The role of trauma symptoms in nonsuicidal self-injury

Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population

BACKGROUND

The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms.

OBJECTIVES

This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students.

METHODS

An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance.

RESULTS

Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning.

CONCLUSION

The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.

Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms

Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.

Depression and posttraumatic stress disorder in adolescents with nonsuicidal self-injury: comparisons of the psychological correlates and suicidal presentations across diagnostic subgroups

BACKGROUND

Nonsuicidal self-injury (NSSI) combined with suicide ideation increases the risk of suicidal behaviors. Depression and posttraumatic stress disorder (PTSD) are comorbidities of NSSI compounding this relationship. The present study compared diagnostic subgroups of NSSI based on current depression and PTSD on psychological correlates (i.e., vulnerabilities and impairment) and suicidal presentations (i.e., suicidal cognitions and behaviors) in a psychiatric sample of adolescents.

METHODS

Eighty-seven adolescents meeting DSM-5 criteria for NSSI and 104 age-range-matched nonclinical controls (NC) participated. Participants completed self-report measures on psychological vulnerabilities and impairment (e.g., emotion regulation difficulties, negative cognitions). Adolescents with NSSI also completed clinical interviews on psychiatric diagnoses and a recent self-injurious behavior (SIB). Scores on the psychological correlates of NSSI were compared between adolescents with NSSI and NC, and across three diagnostic subgroups of NSSI (A: NSSI+/depression-/PTSD-, n = 14; B: NSSI+/depression+/PTSD-, n = 57; C: NSSI+/depression+/PTSD+, n = 14). Differences between NSSI diagnostic subgroups were tested on the motives for SIB and accompanying suicidal presentations (e.g., desire, intent, motive, lethality).

RESULTS

Common comorbidities of NSSI included depression, panic disorder, generalized anxiety disorder, and PTSD. The NSSI subgroup classification was significantly associated with panic disorder, which was controlled for in the subsequent group comparisons. Overall, adolescents who engage in NSSI with vs. without depression reported more psychological vulnerabilities and impairment and a greater degree of suicidal thoughts/desire in SIB (i.e., groups B, C >A), which remained significant after controlling for panic disorder. An increased odds of the suicidal motive for SIB was found in adolescents with all three conditions (i.e., group C: NSSI+/depression+/PTSD+) compared to those with NSSI but neither depression nor PTSD (i.e., group A: NSSI+/depression-/PTSD-); however, this was not significant after controlling for panic disorder.

CONCLUSIONS

Psychological underpinnings of adolescent NSSI in clinical contexts may be largely associated with concurrent depression. Suicidal motives in adolescents who engage in NSSI in the presence of depression and PTSD may be confounded by the co-occurrence of panic disorder. This study warrants the importance of attending to the comorbid depression with NSSI in adolescents as it is related to an increase in suicidal desire accompanying SIB.

A Longitudinal Examination of Recent Posttraumatic Stress Symptoms and Nonsuicidal Self-Injury among University Students

Nonsuicidal self-injury is a burgeoning mental health concern amongst post-secondary students. In the present study, the link between posttraumatic stress symptoms (PTSS) and nonsuicidal self-injury (NSSI) was examined among post-secondary students over time, while accounting for the role of co-occurring depressive symptoms. Participants were 841 first-year university students with self-reported lifetime histories of trauma who reported on traumatic experiences, PTSS, depressive symptoms, and NSSI at three time points over the course of their first year of university. This study also included exploratory correlational analyses of the relation among PTSS and motivations for NSSI engagement. As expected, PTSS predicted NSSI engagement among students within and across time, though effects were small. The strongest correlations were among PTSS and engaging in NSSI for the purposes of fulfilling self-punishment desires and anti-dissociation (e.g., to reduce feelings of numbness). This study provides further support for theories underscoring NSSI as a means of coping with intra- and interpersonal distress among post-secondary students experiencing stressful life events, such as trauma.

Childhood maltreatment affects college students' nonsuicidal self-injury: Dual effects via trauma-related guilt, trauma-related shame, and prosocial behaviors

BACKGROUND

Few studies have explored the impact of trauma-related guilt, trauma-related shame and prosocial behaviors on the relationship between childhood maltreatment and college students' NSSI.

OBJECTIVE

The present study examined how trauma-related guilt, trauma-related shame, and prosocial behaviors mediate the relationship between childhood maltreatment and college students' NSSI.

PARTICIPANTS AND SETTING

The sample comprised 496 college students (40.7 % male participants, age = 18.98 ± 1.35 years) from five universities in China.

METHODS

This longitudinal study was conducted three times with a six-month interval. Childhood maltreatment was assessed at Time 1; trauma-related guilt, trauma-related shame, and prosocial behaviors were assessed at Time 2; and NSSI was assessed at Time 3.

RESULTS

The results suggested that prosocial behaviors mediated the relationship between childhood maltreatment and college students' NSSI (β = 0.021, 95 % CI = 0.005 to 0.049), and trauma-related shame played a mediating role in the relationship between childhood maltreatment and college students' NSSI (β = 0.030, 95 % CI = 0.004 to 0.077). In addition, trauma-related guilt and prosocial behaviors showed a serial mediating effect between childhood maltreatment and NSSI (β = -0.002, 95 % CI = -0.009 to -0.0003). Trauma-related shame and prosocial behaviors also showed a serial mediating effect between childhood maltreatment and NSSI (β = 0.002, 95 % CI = 0.0002 to 0.009).

CONCLUSION

Prosocial behaviors act as a protective factor of college students' NSSI. Trauma-related shame following childhood maltreatment could reduce prosocial behaviors, which may ultimately increase NSSI.

Non-suicidal self-injury in a college sample: Intrapersonal and family factors

Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (M_age = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R² = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.

Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms

INTRODUCTION

Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS).

METHODS

Participants were 81 individuals with a history of sexual assault and NSSI (M_age  = 33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD = 31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study.

RESULTS

Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average.

CONCLUSION

Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.

Association of Dissociation with Suicide Attempt and Non-Suicidal Self Injury in Adolescents with a History of Sexual Abuse

Objective: Dissociative symptoms are considered risk factors for suicide and non-suicidal self-injury (NSSI). In this study, the relationship between suicidal behaviors and NSSI with dissociative symptoms in adolescents with a history of Child Sexual Abuse (CSA) was investigated. Methods: A total of 100 adolescents with a history of CSA were evaluated with a detailed forensic psychiatric interview. Dissociative symptoms were measured with the self-report Adolescent Dissociative Experiences Scale (A-DES) and the parent-reported Child Dissociative Checklist (CDC). Results: While dissociative symptoms did not differ between adolescents with and without suicide attempts (CDC; p = .068 and A-DES; p = .060), they were significantly higher in adolescents with non-suicidal self-harming behavior (CDC; p < .001 and A-DES; p = .001). Suicide attempts and NSSI were more common in those who reported genital touching as a type of sexual abuse (respectively, p = .003; p = .048). In regression analysis; history of psychiatric treatment (OR = 9.09 [95% CI = 1.52, 54.29]) and NSSI (OR = 8.18 [95% CI = 2.01, 33.23]) were independently associated with suicide attempts. In addition, parent-reported dissociative symptoms (CDC scores) (OR = 1.27 [95% CI = 1.06, 1.53] and suicide attempt (OR = 8.09 [95%CI = 1.96,33.42] showed independent association with NSSI. Conclusions: Dissociative symptoms may be predictive factors for NSSI and should be considered in risk assessment of adolescents with a history of CSA.

Self-harm in Young People: Investigating the Role of Resilience and Posttraumatic Stress Related to the COVID-19 Pandemic

Evidence shows that young people may have experienced increased levels of posttraumatic stress and depression during the COVID-19 pandemic. However, the landscape on self-harm is still unclear. This study aimed to examine the role of COVID-19 related posttraumatic stress, depression and resilience as predictors of self-harm with and without suicidal intent. Participants were 625 young people aged 17-25 years old (M = 20.2 years, SD = 2.47). Resilience was measured using the self-reported Child & Youth Resilience Scale Measure - Revised (CYRM-R). Posttraumatic stress related to COVID-19 were measured using the Impact of Event Scale- Revised. Depression was measured using the depression subscale of the Depression, Anxiety and Stress Scale-21. Self-harm was evaluated with two dichotomous items. Participants reported high levels of depression and COVID-19 posttraumatic stress, and a significant percentage reported engaging in self-harm. Hierarchical logistic regressions showed that caregiver resilience decreased approximately 20% the odds of engaging in self harm with and without suicidal intent remaining a consistent predictor even after accounting posttraumatic stress and depression in the models. Posttraumatic stress and depression predicted a one-fold increase in the odds of engaging in self-harm with and without suicidal intent. However, posttraumatic stress was no longer a significant predictor when depression was entered in the model in self-harm without suicidal intent. The COVID-19 pandemic may have increased the likelihood of engaging in self-harm in young people. However, caregiver resilience seems to operate as a protective factor. This important finding carries implications beyond the context of the COVID-19 pandemic.

Adverse childhood experiences, recent negative life events, and non-suicidal self-injury among Chinese college students: the protective role of self-efficacy

BACKGROUND

Non-suicidal self-injury (NSSI) is a severe health problem closely related to adverse childhood experiences (ACEs). However, the underlying mechanisms by which ACEs may affect NSSI are largely unknown. Self-efficacy (NSSI-SE) and recent negative life events (RNLEs) may play important roles in this relationship. This study aimed to clarify the relationship between ACEs and NSSI among college students by examining the role of self-efficacy (NSSI-SE) and RNLEs in this process.

METHOD

Relevant self-report questionnaires were used to evaluate ACEs, RNLEs, NSSI-SE, and NSSI. A questionnaire of 1036 Chinese undergraduates (M_age = 19.65, 28.9% males, 71.1% females) was collected in a cross-sectional manner. The associations between ACEs, RNLEs, NSSI-SE and NSSI were assessed using Pearson correlation analyses. Then, hierarchical multiple linear regressions were used to analyze the effects of ACEs and RNLEs on NSSI, as well as the protective effect of NSSI-SE on the above relations.

RESULTS

NSSI was associated with both ACEs and RNLEs. ACEs and RNLEs could directly increase the risks of participating in NSSI, and the effects of ACEs and RNLEs on NSSI were independent without an interactive effect. NSSI-SE buffered the relationship between ACEs and NSSI, as well as between RNLEs and NSSI. Compared to individuals with a low level of NSSI-SE, ACEs and RNLEs were not significantly associated with NSSI in persons with a high level of NSSI-SE.

CONCLUSION

NSSI-SE may buffer the effect of ACEs and RNLEs on NSSI, indicating that future interventions can be enhanced by targeting NSSI-SE among college students with ACEs or RNLEs to prevent their engagement in NSSI.

Diminished body trust uniquely predicts suicidal ideation and nonsuicidal self-injury among people with recent self-injurious thoughts and behaviors

INTRODUCTION

Self-injurious thoughts and behaviors (SITBs) are difficult to predict, and novel risk factors must be identified. While diminished interoception is associated with SITBs cross-sectionally, the current study assesses whether multiple measures of interoception predict future SITBs.

METHODS

Adults (N = 43) with recent SITBs completed assessments of interoception during a baseline visit. Participants then completed biweekly assessments for 6 months in which they reported the presence and severity/frequency of suicidal ideation and nonsuicidal self-injury (NSSI).

RESULTS

Multilevel models were performed, where baseline interoceptive measures predicted presence and severity/frequency of suicidal ideation and NSSI at follow-up. The Multidimensional Assessment of Interoceptive Awareness (MAIA) Trusting subscale was the only significant predictor of the presence/severity of suicidal ideation. The MAIA Trusting, Emotional Awareness, and Body Listening subscales significantly predicted the presence of NSSI. The MAIA Emotional Awareness subscale and the Body Perception Questionnaire significantly predicted NSSI frequency.

DISCUSSION

Diminished body trust predicted both suicidal ideation and NSSI, indicating a potential shared risk pathway. However, two interoception measures (Body Listening subscale and Body Perception Questionnaire) were associated with NSSI only, indicating potentially unique risk pathways. Given the differential associations between interoception measures and SITBs, results highlight the importance of clearly defining how interoception is measured.

It Is Not What Happens to You But How You React to It That Matters: PTSD as a Moderator of the Association Between Trauma and Impulsive Behaviors

ABSTRACT

We examined the moderating role of posttraumatic stress disorder (PTSD) in the association between trauma and impulsive behaviors. Adult women ( N = 97) with a history of childhood sexual abuse (CSA; n = 26), rape in adulthood ( n = 21), both CSA and adult rape ( n = 25), or no history of sexual trauma ( n = 25) completed self-report questionnaires. PTSD symptoms were positively associated with self-harm and with stealing and accident proneness, but not with sexual impulsivity. Trauma group had no independent associations with impulsive behaviors. PTSD reexperiencing symptoms interacted with trauma group such that reexperiencing symptoms were positively associated with self-harm for the two trauma groups that included CSA but not for the control and adult rape-only groups. Overall, results indicate that PTSD symptoms-more so than the occurrence of trauma itself-associate with impulsive behavior. Results highlight the importance of assessing posttraumatic symptomatology, and not just trauma occurrence, when aiming to prevent or treat impulsive behaviors.

Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder

BACKGROUND

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder.

METHODS

This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey.

RESULTS

Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD.

LIMITATIONS

This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts.

CONCLUSIONS

Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.

Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation

BACKGROUND

Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia.

METHODS

A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated.

RESULTS

Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8).

LIMITATIONS

Retrospective design, referral population, single center study, and exclusion of psychotic patients.

CONCLUSIONS

NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.

The reasons dissociative disorder patients self-injure

BACKGROUND

Most individuals with dissociative disorders (DDs) report engaging in self-injury.

OBJECTIVE

The present study aimed to understand the reasons for self-injury among a clinical sample of 156 DD patients enrolled in the TOP DD Network study.

METHOD

Participants answered questions about self-injury, including a prompt asking how often they are aware of the reasons they have urges to self-injure, as well as a prompt asking them to list three reasons they self-injure.

RESULTS

Six themes of reasons for self-injury, each with subthemes, were identified in the qualitative data: (1) Trauma-related Cues, (2) Emotion Dysregulation, (3) Stressors, (4) Psychiatric and Physical Health Symptoms, (5) Dissociative Experiences, and (6) Ineffective Coping Attempts. Participants reported that they were able to identify their reasons for self-injuring sometimes (60.26%) or almost always (28.85%), with only 3.20% unable to identify any reasons for their self-injury.

CONCLUSION

Results suggest that the vast majority of DD patients (92.31%) reported being at least partially unaware of what leads them to have self-injury urges, and many individuals with DDs experience some reasons for self-injury that are different from those with other disorders. The treatment implications of these findings are discussed.

Non-suicidal self-injury in US military veterans: Results from the National Health and Resilience in Veterans Study

BACKGROUND

To evaluate the prevalence of lifetime non-suicidal self-injury (NSSI) among US military veterans and identify sociodemographic, military, psychiatric and clinical correlates associated with NSSI.

METHODS

Data were analysed from the 2019-2020 National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 4069 US veterans. Outcomes measured included lifetime history of NSSI, trauma history, lifetime and current DSM-V mental disorders and lifetime and recent suicidal behaviours.

RESULTS

The overall prevalence of lifetime NSSI was 4.2% (95% confidence interval [3.6%, 4.9%]). Multivariable analyses revealed that veterans who endorsed lifetime NSSI were more likely to be younger, female, non-Caucasian, unmarried or unpartnered, and to have a lower annual household income. Veterans who endorsed lifetime NSSI reported more adverse childhood experiences and lifetime traumas and were more likely to have experienced military sexual trauma. They also were more likely to screen positive for lifetime posttraumatic stress disorder, major depressive disorder (MDD) and substance use disorders and to have attempted suicide. Finally, lifetime NSSI was associated with current MDD, generalized anxiety disorder, and substance use disorders, as well as past-year suicidal ideation.

CONCLUSION

Results of this study provide the first-known data on the epidemiology of NSSI in US military veterans. They suggest that certain correlates can help identify veterans who may be at greater risk for engaging in NSSI, as well as the potential prognostic utility of lifetime NSSI in predicting current psychiatric problems and suicide risk in this population.

Military Sexual Trauma and Risky Behaviors: A Systematic Review

INTRODUCTION

Military sexual trauma (MST) is a serious and pervasive problem among military men and women. Recent findings have linked MST with various negative outcomes including risky, self-destructive, and health-compromising behaviors.

OBJECTIVE

The current review summarizes the existing literature on the association between MST and risky behaviors among military men and women who have served in the U.S. Armed Forces.

METHOD

We systematically searched five electronic databases (PubMed, EMBASE, PSYCINFO, PILOTS, and CINAHL Plus) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Of the initial 2,021 articles, 47 met the inclusion criteria. Reviewed studies revealed three patterns of findings: (1) largely studied and consistent (i.e., suicidal behaviors, disordered eating), (2) mixed and in need of future research (i.e., alcohol and drug use, smoking), and (3) underexamined (i.e., sexual behaviors, illegal/aggressive behaviors) or completely neglected (e.g., problematic technology use, gambling).

DISCUSSION

The current systematic review advances literature by providing strong support for an association between MST and a wide range of risky behaviors. Moreover, it highlights important areas for future research.

Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups

Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.

The Impact of Adverse Childhood Experiences on Therapy Outcome in Adolescents Engaging in Nonsuicidal Self-Injury

Objective: Nonsuicidal self-injury (NSSI) is a prevalent and clinically significant behavior. There is a substantial association between adverse childhood experiences (ACEs) and NSSI. However, there are no studies investigating the impact of ACEs on NSSI treatment (psychotherapy) outcome. The aim of this secondary analysis of a randomized controlled trial (RCT) on psychotherapy of NSSI was to investigate the relationship between ACEs and treatment outcome in adolescents engaging in NSSI. Method: A sample of 74 adolescent outpatients engaging in repetitive NSSI (incidents on ≥ 5 days within the last 6 months) was recruited for a RCT. ACEs were assessed by the Childhood Experience of Care and Abuse (CECA) interview before treatment onset. Based on the CECA, participants were divided in two groups: with a history of ACEs (n = 30) and without a history of ACEs (n = 44). Frequencies of NSSI, depression, and suicide attempts as well as quality of life were measured at three points in time: before treatment onset (baseline; T0), 4 (T1), and 10 months (T2) after treatment onset. Results: Both participants with and without ACEs were able to reduce the frequency of NSSI significantly [χ2 (1) = 26.72; p < 0.001]. Surprisingly, participants with ACEs reached a significantly greater reduction in NSSI frequency within the past 6 months compared to participants without ACEs [χ2 (1) = 5.08; p = 0.024]. There were also substantial and similar improvements regarding depressive symptoms, suicide attempts and quality of life in both groups. Conclusion: ACEs seem to positively predict treatment response in psychotherapy for adolescent NSSI. This is contrary to prior research suggesting ACE as an unfavorable prognostic factor in the treatment of mental disorders. Clinical Trial Registration: Short term therapy in adolescents with self-destructive and risk-taking behaviors; http://www.drks.de; DRKS00003605.

Posttraumatic stress symptomology and non-suicidal self-injury: The role of intrusion and arousal symptoms

BACKGROUND

Previous evidence has shown a strong relation between Posttraumatic Stress Disorder (PTSD) symptomology and Non-Suicidal Self-Injury (NSSI). The current study aimed to extend prior research by investigating the relationship between PTSD symptom clusters (arousal and intrusion) and NSSI, and putative moderators of this association within a large-scale adult sample in England.

METHOD

A subsample of participants with experiences of trauma in adulthood (n = 2,480) from the Adult Psychiatric Morbidity Survey 2007 (APMS 2007) was utilised to examine the relations among PTSD intrusion and arousal symptom clusters, childhood interpersonal trauma, perceived social support and lifetime NSSI.

RESULTS

Arousal symptoms were consistently associated with NSSI, even when adjusting for multiple covariates, and had a stronger relationship than intrusion symptoms. Childhood interpersonal trauma was independently and significantly associated with lifetime NSSI after adjusting for covariates. The moderating effects of childhood interpersonal trauma and perceived social support were not statistically significant.

LIMITATIONS

The study was cross-sectional and utilised self-report assessments to measure PTSD, NSSI, and childhood interpersonal trauma.

CONCLUSION

Findings support the role of PTSD arousal and childhood interpersonal trauma in relation to NSSI. The moderating role of childhood interpersonal trauma and perceived social support lacks supporting evidence. Findings highlight the need for NSSI screening as well as for specific interventions that target the complex needs of those who exhibit elevated PTSD arousal symptoms, especially those with a history of childhood interpersonal trauma.

Derealization and self-harm strategies are used to regulate disgust, fear, and sadness in adult survivors of childhood sexual abuse

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post-traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma-related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self-harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self-harm and/or self-harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post-traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma-related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma-related emotions on PTSD severity. Three trauma-related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self-harm and via self-harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self-harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self-harm might enable the reduction of PTSD among CSA survivors.

An initial investigation of nonsuicidal self-injury among male and female survivors of military sexual trauma

Nonsuicidal self-injury (NSSI) has been understudied among survivors of military sexual trauma (MST). The aims of the current study were to: (1) describe characteristics of NSSI among survivors of MST and (2) determine if MST survivors who have engaged in NSSI differ from those who have never engaged in NSSI in terms of the severity of posttraumatic stress disorder (PTSD) and depressive symptoms, trauma-related cognitions, and recent suicidal ideation. Participants were 107 veterans (65 females, 42 males) with a history of MST who completed measures of NSSI, PTSD and depressive symptoms, recent suicidal ideation, and trauma-related cognitions. Approximately one-fourth of participants (n = 27; 25.23%) endorsed a history of NSSI. The majority of participants who engaged in NSSI reported that they first engaged in NSSI following MST (n = 18; 66.67%). MST survivors with a history of NSSI reported more severe PTSD symptoms, recent suicidal ideation, and trauma-related cognitions. NSSI was relatively common in the sample and was associated with a more severe clinical presentation. Longitudinal research is needed to understand the development, maintenance, and function of NSSI in MST survivors, especially as it pertains to risk for suicidal self-directed violence.

Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury

OBJECTIVE

To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics.

METHODS

A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models.

RESULTS

11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040).

CONCLUSIONS

Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

The mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents: Findings from community and inpatient mental health settings in Ontario, Canada

Although bullying victimization has been linked to a number of behavioral and emotional problems among adolescents, few studies have investigate the mechanism through which bullying victimization affect non-suicidal self-injury. The objectives of this study were to examine the effect of bullying victimization on non-suicidal self-injury and the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents. Data for this study came from the interRAI Child and Youth Mental Health dataset. A total of 1650 adolescents aged 12-18 years (M =14.56; SD =1.79; 54.2% males) were analyzed. Binary logistic and Poisson regression models were conducted to identify the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury. Of the 1650 adolescents studied, 611 representing 37% engaged in non-suicidal self-injury and 26.7% were victims of bullying. The effect of bullying victimization on non-suicidal self-injury was partially mediated by depressive symptoms after adjusting for the effect of demographic characteristics, history of childhood abuse, social support, and mental health diagnoses. The contribution of bullying victimization and depression to non-suicidal self-injury adds to the case for the development of trauma-focused interventions in reducing the risk of non-suicidal self-injury among adolescents.

Functions of Nonsuicidal Self-Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, ; Joiner, Sachs-Ericson, Wingate, Brown, Anestis, & Selby, ) wherein painful and provocative experiences (e.g., nonsuicidal self-injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, ; Smith, ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; M_age  = 18.69, range 18-22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI (β = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts (β = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.

The prevalence of deliberate self-harm and its relationships to trauma and dissociation among Iranian young adults

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.

The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings

The objectives of this study were to examine the prevalence of, and determine the effect of adverse childhood experiences on non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8-18 years (M=12.49; SD=2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of non-suicidal self-injury as a function of adverse childhood experiences, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, marital status of parents/caregivers, history of foster family placement, and mental health diagnoses. Of the 2038 children and adolescents examined, 592 (29%) of this clinical sample engaged in non-suicidal self-injury. In the multivariate logistic regression model, children and adolescents who were physically abused had 49% higher odds of engaging in non-suicidal self-injury and children and adolescents who were sexually abused had 60% higher odds of engaging in non-suicidal self-injury, when compared to their non-abused counterparts. Other predictors of non-suicidal self-injury include: older age, female gender, inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders. Children and adolescents who had some form of social support had a 26% decrease in the odds of engaging in non-suicidal self-injury. Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of adverse childhood experiences, should also take into account non-suicidal self-injury. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future non-suicidal self-injury behaviors.

A short-term longitudinal examination of the relations between depression, anhedonia, and self-injurious thoughts and behaviors in adults with a history of self-injury

BACKGROUND

Limited research has addressed the role of anhedonia in predicting suicidality and/or nonsuicidal self-injury (NSSI) in adults, despite evidence suggesting that loss of interest or pleasure may increase vulnerability for self-inflicted harm, even beyond other depressive symptoms.

METHODS

In the current study, we explored the role of symptoms of depression and recent changes in anhedonia in predicting suicidality, NSSI ideation, and perceptions of NSSI helpfulness among individuals with a history of NSSI or suicide attempts (N=187).

RESULTS

We found that changes in anhedonia partially mediated the effect of depression on suicidality, and fully mediated the effect of depression on perceptions of NSSI helpfulness. Anhedonia did not predict NSSI ideation above and beyond depression symptoms, and did not significantly predict NSSI frequency when accounting for suicidality. Compared to individuals with a history of NSSI only or suicide attempt only, people with a history of both NSSI and suicide attempt evidenced greater risk and symptomatology.

CONCLUSIONS

Results confirm the relation between anhedonia and suicidality evidenced in past research, but suggest a complex relationship between anhedonia, depression, and facets of non-suicidal self-injury.

Borderline personality disorder in youth: The prospective impact of child abuse on non-suicidal self-injury and suicidality

BACKGROUND

Borderline personality disorder (BPD) is characterized by greater engagement in non-suicidal self-injury (NSSI) and suicidality. The aim of the study is to test whether the occurrence of child abuse contributes to these high-risk behaviors in BPD youth.

MATERIALS AND METHODS

BPD female youth aged 13-21years with (n=29) and without (n=29) a history of child abuse were administered clinical interviews assessing diagnostic history, child abuse, NSSI and suicidality (i.e., ideation, plans, and attempts). NSSI and suicidality were subsequently reevaluated at the 1- and 2-month follow-up assessments.

RESULTS

Several findings emerged. First, relative to BPD youth without abuse, the abuse group reported greater past NSSI; however, no significant differences emerged in the follow-up period. Second, the occurrence of child abuse was associated with a 5-fold increase in the rate of lifetime suicide attempts relative to the no abuse group and additionally, prospectively predicted suicide ideation (but not attempts). Last, exploratory analyses indicated that the co-occurrence of physical and sexual abuse was associated with greater past NSSI and suicidality as compared to the no abuse and sexual abuse only participants.

CONCLUSION

As a whole, child abuse - particularly co-occurring physical and sexual abuse - increases risk for NSSI and suicidality among BPD youth, which may have important treatment implications in this high-risk population.

Models of correction and prevention of self-injurious behavior

We present a review of models of correction of self-injurious and suicidal behavior. Cognitive-behavioral approach includes cognitive-behavioral therapy, acceptance-based group therapy focused on enhancing emotional regulation and rising emotional aware- ness, dialectical behavioral therapy directed at rising emotional awareness, improving in- terpersonal relationships and teaching adaptive ways of coping with emotions, functional analysis and functional communication training. Psychodynamic approach includes mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy. Model of family therapy based on theory of attachment and multilevel model of intervention are considered. We discuss general and specific aspects of prevention of self-injury in clinical and normal populations. Requirements for the development of self-injury prevention programs for schools are listed.

The mediating role of sleep disturbances in the relationship between posttraumatic stress disorder and self-injurious behavior

Although posttraumatic stress disorder (PTSD) is associated with self-injurious behavior, it is currently unclear what mechanisms may account for this relationship. Sleep disturbances may be relevant as they are common among those with PTSD and are associated with emotion regulation difficulties, which may increase vulnerability to self-injurious behavior. As such, we investigated the relationship between PTSD and self-injurious behaviors, and the mediating roles of nightmares and insomnia. Hypotheses were tested cross-sectionally in a sample of psychology clinic outpatients (N=255). Participants completed a structured clinical interview assessing PTSD and self-report questionnaires measuring insomnia, nightmares, and self-injurious behaviors (i.e., Have you ever cut, burned, or scratched yourself on purpose?). PTSD was associated with self-injurious behavior after covarying for depression, and nightmare severity mediated the relationship between PTSD and self-injurious behavior. Findings are consistent with research indicating that sleep disturbances, specifically nightmares, are important predictors of poor outcomes among those with PTSD, and extend this research to suggest their role in self-injurious behaviors as well.

Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data

Non-suicidal self-injury (NSSI) is common among adolescents and linked to many maladaptive outcomes. This study aimed to assess the prevalence and correlates of NSSI among a community sample of New Zealand adolescents. A self-report questionnaire was administered to adolescents at time 1 (N = 1162, mean age = 16.35), and approximately five months later (time 2, N = 830, mean age = 16.49). Prevalence and bivariate correlations were assessed at both time points, and cross-lag correlations using matched data (N = 495, mean age = 16.23). Lifetime history of NSSI was 48.7 % (females 49.4 %, males 48 %). Consistent with previous international research, NSSI was associated with higher Alexithymia, depression, anxiety, bullying, impulsivity, substance abuse, abuse history and sexuality concerns and lower mindfulness, resilience and self-esteem. Cross-lag correlations suggested NSSI is directly (perhaps causally) related to psychological vulnerability in various domains (e.g., increased depression and lower self-esteem), while bullying may be more distal to NSSI, rather than a proximal predictor.

Differences between nonsuicidal self-injury and suicidal behavior in patients with eating disorders

Although it has been reported that 25% to 50% of patients with eating disorders engage in self-harming behaviors (SHBs), including nonsuicidal self-injury (NSSI) and suicidal behavior (SB), no study has investigated the psychological mechanisms underlying these SHBs or any differences that may exist between NSSI and SB. This study involved 76 female patients with eating disorders who were treated at the Kyoto University Hospital between July and August, 2010, who answered questionnaires about SHBs, eating attitudes, tendency to dissociate, and attachment style. Some of the participants (22.4%) had other psychiatric disorders in addition to eating disorders, including borderline personality disorder, dissociative disorder, and posttraumatic stress disorder. Of the participants without comorbidity, 23.7% had engaged in SHBs in the past 3 months. Participants with comorbidity tended to dissociate significantly more than participants without comorbidity. Logistic regression indicated that, in all participants, NSSI in the past 3 months was related to the tendency to dissociate and having a higher body mass index, whereas preoccupied attachment style was potentially related to recent SB. Specifically, among the participants without comorbidity, a sense of ineffectiveness and poor interoceptive awareness were related to recent NSSI, and severity of binge-eating was related to SB. In contrast, a history of NSSI in the patients with eating disorders without comorbidity was related to a sense of ineffectiveness. The results of our study suggest that it may be important to help patients with eating disorders recover their own sense of effectiveness as a possible way to reduce SHBs.

Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: a path analytic approach

New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.

The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.

Self-relevant disgust and self-harm urges in patients with borderline personality disorder and depression: a pilot study with a newly designed psychological challenge

Background

Borderline personality disorder (BPD) is a common psychiatric condition associated with self-harm. Self-harm is poorly understood and there is currently no treatment for acute presentations with self-harm urges.

Objectives

By using a new task (Self-relevant Task; SRT), to explore emotions related to one's own person (PERSON task) and body (BODY task), to study the correlations of these emotions, specifically disgust, with self-harm urge level changes, and to test the task's potential to be developed into an experimental model of self-harming for treatment trials.

Methods

17 BPD patients, 27 major depressive disorder (MDD) patients, and 25 healthy volunteers performed the SRT. Emotion labels were extracted from task narratives and disgust and self-harm urge level changes measured by visual analogue scales. We used validated rating scales to measure symptom severity.

Results

The SRT was effective at inducing negative emotions and self-harm urge changes. Self-harm urge changes correlated with borderline symptom severity. Post-task disgust levels on the visual analogue scales were higher in BPD patients than in healthy controls in the PERSON task, and higher than in both control groups in the BODY task. Changes in disgust levels during the task were significantly greater in the patient groups. Post-task disgust levels or changes in disgust were not associated with self-harm urge changes (except the latter in MDD in the PERSON task), but self-harm urge changes and disgust (but no other emotion) narrative labels were on a whole sample level.

Conclusion

Although associations with the analogue scale measures were not significant, self-disgust reported in the narrative of patients may be associated with a higher probability of self-harm urges. Further research with larger sample sizes is needed to confirm this relationship and to examine whether reducing self-disgust could reduce self-harm urges. The SRT was effective and safe, and could be standardized for experimental studies.

A Google Trends-based approach for monitoring NSSI

Non-suicidal self-injury (NSSI) is an intentional, direct, and socially unacceptable behavior resulting in the destruction of one’s own body tissues with no intention of dying or committing suicide, even though it is associated with a higher risk of attempted, planned, or just considered suicide. In this preliminary report, we introduce the concept of “NSSI 2.0”; that is to say, the study of the Internet usage by subjects with NSSI, and we introduce a Google Trends-based approach for monitoring NSSI, called NSSI infodemiology and infoveillance. Despite some limitations, Google Trends has already proven to be reliable for infectious diseases monitoring, and here we extend its application and potentiality in the field of suicidology. Ad hoc web portals and surveys could be designed in light of the reported results for helping people with NSSI.