Nonsuicidal Self-Injury-Related Differences in the Experience of Negative and Positive Emotion

Emotion dysregulation in nonsuicidal self-injury: Dissociations between global self-reports and real-time responses to emotional challenge

INTRODUCTION

Prominent theories of nonsuicidal self-injury (NSSI) propose that the behaviour is characterised by amplified emotional responses. However, little is known about how people who self-injure respond during emotional challenge.

METHODS

We measured subjective and physiological responding (heart rate, heart rate variability, and electrodermal responding) among young adults with past-year NSSI (n = 51) and those with no lifetime NSSI (n = 50) during a resting baseline, a stress induction, and a post-stress resting phase. Participants reported the extent to which they spontaneously used cognitive reappraisal and expressive suppression during the post-stress phase. Two weeks later, a subset of the sample (n = 42) reported how they remembered feeling during the laboratory session.

RESULTS

Although the NSSI group reported considerably greater emotion dysregulation than Controls, both groups showed similar subjective and psychological reactivity to, and recovery from, emotional challenge. Both groups used reappraisal and suppression regulation strategies following acute stress to a similar extent, and later came to remember the emotional challenge in a similar manner.

LIMITATIONS

Within the NSSI group, past-year self-injury tended to be infrequent and sporadic. Only 43.6% of the sample participated in the follow-up survey assessing memory of emotional challenge.

CONCLUSIONS

Findings demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for, raising substantial questions regarding the nature of emotion in NSSI. A more comprehensive understanding of the role of emotion in NSSI is needed to inform intervention strategies to better support people who self-injure.

The smallest things make me emotional! Emotion reactivity in non-suicidal self-injury: trait, state, and physiological differences

Objective

The current study sought to clarify the role of emotion reactivity in non-suicidal self-injury (NSSI) by examining three forms of emotion reactivity (physiological and self-reported trait and state reactivity) among a sample of young adults with or without a history of NSSI.

Materials and methods

Seventy-six adults (M age = 20.97, 73.7% female) participated in a semi-structured clinical interview to determine NSSI history and completed a measure of trait emotion reactivity. Participants then provided state emotion reactivity ratings before and after a social rejection task, recovery period, and positive mood induction while physiological data was continuously recorded.

Results

Although individuals with a history of NSSI perceived themselves to be more emotionally reactive, these participants were not more physiologically reactive, nor were their state reactivity ratings significantly different from individuals without a history of NSSI.

Discussion

Results suggest increased emotionality in response to a stressor is within normal bounds and not unique to individuals with a history of NSSI, and provide implications for future research on the etiology and treatment of NSSI.

Does Bullying Victimization Accelerate Adolescents' Non-suicidal Self-injury? The Mediating Role of Negation Emotions and The Moderating Role of Submissive Behavior

Based on general strain theory, the current study examined whether bullying victimization was significantly related to adolescents' non-suicidal self-injury and whether negation emotions mediated this association and submissive behavior moderated this mediation process. A total of 1,984 adolescents completed a series of anonymous questionnaires regarding bullying victimization, negative emotions, non-suicidal self-injury, and submissive behavior. Results showed that bullying victimization was significantly and positively associated with non-suicidal self-injury and this relation was partially mediated by negative emotions. Submissive behavior moderated the relation between bullying victimization and non-suicidal self-injury as well as negation emotions and non-suicidal self-injury. Specifically, the victims of bullying with high submissive behavior were more likely to develop non-suicidal self-injury. Adolescents who had higher negative emotions were at greater risk of engaging in non-suicidal self-injury when they also had high submissive behavior. The positive association between negative emotions and non-suicidal self-injury was stronger in females than males.

Reward responsivity and habit formation in the co-occurrence of restrictive eating and nonsuicidal self-injury

Dysfunctions in reward and/or habit formation have been proposed as factors contributing individually to the maintenance of restrictive eating and nonsuicidal self-injury (NSSI). However, despite the high comorbidity between these behaviors, the associations between reward and habit formation in their co-occurrence remains unclear. This study examined self-reported reward responsivity and habit strength among individuals with co-occurring restrictive eating and NSSI (Comorbid group; n = 108) and those with one behavior only (One-behavior group; n = 113). Hierarchical logistic regression analyses assessed the association between reward and habit features and the co-occurrence of restrictive eating and NSSI, accounting for the effects of impulsivity (a characteristic commonly considered to underlie co-occurring disordered eating and NSSI). Partial correlations examined the relationships between these features and the severity of eating disorder and NSSI symptoms, also controlling for impulsivity. Lower reward responsivity was associated with the co-occurrence of restrictive eating and NSSI, even after accounting for impulsivity (p = 0.017). In exploratory analyses, this relationship was no longer significant after accounting for self-reported depression. No significant associations were found regarding habit formation and restrictive eating and NSSI co-occurrence. Lower reward responsivity was linked to increased NSSI frequency and versatility in both groups and associated with severity of eating pathology in the Comorbid group (ps < 0.05). Our findings suggest that blunted reward responsivity may relate to the co-occurrence of restrictive eating, NSSI, and depressive symptoms, as well as the severity of restrictive eating and NSSI. Reward disturbances may serve as a crucial target in the treatment of multiple self-destructive behaviors.

Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review

INTRODUCTION

Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity.

METHODS

The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined.

RESULTS

A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present.

CONCLUSION

Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

A Comparison of Affective-Cognitive States in Daily Life Between Emerging Adults With and Without Past-Year Nonsuicidal Self-Injury

Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of nonsuicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages = 18-22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance = 83.3%; IQR = 71.9-91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas those who do not engage in NSSI experience higher intensity and lower variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions.

An experimental investigation of biased attention in non-suicidal self-injury: The effects of perfectionism and emotional valence on attentional engagement and disengagement

BACKGROUND AND OBJECTIVES

Theoretical models of non-suicidal self-injury (NSSI) propose that individuals who self-injure may find their attention more strongly captured by negative emotion, and that this intensifies distress which leads to episodes of NSSI. Elevated perfectionism is associated with NSSI, and when an individual is highly perfectionistic, a focus on perceived flaws/failures may increase risk of NSSI. We explored how history of NSSI and trait perfectionism are associated with different types of attention bias (engagement vs. disengagement) to stimuli that differ in emotional valence (negative vs positive) and perfectionism relevance (relevant vs irrelevant).

METHODS

Undergraduate university students (N = 242) completed measures of NSSI, perfectionism, and a modified dot-probe task to measure attentional engagement with and disengagement from both positive and negative stimuli.

RESULTS

There were interactions between NSSI and perfectionism in attention biases. Amongst individuals who engage in NSSI, those with elevated trait perfectionism exhibit speeded responding to and disengagement from emotional stimuli (both positive and negative). Furthermore, individuals with a history of NSSI and elevated perfectionism were slower to respond to positive stimuli, and faster to negative stimuli.

LIMITATIONS

This experiment was cross-sectional in design so does not provide information about temporal ordering of these relationships, and given the use of a community sample, would benefit from replication in clinical samples.

CONCLUSIONS

These findings lend support to the emerging idea that biased attention plays a role in how perfectionism is associated with NSSI. Future studies should replicate these findings using other behavioural paradigms and diverse samples.

Adolescents' attitudes toward non-suicidal self-injury (NSSI) and their perspectives of barriers to seeking professional treatment for NSSI

PURPOSE

This study aimed to investigate the attitudes of adolescents toward NSSI, and to explore their perspectives on barriers to seeking professional treatment for NSSI.

METHODS

A qualitative phenomenological design was used to conduct in-depth interviews with 17 adolescents with NSSI in a psychiatric hospital in Beijing, China. Data from the 17 adolescents were analyzed using Colaizzi's 7-step analysis.

RESULTS

Two themes were extracted: (1) attitudes toward NSSI (normal, effective, ignorant, disgraceful); (2) subjective/objective barriers to seeking professional treatment (negative attitudes toward NSSI, fear of being regarded as an attention getter, fear of interfering with personal relationships, fear of aggravating the family burden, fear of being criticized by parents, fear of ongoing hospitalization, fear of the side effects of medication, etc.).

CONCLUSIONS

It is suggested to strengthen the knowledge of NSSI among adolescents, families and society, formulate interventions suitable for Chinese sociocultural backgrounds, and cultivate the specialty literacy of mental health nurses and their abilities to identify the barriers, which are required for eliminating barriers to seeking professional treatment and establishing a system for seeking full coverage of professional treatment.

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

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

Body regard disrupts emotional cascade processes in nonsuicidal self-injury

OBJECTIVES

This study sought to empirically examine the Emotional Cascade Model of nonsuicidal self-injury (NSSI), and to examine if body regard mitigates these variables' impact on NSSI in college students. We tested a three-way interaction between emotional reactivity, maladaptive cognitive regulation strategies, and body regard predicting NSSI frequency.

METHODS

Two thousand sixty-six undergraduate students (M_age  = 20.38; 72.4% identified as female; 91.7% White; 22.7% with NSSI) completed measures of emotion reactivity, maladaptive cognitive regulation strategies, body regard, and lifetime NSSI frequency.

RESULTS

The three-way interaction between emotion reactivity, maladaptive cognitive regulation strategies, and body regard was significant. The interaction effect of emotional reactivity and maladaptive cognitive regulation strategies on NSSI was significant when body regard was low but not significant at average and high levels of body regard. The highest NSSI frequency was reported by those high in emotion reactivity and maladaptive cognitive regulation strategies, and low in body regard.

CONCLUSION

These results support the emotional cascade theory of NSSI, and support assertions that body regard might act as a protective barrier against NSSI in the context of heightened emotion reactivity and maladaptive cognitive regulation strategies.

Emotional responding to overt and subtle social exclusion among young women who engage in non-suicidal self-injury

People who engage in non-suicidal self-injury (NSSI) consistently report greater emotion reactivity and dysregulation than their peers. However, evidence that these self-reports reflect an amplified emotional response under controlled conditions is limited. Here we test the effects of both subtle and overt social exclusion, to determine whether self-reported emotion dysregulation reflects responses to real-time emotional challenge for people who self-injure. We recruited 100 young women with past-year NSSI and 100 without NSSI to an online experiment. Participants took part in a baseline social inclusion ball-tossing game, followed by either an overt or subtle social exclusion ball-tossing game, while we measured negative mood and belongingness. Despite reporting greater emotion reactivity (d = 1.40) and dysregulation (d = 1.63) than controls, women with past-year NSSI showed no differences in negative mood or belongingness ratings in response to either overt or subtle social exclusion. Within the NSSI group, exploratory analyses found greater endorsement of intrapersonal functions predicted greater negative mood following social exclusion (β = 0.19). Given that amplified emotional responding is central to prominent theoretical models of NSSI, findings highlight the need to better understand the divergence in findings between self-reported emotion dysregulation and real-time emotional responding among people who self-injure.

Developmental and Momentary Dynamics in the Onset and Maintenance of Nonsuicidal Self-Injurious Behavior and Borderline Personality Disorder

PURPOSE OF REVIEW

Traditional conceptualizations of both nonsuicidal self-injury (NSSI) and borderline personality disorder (BPD) typically rely on static and unidirectional, linear associations between key biopsychosocial vulnerabilities. Instead, we argue that utilizing a complex dynamic systems view of NSSI and BPD will advance the field, as such conceptual models allow for analysis of bottom-up effects for key vulnerabilities on disorder and behavior emergence, as well as top-down effects of the emergent disorder on underlying vulnerabilities.

RECENT FINDINGS

Following the presentation of a novel framework highlighting momentary and developmental dynamics, we explore several advances in the field that exhibit key dynamic qualities or inform dynamic conceptualizations of NSSI and BPD. At the momentary dynamic level, several advances are being made with multimethod and repeated assessment approaches, as well as advanced bidirectional and complex modeling procedures. Additional progress is being made at the developmental dynamic level, although several questions have arisen regarding the problem of onset and subsequent trajectory, particularly with issues such as pain perception and the interplay between interpersonal, emotional, and behavioral symptoms before and after treatment. Self-injury and BPD both exhibit substantial momentary and developmental dynamics in underlying vulnerabilities, including potential variance in momentary dynamics as a function of psychopathological developmental stage (e.g., onset versus maintenance versus recovery). Recent work has highlighted the necessity of utilizing multimodal research to encapsulate a holistic view of the interplay of several vulnerability factors, the developmental importance of assessment timing, and the need to examine the dynamic interplay between affect, behavior, and interpersonal experiences in BPD and/or NSSI. Research also indicated substantial variation in key vulnerability factors at both between- and within-person levels, highlighting the utility of harnessing statistical models that allow for the simultaneous incorporation of numerous variables at both levels and across several time points. As such, by using a complex dynamic systems conceptualization, we can begin to better understand integrated connections between key vulnerabilities, how they collectively interact in the short term, and how changes in the dynamic interplay between vulnerabilities may arise over the long term and with successful treatment.

Patterns of psychological pain and self-harm behaviors in adolescents

BACKGROUND

The study examined the role of campus stressors and psychological pain on non-suicidal self-injury (NSSI) and suicide attempt (SA).

METHODS

Specific patterns of co-occurring psychological pain, campus stressors, and self-harm behaviors were identified by latent profile analysis, and their odds ratios (ORs) on NSSI and SA were analyzed in cross-sectional study and 2-year follow-up study. Structural Equation Model was used to explore indirect effect of campus stressors on SA and NSSI via different components of psychological pain.

RESULTS

Three classes were identified as low-risk class (68.58%) with low endorsements on the three measures, moderate-risk class (26.52%) with the elevated academic stressors, high levels of painful feelings, and high probabilities on NSSI; and high-risk class (4.90%) with the elevated combined stressors, high levels of pain avoidance, and high probabilities on SA. Compared to the moderate-risk class, adolescents in the high-risk class had a 4.97 OR of reporting NSSI, 17.98 OR of reporting SA. Pain avoidance class at baseline reported a higher probability in SA class (OR = 224.00) in a 2-year study.

CONCLUSIONS

Painful feelings might be shared psychosocial correlates for NSSI and SA. However, pain avoidance may play a role in distinguishing SA from NSSI, which shed light on the intervention of adolescents who engage in self-harm behaviors.

Neural correlates of affective theory of mind in medication-free nonsuicidal self-injury: An fMRI study

Emerging evidence indicates that emotion processing deficits are associated with nonsuicidal self-injury (NSSI). However, limited attention has been paid to the socio-affective functions of NSSI. In this study, we aimed to investigate the affective theory of mind (ToM) in medication-free individuals engaging in NSSI at both behavioral and neural levels. Twenty-eight individuals (mean age = 22.96 years) who engaged in NSSI and 38 age-, sex-, and IQ-matched controls (mean age = 22.79 years) underwent functional magnetic resonance imaging while performing the "Reading the Mind in the Eyes Test" (RMET). All participants also completed the Difficulties in Emotion Regulation Scale (DERS), Toronto Alexithymia Scale (TAS-20), and Beck Scale for Suicide Ideation (BSI). Although we did not find significant group differences in the RMET performance, the NSSI group, relative to the controls, exhibited significantly greater left medial superior frontal lobe activation and decreased right angular gyrus activation than did the control group. Reduced right angular gyrus activity was related to higher DERS and TAS scores across all participants. Our findings provide new evidence for aberrant neural processing of affective ToM in self-injurers. Future studies in developing intervention protocols for NSSI should focus on the multifaceted phases of socio-affective processing.

Daily associations of interpersonal and emotional experiences following stressful events among young adults with and without nonsuicidal self-injury

OBJECTIVES

Emotional and interpersonal dysfunction appears central to nonsuicidal self-injury (NSSI), yet research examining the interplay of these factors among individuals with NSSI is limited. This study aimed to specify such associations before and after daily stressful events among individuals with (vs. without) NSSI.

METHODS

Young adult participants (M_age  = 20.4) with past-year (n = 56) or no history (n = 47) of NSSI completed daily diary assessments over a 2-week period.

RESULTS

No differences in rates of positive or negative interpersonal experiences before or after stressful events were identified. NSSI participants, however, reported greater negative emotion following stressful events compared with non-NSSI participants. The presence (vs. absence) of a positive interpersonal experience following a stressful event was related to lower negative emotional responses only in the NSSI group.

CONCLUSION

Positive interpersonal experiences may downregulate negative emotions following stressful events among individuals with NSSI, highlighting the potential relevance of interpersonal emotion regulation to this population.

The Role of Distress Tolerance in the Relationship Between Affect and NSSI

OBJECTIVE

Non-suicidal self-injury (NSSI), the deliberate and self-inflicted damage of body tissue, typically serves an emotion regulation function. Both negative and positive affectivity have been associated with NSSI, as has low distress tolerance. In the current study, we tested whether relationships between both negative and positive affectivity and NSSI are moderated by the four facets of distress tolerance (tolerance, absorption, appraisal, regulation) captured by the Distress Tolerance Scale.

METHODS

A sample of 531 university students completed well-validated measures of NSSI, negative affectivity, positive affectivity, and distress tolerance.

RESULTS

Findings indicate that negative and positive affectivity, as well as the appraisal (i.e. negative perceptions of distress) and absorption (i.e. allocation of attention to distress) facets of distress tolerance, were directly associated with NSSI. Positive affectivity and appraisal also interacted in differentiating participants with recent, lifetime and no history of NSSI. Specifically, the association between negative perceptions of distress and self-injury was weaker at high levels of positive affectivity. Positive affectivity and absorption also interacted to differentiate between individuals with no history of NSSI and individuals who recently engaged in NSSI. Specifically, positive affectivity was negatively associated with self-injury, but only among individuals who allocate less attention to their distress.

CONCLUSIONS

Considering the independent roles of negative and positive affectivity alongside specific facets of distress tolerance and their interactions with emotional experience, may enhance understanding of NSSI. Prevention and intervention initiatives that assist regulation of negative affectivity, increase positive affectivity, and improve distress tolerance, may reduce the likelihood of engaging in self-injury.HighlightsNegative and positive affectivity are independently associated with NSSIAppraisal and absorption facets of distress tolerance are associated with NSSIPositive affectivity moderates associations between appraisal and absorption and NSSI.

Different profiles with multiple risk factors of nonsuicidal self-injury and their transitions during adolescence: A person-centered analysis

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. However, adolescents with different combinations of NSSI risk factors may constitute different subgroups that vary in subsequent risks of NSSI engagement, and the membership in these subgroups may change during early adolescence. Gender differences related to risk profiles and transition patterns may also exist. This study thus aimed to address these three questions.

METHODS

A total of 2,942 participants ranging from 12 to 17 years old (55.2% females; M_age = 14.60, SD = 1.21) completed a series of questionnaires about NSSI and its risk factors on three occasions, every six months. Latent profile and latent transition analyses were used to examine NSSI risk profiles (subgroups), their transition patterns, and gender differences.

RESULTS

Three distinct risk profiles were identified: Low-risk profile, Medium-risk profile, and High-risk profile. The profile membership was fairly stable over one year, and the shift across profiles represented a "resilient" pattern. Regarding gender differences, boys were less likely to be in either the Medium- or the High-risk groups, but more likely to transition from the Medium- to the Low-risk group, relative to girls.

LIMITATIONS

This study relied upon self-report measures. Additional research is needed to investigate the generalizability of the results to other populations, and to examine more predictors of class membership and transitions.

CONCLUSIONS

The results highlight the importance of considering subgroup differences in understanding NSSI risks. Differentiated interventions with multi-pronged approaches tailoring to different risk classes and gender groups may therefore prove more efficient and effective.

Emotion profiles of university students engaging in non-suicidal self-injury: Association with functions of self-injury and other mental health concerns

We investigated emotion profiles among undergraduate students with lived experience of non-suicidal self-injury (NSSI) and their associations with different NSSI functions and other dysregulated behaviors, including risky drinking, symptoms of borderline personality disorder, eating disorders, anxiety, depression, and stress. A sample of 270 undergraduate students (84% female, M_age = 21.5 years) with a history of self-injury completed well-validated measures of self-injury, emotion regulation, alexithymia, coping strategies and of other dysregulated behaviors. A K-means cluster analysis was conducted to extract emotion profiles from the data. Analyses of variance were used to test associations between emotion profiles, demographic factors, functions of NSSI and comorbid dysregulated behaviors. A three-cluster solution was supported. Similar characteristics were presented regarding difficulties in emotion regulation and alexithymia between the considerate emotion difficulties and the passive moderate emotion difficulties groups, although they demonstrated different associations with the functions of NSSI and other dysregulating behaviors. This emphasizes the importance of investigating the type of coping strategies used during functional assessment to inform future treatment. The group reporting no emotion difficulties engaged in more adaptive coping strategies compared to the others. These emotion profiles and their association with NSSI functions could be used to develop more person-centered interventions for NSSI.

Measurement invariance of the distress tolerance scale among university students with and without a history of non-suicidal self-injury

Non-suicidal self-injury (NSSI) is the intentional damage to one's body tissue in the absence of suicidal intent. NSSI primarily serves an emotion regulation function, with individuals engaging in self-injury to escape intense or unwanted emotion. Low distress tolerance has been identified as a mechanism that underlies self-injury, and is commonly assessed using the self-report Distress Tolerance Scale. There are mixed findings regarding the factor structure of the Distress Tolerance Scale, with some researchers utilising a higher-order distress tolerance score (derived from the scores on the four lower-order subscales) and other researchers using the four subscales as unique predictors of psychological outcomes. Neither of these factor structures have been assessed among individuals with a history of self-injury. Of note, an inability to tolerate distress (thought to underlie NSSI) may limit an individual's capacity to accurately observe and report specific thoughts and emotions experienced in a state of heightened distress, which may impact the validity of scores on the Distress Tolerance Scale. Therefore, measurement invariance should be established before attributing NSSI-related differences on the scale to true differences in distress tolerance. We compared the Distress Tolerance Scale higher-order model with the lower-order four factor model among university students with and without a history of NSSI. Our results indicated that the lower-order four factor model was a significantly better fit to the data than the higher-order model. We then tested the measurement invariance of this lower-order factor model among individuals with and without a history of NSSI, and established configural and full metric invariance, followed by partial scalar and full residual error invariance. These results suggest the four subscales of the Distress Tolerance Scale can be used to confidently discern NSSI-related differences in distress tolerance.

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

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

Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics

More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; M_age = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; M_age = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.

Emotion Reactivity and Suicide Risk in Patients With Depression: The Mediating Role of Non-Suicidal Self-Injury and Moderating Role of Childhood Neglect

Background: The association between emotion reactivity (ER) and suicide risk has been confirmed in recent studies, especially in patients with depression. However, there is a lack of understanding of the underlying mechanism of the relation from ER to suicide risk among patients with depression. This study planned to examine a model of how ER, non-suicidal self-injury (NSSI), and childhood neglect (CN) interact to affect suicide risk in depressed patients. Methods: Four hundred and ninety-six patients (64.5% female, mean age = 30.40 years, SD = 12.56) who have accomplished self-rating instruments of ER, NSSI, CN, and suicide risk were included. Results: Findings showed that ER was positively connected with suicide risk, and NSSI partially mediated the above connection. Besides, CN moderated the mediation model, that is, the mediation effect was more pronounced in depressed patients with CN compared to depressed patients without CN. Conclusions: It was concluded that there is a relationship among ER, NSSI, CN, and suicide risk in patients with depression, and it strengthens our knowledge of the mechanism behind suicide risk. Our findings emphasize that the identification of NSSI and CN should be considered when assessing the suicide risk of patients with depression, as well as the intervention focus on emotion regulation and support for patients.