness: paranoid thinking, emotion regulation, and engaging in maladaptive behaviours. Maladaptive behaviours include deliberate self-harm, substance misuse, and high-risk sexual practices. Currently, no studies have investigated the specific psychological mechanisms, such as difficulty regulating emotions, which underpin the association between paranoia and maladaptive behaviours.

DESIGN

A mediational design was employed in a group of homeless individuals.

METHOD

Participants (N = 40), who were homeless at the time of the study, completed a single-session assessment of paranoia, emotion regulation, and maladaptive behaviours.

RESULTS

Mediation analyses indicated that individuals scoring high on paranoia were more likely to engage in maladaptive behaviours, particularly substance misuse and aggression, when they had difficulty regulating their emotions. These results demonstrate a novel finding relating to the effect of emotion regulation in maintaining psychopathology and behaviours in vulnerable individuals, which may in turn sustain periods of homelessness.

CONCLUSIONS

Emotion regulation may therefore be one particular psychological mechanism through which severe mental illness affects engagement in self-destructive behaviours in homelessness. These findings have valuable clinical implications for targeted therapeutic interventions, in this often difficult to treat homeless population.

PRACTITIONER POINTS

Psychosis is over-represented in the homeless population; the cycle of homelessness may be attenuated by addressing psychotic symptomology. Homeless individuals engage in drug abuse, self-harm, aggression, and high-risk sexual practices due to an inability to regulate distressing emotions effectively. Therapeutic interventions, such as MBT and DBT, which target emotion regulation difficulties, may be useful in reducing maladaptive behaviours and preventing homelessness, by providing emotion regulation strategies to cope when homeless persons become distressed.

Comparison of Brief Measures of the Prevalence of Nonsuicidal Self-Injury in a Nonclinical Sample of Young Adults

This study compared the past-year prevalence rates of nonsuicidal self-injury produced by a behavioral checklist assessment and a single-item measure. In order to extend previous research on differences in prevalence rates across research samples, we employed both assessment types within a single sample of young adults (N = 433). Moreover, as an indicator of convergent validity, those rates were analyzed in association with participants' depression and anxiety scores. Findings indicated that the checklist assessment, relative to the single-item measure, produced a substantially higher prevalence rate, thereby providing greater evidence for the validity of its outcomes on the basis of convergence.

The Role of Difficulty in Identifying and Describing Feelings in Non-Suicidal Self-Injury Behavior (NSSI): Associations With Perceived Attachment Quality, Stressful Life Events, and Suicidal Ideation

Objective: Core alexithymic features, such as the difficulty in identifying and describing feelings, are associated with poor attachment styles and emotional trauma, which influence the capacity to regulate affect. Additionally, emotional regulation has been found to be the most commonly identified function associated with non-suicidal self-injury behavior (NSSI) in adolescents as they attempt to modulate strong emotions. However, few studies have examined the link between difficulty in identifying and describing feelings (core components of alexithymia), NSSI behaviors, quality of attachment, life stressors and suicidal ideation in healthy early adolescents. Consequently, this study aims to investigate these constructs and the relationship among them in a large non-clinical sample of adolescents.

Methods: Seven hundred and nine middle school students (50.4% males), aged 10–15 years (M = 12.6; SD = 1.06) were involved in this study. In order to investigate the variables considered in the study, the following measures were administered: the Deliberate Self-Harm Inventory exploring non-suicidal self-injurious behaviors; the Alexithymia Questionnaire for Children examining difficulty in identifying and describing feelings; the Inventory of Parent and Peer Attachment assessing the quality of parental and peer attachment; the Life Stressor Checklist-Revised outlining stressful/traumatic events and the Children’s Depression Inventory evaluating suicidal ideation.

Results: We found significantly positive relationships among difficulty in identifying and describing feelings, NSSI behaviors, stressful events, and suicidal ideation. Data indicated a significant negative association of difficulty in identifying and describing feelings with quality of attachment to parents and peers. Further findings highlighted that difficulty in identifying and describing feelings significantly mediated the effect of quality of attachment (parent and peer) on NSSI and suicidal ideation.

Conclusion: The ability to identify and describing feelings is important to managing emotional expression and understanding the feelings of others, both crucial in attaining successful interpersonal relationships. Our data revealed that, while controlling for stressful life events, low levels of attachment may increase adolescents’ difficulty in identifying and describing their own feelings, which in turn may increase the risk of both NSSI and suicidal ideation.

The relationship between interpersonal trauma history and the functions of non-suicidal self-injury in young adults: An experience sampling study

Non-suicidal self-injury (NSSI) has been reported to serve a range of functions for individuals who engage in it. Despite considerable variation in NSSI functions between individuals, limited attention has been paid to exploring relationships between NSSI functions and other characteristics of self-injuring individuals, such as trauma history. This is despite allusion to trauma history in the suggested etiology of some NSSI functions (e.g., anti-dissociation, self-punishment). The present study used a 21-day online daily diary to explore possible relationships between common NSSI functions and past interpersonal trauma in community young adults (n = 38). The interpersonal boundaries and anti-dissociation functions significantly related to interpersonal trauma severity in multiple regression analyses; the interpersonal boundaries function continued to significantly relate to interpersonal trauma severity when controlling for the number of NSSI functions endorsed.

The interaction between monoamine oxidase A (MAOA) and childhood maltreatment as a predictor of personality pathology in females: Emotional reactivity as a potential mediating mechanism

Research consistently demonstrates that common polymorphic variation in monoamine oxidase A (MAOA) moderates the influence of childhood maltreatment on later antisocial behavior, with growing evidence that the "risk" allele (high vs. low activity) differs for females. However, little is known about how this Gene × Environment interaction functions to increase risk, or if this risk pathway is specific to antisocial behavior. Using a prospectively assessed, longitudinal sample of females (n = 2,004), we examined whether changes in emotional reactivity (ER) during adolescence mediated associations between this Gene × Environment and antisocial personality disorder in early adulthood. In addition, we assessed whether this putative risk pathway also conferred risk for borderline personality disorder, a related disorder characterized by high ER. While direct associations between early maltreatment and later personality pathology did not vary by genotype, there was a significant difference in the indirect path via ER during adolescence. Consistent with hypotheses, females with high-activity MAOA genotype who experienced early maltreatment had greater increases in ER during adolescence, and higher levels of ER predicted both antisocial personality disorder and borderline personality disorder symptom severity. Taken together, findings suggest that the interaction between MAOA and early maltreatment places women at risk for a broader range of personality pathology via effects on ER.

The mediating role of coping strategy in the association between family functioning and nonsuicidal self-injury among Taiwanese adolescents

OBJECTIVE

Nock's (2009) integrated theoretical model suggests that both intrapersonal and interpersonal factors contribute to the development of nonsuicidal self-injury (NSSI). Based on this model, the present study examined the roles of family functioning and coping strategy in predicting NSSI, as well as the mediating effect of coping strategy in the relationship between family functioning and NSSI. Gender differences on the associations of these variables were also examined.

METHOD

A sample of 1,989 secondary school students (52.0% females) in Taiwan was assessed by self-report measures of perceived family functioning, coping strategy, and NSSI.

RESULTS

Results showed that both family functioning and avoidance/emotion-focused coping strategy predicted NSSI. Additionally, the association between family functioning and NSSI was mediated by avoidance/emotion-focused coping strategy. Gender differences were not found on the associations among these study variables.

CONCLUSIONS

These data provided evidences that the Nock's (2009) integrated theoretical model may help to explain how coping strategy mediates the effect of family functioning on NSSI. The implications of the findings for future research and intervention were discussed.

The role of emotional clarity and distress tolerance in deliberate self-harm in a sample of trauma-exposed inpatient adolescents at risk for suicide

OBJECTIVE

The purpose of this study was to examine distress tolerance as a moderator of the relationship between emotional clarity and deliberate self-harm (DSH) in a diverse sample of trauma-exposed adolescents in acute psychiatric care at high risk of suicidal behavior. It was hypothesized that distress tolerance would emerge as a significant moderator, such that the association between emotional clarity and DSH would be significant among youth with high, but not low, distress tolerance.

METHOD

Participants (N=50; 52.0% female; M=15.1years, SD=0.51; 44% White) completed measures of emotion dysregulation, DSH, history of suicide attempts, as well as a behavioral measure of distress tolerance.

RESULTS

Controlling for history of suicide attempts, results revealed a significant interaction between distress tolerance and emotional clarity in relation to DSH. Specifically, emotional clarity difficulties were related to DSH at high, but not low, levels of distress tolerance.

CONCLUSIONS

Findings suggest that DSH among trauma-exposed youth with high rates of past suicide attempts is most likely when low emotion clarity is coupled with a high tolerance for emotional distress. Given that DSH significantly increases risk for suicide among youth with psychiatric needs, assessment of emotional clarity and distress tolerance deficits is apt to be warranted to facilitate identification of these youth for targeted intervention.

Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis

BACKGROUND

Non-suicidal self-injury is being increasingly recognised as a prominent public health concern. Identification of early and modifiable risk factors is necessary to advance the screening and intervention efforts, particularly early detection of at-risk individuals. We aimed to examine childhood maltreatment, including its specific subtypes, in relation to non-suicidal self-injury.

METHODS

We did a comprehensive meta-analysis of childhood maltreatment (overall, sexual abuse, physical abuse and neglect, and emotional abuse and neglect) in association with non-suicidal self-injury. We also provided a qualitative review of mediators and moderators of this association. We identified relevant articles published from inception to Sept 25, 2017, through a systematic search of Embase, MEDLINE, and PsycINFO. We extracted continuous and categorical data and assessed for potential moderators using ten study characteristics. We generated random-effects models for analysis and evaluated for publication bias.

FINDINGS

We identified 71 publications that met eligibility criteria. Overall childhood maltreatment was associated with non-suicidal self-injury (odds ratio 3·42, 95% CI 2·74-4·26), and effect sizes for maltreatment subtypes ranged from 1·84 (1·45-2·34) for childhood emotional neglect to 3·03 (2·56-3·54) for childhood emotional abuse. Publication bias was not evident, except in the case of childhood emotional neglect. Across multiple maltreatment subtypes, we found stronger associations with non-suicidal self-injury in non-clinical samples.

INTERPRETATION

With the exception of childhood emotional neglect, childhood maltreatment and its subtypes are associated with non-suicidal self-injury. Screening of childhood maltreatment history in non-suicidal self-injury risk assessments might hold particular value in community settings, and increased attention to childhood emotional abuse is warranted.

FUNDING

National Institute of Mental Health.

Event-Related Potential Measures of Attention Capture in Adolescent Inpatients With Acute Suicidal Behavior

Impaired executive functions, modulated by the frontal lobes, have been suggested to be associated with suicidal behavior. The present study examines one of these executive functions, attentional control, maintaining attention to the task-at-hand. A group of inpatient adolescents with acute suicidal behavior and healthy controls were studied using a passively presented auditory optimal paradigm. This "optimal" paradigm consisted of a series of frequently presented homogenous pure tone "standards" and different "deviants," constructed by changing one or more features of the standard. The optimal paradigm has been shown to be a more time-efficient replacement to the traditional oddball paradigm, which makes it suitable for use in clinical populations. The extent of processing of these "to-be-ignored" auditory stimuli was measured by recording event-related potentials (ERPs). The P3a ERP component is thought to reflect processes associated with the capturing of attention. Rare and novel stimuli may result in an executive decision to switch attention away from the current cognitive task and toward a probe of the potentially more relevant "interrupting" auditory input. On the other hand, stimuli that are quite similar to the standard should not elicit P3a. The P3a has been shown to be larger in immature brains in early compared to later adolescence. An overall enhanced P3a was observed in the suicidal group. The P3a was larger in this group for both the environmental sound and white noise deviants, although only the environmental sound P3a attained significance. Other deviants representing only a small change from the standard did not elicit a P3a in healthy controls. They did elicit a small P3a in the suicidal group. These findings suggest a lowered threshold for the triggering of the involuntary switch of attention in these patients, which may play a role in their reported distractibility. The enhanced P3a is also suggestive of an immature frontal central executive and may provide a promising marker for early identification of some of the risk factors for some of the cognitive difficulties linked to suicidality.

Explicit Motives, Antecedents, and Consequences of Direct Self-Injurious Behaviors

BACKGROUND

Self-injurious behaviors in adolescence are a serious public health concern.

AIMS

The current study aims to expand our understanding of motives for direct self-injurious behaviors (D-SIB). We examined the explicit motives but also the actual antecedents and consequences of D-SIB over time.

METHOD

As part of the Saving and Empowering Young Lives in Europe (SEYLE) study, adolescents between the ages of 14 and 18 years from Israel completed self-report questionnaires at baseline, 3-month, and 12-month follow-ups.

RESULTS

Decreases in social support predicted later increases in D-SIB, an effect mediated by negative affect. Both peer and parental support also exerted quadratic effects on D-SIB. Thus, low as well as high support predicted subsequent D-SIB. In turn, D-SIB was followed by increased peer and parental support.

LIMITATIONS

Our methodology relies on self-reports, affected by social desirability and recall biases.

CONCLUSION

The findings support a causal path for the development of D-SIB: from interpersonal distress to emotional distress and then to D-SIB. They also point to interesting avenues regarding subgroupings of adolescents who self-injure depending on their motives. Finally, our results reveal that D-SIB, although of negative import, might paradoxically be effective in serving certain functions such as gaining support from parents and peers.

Self-harm - an overview of the tools used to assess non-suicidal self-harming behaviors

Introduction: Non-Suicidal Self-Injury (NSSI) is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.

The aim of the work is to present and discuss the most commonly used scales for NSSI assessment.

Method: A review of available literature was made using the databases Medline / PubMed, using the key words: “self injury”, “self-mutilation”, “non-suicidal,”, “NSSI”, “self-harm” and time descriptors: 2005-2017

Results: Available tools were divided into three groups: I- scale of self-assessment made by the patient, II- assessment made by the clinician, and III- auxiliary scale.

Conclusions: None of the available scales covers the complexity of the NSSI phenomenon. For the overall NSSI assessment, several NSSI assessment tools are suggested, taking into account both self-assessment scales and clinical evaluation.

Profiles of Emotion Deficits and Adolescent Nonsuicidal Self-Injury in an Inpatient Sample

This study examined profiles of specific emotion deficits, including poor emotion awareness, reluctance to express emotion, sadness inhibition and dysregulation, and anger inhibition and dysregulation. Self-report questionnaires assessed adolescents' emotion skills and nonsuicidal self-injury (NSSI) engagement, frequency, severity, methods, and age of onset. Latent profile analysis yielded a three-profile solution: Low Deficit (LD; n = 49), Unaware/Anger Dysregulated (UAD; n = 24), and Anger Inhibited (AI; n = 20) profiles. Adolescents in the UAD profile were more likely to engage in NSSI, displayed a higher NSSI frequency, and reported a higher number of NSSI methods when compared to adolescents in the LD profile. No links emerged for NSSI severity or age of onset.

Nonsuicidal Self-injury: A Systematic Review

Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors.

Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles.

Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder.

Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.

Self-esteem and non-suicidal self-injury in adulthood: A systematic review

BACKGROUND

Non-suicidal self-injury (NSSI) is a self-destructive act that represents a considerable burden on the individual and society. Low self-esteem may be a psychological variable that is related to NSSI. However, little is known about the nature of this relationship in adulthood. This systematic review therefore aimed to provide a synthesis of the available literature on the relationship between self-esteem and NSSI.

METHODS

Articles were independently identified and risk of bias assessed by two reviewers searching PsycINFO, CINAHL, Medline and Web of Science databases. Inclusion criteria were: (1) a mean sample age of eighteen years or over (2) full manuscripts available in English (3) assessment of NSSI (4) assessment(s) of self-esteem. A narrative synthesis of results was undertaken. A random-effects meta-analysis of differences in self-esteem between NSSI and non-NSSI groups was also undertaken.

RESULTS

Seventeen studies were identified and indicated a significant negative relationship between self-esteem and NSSI. The meta-analysis indicated lower self-esteem in those with experiences of NSSI versus those without, d = 0.59 - 1.17. Results suggested that although low self-esteem and NSSI are related in both clinical and non-clinical populations, there are a number of factors which also influence this relationship.

LIMITATIONS

The absence of longitudinal research is a major limitation of this literature.

CONCLUSIONS

It will be important for clinicians to consider the impact of self-esteem in those seeking support for NSSI. Further research should undertake longitudinal research to better understand the self-esteem and NSSI relationship.

The mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents: Findings from community and inpatient mental health settings in Ontario, Canada

Although bullying victimization has been linked to a number of behavioral and emotional problems among adolescents, few studies have investigate the mechanism through which bullying victimization affect non-suicidal self-injury. The objectives of this study were to examine the effect of bullying victimization on non-suicidal self-injury and the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents. Data for this study came from the interRAI Child and Youth Mental Health dataset. A total of 1650 adolescents aged 12-18 years (M =14.56; SD =1.79; 54.2% males) were analyzed. Binary logistic and Poisson regression models were conducted to identify the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury. Of the 1650 adolescents studied, 611 representing 37% engaged in non-suicidal self-injury and 26.7% were victims of bullying. The effect of bullying victimization on non-suicidal self-injury was partially mediated by depressive symptoms after adjusting for the effect of demographic characteristics, history of childhood abuse, social support, and mental health diagnoses. The contribution of bullying victimization and depression to non-suicidal self-injury adds to the case for the development of trauma-focused interventions in reducing the risk of non-suicidal self-injury among adolescents.

The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings

The objectives of this study were to examine the prevalence of, and determine the effect of adverse childhood experiences on non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8-18 years (M=12.49; SD=2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of non-suicidal self-injury as a function of adverse childhood experiences, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, marital status of parents/caregivers, history of foster family placement, and mental health diagnoses. Of the 2038 children and adolescents examined, 592 (29%) of this clinical sample engaged in non-suicidal self-injury. In the multivariate logistic regression model, children and adolescents who were physically abused had 49% higher odds of engaging in non-suicidal self-injury and children and adolescents who were sexually abused had 60% higher odds of engaging in non-suicidal self-injury, when compared to their non-abused counterparts. Other predictors of non-suicidal self-injury include: older age, female gender, inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders. Children and adolescents who had some form of social support had a 26% decrease in the odds of engaging in non-suicidal self-injury. Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of adverse childhood experiences, should also take into account non-suicidal self-injury. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future non-suicidal self-injury behaviors.

The relation of protective factors to deliberate self-harm among African-American adults: moderating roles of gender and sexual orientation identity

BACKGROUND

Few studies have examined correlates of deliberate self-harm (DSH) among African-Americans. Moreover, most research on the correlates of DSH in general has focused on risk factors rather than protective factors.

AIMS

This study examined differences in perceived social support, religiosity (both spirituality and church attendance) and overall life satisfaction between African-Americans with and without a history of DSH, as well as the moderating roles of gender and sexual orientation in these relations.

METHOD

Participants were 244 African-American university students who completed questionnaires.

RESULTS

Participants with (vs. without) DSH reported significantly lower levels of social support. Additionally, rates of DSH were significantly higher among participants who attended church irregularly versus regularly or rarely/never. However, the association between DSH and church attendance was significant only for women (vs. men) and LGBQ (vs. heterosexual) women. Further, gender moderated the relation between DSH and social support from both significant others and friends, with self-harming women (but not men) reporting less support than their non-DSH counterparts.

CONCLUSIONS

Findings add to the literature on DSH among African-Americans, highlighting both social support and church attendance (depending on regularity) as potential protective factors within this population.

Specific coping strategies moderate the link between emotion expression deficits and nonsuicidal self-injury in an inpatient sample of adolescents

BACKGROUND

Non-suicidal self-injury (NSSI) is a behavior of increasing prevalence in adolescents with links to various negative mental health and adjustment outcomes. Poor emotion expression has been linked with NSSI use, whereas the use of adaptive coping strategies has been identified as a protective factor against NSSI. The current study examined whether specific coping strategies moderate the relation between poor emotion expression and NSSI, and whether moderation is conditional on adolescent gender.

METHODS

Ninety-five adolescents hospitalized on an acute care inpatient psychiatric unit completed questionnaires measuring NSSI, emotion expression and use of specific coping strategies (i.e., problem-focused coping, positive reframing coping, support seeking, avoidance, and distraction).

RESULTS

Results indicated that poor emotion expression was positively associated with NSSI. Positive reframing and support seeking emerged as significant moderators of the poor emotion expression-NSSI link. This result was not conditional upon adolescent gender. Problem-focused coping, avoidance, and distraction did not emerge as significant moderators.

CONCLUSIONS

Encouraging youth to use particular coping strategies might protect against the negative impact of emotion expression deficits for both boys and girls.

Perceived Parental Monitoring and Sexual Orientation Moderate Lifetime Acts of Non-Suicidal Self-Injury

Being non-heterosexual, particularly bisexual, is associated with high rates of engagement in NSSI amongst young adults. The goal of the present study was to determine if parenting practices, specifically parental monitoring, and sexual orientation moderate engagement with NSSI. Undergraduates (N = 1,353) completed a survey on sexual orientation, non-suicidal self-injury (NSSI) acts, and multiple aspects of perceived parental monitoring during high school. Moderation analyses revealed that most facets of parental monitoring were similarly negatively correlated with NSSI for both individuals whose sexual orientation where nearly, or entirely, gay and heterosexual youth. Youth who were neither exclusively heterosexual nor exclusively gay (mixed sexual orientation) reported the most NSSI acts, and no facet of parental monitoring predicted reduced NSSI acts for this group. While previous literature shows that many aspects of parental monitoring may be protective against engagement in health risk behaviors, the present study adds to these findings that similar aspects are negatively associated with self-injurious behavior for some, but not all, individuals. More research is needed to better understand the causes of increased NSSI for individuals with a mixed sexual orientation.

Suicidality, self-harm and psychotic-like symptoms in a general adolescent psychiatric sample

AIM

We investigated the associations between clinical high-risk for psychosis (CHR), psychotic-like symptoms and suicidality among adolescent psychiatric patients.

METHODS

The sample consisted of 54 CHR and 107 non-CHR psychiatric patients aged 15-18 in Helsinki, Finland, who were assessed at the beginning of their psychiatric treatment with the Structured Interview for Prodromal Syndromes (SIPS). Current suicidality was measured with the Beck Depression Inventory (item 9), while lifetime suicidality was evaluated from all available data, including patient files. The participants were followed for 2.8-8.9 years via the national hospital discharge register, with the follow-up outcome being intentional self-harm. Data on suicides were also gathered from the Causes of Death statistics.

RESULTS

Only 30.5% of the adolescents had no suicidal ideation at the beginning of their treatment. CHR risk state and SIPS-assessed delusions, suspiciousness, and hallucinations were associated with higher current suicidality. Of the 154 adolescents with register follow-up, there were five (3.2%) with intentional self-harm resulting in hospital treatment, all female. CHR status was not associated with self-harm. Current suicidality, familial risk of psychosis, and SIPS decreased expression of emotions were associated with self-harm during follow-up. In a Cox regression analysis model among girls, only decreased expression of emotions remained a significant predictor of intentional self-harm. Baseline suicidality measures were not associated with transitions to psychosis.

CONCLUSIONS

CHR status was associated with higher current suicidality but did not predict follow-up intentional self-harm in treatment-seeking adolescents. Decreased expression of emotions may indicate higher risk of intentional self-harm in adolescent treatment-seeking girls.

Exploring Complexity of Deliberate Self-Poisoning through Network Analysis

The purpose of this research was to examine the complexity of circumstances that result in deliberate self-poisoning cases. For the purposes of this paper, the cases were patients that presented for care and were admitted to the specialty hospital in Northwest of Iran. The research examined the problems preceding deliberate self-poisoning and the interrelations among them by applying network analysis methods. The network was scored for degrees of centrality and betweenness centrality. Structural analysis of network also was conducted using block modelling. The results showed that family conflicts had the highest score for degree of centrality among women, while the highest score for degree of centrality among men belonged to those dealing with drug addiction. Analysis for degree of betweenness centrality revealed that drug addiction had the highest score among men, whereas the highest score for women on betweenness centrality was related to physical illness. Structural analysis of the network showed differences in role that various problems played in intentional self-poisoning. The findings from this research can be used by public health authorities to create prevention programs that address the problems leading to deliberate self-poisoning.

The Incremental Utility of Emotion Regulation But Not Emotion Reactivity in Nonsuicidal Self-Injury

This study assessed the incremental utility of emotion reactivity and emotion regulation in relation to nonsuicidal self-injury (NSSI). Participants included 379 college students aged 18-22 who completed self-report measures of emotion regulation, emotion reactivity, and NSSI. Emotion regulation was significantly related to NSSI both ignoring and controlling for reactivity, but the reverse was not true. Participants' use of NSSI for affect regulation appeared to moderate this relation. Findings support emotion regulation deficits as a target for intervention over and above heightened emotion reactivity, especially in those who use NSSI to regulate negative affect.

Childhood trauma in obese and overweight women with food addiction and clinical-level of binge eating

Childhood trauma (CT) is considered a major risk factor for several disorders as well as for the development of eating psychopathology and adult obesity. The main aims of the present study were to assess in overweight and obese women: (i) the independent association between CT and food addiction (FA), and (ii) CT in patients with both FA and clinical-level of binge eating (BE), versus patients who only engage in FA or BE. Participants were 301 overweight and obese women seeking low-energy-diet therapy. All of the patients were administered self-report measures investigating FA, BE, CT, anxiety and depressive symptoms. CT severity was moderately and positively associated with both FA (r=0.37; p<0.001) and BE (r=0.36; p<0.001) severity. The association between FA and CT remained significant after controlling for potential confounding variables. Furthermore, compared to patients without dysfunctional eating patterns, the co-occurrence of FA and BE was associated with more severe CT as well as with more severe psychopathology (i.e., anxiety and depressive symptoms) and higher BMI. Our results suggest that clinicians should carefully assess the presence of CT in individuals who report dysfunctional eating patterns in order to develop treatment approaches specifically for obese and overweight patients with a history of CT.

Changes in parenting strategies after a young person's self-harm: a qualitative study

BACKGROUND

When faced with the discovery of their child's self-harm, mothers and fathers may re-evaluate their parenting strategies. This can include changes to the amount of support they provide their child and changes to the degree to which they control and monitor their child.

METHODS

We conducted an in-depth qualitative study with 37 parents of young people who had self-harmed in which we explored how and why their parenting changed after the discovery of self-harm.

RESULTS

Early on, parents often found themselves "walking on eggshells" so as not to upset their child, but later they felt more able to take some control. Parents' reactions to the self-harm often depended on how they conceptualised it: as part of adolescence, as a mental health issue or as "naughty behaviour". Parenting of other children in the family could also be affected, with parents worrying about less of their time being available for siblings. Many parents developed specific strategies they felt helped them to be more effective parents, such as learning to avoid blaming themselves or their child for the self-harm and developing new ways to communicate with their child. Parents were generally eager to pass their knowledge on to other people in the same situation.

CONCLUSIONS

Parents reported changes in their parenting behaviours after the discovery of a child's self-harm. Professionals involved in the care of young people who self-harm might use this information in supporting and advising parents.