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Erol Y, Inozu M. An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury. Arch Suicide Res 2024; 28:815-829. [PMID: 37470456 DOI: 10.1080/13811118.2023.2237083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. METHOD The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. RESULTS Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. CONCLUSION The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI.HIGHLIGHTSEmotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI).Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI.Emotion regulation difficulty may make people engage in NSSI to regulate emotions.
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Brouwer B, Borg C, de Jong PJ. Self-Disgust and Sexual Functioning: A Scenario-Based Study Testing the Ability of Sex-Related Experiences to Elicit Self-Directed Disgust. JOURNAL OF SEX RESEARCH 2024; 61:649-657. [PMID: 36598143 DOI: 10.1080/00224499.2022.2158301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Increasing evidence indicates that disgust might compromise sexual functioning and can contribute to sexual problems. Although the stimuli and conditions that elicit disgust vary greatly across individuals, they cluster in three categories of disgust elicitors: Stimuli that are associated with an increased risk of the transmission of infectious diseases (pathogen disgust), stimuli that signal poor mating quality and may jeopardize reproductive success (sexual disgust), and behaviors that violate social norms (moral disgust). It has been argued that each of these categories of disgust may interfere with sexual responses. Thus far, research on the role of disgust in sexual contexts focused on external stimuli (e.g., sperm). Yet, recently it has been proposed that disgust can also become directed to features of the self. Such self-directed disgust may also apply to sexual contexts and contribute to sexual problems. As a first step to explore the relevance of self-disgust in sexual functioning, we tested if indeed particular sexual experiences have the ability to elicit self-disgust. Using a within subject design, participants (N = 124; all women) imagined themselves as well as others experiencing a series of sex-related scenarios, each relevant for one of the three categories of disgust, and subsequently rated their self-disgust. For all types of disgust, the scenarios evoked self-disgust, and the "self-perspective" elicited significantly more self-disgust than the "other-perspective." These findings support theoretical models pointing to the relevance of taking self-disgust into consideration as a factor that may compromise sexual functioning. Future research should test whether this also holds for men.
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Affiliation(s)
- Berber Brouwer
- Department of Clinical Psychology & Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Charmaine Borg
- Department of Clinical Psychology & Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology & Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
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Wilner JG, Ronzio B, Gillen C, Aguirre B. Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder. J Pers Disord 2024; 38:157-170. [PMID: 38592908 DOI: 10.1521/pedi.2024.38.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.
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Affiliation(s)
- Julianne G Wilner
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blake Ronzio
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Carly Gillen
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blaise Aguirre
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
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Ilieff M, Hamza CA. A Longitudinal Examination of Recent Posttraumatic Stress Symptoms and Nonsuicidal Self-Injury among University Students. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:773-782. [PMID: 37593057 PMCID: PMC10427599 DOI: 10.1007/s40653-023-00544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 08/19/2023]
Abstract
Nonsuicidal self-injury is a burgeoning mental health concern amongst post-secondary students. In the present study, the link between posttraumatic stress symptoms (PTSS) and nonsuicidal self-injury (NSSI) was examined among post-secondary students over time, while accounting for the role of co-occurring depressive symptoms. Participants were 841 first-year university students with self-reported lifetime histories of trauma who reported on traumatic experiences, PTSS, depressive symptoms, and NSSI at three time points over the course of their first year of university. This study also included exploratory correlational analyses of the relation among PTSS and motivations for NSSI engagement. As expected, PTSS predicted NSSI engagement among students within and across time, though effects were small. The strongest correlations were among PTSS and engaging in NSSI for the purposes of fulfilling self-punishment desires and anti-dissociation (e.g., to reduce feelings of numbness). This study provides further support for theories underscoring NSSI as a means of coping with intra- and interpersonal distress among post-secondary students experiencing stressful life events, such as trauma.
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Affiliation(s)
- Maria Ilieff
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON M5S 1V6 Canada
| | - Chloe A. Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON M5S 1V6 Canada
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Kot E, Kostecka B, Radoszewska J, Kucharska K. Self-disgust in patients with borderline personality disorder. The associations with alexithymia, emotion dysregulation, and comorbid psychopathology. Borderline Personal Disord Emot Dysregul 2023; 10:24. [PMID: 37641140 PMCID: PMC10463936 DOI: 10.1186/s40479-023-00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Self-disgust is a negative self-conscious emotion, which has been linked with borderline personality disorder (BPD). However, it has not yet been investigated in relation to both emotion dysregulation and alexithymia, which are recognized as crucial to BPD. Therefore, the aim of our study was to measure these variables and examine the possible mediational role of emotional alterations and comorbid anxiety and depression symptoms in shaping self-disgust in patients with BPD and healthy controls (HCs). METHODS In total, the study included 100 inpatients with BPD and 104 HCs. Participants completed: the Self-Disgust Scale (SDS), Disgust Scale - Revised (DS-R), Toronto Alexithymia Scale (TAS-20), Emotion Dysregulation Scale short version (EDS-short), Borderline Personality Disorder Checklist (BPD Checklist), State-Trait Anxiety Inventory (STAI), and Center for Epidemiologic Studies Depression Scale (CESD-R). RESULTS Inpatients with BPD showed higher self-disgust, alexithymia, emotion dysregulation, core and comorbid symptoms levels, and lower disgust sensitivity. Alexithymia, emotion dysregulation, and trait anxiety partially mediated between BPD diagnosis and self-disgust. The relationship between the severity of BPD symptoms and self-disgust was fully mediated by alexithymia, emotion dysregulation, depressive symptoms, and trait anxiety. CONCLUSIONS The results of our study may imply the contribution of emotion dysregulation, alexithymia, and comorbid psychopathology to self-referenced disgust in BPD.
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Affiliation(s)
- Emilia Kot
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, Warsaw, 02-957, Poland.
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, 8 Kondratowicza Street, Warsaw, 03-242, Poland
| | - Joanna Radoszewska
- Faculty of Psychology, University of Warsaw, 5/7 Stawki Street, Warsaw, 00-183, Poland
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 1/3 Wóycickiego Street, Warsaw, 01-938, Poland
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Kim S, Woo S, Lee JS. Investigation of the Subtypes of Nonsuicidal Self-Injury Based on the Forms of Self-Harm Behavior: Examining Validity and Utility via Latent Class Analysis and Ecological Momentary Assessment. J Korean Med Sci 2023; 38:e132. [PMID: 37128876 PMCID: PMC10151622 DOI: 10.3346/jkms.2023.38.e132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/19/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND This study aimed to empirically derive and validate subtypes of nonsuicidal self-injury (NSSI) based on the forms of self-harm behavior. METHODS Sixty young adults who exhibited repetitive NSSI completed a clinical interview and baseline measures, followed by a two-week ecological momentary assessment (EMA). A latent class analysis was administered to identify NSSI subtypes based on the forms of self-harm behavior. The subtypes were then compared to baseline clinical and EMA variables, including emotions and urges to self-harm. RESULTS The best-fitting model supported two subtypes: 1) substance abuse and suicide attempt subtype and 2) cutting and scratching subtype. The substance abuse and suicide attempt subtype reported a higher rate of engaging in lifetime suicide plans and suicide attempts and a higher number of lifetime suicide attempts. They also showed significantly higher severity of self-harm behavior, borderline personality traits, anger, posttraumatic symptoms, and difficulties in emotion regulation when compared to the cutting and scratching subtype. However, there was no inter-subtype difference in self-esteem. In the EMA data, anger toward others, feeling of rejection, loneliness, and helplessness were significantly high in the substance abuse and suicide attempt subtype. The variability of anger toward others was also higher in this subtype compared to the cutting and scratching subtype. Finally, in the two-week research period, the substance abuse and suicide attempt group showed a higher rate of reported urges to self-harm with or without suicidal intent. CONCLUSION Findings support the validity of the subtypes based on the forms of self-harm behavior, suggesting the clinical utility of addressing heterogeneity within individuals exhibiting self-harm for assessment and treatment.
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Affiliation(s)
- Sojung Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
- Department of Psychology, Yeungnam University, Gyeongsan, Korea.
| | - Sungbum Woo
- Cultural Contents Technology Research Institute, Gachon University, Seongnam, Korea
- Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon, Korea
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Biermann M, Schulze A, Vonderlin R, Bohus M, Lyssenko L, Lis S. Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face. Front Psychiatry 2023; 14:1082785. [PMID: 36970260 PMCID: PMC10030617 DOI: 10.3389/fpsyt.2023.1082785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
BackgroundA markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.MethodsA sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).ResultsIndividuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.ConclusionOur study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.
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Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- *Correspondence: Miriam Biermann,
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ruben Vonderlin
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Ruhr University Bochum, Bochum, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa Lyssenko
- Department of Public Health, Freiburg University of Education, Freiburg, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Raudales AM, Yang M, Schatten HT, Armey MF, Weiss NH. Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms. Suicide Life Threat Behav 2023; 53:124-136. [PMID: 36326152 DOI: 10.1111/sltb.12927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/03/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS). METHODS Participants were 81 individuals with a history of sexual assault and NSSI (Mage = 33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD = 31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study. RESULTS Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average. CONCLUSION Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.
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Affiliation(s)
- Alexa M Raudales
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Gao S, Zhang L, Yao X, Lin J, Meng X. Associations between self-disgust, depression, and anxiety: A three-level meta-analytic review. Acta Psychol (Amst) 2022; 228:103658. [DOI: 10.1016/j.actpsy.2022.103658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 06/05/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
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Aghamohammadi S, Mazaheri M, Fata L, Mootabi F. Relationship between Non-Suicidal Self-Injury and Attachment: Protocol for Systematic Review and Meta-Analysis (Preprint). JMIR Res Protoc 2022; 12:e40808. [DOI: 10.2196/40808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/28/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
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Baer MM, Tull MT, Gratz KL. Substance Use Frequency Relates to Suicidal Ideation Through Perceived Burdensomeness and to Suicide Attempts Through Capability for Suicide. Arch Suicide Res 2022; 26:1520-1540. [PMID: 34529923 DOI: 10.1080/13811118.2021.1931595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequency of substance use is indirectly related to suicidal ideation and suicide attempts through core ITS variables (i.e., burdensomeness, thwarted belongingness, and suicide capability). METHODS An online sample of Mechanical Turk workers (N = 365) completed measures assessing substance use frequency, burdensomeness, thwarted belongingness, suicide capability, suicidal ideation, and suicide attempts. RESULTS After controlling for relevant clinical and demographic covariates, substance use frequency was indirectly related to suicidal ideation through burdensomeness but not thwarted belongingness. Substance use frequency was indirectly related to suicide attempts through suicide capability only. LIMITATIONS The cross-sectional design precludes conclusions about the precise nature and direction of the relations examined. The use of a community sample limits generalizability to more severe substance using samples. CONCLUSIONS Results highlight the relevance of distinct ITS factors in the relation between substance use frequency and both suicidal ideation and suicide attempts. Results may inform specific targets for novel interventions aimed at reducing suicide risk among substance-using individuals.HighlightsSubstance use frequency was indirectly related to SI through burdensomeness.Substance use frequency was not indirectly related to SI through thwarted belongingness.Substance use frequency was indirectly related to SA only through suicide capability.
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Kim H, Hur JW. What's Different About Those Who Have Ceased Self-Injury? Comparison Between Current and Lifetime Nonsuicidal Self-Injury. Arch Suicide Res 2022; 27:718-733. [PMID: 35446236 DOI: 10.1080/13811118.2022.2064256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The current study aimed to investigate the sociodemographic and psychological variables as well as the function of NSSI related to the cessation of NSSI by analyzing the difference between those currently engaged in nonsuicidal self-injury (NSSI) and those who have stopped NSSI behaviors. METHODS A total of 490 adults with a history of NSSI (359 females) were assigned to one of two groups: NSSI engagement within the last 12 months or "current NSSI" (n = 402) vs. no episode of NSSI in the previous 12 months or "lifetime NSSI" (n = 88). RESULTS There were no significant group differences in sex or socioeconomic status, while individuals with current NSSI were slightly younger than those who had ceased NSSI behavior. Regarding the functions of NSSI, the current NSSI group endorsed more intrapersonal functions. Moreover, the participants who had ceased NSSI behavior reported significantly less perceived stress, dysfunctional attitudes, alexithymia, emotion reactivity, and suicidal ideation. On the other hand, the lifetime NSSI group showed greater psychological resources such as self-esteem, distress tolerance, and resilience. CONCLUSIONS We revealed apparent differences in NSSI functions, clinical symptoms, and psychological resources depending on the maintenance and cessation of NSSI. This study highlights the need for a better understanding of the factors that stop as well as those that continue NSSI behaviors. HIGHLIGHTSThe lifetime NSSI group reported less intrapersonal NSSI functions.The current NSSI group suffered from more clinical symptoms.Individuals who ceased NSSI had more psychological resources.
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Nilsson M, Lundh L, Westling S. Childhood maltreatment and self-hatred as distinguishing characteristics of psychiatric patients with self-harm: A comparison with clinical and healthy controls. Clin Psychol Psychother 2022; 29:1778-1789. [PMID: 35467060 PMCID: PMC9790602 DOI: 10.1002/cpp.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Deliberate self-harm (DSH) is common in clinical populations. Childhood maltreatment (CM) and attitudes both towards oneself and towards DSH may be of importance for the development of DSH. This study aimed to test whether patients with DSH report more CM, more negative attitudes towards oneself and more positive attitudes towards DSH than a clinical and a healthy comparison group, and whether the effects of CM are mediated by negative attitudes towards oneself. METHOD Females with DSH and psychiatric disorders (n = 34), females without DSH but with psychiatric disorders (n = 31) and healthy female individuals (n = 29) were compared regarding DSH, CM, attitudes towards the self and attitudes towards self-harm. RESULTS Females with DSH reported more emotional abuse and more self-hatred as compared to both comparison groups. The effect of emotional abuse was mediated by self-hatred. The DSH-group had significantly more positive attitudes towards DSH than the healthy comparison group. CONCLUSION Self-hatred and CM in the form of emotional abuse may be distinguishing characteristics of female patients with DSH in psychiatric settings. The present results are compatible with the hypothesis that emotional abuse leads to DSH via self-hatred, but the cross-sectional nature of the study precludes any causal conclusions. The clinical utility of the results is discussed.
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Affiliation(s)
- Magnus Nilsson
- Department of Clinical Sciences, PsychiatryLund UniversityLundSweden
| | | | - Sofie Westling
- Clinical Psychiatric Research CenterRegion SkåneLundSweden
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Self-Critical and Self-Punishment Cognitions Differentiate Those With and Without a History of Nonsuicidal Self-Injury: An Ecological Momentary Assessment Study. Behav Ther 2021; 52:686-697. [PMID: 33990242 DOI: 10.1016/j.beth.2020.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022]
Abstract
The aim of this study was to examine trait, state, and temporal instability measures of self-critical and self-punishment cognitions to evaluate their respective roles in nonsuicidal self-injury (NSSI). Participants were university students with a history of NSSI (n = 64) and those with no history of NSSI (n = 59). At baseline, participants completed measures assessing history of NSSI behavior, as well as trait measures of self-criticism and self-punishment. After completion of baseline procedures, participants subsequently participated in a 10-day ecological momentary assessment protocol in which self-critical and self-punishment cognitions were assessed in real time three times daily. Employing bivariate and multivariate frameworks, our results demonstrate that both trait and state levels of self-critical and self-punishment cognitions robustly differentiate between young adults with and without a lifetime history of NSSI. The present results also confirm that the temporal instability of these cognitive states also meaningfully differentiate between groups, such that those who exhibit greater fluctuations in these cognitive states are more likely to have a history of NSSI. The current findings suggest that trait, state, and temporal instability of negative self-focused cognitions may be vulnerability factors for engagement in NSSI.
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Hamza CA, Goldstein AL, Heath NL, Ewing L. Stressful Experiences in University Predict Non-suicidal Self-Injury Through Emotional Reactivity. Front Psychol 2021; 12:610670. [PMID: 33927664 PMCID: PMC8076506 DOI: 10.3389/fpsyg.2021.610670] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, Mage = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI.
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Affiliation(s)
- Chloe A Hamza
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Nancy L Heath
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Lexi Ewing
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
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16
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Schienle A, Schwab D, Höfler C, Freudenthaler HH. Self-Disgust and Its Relationship With Lifetime Suicidal Ideation and Behavior. CRISIS 2020; 41:344-350. [DOI: 10.1027/0227-5910/a000645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract. Background: The emotion disgust is typically directed toward stimuli in the external environment, but sometimes people develop self-directed disgust responses. Aims: The current questionnaire study focused on the role of self-disgust in lifetime suicidal ideation and behavior. Method: A total of 1,167 individuals participated in an Internet-based survey containing self-report measures of self-disgust, externally directed disgust proneness, coping styles, diagnoses of mental disorders, and suicide risk. Hierarchical regression analyses as well as mediation analyses were computed. Results: Self-disgust was the most relevant predictor of suicide risk among the assessed variables. Self-disgust was negatively associated with the use of support by others, and positively associated with evasive coping (self-blame, venting, denial), which in turn was positively associated with suicidality. Limitations: This cross-sectional study provided information on the relationship between self-disgust and suicidality in a self-selected sample. Longitudinal studies are warranted. Conclusion: Future studies are required to replicate these findings. Additionally, stronger research designs are needed in order to investigate whether self-disgust should be targeted in suicide prevention programs and interventions.
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Affiliation(s)
- Anne Schienle
- Institute of Psychology, University of Graz, Austria
| | | | - Carina Höfler
- Institute of Psychology, University of Graz, Austria
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17
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Halicka-Masłowska J, Szewczuk-Bogusławska M, Rymaszewska J, Adamska A, Misiak B. From Emotional Intelligence to Self-Injuries: A Path Analysis in Adolescents With Conduct Disorder. Front Psychiatry 2020; 11:556278. [PMID: 33488414 PMCID: PMC7819897 DOI: 10.3389/fpsyt.2020.556278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: Self-harm acts are highly prevalent among adolescents with conduct disorder. It has been shown that low level of emotional intelligence (EI) might be related to a higher risk of self-injuries. However, the exact mechanisms underlying this association are still unclear. The purpose of this study was to explore whether psychopathological symptoms and selected psychological processes mediate the association between EI and self-harm risk in adolescents with conduct disorders. Method: Out of 162 adolescents with conduct disorder approached for participation, 136 individuals (aged 14.8 ± 1.2 years, 56.6% females) were enrolled and completed the questionnaires evaluating the level of EI, depression, anxiety, impulsiveness, empathy, venturesomeness, self-esteem, and disgust. Results: Individuals with a lifetime history of self-injuries had significantly higher levels of depression, anxiety and impulsivity as well as significantly lower levels of EI and self-esteem. Higher levels of EI were associated with significantly higher levels of self-esteem, venturesomeness and empathy as well as significantly lower levels of depression, anxiety and impulsivity. Further analysis revealed that trait and state anxiety as well as self-esteem were complete mediators of the association between EI and self-harm risk. Conclusions: Our findings indicate that anxiety and self-esteem might mediate the association between EI and a risk of self-injuries in adolescents with conduct disorder. However, a cross-sectional design of this study limits conclusions on the direction of causality. Longitudinal studies are needed to test validity of our model.
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Affiliation(s)
| | | | | | - Agnieszka Adamska
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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18
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Sonnier H, Alex Brake C, Flores J, Badour CL. Posttraumatic stress and hazardous alcohol use in trauma-exposed young adults: indirect effects of self-disgust. Subst Use Misuse 2019; 54:1051-1059. [PMID: 30892115 PMCID: PMC6483896 DOI: 10.1080/10826084.2018.1517173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol use disorders are highly co-occurring. Several explanatory models of the relation between PTSD and hazardous alcohol use have been identified. However, the exact nature of this relation is not fully understood. Self-disgust may explain the relation between PTSD symptoms and hazardous drinking. OBJECTIVES The goal of the current study was to examine whether there was an indirect effect of probable PTSD on hazardous alcohol use via two domains of self-disgust: (disgust with characteristics of the self, disgust with one's behavior). Participants were 376 undergraduate students who reported experiencing at least one Diagnostic and Statistical Manual for DSM Disorders, 5th edition-defined traumatic event. Participants completed self-report measures online, which assessed their trauma exposure, PTSD symptoms, self-disgust, and their alcohol use behaviors. RESULTS Probable PTSD was indirectly associated with an increased likelihood of engaging in hazardous drinking through the pathway of increased disgust toward one's behaviors. Although probable PTSD was also positively linked to disgust with characteristics of the self, this form of self-disgust was associated with a decreased likelihood of engaging in hazardous drinking, leading to a negative indirect relationship between probable PTSD and hazardous drinking. Conclusions/Importance: Overall, this study suggests that the role of self-disgust in the association between PTSD and hazardous drinking is complex, highlighting the need for further research in this area.
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Affiliation(s)
- Hannah Sonnier
- a Department of Psychology , University of Kentucky , Lexington , KY , USA
| | - C Alex Brake
- a Department of Psychology , University of Kentucky , Lexington , KY , USA
| | - Jessica Flores
- a Department of Psychology , University of Kentucky , Lexington , KY , USA
| | - Christal L Badour
- a Department of Psychology , University of Kentucky , Lexington , KY , USA
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19
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Clarke A, Simpson J, Varese F. A systematic review of the clinical utility of the concept of self-disgust. Clin Psychol Psychother 2018; 26:110-134. [DOI: 10.1002/cpp.2335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/13/2018] [Accepted: 09/13/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Aoife Clarke
- Division of Health Research; Lancaster University; Lancaster UK
| | - Jane Simpson
- Division of Health Research; Lancaster University; Lancaster UK
| | - Filippo Varese
- Division of Psychology and Mental Health; University of Manchester; Manchester UK
- Complex Trauma and Resilience Research Unit; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester UK
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20
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Tan SC, Tam CL, Bonn G. Feeling better or worse? The lived experience of non-suicidal self-injury among Malaysian University students. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2018. [DOI: 10.1080/21507686.2018.1541912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Su Chen Tan
- Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Cai Lian Tam
- Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Gregory Bonn
- Department of General Studies –Psychology, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
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21
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A lab-based study exploring the associations among nonsuicidal self-injury, pain, and emotion among university students. Psychiatry Res 2018; 269:462-468. [PMID: 30195739 DOI: 10.1016/j.psychres.2018.08.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/05/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI; e.g., self-cutting without lethal intent) is a widespread mental health concern among emerging adults in university. Although accumulating evidence suggests that NSSI is primarily an emotion coping behaviour, little is known about variability in emotional response to pain among individuals who self-injure. Recent theory on NSSI suggests that individuals who engage in NSSI to self-punish may experience additional affective gains in response to pain compared to individuals without self-punishment motivations for NSSI and individuals who do not self-injure. To test this hypothesis, 82 undergraduate students (Mage = 21.52 years) were recruited from a mid-sized university, and reported on their emotions three times: at baseline, following a stress-induction task, and after a cold-pressor task. Although all participants showed decreased negative emotions (e.g., hostility, fear) and increased serenity following cold pain, students who engaged in NSSI specifically to self-punish also showed decreased guilt and sadness. The present findings demonstrate that pain may serve to regulate different emotions for students who self-injure depending on their motivations for engaging in NSSI. Additionally, findings suggest that prevention and intervention efforts aimed at reducing the need to self-punish may help to reduce some of the emotionally reinforcing properties of NSSI.
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22
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Forrester RL, Slater H, Jomar K, Mitzman S, Taylor PJ. Self-esteem and non-suicidal self-injury in adulthood: A systematic review. J Affect Disord 2017. [PMID: 28647667 DOI: 10.1016/j.jad.2017.06.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Rebecca L Forrester
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, England L69 3GB, United Kingdom.
| | - Hayley Slater
- Division of Health Research, University of Lancaster, Lancaster, England LA1 4YG, United Kingdom
| | - Khowla Jomar
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, England L69 3GB, United Kingdom
| | - Susan Mitzman
- Instiute of Learning and Teaching, University of Liverpool, Liverpool, England L69 3GB, United Kingdom
| | - Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, England M13 9PL, United Kingdom
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23
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Brake CA, Rojas SM, Badour CL, Dutton CE, Feldner MT. Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk. J Anxiety Disord 2017; 47:1-9. [PMID: 28126678 DOI: 10.1016/j.janxdis.2017.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 01/04/2023]
Abstract
Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one's behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.
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Affiliation(s)
- C Alex Brake
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA.
| | - Sasha M Rojas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
| | - Courtney E Dutton
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Matthew T Feldner
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA; Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74136, USA
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24
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Riley EN, Combs JL, Jordan CE, Smith GT. Negative Urgency and Lack of Perseverance: Identification of Differential Pathways of Onset and Maintenance Risk in the Longitudinal Prediction of Nonsuicidal Self-Injury. Behav Ther 2015; 46:439-48. [PMID: 26163709 PMCID: PMC4801770 DOI: 10.1016/j.beth.2015.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 11/19/2022]
Abstract
Many researchers have identified impulsivity-related personality traits as correlates of and risk factors for nonsuicidal self-injury (NSSI). Using a longitudinal design, we tested the hypothesis that one such trait, negative urgency (the tendency to act rashly when distressed), predicts the onset of NSSI during the first year of college and a different trait, lack of perseverance (the disposition to fail to maintain focus on tasks that are difficult or boring), predicts the maintenance of NSSI during the first year of college. In a sample of n=1,158 college women (mean age=18.04, 95% of participants were 18 at Time 1), we found support for these hypotheses. Negative urgency, measured prior to college entry, predicted the onset of NSSI behavior across the first year of college (odds ratio=1.58). Lack of perseverance predicted the maintenance of NSSI status across the first year of college, controlling for prior NSSI behavior (odds ratio=1.73). These findings indicate that different impulsivity-related personality traits may play different roles in the risk process for NSSI.
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25
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Olatunji BO, Cox R, Ebesutani C, Wall D. Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect. J Psychiatr Res 2015; 65:37-46. [PMID: 25868550 DOI: 10.1016/j.jpsychires.2015.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022]
Abstract
Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed.
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Affiliation(s)
| | | | | | - David Wall
- Remuda Ranch Programs for Eating Disorders, USA
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