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Bresin K, Hunt RA. Appetitive and Aversive Motivation in Dysregulated Behaviors: A Meta-Analysis. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2025; 51:239-252. [PMID: 37475669 DOI: 10.1177/01461672231185509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Appetitive and aversive motivation are prominent in theories of dysregulated behaviors. The authors conducted a meta-analysis of the association between individual differences in appetitive and aversive motivation and several dysregulated behaviors (i.e., alcohol use, marijuana use, tobacco use, binge eating, aggression, gambling, and nonsuicidal self-injury). Alcohol use (r = .17, k = 141), marijuana use (r = .13, k = 23), aggression (r = .22, k = 52), and gambling (r = .08, k = 55) were all significantly positively related to appetitive motivation. Binge eating (r = .28, k = 34) and self-injury (r = .17, k = 10) were significantly positively related to aversive motivation. Effect sizes were similar to the median effect size in personality research. Together, these results provide some evidence that some dysregulated behaviors are more correlated with approach motivation, whereas others are more correlated with aversive motivation, which may indicate distinct etiological pathways.
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2
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Lin L, Liu Y, Qiu S, Yang Y, Yang Y, Tian M, Wang S, Zhang J, Bai X, Xu Z. Orbital frontal cortex functional connectivity during gain anticipation linking the rumination and non-suicidal self-injury in late adolescence. J Affect Disord 2024; 350:673-680. [PMID: 38228278 DOI: 10.1016/j.jad.2024.01.117] [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] [Received: 05/08/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is prevalent and especially among the adolescence population. It has been argued that abnormal brain activations in reward processing could be regarded as objective biomarkers in NSSI, but the evidence is mixed. This study aims to explore the reward processing mechanism of NSSI from the perspective of functional brain circuitry and investigate the role of a cognitive factor (rumination). METHOD Seventy-one 17-21 years old participants performed a monetary incentive delay (MID) task during functional magnetic resonance imaging scanning. Psychophysiological interaction (PPI) analysis was used to test the inner-group differences of brain functional connectivity. In addition, a mediation model was established with the mediation effect of rumination on the relationship between functional brain circuitry and NSSI. RESULTS PPI analysis suggested that functional connectivity of the orbital frontal cortex (OFC) (with precuneus, SMA) was significantly enhanced in NSSI in the gain > loss contrast, but not in the loss > gain contrast. Mediation analysis revealed that rumination mediated the relationship between NSSI and the OFC- precuneus functional connectivity in the gain > loss contrast. CONCLUSION Our research revealed that the abnormal OFC functional connectivity in gain (not loss) anticipation can be served as the sensitive biomarkers of NSSI. And there was a chain path for NSSI, that was from functional brain circuitry to negative cognition and then to problem behavior.
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Affiliation(s)
- Lin Lin
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Yu Liu
- Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua 321004, Zhejiang, China; Department of Psychology, Zhejiang Normal University, Jinhua 321004, Zhejiang, China
| | - Shaojie Qiu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yanan Yang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Yang Yang
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Beijing 100875, China
| | - Mingyangjia Tian
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- Central University of Finance and Economics, Beijing 100081, China; Buffalo State Department of Sociology, State University of New York, Buffalo 10001, USA
| | - Xuejun Bai
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Zhansheng Xu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China.
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Unique and shared correlates of disordered eating and non-suicidal self-injury among school-based adolescents. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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4
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Miller AE, Racine SE. Emotion regulation difficulties as common and unique predictors of impulsive behaviors in university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1387-1395. [PMID: 32790500 DOI: 10.1080/07448481.2020.1799804] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Researchers examined associations between specific forms of emotion dysregulation and numerous behavioral manifestations of impulsivity (i.e., problematic alcohol use, drug use, risky sexual activity, binge eating, non-suicidal self-injury). Participants: Participants were 238 undergraduate students (69% female). Method: Emotion dysregulation was assessed using the Difficulties in Emotion Regulation Scale (DERS). Path models examined each DERS subscale on its own, and all DERS subscales together, as predictors of all impulsive behaviors. Results: Lack of emotional clarity predicted the largest number of impulsive behaviors, both on its own and after controlling for other forms of emotion dysregulation. Non-acceptance of emotions and difficulties achieving goals when upset also related to several impulsive behaviors. Conclusions: Certain emotion regulation difficulties, particularly poor emotional clarity, may represent specific mechanisms that lead to maladaptive impulsive behaviors. Findings provide useful information for incorporating specific emotion regulation skills in harm prevention programs and treatments for university students.
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Affiliation(s)
- Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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5
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Munson KA, Janney CA, Goodwin K, Nagalla M. Cultural Representations of Borderline Personality Disorder. FRONTIERS IN SOCIOLOGY 2022; 7:832497. [PMID: 35399194 PMCID: PMC8990760 DOI: 10.3389/fsoc.2022.832497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE Borderline Personality Disorder (BPD) is characterized by unstable interpersonal relationships, impulsivity, and self-harm. There are many distinct stressors that predispose individuals to develop BPD or engage in self-harm behaviors. The objective of this systematic review was to compare methods of self-harm and psychological stressors in BPD across different cultures. METHODS A PubMed database search was conducted with the goal of capturing all articles (n = 22) that discussed methods of self-harm in BPD in any culture. Data extracted from the articles included methods of self-harm, psychological stressors, sample size, rurality, geographical location, and proportion of males to females. RESULTS Key differences were noted in the methods of self-harm. Eastern nations (n = 5) reported higher rates of self-poisoning (60%) than Western nations (11%). Western nations (n = 9) reported higher rates of skin-mutilating behavior (100%) than Eastern nations (80%). Two of the articles included participants from rural settings, one in the Sundarban region of India and the other in Mississippi. Notably, the Sundarban region reported the highest rate of poisoning (93%) whereas the Mississippi region reported high rates of skin mutilation. Differences were also noted in psychological stressors as the rates of interpersonal problems were higher in Western than in Eastern nations. CONCLUSIONS Additional research should be conducted into the presentation of BPD in different cultures. An improved understanding of the cultural presentations of BPD could improve diagnosis and treatment in various populations.
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Affiliation(s)
- Katherine A. Munson
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Carol A. Janney
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Kelsie Goodwin
- School of Osteopathic Medicine, A. T. Still University, Kirksville, MO, United States
| | - Madhavi Nagalla
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
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6
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Burke TA, Shao S, Jacobucci R, Kautz M, Alloy LB, Ammerman BA. Examining momentary associations between behavioral approach system indices and nonsuicidal self-injury urges. J Affect Disord 2022; 296:244-249. [PMID: 34619451 PMCID: PMC9022186 DOI: 10.1016/j.jad.2021.09.029] [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: 02/22/2021] [Revised: 08/05/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The current study aimed to examine the concurrent and prospective relationships between the three hypothesized components of behavioral approach system (BAS) sensitivity: drive, reflecting the motivation to pursue one's desired goals; reward responsiveness, reflecting sensitivity to reward or reinforcement; and fun-seeking, reflecting the motivation for pursuing novel rewards in a spontaneous manner, and NSSI urge severity. METHODS A sample of 64 undergraduates with a history of repetitive NSSI completed an ecological momentary assessment protocol. During this period of time, participants reported on the BAS-constructs of drive, reward responsiveness, and fun-seeking, as well as NSSI urge severity on a momentary basis at three random intervals each day for a period of ten-days. RESULTS Drive and reward responsiveness, but not fun-seeking, were concurrently positively associated with NSSI urge severity. However, no associations between BAS facets and prospective NSSI urges were found. LIMITATIONS This study was limited by its use of single items to assess the BAS-constructs of drive, reward responsiveness, and fun-seeking. CONCLUSIONS Our findings indicate that feeling strongly impacted by rewards and having a strong sense of drive toward goal attainment may represent cognitive risk states that are associated with increased within-person NSSI risk. However, their lack of prospective prediction may suggest that these cognitive states are associated only on a momentary basis with NSSI urges and may not confer risk.
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Affiliation(s)
- Taylor A. Burke
- Massachusetts General Hospital,Harvard Medical School, Department of Psychiatry
| | - Sijing Shao
- University of Notre Dame, Department of Psychology
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7
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Lowman KL, Patrick CJ, Perkins ER, Bottesi G, Caruso M, Giulini P, Sica C. Evaluating the validity of brief prototype-based informant ratings of triarchic psychopathy traits in prisoners. BEHAVIORAL SCIENCES & THE LAW 2021; 39:641-662. [PMID: 34658071 PMCID: PMC9297945 DOI: 10.1002/bsl.2542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
The validity of self-report psychopathy assessment has been questioned, especially in forensic settings where clinical evaluations influence critical decision-making (e.g., institutional placement, parole eligibility). Informant-based assessment offers a potentially valuable supplement to self-report but is challenging to acquire in under-resourced forensic contexts. The current study evaluated, within an incarcerated sample (n = 322), the extent to which brief prototype-based informant ratings of psychopathic traits as described by the triarchic model (boldness, meanness, disinhibition; Patrick et al., 2009) converge with self-report trait scores and show incremental validity in predicting criterion measures. Self/informant convergence was robust for traits of boldness and disinhibition, but weaker for meanness. Informant-rated traits showed incremental predictive validity over self-report traits, both within and across assessment domains. These findings indicate that simple prototype-based informant ratings of the triarchic traits can provide a useful supplement to self-report in assessing psychopathy within forensic-clinical settings.
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Affiliation(s)
- Kelsey L. Lowman
- Department of PsychologyFlorida State UniversityTallahasseeFloridaUSA
| | | | - Emily R. Perkins
- Department of PsychologyFlorida State UniversityTallahasseeFloridaUSA
| | - Gioia Bottesi
- Department of General PsychologyUniversity of PadovaPadovaItaly
| | - Maria Caruso
- Department of Health SciencesPsychology SectionUniversity of FirenzeFirenzeItaly
| | - Paolo Giulini
- Department of Health SciencesPsychology SectionUniversity of FirenzeFirenzeItaly
| | - Claudio Sica
- Department of Health SciencesPsychology SectionUniversity of FirenzeFirenzeItaly
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8
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Hielscher E, DeVylder J, Hasking P, Connell M, Martin G, Scott JG. Mediators of the association between psychotic experiences and future non-suicidal self-injury and suicide attempts: results from a three-wave, prospective adolescent cohort study. Eur Child Adolesc Psychiatry 2021; 30:1351-1365. [PMID: 32712716 DOI: 10.1007/s00787-020-01593-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/28/2020] [Indexed: 01/17/2023]
Abstract
Psychotic experiences (PEs) are robustly associated with subsequent non-suicidal self-injury (NSSI) and suicide attempts, but questions remain as to the temporal relation and underlying cause of this association. Most investigations have incorporated only two waves of data, and no study has comprehensively investigated mediating pathways. This study aimed to investigate both the PE-NSSI and PE-suicide attempt association, and their relevant mediators, across three waves of prospective data. Participants were from an Australian prospective longitudinal cohort of 1100 adolescents (12-17 years); data were collected at three time points over 2 years. NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess four PE subtypes (auditory hallucinatory experiences [HEs] and three delusional experiences). Potential mediators of interest included: psychological distress, self-reported mental disorders, self-esteem, recent traumatic life events (e.g. bullying, sexual assault), emotion regulation, and impulsivity/other personality traits. Analyses were adjusted for sociodemographics and substance use. Auditory HEs were indirectly associated with future NSSI and suicide attempts via recent traumatic life events, high psychological distress, and low self-esteem, across three waves of data. Other PE subtypes were generally not associated with incident NSSI/suicide attempts at 1- and 2-year follow-up, either directly or indirectly. These findings highlight the importance of screening for auditory HEs when assessing a young person's self-harm/suicide risk. Clinical assessment would be further enhanced by a comprehensive review of recent interpersonal traumatic events, as well as levels of self-esteem and distress.
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Affiliation(s)
- Emily Hielscher
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia. .,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - Melissa Connell
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Graham Martin
- Department of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD, Australia
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9
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Examining the Neurobiology of Non-Suicidal Self-Injury in Children and Adolescents: The Role of Reward Responsivity. J Clin Med 2021; 10:jcm10163561. [PMID: 34441857 PMCID: PMC8396887 DOI: 10.3390/jcm10163561] [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: 07/14/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Although prior work has shown heightened response to negative outcomes and reduced response to positive outcomes in youth with a history of non-suicidal self-injury (NSSI), little is known about the neural processes underlying these responses. Thus, this study examined associations between NSSI engagement and functional activation in specific regions of interest (ROIs) and whole-brain connectivity between striatal, frontal, and limbic region seeds during monetary and social reward tasks. To test for specificity of the influence of NSSI, analyses were conducted with and without depressive symptoms as a covariate. We found that NSSI was associated with decreased activation following monetary gains in all ROIs, even after controlling for depressive symptoms. Exploratory connectivity analyses found that NSSI was associated with differential connectivity between regions including the DS, vmPFC, insula, and parietal operculum cortex when controlling for depressive symptoms. Disrupted connectivity between these regions could suggest altered inhibitory control of emotions and pain processing in individuals with NSSI. Findings suggest dysfunctional reward processes in youth with NSSI, even very early in the course of the behavior.
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Lanfredi M, Macis A, Ferrari C, Meloni S, Pedrini L, Ridolfi ME, Zonca V, Cattane N, Cattaneo A, Rossi R. Maladaptive behaviours in adolescence and their associations with personality traits, emotion dysregulation and other clinical features in a sample of Italian students: a cross-sectional study. Borderline Personal Disord Emot Dysregul 2021; 8:14. [PMID: 33941285 PMCID: PMC8094601 DOI: 10.1186/s40479-021-00154-w] [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: 09/15/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Emotion Dysregulation (ED), childhood trauma and personality are linked to the occurrence of maladaptive behaviours in adolescence which, in turn, may be related to increased risk for psychopathology in the life course. We sought to explore the relationship among the occurrence of different clusters of maladaptive behaviours and ED, clinical features (i.e. impulsivity, childhood maltreatment, anxiety, depressive symptoms) and personality traits that have been found to be associated to Borderline Personality Disorder (BPD), in a sample of 179 adolescent students. METHODS Multiple Correspondence Analysis (MCA) was applied to detect clustered types of maladaptive behaviours and groups of students were defined as individuals engaging in these clustered behaviours (non-suicidal self-injury-NSSI, binge eating, binge drinking, cannabis use, and sexual risk behaviours). Logistic models were used to evaluate the association among clinical scales, and student groups. Mediation analysis was used to evaluate whether clinical features affected the association between personality traits and student groups. RESULTS MCA analysis allowed to identify three student groups: NSSI/binge eating (NSSI-BE) behaviours, other maladaptive behaviours and "none". Higher scores in ED, impulsivity, childhood maltreatment, anxiety and depressive symptoms increased the risk of belonging to the cluster of NSSI-BE behaviours compared to the other two groups. ED, depression and anxiety symptoms were found to be mediators of the relationship between specific personality traits, mainly pertaining to the negative affectivity construct, and NSSI/BE. CONCLUSIONS Individuals engaging in NSSI-BE behaviours represent a vulnerable adolescent population. ED, depression and anxiety were mediators of the relationship between a variety of personality traits related to BPD and NSSI and binge eating behaviours. Findings have important clinical implications in terms of prevention and interventions among adolescents engaging in self-damaging behaviours.
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Affiliation(s)
- Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy.
| | - Ambra Macis
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Serena Meloni
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy
| | | | - Valentina Zonca
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological Biomolecular Sciences, University of Milan, Milano, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy
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11
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Ouerchefani R, Ouerchefani N, Ben Rejeb MR, Le Gall D. Cognitive emotion regulation questionnaire: Psychometric properties of the Tunisian version. Encephale 2021; 47:406-412. [PMID: 33832717 DOI: 10.1016/j.encep.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study investigated the psychometric properties of the Cognitive Emotion Regulation Questionnaire in a Tunisian Arabic-Speaking population. METHOD The CERQ original version was translated and back-translated and then administrated to 360 participants. Afterwards, using the explanatory and confirmatory factor analysis, we studied the latent factor structure for CERQ. The internal consistency of the subscales was assessed by Cronbach's alfa coefficients, and the test-retest and interscale reliability were assessed with Pearson correlations. The criterion validity was also examined using correlations between the CERQ subscales and both the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scales at first evaluation and at a one year follow-up. RESULTS The Tunisian version was quite satisfactory with the nine-factor structure, as in the original CERQ. Moreover, all validity and reliability measures were comparable to the original CERQ. CONCLUSION The present study is the first work devoted to a Tunisian adaptation of the CERQ. Our findings highlight that the Tunisian version is both reliable and valid for the measurement of cognitive emotion regulation strategies.
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Affiliation(s)
- R Ouerchefani
- High Institute of Human sciences, University of Tunis El-Manar, 26, boulevard Darghouth-Pacha, Tunis, Tunisia; Laboratory of Psychology of Pays de la Loire (EA 4638), 5 bis, boulevard Lavoisier, 49045 Angers cedex 01, France.
| | - N Ouerchefani
- Department of Neurosurgery, Foch Hospital, 40, rue Worth, 92151 Suresnes, Paris, France
| | - M R Ben Rejeb
- Faculty of Human and Social Science of Tunisia, University of Tunis I, boulevard 9 Avril, 1007, Tunis, Tunisia
| | - D Le Gall
- Laboratory of Psychology of Pays de la Loire (EA 4638), 5 bis, boulevard Lavoisier, 49045 Angers cedex 01, France
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12
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Faura-Garcia J, Orue I, Calvete E. Clinical assessment of non-suicidal self-injury: A systematic review of instruments. Clin Psychol Psychother 2021; 28:739-765. [PMID: 33283952 DOI: 10.1002/cpp.2537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
There has been an increase in the number of assessment instruments for non-suicidal self-injury (NSSI). However, previous reviews are inconsistent and do not provide a comprehensive psychometric assessment of the instruments. This study aimed to systematically assess and compare the psychometric properties of clinically relevant instruments to measure NSSI in any population. Through a systematic review guided by COSMIN and PRISMA, two searches were conducted in English and Spanish in February 2020 in 13 databases including grey literature. Of the 7,813 initial records, 152 validations were extracted. From these, 83 instruments (22 versions or adaptations) were excluded for not measuring NSSI, having no potential clinical utility or not including psychometric properties. Finally, 26 (22 versions, 35 adaptations and 19 creations) instruments measuring NSSI were included. Predominantly, the studies were North American self-reports in English for community adolescents, adaptations or versions emanating from a small number of instruments. Twenty-six indicators were categorized to assess NSSI. The most frequent instruments are structured interviews, and their indicators were related to NSSI function and topography. Evidence of validity and reliability was positive but limited. Despite the high number of instruments and diversity of evaluations, we found no instrument with sufficient evidence for clinical assessment. Findings broadly overview NSSI assessment instruments' current use and future improvement in clinical and research settings.
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Affiliation(s)
- Juan Faura-Garcia
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Izaskun Orue
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Esther Calvete
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
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13
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Kautz MM, Burke TA, Siegel DM, Case J, Alloy LB. The role of reward sensitivity and childhood maltreatment in predicting nonsuicidal self-injury. Suicide Life Threat Behav 2020; 50:1250-1263. [PMID: 33135809 DOI: 10.1111/sltb.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/07/2020] [Accepted: 06/24/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Findings from prior research on reward sensitivity in nonsuicidal self-injury (NSSI) have been mixed. Childhood maltreatment is an independent risk factor for NSSI and for hyposensitivity to rewards. This study aimed to disentangle the role of reward sensitivity as a predictor of NSSI for those with an elevated severity of childhood maltreatment. METHOD In a diverse undergraduate sample (N = 586), trait reward sensitivity (i.e., behavioral approach system subscales) and the severity of maltreatment were assessed as predictors of a lifetime history of NSSI. In a subset of this sample (n = 51), predictors of NSSI urge intensity were measured using ecological momentary assessment. RESULTS Individuals with elevated maltreatment who reported less positive responsiveness to rewards were more likely to have a lifetime history of NSSI. Those with elevated maltreatment who reported a lower likelihood to approach rewards experienced more intense NSSI urges across the ten-day observation period. However, those with elevated maltreatment who reported a greater likelihood to approach rewards experienced less intense NSSI urges. CONCLUSIONS The role of reward sensitivity as a cognitive risk factor for NSSI varies depending on childhood maltreatment history. Findings indicate that, for those with elevated maltreatment, hypersensitivity to approaching rewards may decrease risk for NSSI urges.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - David M Siegel
- Graduate School of Applied and Professional Psychology, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Julia Case
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
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14
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Pallini S, Terrinoni A, Iannello S, Cerutti R, Ferrara M, Fantini F, Laghi F. Attachment-Related Representations and Suicidal Ideations in Nonsuicidal Self-Injury Adolescents with and without Suicide Attempts: A Pilot Study. Suicide Life Threat Behav 2020; 50:909-920. [PMID: 32175618 DOI: 10.1111/sltb.12633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Consistent with the debate surrounding the association between nonsuicidal self-injury (NSSI), suicidal intent, and suicidal behavior, and between NSSI and dysregulation processes, we attempted to analyze suicide intent and emotion dysregulation in NSSI adolescents, in the framework of the attachment representations and exploring these clues of emotion dysregulation characteristics of insecure attachment. Furthermore, we intended to focus on these attachment-related segregated systems regarding death and suicidal ideations, to explore how differently they would characterize self-injuring adolescents with and without suicide attempts. METHODS Thirty-four NSSI inpatient adolescents, 17 with suicide attempts, 17 without suicide attempts, and 17 healthy controls (age 11-17) were assessed using Adult Attachment Projective, which allows for the classification of attachment status and related emotion dysregulation and segregated systems. RESULTS The majority of the NSSI group with and without suicide attempts showed unresolved (disorganized) attachment-related representations and clues of damaged reflective functions, whereas only the NSSI with suicide attempts showed clues of impaired interpersonal relationships. The two clinical groups used words expressing suicidal intent, whereas the healthy group did not. CONCLUSIONS Therapists are encouraged not to underestimate suicidal ideation in NSSI regardless of whether or not they have already attempted suicide.
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Affiliation(s)
- Susanna Pallini
- Department of Education, University of Rome Tre, Roma, Italy
| | - Arianna Terrinoni
- Department of Pediatrics and Child and Adolescent Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Sara Iannello
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mauro Ferrara
- Department of Pediatrics and Child and Adolescent Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Fiorella Fantini
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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15
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Laghi F, Cerutti R, Terrinoni A, Lonigro A, Pongetti A, Ferrara M, Fantini F. Evaluation of the “Reading the Mind in the Eyes Test” with Non-Suicidal Self-Injury (NSSI) adolescents: A pilot study. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00505-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Refaeli T, Eyal-Lubling R, Komem M. Predicting high-risk situations among marginalized young women navigating towards adulthood: Protective and accelerating factors. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Nitkowski D, Wünsch-Leiteritz W, Braks K, Hristova S, Petermann F. Indirekte und direkte nichtsuizidale Selbstverletzungen bei Mädchen und jungen Frauen mit Essstörungen. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Zusammenfassung. Nichtsuizidales selbstverletzendes Verhalten (NSSV) tritt häufig bei Essstörungen auf. Die Befundlage zum Zusammenhang zwischen einem restriktiv-asketischen beziehungsweise bulimischen Essverhalten und NSSV ist jedoch nicht konsistent. Es wird geprüft, ob borderlinespezifische Gedanken die Beziehung zwischen asketischen beziehungsweise bulimischen Essverhalten auf der einen Seite und NSSV auf der anderen Seite mediieren. Eine Stichprobe von 74 Mädchen und jungen Frauen im Alter von 14 bis 21 Jahren ( M = 17.49; SD = 1.85), die eine Anorexie oder eine Bulimie aufweisen, bearbeiteten Fragebögen zu NSSV, borderlinespezifischen Gedanken sowie zu asketischen und bulimischen Verhaltensweisen. Borderline-Gedanken mediierten den Zusammenhang zwischen asketischem Verhalten auf der einen Seite und der Anzahl an bisher genutzten NSSV-Methoden und NSSI zur psychischen Regulation auf der anderen Seite. Bei Bulimie fand sich hingegen keine Mediation. Ein asketisches Verhalten ist bei Mädchen und jungen Frauen mit einer Essstörung über Borderline-Gedankenmuster mit der Anzahl an NSSV-Methoden und der Nutzung von NSSV zur psychischen Regulation verbunden. Ein primär durch Essattacken gekennzeichnetes Verhalten weist keinen Zusammenhang mit NSSV auf. Die verschiedenen Arten von gestörtem Essverhalten sollten separat auf einen Zusammenhang mit NSSV untersucht werden.
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Affiliation(s)
- Dennis Nitkowski
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Wally Wünsch-Leiteritz
- Klinik Lüneburger Heide, Kompetenzzentrum für die Behandlung von Essstörungen und ADHS, Bad Bevensen
| | - Karsten Braks
- Klinik am Korso, Fachzentrum für gestörtes Essverhalten, Bad Oeynhausen
| | - Stella Hristova
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
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18
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Masiero M, Lucchiari C, Maisonneuve P, Pravettoni G, Veronesi G, Mazzocco K. The Attentional Bias in Current and Former Smokers. Front Behav Neurosci 2019; 13:154. [PMID: 31354446 PMCID: PMC6637300 DOI: 10.3389/fnbeh.2019.00154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
Attentional bias has been defined as the propensity of a person to allocate selective attention automatically to salient cues (Field and Powell, 2007). In the case of smoking, this bias implies that smokers are implicitly attracted by smoking-related stimuli, which produce behavioral, memory, and emotional effects (Volkow et al., 2006; Giardini et al., 2009). In more detail, scientific evidence pointed out that smoking is strongly supported by attentional bias that activates craving and urgency to smoke a cigarette. However, poor and conflicting data are available regarding the role of this cognitive bias on former smokers. The main aim of this study is to explore the occurrence of the attentional bias on of both current and former smokers, also with the aim to identify associations with behavioral, psychological and cognitive characteristic of participants. We collected data on 245 current, volunteers (male 50.6%; female 49.4%) aged 54.81 (SD = 14.352, range = 18–63), divided in current smokers (98), former smokers (102) and non-smokers (45). A combination of neuropsychology tests (Emotional Smoke Stroop Task and Go/no-Go task), and standardized questionnaires [Behavioral Inhibition System-Behavioral Approach System (BIS-BAS), Fagerström Test for Nicotine Dependence (FTND), Barratt Impulsiveness Scale, Motivational questionnaire] were used to assess the attentional bias, psychological variables, and smoking-related characteristics. Responses at the Emotional Smoke Stroop task revealed that current and former smokers are actually slower than non-smokers are when facing smoking cues, while performances at other Stroop conditions and at the Go/no-Go task are not statistically different. These results confirmed the occurrence of the attentional bias in current smokers, and above all points out that the same effect is present in former smokers. We found only small and selective correlations between attentional bias and psychological variables (e.g., impulsiveness and inhibition). In particular, impulsivity is not directly associated with the AB intensity. Also, smoking characteristics (e.g., years of smoking and dependence level) and the length of the period of abstinence do not seem to modulate implicit cognition of smoking cue. Our data support the idea that the attentional bias may be considered relevant in sustaining smoking and favoring relapse.
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Affiliation(s)
- Marianna Masiero
- Department of Biomedical and Clinical Sciences (DIBIC), Luigi Sacco, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCSS, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology (IEO), IRCSS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCSS, Milan, Italy.,Department of Oncology and Emato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCSS, Milan, Italy.,Department of Oncology and Emato-Oncology (DIPO), University of Milan, Milan, Italy
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19
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Hielscher E, Whitford TJ, Scott JG, Zopf R. When the body is the target—Representations of one’s own body and bodily sensations in self-harm: A systematic review. Neurosci Biobehav Rev 2019; 101:85-112. [DOI: 10.1016/j.neubiorev.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/14/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
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20
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Peterson AL, Chen JI, Karver MS, Labouliere CD. Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties. Psychiatry Res 2019; 275:61-70. [PMID: 30878858 PMCID: PMC6543814 DOI: 10.1016/j.psychres.2019.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/23/2022]
Abstract
Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.
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Affiliation(s)
- Amanda L Peterson
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave, PCD4118G, Tampa, FL 33620, USA.
| | - Jason I Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave, PCD4118G, Tampa, FL 33620, USA
| | - Christa D Labouliere
- New York State Psychiatric Institue, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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21
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Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09739-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Wolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, Scopelliti K, Frazier EA, Liu RT. Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. Eur Psychiatry 2019; 59:25-36. [PMID: 30986729 DOI: 10.1016/j.eurpsy.2019.03.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists. METHODS The present study presents a comprehensive meta-analytic review of the literature on the association between NSSI and emotion dysregulation. A total of 48 publications, including 49 independent samples, were included in this analysis. RESULTS Overall, a significant association was found between emotion dysregulation and NSSI (pooled OR = 3.03 [95% CI = 2.56-3.59]). This association was reduced but remained significant (OR = 2.40 [95% CI = 2.01-2.86]) after adjustment for publication bias. Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior. Lack of emotional awareness/clarity and cognitive aspects of dysregulation yielded weaker, yet significant, positive associations with NSSI. CONCLUSIONS Findings support the notion that greater emotion dysregulation is associated with higher risk for NSSI among individuals across settings, regardless of age or sex. Furthermore, findings reveal facets of dysregulation that may have unique implications for NSSI. This meta-analysis highlights the importance of better understanding emotion dysregulation as a treatment target for preventing NSSI.
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Affiliation(s)
- Jennifer C Wolff
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States.
| | - Elizabeth Thompson
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Sarah A Thomas
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Jacqueline Nesi
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Alexandra H Bettis
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Briana Ransford
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Katie Scopelliti
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Elisabeth A Frazier
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Richard T Liu
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
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23
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Behavioral inhibition system and self-esteem as mediators between shyness and social anxiety. Psychiatry Res 2018; 270:568-573. [PMID: 30347379 DOI: 10.1016/j.psychres.2018.10.017] [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: 12/20/2017] [Revised: 06/08/2018] [Accepted: 10/07/2018] [Indexed: 01/06/2023]
Abstract
Shyness has been demonstrated to be an important factor associating with social anxiety. However, it is less clear on the mechanisms responsible for such association. The aim of the present study was to examine whether behavioral inhibition system (BIS) and self-esteem mediated the relationship between shyness and social anxiety. A sample of 521 healthy volunteers in the age range of 18-25 years completed self-report measures of BIS, self-esteem, shyness and social anxiety. Our correlational analyses showed that shyness was positively associated with social anxiety, supporting the overlapping and continuum hypotheses. Furthermore, BIS was positively correlated with shyness and social anxiety while self-esteem was negatively related to them, indicating that BIS and self-esteem were different in the relation between shyness and social anxiety. Importantly, results from structural equation modeling revealed that the relation between shyness and social anxiety was partially mediated by BIS and self-esteem, which suggested that they might play important roles in the relation between shyness and social anxiety.
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24
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Tsypes A, Owens M, Hajcak G, Gibb BE. Neural reward responsiveness in children who engage in nonsuicidal self-injury: an ERP study. J Child Psychol Psychiatry 2018; 59:1289-1297. [PMID: 29665047 PMCID: PMC6192869 DOI: 10.1111/jcpp.12919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND A better understanding of the correlates of nonsuicidal self-injury (NSSI) in children is important for the identification and prevention of future suicide risk. However, although abnormalities in reward responsiveness might constitute one potential transdiagnostic mechanism of risk for NSSI, no studies have examined initial response to reward in children with a history of NSSI. The goal of the present study was to address this important gap in the literature. To objectively assess initial response to reward, we utilized the feedback negativity (FN) event-related potential, a well-established psychophysiological marker of reward responsiveness. METHODS Participants were 57 children (19 with a history of NSSI and 38 demographically matched controls) between the ages of 7 and 11. Diagnostic interviews were used to assess for current and past DSM-IV mood and anxiety diagnoses and NSSI history. Children also completed a guessing task, during which continuous electroencephalography was recorded. RESULTS Children with a history of NSSI exhibited significantly more negative ΔFN (i.e., FN to losses minus FN to gains) than children without NSSI. These findings appeared to be at least partially independent of children's history of psychopathology and current symptoms, suggesting their specificity to NSSI. CONCLUSIONS These results provide initial evidence for heightened neural initial reward responsiveness to losses versus rewards in children with a history of NSSI. Pending replications and longitudinal studies, the ΔFN might represent a psychophysiological marker of risk for self-harm.
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Affiliation(s)
- Aliona Tsypes
- Center for Affective Science, Binghamton University, Binghamton, NY
| | - Max Owens
- University of South Florida, St. Petersburg, FL
| | - Greg Hajcak
- Stony Brook University, Stony Brook, NY, USA
| | - Brandon E. Gibb
- Center for Affective Science, Binghamton University, Binghamton, NY
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25
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Is the association of deliberate self-harm with emotional relief stable or dependent on emotional context? J Behav Ther Exp Psychiatry 2018; 60:61-68. [PMID: 29605669 DOI: 10.1016/j.jbtep.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite strong support for the role of emotional relief in deliberate self-harm (DSH), no research has examined the impact of emotional distress on the strength of the DSH-relief association. Thus, it remains unclear whether the association of DSH with emotional relief is stable across emotional contexts or context-dependent. This study aimed to examine if the implicit DSH-relief association is stronger in the context of emotional distress (relative to a neutral emotional context). METHODS Young adult women with (n = 60) and without (n = 60) a history of recent recurrent DSH were randomly assigned to complete a novel version of the Implicit Association Test (IAT) assessing the DSH-relief association at baseline (following an initial neutral emotion induction) and again following either a neutral or negative (i.e., social rejection) emotion induction. RESULTS Consistent with hypotheses, the DSH-relief association was stronger among women with recent recurrent DSH (vs. those without DSH) at baseline. Contrary to hypotheses, however, whereas the DSH-relief association remained stable following both the neutral and negative emotion inductions among participants with DSH, it became stronger across both conditions for participants without DSH. LIMITATIONS The use of a community sample of young adult women may limit generalizability to other relevant populations (e.g., clinical populations, young men, adolescents). Additionally, the negative emotion induction may not have been powerful enough to affect the strength of the learned DSH-relief association among individuals with a repeated history of DSH. CONCLUSIONS Findings suggest that the repeated use of DSH to bring about emotional relief may engender associations of DSH with relief that are relatively insensitive to emotional context.
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26
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Cerutti R, Zuffianò A, Spensieri V. The Role of Difficulty in Identifying and Describing Feelings in Non-Suicidal Self-Injury Behavior (NSSI): Associations With Perceived Attachment Quality, Stressful Life Events, and Suicidal Ideation. Front Psychol 2018; 9:318. [PMID: 29593617 PMCID: PMC5859383 DOI: 10.3389/fpsyg.2018.00318] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: Core alexithymic features, such as the difficulty in identifying and describing feelings, are associated with poor attachment styles and emotional trauma, which influence the capacity to regulate affect. Additionally, emotional regulation has been found to be the most commonly identified function associated with non-suicidal self-injury behavior (NSSI) in adolescents as they attempt to modulate strong emotions. However, few studies have examined the link between difficulty in identifying and describing feelings (core components of alexithymia), NSSI behaviors, quality of attachment, life stressors and suicidal ideation in healthy early adolescents. Consequently, this study aims to investigate these constructs and the relationship among them in a large non-clinical sample of adolescents. Methods: Seven hundred and nine middle school students (50.4% males), aged 10–15 years (M = 12.6; SD = 1.06) were involved in this study. In order to investigate the variables considered in the study, the following measures were administered: the Deliberate Self-Harm Inventory exploring non-suicidal self-injurious behaviors; the Alexithymia Questionnaire for Children examining difficulty in identifying and describing feelings; the Inventory of Parent and Peer Attachment assessing the quality of parental and peer attachment; the Life Stressor Checklist-Revised outlining stressful/traumatic events and the Children’s Depression Inventory evaluating suicidal ideation. Results: We found significantly positive relationships among difficulty in identifying and describing feelings, NSSI behaviors, stressful events, and suicidal ideation. Data indicated a significant negative association of difficulty in identifying and describing feelings with quality of attachment to parents and peers. Further findings highlighted that difficulty in identifying and describing feelings significantly mediated the effect of quality of attachment (parent and peer) on NSSI and suicidal ideation. Conclusion: The ability to identify and describing feelings is important to managing emotional expression and understanding the feelings of others, both crucial in attaining successful interpersonal relationships. Our data revealed that, while controlling for stressful life events, low levels of attachment may increase adolescents’ difficulty in identifying and describing their own feelings, which in turn may increase the risk of both NSSI and suicidal ideation.
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Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonio Zuffianò
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom
| | - Valentina Spensieri
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
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27
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An integrative model of emotion regulation and associations with positive and negative affectivity across four Arabic speaking countries and the USA. MOTIVATION AND EMOTION 2018. [DOI: 10.1007/s11031-018-9682-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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28
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Masi G, Milone A, Montesanto AR, Valente E, Pisano S. Non suicidal self-injury in referred adolescents with mood disorders and its association with cyclothymic-hypersensitive temperament. J Affect Disord 2018; 227:477-482. [PMID: 29156361 DOI: 10.1016/j.jad.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/24/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non suicidal self-injuries (NSSIs) are deliberate self-harm behaviors without suicidal intent, usually starting in adolescence, with increasing rates of occurrence both in epidemiological and clinical samples. Several studies associated cyclothymic-hypersensitive temperament (CHT) with self-harm behaviors and suicidal risk. Aim of this study is to explore the association between NSSIs and CHT in a clinical sample of adolescents. We hypothesized that CHT may differentiate NSSI from non-NSSI adolescents with mood disorders, when other psychopathological features are controlled for. METHODS A consecutive sample of 89 adolescents with mood disorders were assessed for presence and phenomenology of NSSIs, CHT, demographics, comorbid categorical psychiatric diagnoses, dimensional psychopathology, impairment and previous suicide attempts. RESULTS NSSIs were reported in 52% of the sample, with higher rates in females and in bipolar disorder. Regression analyses showed that CHT, but not age, gender, bipolar vs depression diagnosis, functional impairment, was associated with NSSIs. DISCUSSION CHT may be in close association with NSSIs in adolescents with mood disorders. An assessment of CHT in adolescents referred for mood disorder may help to detect specific psychological features of NSSIs, which may improve diagnostic and treatment strategies. LIMITATIONS Given the cross-sectional design, a developmental relation between CHT and NSSIs cannot be determined. The small sample size and the selection bias of severely impaired patients limit the generalization of the results. More sophisticated measures of CHT may consent to explore other dimensions of the cyclothymic construct (i.e., emotional intensity, emotional reactivity, emotional stability, positive vs. negative emotions, interpersonal sensitivity, impulsivity).
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Anna Rita Montesanto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.
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29
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Cipriano A, Cella S, Cotrufo P. Nonsuicidal Self-injury: A Systematic Review. Front Psychol 2017; 8:1946. [PMID: 29167651 PMCID: PMC5682335 DOI: 10.3389/fpsyg.2017.01946] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/23/2017] [Indexed: 01/22/2023] Open
Abstract
Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors. Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles. Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder. Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.
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Affiliation(s)
- Annarosa Cipriano
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Stefania Cella
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Paolo Cotrufo
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Sellbom M, Sansone RA, Songer DA. Elucidating the association between the self-harm inventory and several borderline personality measures in an inpatient psychiatric sample. Int J Psychiatry Clin Pract 2017; 21:231-235. [PMID: 28362142 DOI: 10.1080/13651501.2017.1306628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The current study evaluated the utility of the self-harm inventory (SHI) as a proxy for and screening measure of borderline personality disorder (BPD) using several diagnostic and statistical manual of mental disorders (DSM)-based BPD measures as criteria. METHODS We used a sample of 145 psychiatric inpatients, who completed the SHI and a series of well-validated, DSM-based self-report measures of BPD. RESULTS Using a series of latent trait and latent class analyses, we found that the SHI was substantially associated with a latent construct representing BPD, as well as differentiated latent classes of 'high' vs. 'low' BPD, with good accuracy. CONCLUSIONS The SHI can serve as proxy for and a good screening measure for BPD, but future research needs to replicate these findings using structured interview-based measurement of BPD.
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Affiliation(s)
- Martin Sellbom
- a Department of Psychology , University of Otago , Dunedin , New Zealand
| | - Randy A Sansone
- b Department of Psychiatry and Internal Medicine , Wright State University School of Medicine , Dayton , OH , USA
| | - Douglas A Songer
- b Department of Psychiatry and Internal Medicine , Wright State University School of Medicine , Dayton , OH , USA.,c Miami Valley Hospital , Dayton , OH , USA
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Nobakht HN, Dale KY. The prevalence of deliberate self-harm and its relationships to trauma and dissociation among Iranian young adults. J Trauma Dissociation 2017; 18:610-623. [PMID: 27736465 DOI: 10.1080/15299732.2016.1246397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to investigate the prevalence of deliberate self-harm and its relationships to childhood and recent trauma and different patterns of dissociative features. A total of 100 male and 100 female college students were administered a 58-item questionnaire designed to detect the extent of dissociation, deliberate self-harm, and trauma history. Participants with deliberate self-harm behaviors reported more traumatic experiences and dissociative features than participants without such behaviors. Furthermore, the prevalence of deliberate self-harm (i.e., 40.5%) was similar to previous studies on college student populations. However, and contrary to earlier research, deliberate self-harm was significantly more prevalent among men (48%) than women (33%). The findings support the notion that trauma, pathological dissociation, and depersonalization/derealization play important functional roles in self-harm behaviors. From this perspective, it is feasible to understand individuals who engage in self-harm as either escaping from uncomfortable dissociative states or experiencing an infra-psychological conflict in which one dissociative part of the self is being abusive toward another.
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Affiliation(s)
- Habib Niyaraq Nobakht
- a Department of Engineering and Humanities , Islamic Azad University , Babol Branch, Babol , Iran
| | - Karl Yngvar Dale
- b Department of Health and Social Sciences , Molde University College , Molde , Norway
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Calati R, Bensassi I, Courtet P. The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses. Psychiatry Res 2017; 251:103-114. [PMID: 28196773 DOI: 10.1016/j.psychres.2017.01.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/09/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
Dissociative disorders (DD) are frequently associated with suicidal behaviors. We performed the first meta-analysis of studies comparing rates of suicide attempts (SA) and non-suicidal self-injury (NSSI) in psychiatric individuals with and without DD. We included: 1) studies comparing SA and NSSI rates in psychiatric individuals with and without DD; 2) studies comparing Dissociative Experiences Scale (DES) scores in both SA and NSSI psychiatric patients versus non SA and non NSSI ones. Cochrane Collaboration Review Manager Software and STROBE statement were used. Nineteen studies were included in the analyses. DD patients were more likely to report both previous SA and NSSI in comparison to non DD patients. Importantly, results remained highly significant in both outcomes but with no more heterogeneity when including studies using a DSM-based method to diagnose DD. Both SA and NSSI patients reported higher DES scores in comparison to non SA and non NSSI patients. The presence of DD diagnosis or higher DES scores seems to be related to both SA and NSSI in psychiatric patients. Hence, it may be reasonable to hypothesize the presence of a dissociative subtype in a subset of these patients, which should be considered as a transdiagnostic factor and should be carefully assessed.
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Affiliation(s)
- Raffaella Calati
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France; Department of Emergency Psychiatry & Post Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
| | - Ismaïl Bensassi
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry & Post Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Philippe Courtet
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France; Department of Emergency Psychiatry & Post Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Reigstad B, Kvernmo S. Concurrent adversities and deliberate self-harm among indigenous Sami and majority Norwegian adolescents: the Norwegian Arctic Adolescent Health Study. Scand J Child Adolesc Psychiatr Psychol 2017. [DOI: 10.21307/sjcapp-2017-011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
Few studies have investigated proximal relationships between deliberate self-harm (DSH) and concurrent adversities.
Objective:
We aimed to investigate these relationships in a community population of 4881 indigenous Sami and majority Norwegian adolescents, 15 to 16 years old, and related to ethnicity and gender.
Methods:
Youth with and without self-reports of DSH last year were compared on 12 concurrent adversities, on scales measuring family and peer functioning, and on sociodemographic conditions.
Results:
DSH last year was reported by 22.3% of the adolescents, and by more girls (28.8%) than boys (15.9%). All 12 concurrent adversities were related strongly to DSH last year. Deliberate self-harmers reported twice as many concurrent adversities as non-DSHs, and a large effect size (Cohen’s d = 0.80) indicated a strong multiple additive relationship, but among DSHs no ethnic or gender differences were found. Multivariately, among Sami youth sexual abuse [odds ratio (OR), 8.4] was strongly related to DSH, whereas among majority Norwegians sexual abuse (OR, 3.9) and violence (OR, 4.5) were identified as the strongest predictors. Similarly, among boys violence from adults (OR, 8.8) was associated most strongly with DSH, whereas among girls sexual abuse (OR, 4.3) was the most robust predictor. DSHs reported more conflicts with parents, less family support and involvement, and more peer problems than non-DSHs, and DHS girls had more difficulties in these relationships than DHS boys. Only small ethnic differences were found.
Conclusion:
Adolescent DSHs reported twice as many concurrent adversities as non-DSHs, sexual abuse and violence were strongly related to DSH. Ethnic and gender differences in risk factors were found. Clinicians should inquire about traumatic experiences such as sexual and physical abuses, and should have a family, peer, and gender perspective in their work.
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Affiliation(s)
- Bjørn Reigstad
- Department of Research, Division of Research and Patient Safety , Nordlandssykehuset, Bodø , Norway
| | - Siv Kvernmo
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway , Tromsø , Norway
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Psychological characteristics of self-harming behavior in Korean adolescents. Asian J Psychiatr 2016; 23:119-124. [PMID: 27969068 DOI: 10.1016/j.ajp.2016.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/28/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk.
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Gandhi A, Luyckx K, Maitra S, Claes L. Non-suicidal self-injury and other self-directed violent behaviors in India: A review of definitions and research. Asian J Psychiatr 2016; 22:196-201. [PMID: 26482720 DOI: 10.1016/j.ajp.2015.09.015] [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: 07/16/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
The interpersonal theory of suicide suggests that most forms of self-directed violent behaviors lie on a continuum, with each behavior successively increasing the capability of committing suicide. There is increasing evidence to suggest that the continuum may begin with Non-Suicidal Self-Injury (NSSI). This theory can be important in developing interventions for suicide prevention. However, in India, consistent usage of definitions of various forms of self-directed violent behaviors is lacking. In the present study, we reviewed definitions of various forms of self-directed violent behaviors that have been investigated in India. Further, we compared the usage of these definitions with the usage by WHO. Additionally, we reviewed NSSI research in India. Thirty-eight publications were identified by a comprehensive electronic search undertaken in Indian psychiatry, psychology, and mental health-related databases. Inconsistent definitions of eight self-directed violent behaviors were observed in Indian literature. Agreement on consistent definitions of various forms of self-directed behaviors is essential. Based on the findings of the current review, it can be suggested that culturally relevant large-scale research on NSSI in India is required to confirm the limited evidence that suggests high prevalence of NSSI in India.
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Affiliation(s)
- Amarendra Gandhi
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Shubhada Maitra
- Centre for Health and Mental Health, Tata Institute of Social Sciences, Mumbai, India
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerpen, Belgium
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Theory of mind in non-suicidal self-injury (NSSI) adolescents. Conscious Cogn 2016; 43:38-47. [DOI: 10.1016/j.concog.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 11/19/2022]
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Megreya AM, Latzman RD, Al-Attiyah AA, Alrashidi M. The Robustness of the Nine-Factor Structure of the Cognitive Emotion Regulation Questionnaire across Four Arabic-Speaking Middle Eastern Countries. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2016. [DOI: 10.1177/0022022116644785] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Cognitive Emotion Regulation Questionnaire (CERQ) focuses on the “pure” cognitive components of emotion regulation thought to help people to manage and control their emotions during or after the experience of a stressful event. The aim of this study was to explore the psychometric properties of an Arabic version of the CERQ (CERQ-Ar) across four Arabic-speaking countries in the Middle East (i.e., Egypt, Kingdom of Saudi Arabia, Kuwait, and Qatar; N = 1,470). The original nine-factor CERQ model was confirmed, and these factors had moderate-to-high internal reliabilities, modest-to-strong interrelations, and meaningful associations with positive and negative affect. Results were robust across the four Arabic countries, suggesting that the same cognitive emotion regulation strategies appear to be present across different cultures, but the relative preference to use one or more strategies may quantitatively vary across cultures.
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Webermann AR, Myrick AC, Taylor CL, Chasson GS, Brand BL. Dissociative, depressive, and PTSD symptom severity as correlates of nonsuicidal self-injury and suicidality in dissociative disorder patients. J Trauma Dissociation 2016. [PMID: 26211678 DOI: 10.1080/15299732.2015.1067941] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder and dissociative disorder not otherwise specified with a recent history of nonsuicidal self-injury (NSSI) and suicide attempts from those patients without recent self-harm. A total of 241 clinicians reported on recent history of patient NSSI and suicide attempts. Of these clinicians' patients, 221 completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder patients receiving community treatment were utilized. Analyses evaluated dissociative, depressive, and posttraumatic stress disorder symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, whereas depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with dissociative disorders and have implications for self-harm prevention and treatment.
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Affiliation(s)
- Aliya R Webermann
- a Department of Psychology , Towson University , Towson , Maryland , USA
| | - Amie C Myrick
- b Family and Children's Services of Central Maryland , Bel Air , Maryland , USA
| | | | - Gregory S Chasson
- a Department of Psychology , Towson University , Towson , Maryland , USA
| | - Bethany L Brand
- a Department of Psychology , Towson University , Towson , Maryland , USA
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Gratz KL, Chapman AL, Dixon-Gordon KL, Tull MT. Exploring the association of deliberate self-harm with emotional relief using a novel Implicit Association Test. Personal Disord 2016; 7:91-102. [PMID: 26147069 PMCID: PMC5493474 DOI: 10.1037/per0000138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the growing consensus that negative reinforcement in the form of emotional relief plays a key role in the maintenance of deliberate self-harm (DSH), most of the research in this area has relied exclusively on self-report measures of the perceived motives for and emotional consequences of DSH. Thus, the primary aim of this study was to extend extant research on the role of emotional relief in DSH by examining the strength of the association of DSH with emotional relief using a novel version of the Implicit Association Test (IAT). The strength of the DSH-relief association among both participants with (vs. without) DSH and self-harming participants with (vs. without) BPD, as well as its associations with relevant clinical constructs (including DSH characteristics, self-reported motives for DSH, BPD pathology, and emotion dysregulation and avoidance) were examined in a community sample of young adults (113 with recent recurrent DSH; 135 without DSH). As hypothesized, results revealed stronger associations between DSH and relief among participants with versus without DSH, as well as among DSH participants with versus without BPD. Moreover, the strength of the DSH-relief association was positively associated with DSH frequency and versatility (both lifetime and at 6-month follow-up), BPD pathology, emotion dysregulation, experiential avoidance, and self-reported emotion relief motives for DSH. Findings provide support for theories emphasizing the role of emotional relief in DSH (particularly among individuals with BPD), as well as the construct validity, predictive utility, and incremental validity (relative to self-reported emotion relief motives) of this IAT.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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Ayub N. Predicting suicide ideation through intrapersonal and interpersonal factors: The interplay of Big-Five personality traits and social support. Personal Ment Health 2015; 9:308-18. [PMID: 26148708 DOI: 10.1002/pmh.1301] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 11/09/2022]
Abstract
While a specific personality trait may escalate suicide ideation, contextual factors such as social support, when provided effectively, may alleviate the effects of such personality traits. This study examined the moderating role of social support in the relationship between the Big-Five personality traits and suicide ideation. Significant interactions were found between social support and extraversion and emotional stability. Specifically, the relationship between emotional stability and extraversion to suicide ideation was exacerbated when social support was low. Slope analysis showed openness also interacted with low social support. Results were computed for frequency, duration and attitude dimensions of suicide ideation. Extraversion interacted with social support to predict all three dimensions. Social support moderated emotional stability to predict frequency and duration, moderated conscientiousness towards frequency and attitude, and moderated openness towards attitude. The results imply that whereas personality traits may be difficult to alter, social support may play a significant role in saving a life. Psychologists should include family and friends when treating a suicidal youth, guiding them to awareness of one's personality and being more supportive.
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Affiliation(s)
- Nailah Ayub
- King Abdulaziz University, Jeddah, Saudi Arabia
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Non-suicidal self-injury prospectively predicts interpersonal stressful life events and depressive symptoms among adolescent girls. Psychiatry Res 2015; 228:416-24. [PMID: 26165966 PMCID: PMC4540325 DOI: 10.1016/j.psychres.2015.06.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is the deliberate self-harm of one's tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls.
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Kiekens G, Bruffaerts R, Nock M, Van de Ven M, Witteman C, Mortier P, Demyttenaere K, Claes L. Non-Suicidal Self-Injury Among Dutch and Belgian Adolescents: Personality, Stress and Coping. Eur Psychiatry 2015; 30:743-9. [DOI: 10.1016/j.eurpsy.2015.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/28/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022] Open
Abstract
AbstractBackgroundThis study examines: (1) the prevalence of Non-Suicidal Self-Injury (NSSI) among Dutch and Belgian adolescents, (2) the associations between Big Five personality traits and NSSI engagement/versatility (i.e., number of NSSI methods), and (3) whether these associations are mediated by perceived stress and coping.MethodsA total of 946 Flemish (46%) and Dutch (54%) non-institutionalized adolescents (Mean age = 15.52; SD = 1.34, 44% females) were surveyed. Measures included the NSSI subscale of the Self-Harm-Inventory, the Dutch Quick Big Five Personality questionnaire, the Perceived Stress Scale and the Utrecht Coping List for Adolescents. Examination of zero-order correlations was used to reveal associations, and hierarchical regression analysis was used to reveal potential mediators which were further examined within parallel mediation models by using a bootstrapping-corrected procedure.ResultsLifetime prevalence of NSSI was 24.31%. Neuroticism; perceived stress; and distractive, avoidant, depressive, and emotional coping were positively associated with NSSI engagement, whereas Agreeableness, Conscientiousness; and active, social, and optimistic coping were negatively associated with NSSI engagement. Observed relationships between personality traits and NSSI engagement were consistently explained by perceived stress and depressive coping. A higher versatility of NSSI was not associated with any Big Five personality trait, but was associated with higher scores on perceived stress and depressive coping and with lower scores on active and optimistic coping.ConclusionOur study suggests that a specific personality constellation is associated with NSSI engagement via high stress levels and a typical depressive reaction pattern to handle stressful life events.
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Burke TA, Stange JP, Hamilton JL, Cohen JN, O’Garro-Moore J, Daryanani I, Abramson LY, Alloy LB. Cognitive and Emotion-Regulatory Mediators of the Relationship Between Behavioral Approach System Sensitivity and Nonsuicidal Self-Injury Frequency. Suicide Life Threat Behav 2015; 45:495-504. [PMID: 25443691 PMCID: PMC4452466 DOI: 10.1111/sltb.12145] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/25/2014] [Indexed: 01/20/2023]
Abstract
Nonsuicidal self-injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS-relevant cognitive style of self-criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N = 177) with high and moderate BAS levels completed measures of self-criticism, positive emotion regulation, brooding, and both lifetime and last-year frequency of NSSI. Results indicated that self-criticism and positive emotion dampening independently mediated the relationship between BAS and last-year frequency of NSSI. Self-criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion-regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.
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Islam MA, Steiger H, Jimenez-Murcia S, Israel M, Granero R, Agüera Z, Castro R, Sánchez I, Riesco N, Menchón JM, Fernández-Aranda F. Non-suicidal Self-injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender. EUROPEAN EATING DISORDERS REVIEW 2015; 23:553-60. [DOI: 10.1002/erv.2374] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A. Islam
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Susana Jimenez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Zaida Agüera
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Rita Castro
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
- Ciber Salud Mental (CIBERSAM); Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
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45
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Sansone RA, Wiederman MW. The self-harm inventory: A meta-analysis of its relationship to the personality diagnostic questionnaire-4 as a measure of borderline personality disorder. Int J Psychiatry Clin Pract 2015; 19:290-3. [PMID: 26305711 DOI: 10.3109/13651501.2015.1074708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of the present study was to further examine the efficacy of the Self-Harm Inventory (SHI) as a proxy measure in diagnosing borderline personality disorder, with the comparison measure being the Personality Diagnostic Questionnaire-4 (PDQ-4). METHODS We undertook a meta-analysis of data from our previous studies of psychiatric inpatients (N = 270) and internal medicine outpatients (N = 2587), all of whom completed both the SHI and the PDQ-4. RESULTS Scores on the SHI and PDQ-4 were strongly correlated, especially after correcting for attenuation due to measurement unreliability (0.78 in the compiled inpatient psychiatry sample and 0.83 in the compiled internal medicine sample). Moreover, the SHI demonstrated statistically significantly greater reliability coefficients relative to the PDQ-4. CONCLUSIONS Based upon comparison with the PDQ-4, the SHI appears to be an efficacious proxy measure of borderline personality symptomatology in both psychiatric inpatient samples and primary care outpatient samples.
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Affiliation(s)
- Randy A Sansone
- a Departments of Psychiatry and Internal Medicine , Wright State University School of Medicine in Dayton , Dayton , USA
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Dixon-Gordon KL, Gratz KL, McDermott MJ, Tull MT. The role of executive attention in deliberate self-harm. Psychiatry Res 2014; 218:113-7. [PMID: 24745474 DOI: 10.1016/j.psychres.2014.03.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 02/02/2014] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
Although a wealth of literature has examined the role of emotion-related factors in deliberate self-harm (DSH), less is known about neurocognitive factors and DSH. In particular, despite theoretical literature suggesting that deficits in executive attention may contribute to engagement in DSH, studies have not yet examined the functioning of this attentional network among individuals with DSH. The present study sought to address this gap in the literature by examining the functioning of the alerting, orienting, and executive attentional networks among participants with a recent history of DSH (n=15), a past history of DSH (n=18), and no history of DSH (n=21). Controlling for borderline personality pathology and depression symptoms, participants with a recent history of DSH exhibited deficits in executive attention functioning relative to participants without any history of DSH. No differences were found in terms of performance on the alerting or orienting attentional networks. These results provide preliminary support for the association between executive attention deficits and DSH.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Development of item bank to measure deliberate self-harm behaviours: facilitating tailored scales and computer adaptive testing for specific research and clinical purposes. Psychiatry Res 2014; 217:240-7. [PMID: 24703572 DOI: 10.1016/j.psychres.2014.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/07/2014] [Accepted: 03/11/2014] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the application of item banking to questionnaire items intended to measure Deliberate Self-Harm (DSH) behaviours. The Rasch measurement model was used to evaluate behavioural items extracted from seven published DSH scales administered to 568 Australians aged 18-30 years (62% university students, 21% mental health patients, and 17% community members). Ninety four items were calibrated in the item bank (including 12 items with differential item functioning for gender and age). Tailored scale construction was demonstrated by extracting scales covering different combinations of DSH methods but with the same raw score for each person location on the latent DSH construct. A simulated computer adaptive test (starting with common self-harm methods to minimise presentation of extreme behaviours) demonstrated that 11 items (on average) were needed to achieve a standard error of measurement of 0.387 (corresponding to a Cronbach׳s Alpha of 0.85). This study lays the groundwork for advancing DSH measurement to an item bank approach with the flexibility to measure a specific definitional orientation (e.g., non-suicidal self-injury) or a broad continuum of self-harmful acts, as appropriate to a particular research/clinical purpose.
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48
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Alexithymia and Personality Disorders in the Adolescent Non-suicidal Self Injury: Preliminary Results. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2013.12.714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Manca M, Presaghi F, Cerutti R. Clinical specificity of acute versus chronic self-injury: measurement and evaluation of repetitive non-suicidal self-injury. Psychiatry Res 2014; 215:111-9. [PMID: 24210667 DOI: 10.1016/j.psychres.2013.10.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 09/13/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
Abstract
Overall, previous studies on the prevalence of non-suicidal self-injury (NSSI) behaviors in the general population have stressed the importance of differentiating between occasional and repetitive NSSI, examining different severity levels (e.g., frequency and variety of methods), as well as investigating the diverse psychopathological correlates of NSSI. However, existing NSSI measures have not been explicitly developed by to comply with the NSSI diagnostic criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The purpose of this study is to develop a measure of repetitive NSSI by considering its essential features, as described in the proposed DSM-5 as well as in other clinically relevant aspects emerging from case reports. Two independent samples of participants (N1=383 young adults and 251 adolescents; N2=953 adolescents) belonging to the general population were involved in the present study. The questionnaire showed satisfactory fit statistics and reliably discriminated between occasional and repetitive self-injurers (Area Under Curve, AUC=0.755). The pattern of correlations with psychopathological measures confirmed a more clinically-compromised profile for repetitive rather than occasional self-injurers.
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Affiliation(s)
- Maura Manca
- Department of Psychology of Developmental and Social Processes, Sapienza University of Rome, Via dei Marsi, 71 00185 Rome, Italy
| | - Fabio Presaghi
- Department of Psychology of Developmental and Social Processes, Sapienza University of Rome, Via dei Marsi, 71 00185 Rome, Italy.
| | - Rita Cerutti
- Department of Psychology Dynamic and Clinic, Faculty of Psychology, Sapienza University of Rome, Italy.
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