Self-Injury Is My Drug: The Functions of Describing Nonsuicidal Self-Injury as an Addiction

Experiencing stress impact on adolescent repetitive nonsuicidal self-injury: The Mediating role of emotion dysregulation and maladaptive cognitive schemas

BACKGROUND

Repetitive nonsuicidal self-injury (R-NSSI) is a growing concern in adolescents and is associated with various mental health problems. However, little is known about the potential psychology and addiction mechanisms of R-NSSI in adolescents. This study aimed to examine the mediating effects of emotion dysregulation and maladaptive cognitive schemas based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the integrated model of NSSI among adolescents who repeatedly engage in NSSI.

METHODS

This longitudinal study was conducted in two waves with 6-month lags. A total of 3925 adolescents (Mage = 13.22 ± 0.86 years, 42 % female) were recruited from three middle schools. Relevant questionnaires were used to evaluate stressful life events, emotion dysregulation, maladaptive cognitive schemas, NSSI, and NSSI addictive features. The structural equation modeling approach was conducted separately for adolescents who engaged in occasional NSSI (O-NSSI) and those who engaged in R-NSSI.

RESULTS

Results showed that emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI frequency, and both maladaptive cognitive schemas and emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI addictive features in adolescents who engaged in R-NSSI but not in those who engaged in O-NSSI.

LIMITATIONS

The main limiting factor is self-reported data.

CONCLUSIONS

These findings contribute to the understanding of the psychological and addictive mechanisms involved in R-NSSI. Both emotion dysregulation and maladaptive cognitive schemas could be a suitable therapeutic target to reduce R-NSSI in the context of stress during adolescence.

Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review

Background

Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive.

Aims

To review present evidence related to the potential mechanisms of NSSI in MDD.

Methods

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality.

Results

A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study).

Conclusions

This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.

Reasons for recovery and readiness to change among adolescents and young adults engaging in self-injury

Background

Non-suicidal self-injury (NSSI) typically begins during adolescence and the process of treatment and recovery can be challenging. We examine NSSI through the lens of the Transtheoretical Model of Change, a framework that views the process of change as five stages, with differing degrees of readiness to change.

Methods

Thirty participants, both adolescents and young adults (14 to 35 years), were recruited from a tertiary care neuropsychiatric hospital. The participants were predominantly female and had self-injured at least once in the last year. They completed the Inventory of Statements about Self Injury, the University of Rhode Island Change Assessment and the Reasons to Stop Self-Injury Questionnaire.

Results

Seventy-three percent were in the contemplation stage with respect to their readiness to change, while the rest were in the pre-contemplation stage. Participants endorsed a range of vulnerability and resilience related reasons to stop injuring; reasons related to self-efficacy, the addictive nature of NSSI, self-efficacy and impact on interpersonal relationships were prominent levers for the recovery process. Preliminary trends indicated that participants in the contemplation stage endorsed reasons to stop self-injuring more strongly than those in pre-contemplation.

Conclusion

The findings carry implications for assessment, the amplification of reasons for recovery and individualized interventions to support the recovery process with individuals who engage in NSSI.

The potential addictive mechanism involved in repetitive nonsuicidal self-injury: The roles of emotion dysregulation and impulsivity in adolescents

BACKGROUND AND AIMS

Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and is associated with various mental health problems. Repetitive NSSI (R-NSSI), as an extreme manifestation of NSSI, is a growing concern and has been proposed as a behavioral addiction. However, little is known about the potential addictive mechanisms of NSSI. This study aimed to examine the mediating effect of emotion dysregulation and the moderating effect of impulsivity using the Interaction of Person-Affect-Cognition-Execution (I-PACE) model in adolescents who repeatedly engage in NSSI.

METHODS

A total of 3,915 adolescents (mean age = 13.21 years, SD = 0.87, 57.6% male) were recruited from three middle schools. Relevant questionnaires were used to evaluate childhood maltreatment, emotion dysregulation, impulsivity, and NSSI. Mediation and moderated mediation analyses were conducted separately for adolescents with occasional NSSI (O-NSSI) and R-NSSI to assess the relationship between childhood maltreatment, emotion dysregulation, impulsivity, and NSSI frequency.

RESULTS

Our study found that childhood maltreatment was directly related to NSSI and indirectly related to NSSI through emotion dysregulation in both the R-NSSI and O-NSSI groups. Furthermore, impulsivity played a moderating role in the relationship between emotion dysregulation and NSSI in the R-NSSI group but not in the O-NSSI group.

DISCUSSION AND CONCLUSIONS

The findings suggest that a high level of impulsivity and a high level of emotion dysregulation may be important risk addictive factors of NSSI through childhood maltreatment. Strengthening the emotion regulation skills and inhibitory control of adolescents with NSSI would be helpful to reduce their self-injury behaviors and maintain their mental health. This finding also supports the validity of the I-PACE model for evaluating R-NSSI.

Factors influencing the addiction characteristics of non-suicidal self-injurious behaviors in adolescents: A case-control study

BACKGROUND

Many studies have shown that in the context of public health emergencies, the incidence rate of adolescent non-suicidal self-injury (NSSI) patients increased dramatically. This paper aims to characterize the behavioral characteristics of adolescent NSSI and analyze the influencing factors of NSSI behavior addiction characteristics.

METHODS

Our research was a case-control study which included 84 adolescents with NSSI (female vs. male: 59 vs. 25) and 84 healthy controls (female vs. male: 53 vs. 31). All the participants enrolled were aged 12-18 years. The differences in the scores of the following five scales were compared between the case and control groups: Egna Minnen Barndoms Uppfostran (EMBU), Perceived Social Support Scale (PSSS), Perceived Stress Scale (PSS); Bergen Social Media Addiction Scale (BSMAS) and Video Game Dependence Scale (VDG-S). The characteristics of NSSI behavior of the study group were evaluated using the Ottawa Self Inventory Chinese Revised Edition (OSIC). And a binary logistic regression model was developed to analyze the factors that influence adolescent NSSI behavioral addiction characteristics.

RESULTS

In the study group, the emotional warmth scores in the father's and mother's rearing style scores in the EMBU were significantly lower than the controls. The BSMAS and VDG-S scores were significantly higher than those in the control group. 38 cases of NSSI with addiction characteristics accounted for 45.24% in the study group. The risk factors for NSSI addiction traits were as follows: female, single-child, high level of VDG-S scores, high scores of excessive interferences in father's rearing style, and high scores of punishments and excessive interferences in mother's rearing style score.

CONCLUSION

Female, only child, internet addiction, and negative parenting styles were predictors of NSSI behavioral addiction characteristics in adolescents. Targeted coping strategies should be developed to reduce the occurrence and development of self-injurious behavior, especially for female adolescents with Internet dependence in one-child families with negative parenting styles.