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Chen Y, Fu W, Ji S, Zhang W, Sun L, Yang T, He K, Zhou Y. Relationship between borderline personality features, emotion regulation, and non-suicidal self-injury in depressed adolescents: a cross-sectional study. BMC Psychiatry 2023; 23:293. [PMID: 37118709 PMCID: PMC10148398 DOI: 10.1186/s12888-023-04800-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is common among adolescents and has been linked to mental disorders and suicide in addition to physical injuries. According to the empirical avoidance model, adolescents with NSSI have stronger emotional affect and poorer emotional regulation than those without NSSI, and these constitute core features of borderline personality disorder (BPD). The relationship between borderline personality features, emotional regulation, and NSSI in the population is unclear. This study explored these associations to provide a theoretical basis for the treatment of NSSI in the future. METHODS Depressed adolescents (n = 1192) were evaluated using Chinese versions of the Function Assessment of Self-mutilation Scale, Emotional Regulation Questionnaire for Children and Adolescents, and Borderline Personality Features Scale for Children. RESULTS The majority of depressed adolescents (71.3%, 850/1192) had demonstrated NSSI in the past year, with cutting or scratching being the most common form (57.4%). Pearson correlation analysis with NSSI as a fixed factor (NSSI = 1, no NSSI = 2) revealed a negative correlation between NSSI and borderline personality features (r = -0.314, P < 0.01) but a positive correlation between NSSI and emotional regulation capacity (r = 0.159, P < 0.01), which was positively correlated with the expression suppression dimension (r = 0.079, p < 0.01); however, there was no significant correlation between the cognitive reappraisal dimension and expression suppression (r = 0.022, p > 0.05). The occurrence of NSSI was also positively correlated with borderline personality features in general (r = 0.314, p < 0.01). These results were statistically significant. Emotional regulation played a mediating role between borderline personality traits and NSSI in adolescents with depression (effect value = 0.151). CONCLUSION Borderline personality features and emotional regulation ability were significantly correlated with NSSI in depressed adolescents. Borderline personality symptoms not only directly influenced NSSI risk in adolescents with depression, but also indirectly influenced NSSI risk through emotional regulation.
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Affiliation(s)
- Yang Chen
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
| | - Wenxian Fu
- Anhui Mental Health Center, Hefei, 230022, China
| | - Sifan Ji
- Anhui Mental Health Center, Hefei, 230022, China
| | - Wei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Lingmin Sun
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Tingting Yang
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China
| | - Kongliang He
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China.
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China.
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
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Haywood SB, Hasking P, Boyes ME. Associations between non-suicidal self-injury and experiential avoidance: A systematic review and Robust Bayesian Meta-analysis. J Affect Disord 2023; 325:470-479. [PMID: 36638968 DOI: 10.1016/j.jad.2023.01.027] [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] [Received: 08/10/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) is the intentional and deliberate damage to an individual's own body tissue without the intent to suicide. Individuals who have higher self-reported levels of experiential avoidance are more likely to report a history of NSSI. The current study systematically reviewed the literature and meta-analysed studies assessing associations between experiential avoidance and self-injury. METHOD An extensive review was conducted of several databases (including ProQuest, Joanna Briggs, Web of Science, PsychArticles, PubMed, Scopus, and Ovid). Nineteen articles (two dissertations) met the inclusion criteria for the systematic review and 14 were analysed in a Robust Bayesian Meta-analysis. This review was registered through PROSPERO (CRD42020198041). RESULTS There was a small to medium, pooled effect size (d = 0.48, 95 % Credibility Interval 0.00-0.85). There was strong evidence for this effect size (Bayes Factor = 12.16), although there was considerable heterogeneity between studies (τ =0.68, 95 % CI [0.44, 0.1.05]). The analysis testing whether these findings may be due to publication bias was inconclusive (Bayes Factor = 2.45). LIMITATIONS The majority of studies included were cross-sectional, in English, and most studies were of university students. While some studies reported on recency/frequency of NSSI there was not enough data to conduct meta-analysis. CONCLUSION These results suggest there is a robust association between history of NSSI and experiential avoidance. However, as most studies operationalise avoidance as a unidimensional construct, it is not clear which aspects of avoidance differentiate individuals with and without a history of NSSI.
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Affiliation(s)
- Sophie B Haywood
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Penelope Hasking
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Mark E Boyes
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
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Scheer JR, Helminen EC, Felver JC, Coolhart D. Nonmedical Social Determinants, Syndemic Conditions, and Suicidal Thoughts and Behaviors in a Treatment-seeking Community Sample: A Latent Class Analysis. Arch Suicide Res 2022:1-20. [PMID: 35946421 PMCID: PMC9911562 DOI: 10.1080/13811118.2022.2108741] [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: 11/02/2022]
Abstract
OBJECTIVE Knowledge gaps remain regarding whether syndemic conditions identify treatment-seeking individuals most at risk for suicidal thoughts and behaviors (STB). We employed latent class analysis to: (1) model treatment-seeking individuals' syndemic conditions, (2) examine latent classes across nonmedical social determinants, and (3) assess associations between class membership and STB. METHOD Participants were 982 individuals presenting at a community mental health clinic between October 2014 and February 2020. The three-step latent class analytic approach was used. Regression analyses were employed to examine nonmedical social determinants and STB outcomes associated with class membership. RESULTS Participants were aged 18 to >72 (75.8% White; 76.7% heterosexual; 53.7% cisgender woman; 73.8% earned ≥$20,000 annually). Latent class analysis resulted in a three-class solution. Participants in Class 1 were characterized by low probabilities across syndemic conditions. Class 2 was characterized by high probabilities of anxiety and depression. Class 3 was characterized by high probabilities of eating disorders, anxiety, and depression. Participants of color, sexual minority participants, cisgender women, and those experiencing financial distress were more likely to be in classes characterized by syndemic conditions. Classes characterized by syndemic conditions, relative to no syndemic conditions, were associated with greater risk of STB. CONCLUSION Findings confirm the concentrated clustering of co-occurring syndemic conditions among marginalized groups and highlight differing risks for those considering suicide or who have attempted suicide vs. those engaging in self-harm. Results underscore the need for resource allocation and multilevel interventions targeting syndemic conditions and suicidality for minority populations and those experiencing financial distress.
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Lydecker JA, Grilo CM, Hamilton A, Barnes RD. Digital self-harm is associated with disordered eating behaviors in adults. Eat Weight Disord 2022; 27:2129-2136. [PMID: 35066861 PMCID: PMC9288535 DOI: 10.1007/s40519-021-01355-6] [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] [Received: 08/19/2020] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Eating-disorder psychopathology is associated with self-harm behaviors. With much time spent and many social interactions taking place online, self-cyberbullying has emerged as a new form of self-harm that is digital. The current study examined digital self-harm in adults and its associations with eating-disorder psychopathology and behaviors. METHODS Participants were adults (N = 1794) who completed an online cross-sectional survey. Participants reported whether they had ever posted mean things about themselves online, whether they had ever anonymously bullied themselves online and completed measures of eating-disorder psychopathology and disordered eating behaviors. RESULTS Digital self-harm was reported by adults across demographic characteristics and across the lifespan, although there were some significant differences in demographic characteristics associated with reported digital self-harm. Participants who engaged in digital self-harm were younger than those denying digital self-harm. Eating-disorder psychopathology and disordered eating behaviors were significantly higher among individuals reporting digital self-harm compared with age-matched controls. CONCLUSIONS This was the first study to examine digital self-harm among adults and the first study to examine associations of digital self-harm with eating-disorder psychopathology and disordered eating behaviors. Importantly, digital self-harm is reported by adults and therefore is not limited to youth. Our findings that digital self-harm is associated with disordered eating suggests that digital self-harm is a clinically significant topic that needs further research to inform clinical practice and clinical research. LEVEL OF EVIDENCE Level III, Evidence obtained from well-designed cohort or case-controlled analytic studies.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Antonia Hamilton
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Rachel D Barnes
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.,Health Psychology, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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5
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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Angelakis I, Gooding P. Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis. Suicide Life Threat Behav 2021; 51:978-992. [PMID: 34184775 DOI: 10.1111/sltb.12784] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations. METHOD Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations. RESULTS Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong. DISCUSSION The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.
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Affiliation(s)
- Ioannis Angelakis
- School of Psychology, University of South Wales, Pontypridd, Wales, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, Faculty of Biological, School of Health Sciences, Medical and Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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Matera E, Margari M, Serra M, Petruzzelli MG, Gabellone A, Piarulli FM, Pugliese A, Tassiello AR, Croce F, Renna C, Margari A. Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults. Brain Sci 2021; 11:brainsci11080974. [PMID: 34439593 PMCID: PMC8391479 DOI: 10.3390/brainsci11080974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann-Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.
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Affiliation(s)
- Emilia Matera
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy;
- Correspondence:
| | - Mariella Margari
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Maria Serra
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Maria Giuseppina Petruzzelli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Alessandra Gabellone
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy;
| | - Francesco Maria Piarulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Assunta Pugliese
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Anna Rita Tassiello
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Federica Croce
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Caterina Renna
- Center for Treatment and Research on Eating Disorders Mental Health Department AL, Via Miglietta 5, 73100 Lecce, Italy;
| | - Anna Margari
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
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Vieira AI, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Group-based intervention for eating disorders with non-suicidal-self-injury: a case series. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Gonçalves
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
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Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics. J Youth Adolesc 2021; 50:767-787. [PMID: 33449284 DOI: 10.1007/s10964-020-01378-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; Mage = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; Mage = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.
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10
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Jones EJ, Egan SJ, Howell JA, Hoiles KJ, Mazzucchelli TG. An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents. Eat Behav 2020; 39:101445. [PMID: 33142128 DOI: 10.1016/j.eatbeh.2020.101445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The validity of the transdiagnostic cognitive-behavioural model of eating disorders has been examined in adults, however there is limited examination in adolescents with eating disorders. The present study examined the direct and indirect relationships between eating disorder symptoms and the four maintaining processes: perfectionism, low core self-esteem, mood intolerance, and interpersonal difficulties. METHOD Using a correlational cross-sectional design, adolescents with eating disorders (N = 270; anorexia nervosa [restricting; 35.9%]; anorexia nervosa [binge purge; 8.1%]; bulimia nervosa [9.3%]; atypical anorexia nervosa [27.4%]; bulimia nervosa [of low frequency and/or limited duration; 3%]; purging [1.1%]; and unspecified feeding or eating disorders [15.2%]) completed measures of perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms as part of the intake assessment to an eating disorders program. RESULTS Path analysis revealed that low self-esteem and mood intolerance were directly associated with eating disorder symptoms. Perfectionism was indirectly associated with eating disorder symptoms through self-esteem and mood intolerance. DISCUSSION The findings provide partial support for the transdiagnostic model of eating disorders in an adolescent clinical sample. In particular, core low self-esteem and mood intolerance were found to be pertinent in adolescents with eating disorders. A limitation of the current study was the use of cross-sectional data. Future research should examine the transdiagnostic model with the use of longitudinal data. Furthermore, future research is required to examine potential differences in the way the maintaining mechanisms operate between adolescents and adults with eating disorders and the implications for treatment.
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Affiliation(s)
- Emily J Jones
- School of Psychology, Curtin University, Perth, Australia.
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
| | - Joel A Howell
- School of Psychology, Curtin University, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
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11
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Vieira AI, Moreira CS, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders. J Clin Psychol 2020; 77:607-628. [PMID: 32762121 DOI: 10.1002/jclp.23038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI. METHOD The sample included 171 outpatients (94.2% female; Mage = 28.78, SDage = 11.19). RESULTS Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year. CONCLUSIONS Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.
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Affiliation(s)
- Ana I Vieira
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
| | - Célia S Moreira
- Mathematics Department, Center of Mathematics (CMUP), Faculty of Sciences, University of Porto, Porto, Portugal
| | - Tânia F Rodrigues
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sónia Gonçalves
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
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12
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Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Madjar N, Segal N, Eger G, Shoval G. Exploring Particular Facets of Cognitive Emotion Regulation and Their Relationships With Nonsuicidal Self-Injury Among Adolescents. CRISIS 2019; 40:280-286. [PMID: 30813824 DOI: 10.1027/0227-5910/a000566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Nonsuicidal self-injury (NSSI) has been found to be associated with poor emotion regulation. Aims: The goal of this study was to examine the association of multidimensional cognitive emotion regulation strategies with NSSI among adolescents and compare the different patterns of NSSI. Method: A sample of 594 high-school students (54.4% boys; mean age = 14.96 years), from five regional schools across Israel, were assessed for five facets of cognitive emotion regulation strategies (acceptance, refocus on planning, positive refocusing, putting into perspective, and positive reappraisal) and NSSI behaviors using validated scales. Participants were allocated into three groups: repetitive NSSI (more than six occasions of NSSI; 7.1%), occasional NSSI (at least one incident but less than six; 8.3%), and no NSSI (84.6%). Results: Analysis of covariance, controlling for gender and depression symptoms, revealed that students with NSSI reported higher levels of acceptance, but lower levels of refocus on planning and putting into perspective. Limitations: The study used a cross-sectional design, which was a limitation. Conclusion: These findings demonstrate that particular cognitive emotion regulation strategies differ substantially in their relationship with NSSI. Adolescents who focus on planning and putting stressful situations into perspective may have increased resilience, whereas adolescents who are accepting of negative events that have happened may be more prone to maladaptive coping behaviors.
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Affiliation(s)
- Nir Madjar
- 1 School of Education, Bar-Ilan University, Israel
| | - Nicole Segal
- 1 School of Education, Bar-Ilan University, Israel
| | - Gilad Eger
- 2 Child and Adolescent Psychiatric Division, Geha Mental Health Center, Petach Tikva, Israel.,3 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- 2 Child and Adolescent Psychiatric Division, Geha Mental Health Center, Petach Tikva, Israel.,3 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Unpacking cognitive emotion regulation in eating disorder psychopathology: The differential relationships between rumination, thought suppression, and eating disorder symptoms among men and women. Eat Behav 2019; 32:95-100. [PMID: 30677597 DOI: 10.1016/j.eatbeh.2019.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 11/23/2022]
Abstract
While previous literature suggests that emotion dysregulation is a salient factor contributing to the onset and maintenance of eating disorders (EDs), less is known about how maladaptive, cognitively oriented regulation strategies such as rumination and thought suppression may be uniquely related to ED symptoms in men and women. The present study sought to examine the independent associations of ruminative brooding and thought suppression with ED symptoms, after controlling for negative affect intensity, and assess whether these associations differ by gender. Participants were 263 undergraduates who completed a series of questionnaires, including measures of ED symptoms (Eating Disorder Diagnostic Scale), ruminative brooding (Ruminative Response Scale), and thought suppression (White Bear Suppression Inventory). Generalized linear models examined main effects of ruminative brooding and thought suppression and their interactions with gender on ED symptoms, controlling for negative affect intensity. Higher ruminative brooding was associated with higher binge eating among women. Thought suppression was associated with higher vomiting and fasting frequency in both genders, with a stronger association between suppression and fasting in men compared to women. Together results demonstrate the unique contributions of cognitive perseveration and avoidance in ED symptomatology; specifically, ruminative brooding may be a salient factor contributing to binge eating in women, while high levels of thought suppression among males may contribute to fasting. Findings highlight the potential importance of examining and differentially targeting specific facets of cognitive emotion regulation in men and women engaging in ED behaviors.
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Zinchuk MS, Avedisova AS, Guekht AB. Nonsuicidal self-injury behavior in non-psychotic disorders: epidemiology, social and clinical risk factors. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:108-119. [DOI: 10.17116/jnevro2019119031108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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