The role of emotion dysregulation in self-management behaviors among adults with type 2 diabetes

Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was to examine the relations between different facets of emotion dysregulation and diabetes self-management behaviors among a sample of 373 adults with type 2 diabetes. Separate median regression and binary logistic regression models were used to examine the association of emotion dysregulation facets and each diabetes self-care behavior (i.e., medication nonadherence, diet, exercise, self-monitoring of blood glucose (SMBG), foot care, and smoking). Generally, greater difficulties in emotion regulation were associated with poorer self-management behaviors. However, several facets of emotion dysregulation were linked with better self-management behaviors. Addressing emotion dysregulation among adults with type 2 diabetes has the potential to improve diabetes related self-management.

Clarifying relations of emotion regulation, emotional avoidance and anxiety symptoms in a community-based treatment-seeking sample

OBJECTIVES

Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process-related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust correlate of anxiety symptoms and is often targeted in behavioural treatments applied to anxiety-related problems. Yet, some evidence suggests ER difficulties may be a proxy variable for emotional avoidance (EA). Clarifying the relative influence of ER and EA on anxiety symptom severity may improve specificity in targeting behavioural processes within psychosocial treatments designed to alleviate anxiety-related suffering. Accordingly, we examined relations of ER and EA to anxiety symptom severity after accounting for anxiety sensitivity and anxiolytic medication use in a community-based treatment-seeking sample.

DESIGN

A four-step hierarchical linear regression analysis of cross-sectional data provided by a community-based treatment-seeking sample.

METHODS

Totally, 120 participants (Mage  = 39.18; Female = 58.3%) completed a questionnaire packet upon intake to an anxiety disorders clinic.

RESULTS

EA and ER were strongly correlated, and each accounted for significant variance over and above model covariates. EA was a dominant risk factor for anxiety symptom severity, as ER was not a significant predictor (p = .073) following the inclusion of EA in the model (p = .006).

CONCLUSIONS

EA appears to be a dominant risk factor, and ER a proxy risk factor, for anxiety symptom severity. EA may be an avenue for greater treatment specificity for those with anxiety symptoms.

Examining the roles of disability-related body esteem and perceived burdensomeness in suicidal ideation among adults with vision- and mobility-related disabilities

PURPOSE/OBJECTIVE

People with disabilities (PWD) generally exhibit an increased risk of suicidal ideation (SI) and behaviors. Underlying cognitive states, namely perceived burdensomeness, have been identified as a contributor to the increased risk of suicidal thoughts and behaviors in PWD. However, the role of body esteem in the development of SI in this population remains unexamined, despite its salience in other populations. In this study, we examined whether the interaction of perceived burdensomeness and body esteem contributed to the perceived likelihood of future SI among PWD, and whether this relationship was further moderated by disability type.

METHOD

Participants included 119 adults with self-reported vision- and mobility-related disabilities who participated in a larger study focused on disability and suicide involving interviews and self-report measures. We examined the interaction between perceived burdensomeness and disability-related body esteem on self-reported likelihood of future SI and whether this interaction was further moderated by disability type (i.e., vision- or mobility-related disability).

RESULTS

Greater perceived burdensomeness was associated with a greater perceived likelihood of future SI only for participants with vision impairments and at low levels of body esteem.

CONCLUSIONS/IMPLICATIONS

The combination of experiences of perceived burdensomeness and low body esteem may be particularly relevant to SI among people with vision-related versus mobility-related disabilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Treatment-relevant factors among adults receiving court-mandated substance use treatment: The role of emotion dysregulation

Despite often being mandated to substance use treatment after release, many people on probation do not complete treatment. Several historical factors have been identified as relevant to substance use treatment in this population (i.e., past substance use, treatment history, and criminal history); however, less is known about the psychological characteristics, such as emotion dysregulation, that influence treatment-relevant factors among people in the criminal justice system. The present study used cross-sectional data to examine whether emotion dysregulation was associated with past-year substance use severity, engagement in prior drug and alcohol use treatments (yes/no, number of prior treatments), and previous criminal charges (total number of charges, number of charge types) in a sample of adults on probation who were receiving court-mandated substance use treatment (N = 163). We also examined whether these relationships varied across sex. Results showed that overall emotion dysregulation was more strongly linked to substance use severity and criminal charges for females than males. Emotion dysregulation dimensions of difficulties engaging in goal-directed behaviors and controlling impulsive behaviors when distressed were associated with more severe past-year substance use, more prior drug treatments, and a greater number of lifetime criminal charges and charge types. Emotion dysregulation plays a role in substance use treatment-relevant factors among people on probation. Sex-specific clinical implications of targeting emotion dysregulation in the context of mandated treatment in order to prevent treatment failures are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clarifying the relation between mother and adolescent borderline personality disorder symptoms: The roles of maternal and adolescent emotion regulation and maladaptive maternal emotion socialization

Despite evidence for the intergenerational transmission of borderline personality disorder (BPD) pathology from mothers to offspring, the factors underlying the relation between mother and child BPD symptoms remain unclear and little is known about the pathways through which maternal BPD symptoms may relate to BPD symptoms in their offspring. One set of factors that warrants consideration in this regard is mother and child emotion regulation (ER) difficulties. In particular, theory and research suggest an indirect relation between mother and child BPD symptoms through maternal ER difficulties (and related maladaptive emotion socialization strategies) and, subsequently, child ER difficulties. Thus, this study used structural equation modeling to examine a model wherein maternal BPD symptoms relate to offspring BPD symptoms in adolescence through maternal ER difficulties (and maladaptive maternal emotion socialization strategies) and, subsequently, adolescent ER difficulties. A nationwide community sample of 200 mother-adolescent dyads completed an online study. Results provided support for the proposed model, revealing both a direct relation between maternal and adolescent BPD symptoms and two indirect relations through (a) maternal and adolescent ER difficulties and (b) maternal ER difficulties, maternal maladaptive emotion socialization strategies, and adolescent ER difficulties. Results highlight the relevance of both mother and adolescent ER difficulties in the relation between mother and offspring BPD pathology, as well as the potential clinical utility of targeting mother and child ER in interventions aimed at preventing the intergenerational transmission of BPD pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the Presence, Frequency, and Associated Characteristics of Nonsuicidal Self-Injury by Proxy: Initial Validation of the Nonsuicidal Self-Injury by Proxy Questionnaire (NSSIBPQ)

Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provide preliminary data on the validity of a new self-report measure, the NSSI by Proxy Questionnaire (NSSIBPQ). Two nationwide community samples of young adults (one general community sample and one with a history of traditional NSSI and suicidality) completed online studies. NSSI by proxy was reported by 18% of the general community sample and 45% of the self-injuring sample. Findings support the clinical relevance of NSSI by proxy and its potential to meet criteria for an NSSI disorder diagnosis. Results also provide preliminary support for the internal consistency and convergent, discriminant, and concurrent validity of the NSSIBPQ.

Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder: A Randomized Clinical Trial

Importance

Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking.

Objective

To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects.

Design, Setting, and Participants

This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021.

Interventions

Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only.

Main Outcomes and Measures

Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment.

Results

A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment.

Conclusions and Relevance

In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.

Trial Registration

ClinicalTrials.gov Identifier: NCT03353961.

Mothers' borderline personality disorder symptom severity and accuracy in predicting infant distress

Maternal borderline personality disorder (BPD) symptoms have been found to relate to parenting difficulties that subsequently predict children's maladjustment. One specific area of difficulty for mothers with BPD symptoms surrounds responses to infant distress. Based in mentalization theories of BPD, the current study tested the relation between BPD symptom severity and maternal accuracy in predicting infant distress. Infant biological sex was also tested as a moderator. Participants included 101 mothers, varying in self-reported BPD symptom severity, and their 12- to 23-month-old infants. At a laboratory visit, mothers responded to structured questions about their predictions for infant distress behaviors in fear- and anger-eliciting tasks, which were then observed. Maternal accuracy represented the statistical association between maternal predictions and infant distress behaviors. Maternal accuracy did not differ between infant fear and anger. For male infants, mothers' higher BPD symptom severity related to lower accuracy across fear and anger contexts. For female infants, BPD symptom severity did not influence maternal accuracy. Results are discussed in relation to existing theories of emotional disruption in the relationships between mothers with BPD symptoms and their infants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Is the Risk for Sexual Revictimization Cumulative? A Prospective Examination

INTRODUCTION

Sexual abuse during childhood is associated with risk for sexual assault as an adult, known as revictimization. Although multiple experiences of sexual assault in adulthood are also common, it is unclear how risk trajectories might continue to evolve in emerging adulthood, defined as ages 18-25. Clarifying risk trajectories is important to inform the development of targeted risk reduction interventions. To fill this gap, we examined cumulative risk for sexual assault in emerging adult women following multiple experiences of childhood sexual abuse (CSA) and adulthood sexual assault (ASA).

METHODS

Women (n = 447; aged 18-25 years at enrollment) completed behaviorally specific assessments of unwanted sexual experiences at up to 9 time points across 3 years. Logistic regression was used to predict any sexual assault during the 3-year period as a function of victimization history at baseline. A multilevel logistic regression analysis among ASA survivors was then used to determine whether each successive ASA increased risk for further victimization.

RESULTS

Extending prior research, findings revealed that the risk for sexual assault during the 3-year study was greater for women reporting more prior experiences of CSA and ASA. Unexpectedly, each ASA increased the risk for a subsequent ASA to a lesser extent among women with more experiences of CSA.

CONCLUSIONS

Findings suggest that the risk for sexual revictimization can be cumulative, but that risk does not increase indefinitely. Future research should investigate the points at which survivors of multiple assaults may begin to experience a decreased risk for later assaults, as well as the factors associated with change in risk status (e.g., removal from violent environments or relationships, changes in institutional policies). Such research could inform intervention targets.

Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type

BACKGROUND

Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts).

AIMS

This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type.

METHODS

Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities.

RESULTS

No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities.

LIMITATIONS

The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality.

CONCLUSIONS

Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.

Trauma Symptoms and Deliberate Self-Harm Among Sexual Violence Survivors: Examining State Emotion Regulation and Reactivity as Dual Mechanisms

Objective

Posttraumatic stress disorder (PTSD) symptoms have been associated with elevated rates of deliberate self-harm, including among women who have experienced sexual violence (SV); however, processes underlying this association have not been widely examined. Because a common function of deliberate self-harm is to reduce negative internal states, SV survivors may use self-harm to cope with impairments in broader affective processes associated with PTSD symptoms. To test this hypothesis, the present study examined the role of two aspects of emotional responding (i.e., state emotional reactivity and emotion dysregulation) as mechanisms between greater PTSD symptoms and risk for future deliberate self-harm among SV survivors.

Method

Participants were 140 community women with a history of SV who completed two waves of data collection. At baseline, participants reported on their PTSD symptoms, as well as state emotional reactivity and state emotion dysregulation following a standardized laboratory stressor task (i.e., the Paced Auditory Serial Addition Task [PASAT-C]). Participants then completed a self-report measure of deliberate self-harm 4 months later.

Results

Results from a parallel mediation analysis indicated that greater state emotion dysregulation, but not state emotional reactivity, mediated prospective associations between more severe PTSD symptoms at baseline and greater risk for deliberate self-harm 4-months later.

Conclusions

Applied to the context of survivors' daily lives, these findings underscore the importance of deficits in emotion regulation during times of distress in predicting risk for later deliberate self-harm.

Fear of compassion from others explains the relation between borderline personality disorder symptoms and ineffective conflict resolution strategies among patients with substance use disorders

BACKGROUND

Borderline personality disorder (BPD) pathology is common among patients with substance use disorders (SUDs) and associated with a variety of negative outcomes, including worse SUD outcomes. One particularly relevant outcome with links to substance use problems that is likely to be elevated among SUD patients with BPD symptoms is ineffective conflict resolution strategies in romantic relationships. However, no research to date has examined the relation of BPD pathology to strategies for managing conflict in romantic relationships among patients with SUDs, or the factors that may increase the use of ineffective strategies within this population. Thus, this study examined the relations of BPD symptoms to ineffective responses to romantic relationship conflict surrounding substance use among residential patients with SUDs, as well as the explanatory roles of fear of compassion from and for others in these relations.

METHODS

Patients in a community-based correctional SUD residential treatment facility (N = 93) completed questionnaires, including a measure of BPD symptoms, fear of compassion from and for others, and strategies for responding to conflict surrounding substance use in romantic relationships.

RESULTS

Fear of compassion from others accounted for significant variance in the relations of BPD symptoms to the ineffective conflict resolution strategies of reactivity, domination, and submission, whereas fear of compassion for others only accounted for significant variance in the relation between BPD symptoms and the strategy of separation (which is not always ineffective).

CONCLUSIONS

Together, findings suggest that it is fear of compassion from others (vs. fear of compassion for others) that explains the relation between BPD symptoms and ineffective responses to romantic relationship conflict surrounding substance use among SUD patients. Findings highlight the potential utility of interventions aimed at reducing fears of compassion and increasing comfort with and tolerance of compassion from both others and oneself among SUD patients with BPD symptoms in order to strengthen relationships and reduce risk for relapse.

Examining associations between suicidal desire, implicit fearlessness about death, and lifetime frequency of suicide attempts

INTRODUCTION

Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency.

METHODS

Patients in residential substance use treatment (N = 75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts.

RESULTS

Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels.

CONCLUSION

Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.

The moderating role of sexual minority status in the associations of the experience and tolerance of shame-related emotions to suicide risk

OBJECTIVE

This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status.

METHODS

Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk.

RESULTS

Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust.

CONCLUSION

Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.

Hiding in the open: Consideration of nonsuicidal self-injury by proxy as a clinically meaningful construct

Nonsuicidal self-injury (NSSI) is defined as the deliberate destruction of one's own body tissue without suicidal intent and for purposes not socially sanctioned. However, this definition limits the understanding and assessment of NSSI by excluding a clinically relevant form of NSSI that is both self-driven and associated with self-injurious intentions: NSSI by proxy. Specifically, we propose that NSSI by proxy be defined as the intentional destruction of one's own body tissue through the elicitation of another being's (e.g., human, animal) actions, wherein the agency of the person being injured is a critical facet of the behavior. We review the literature supporting the clinical relevance of this behavior, as well as its similarities to traditional NSSI. Next, we propose four behaviors that may be conceptualized as NSSI by proxy, and identify two other behaviors that warrant further investigation. Finally, we identify future directions for research in this area and implications for the assessment and treatment of NSSI.

The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness

BACKGROUND

Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness.

METHODS

A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months.

RESULTS

Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time.

LIMITATIONS

All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors.

CONCLUSIONS

Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

An experimental investigation of the affect regulating properties of sugar consumption: Examining the roles of socially-oriented positive and negative affect

Obesity is a major public health concern, and sugar consumption is a key risk factor for obesity. Thus, there is a need to identify factors that may increase motivation to consume sugar. One such factor may be negative affect, as research has shown that negative affect increases motivation for and engagement in appetitive behaviors, including sugar consumption. The goal of the present study was to extend past research on the role of negative affect in sugar consumption by examining: (a) the effect of a socially-oriented negative affect induction (i.e., social rejection) on the consumption of flavored beverages with varying levels of sugar, and (b) the negative and positive affect regulating properties of varying levels of sugar consumption. Undergraduate students (N = 116) were randomized to receive either a neutral or socially-oriented negative affect induction. Participants were then presented with three flavored beverages with varying levels of sugar (low, medium, high). Negative and positive affect were assessed prior to and following the affect induction procedure, as well as following consumption of the beverage. Participants exposed to the negative affect induction consumed a larger volume of the high sugar beverage (as well as a larger volume of all sugary beverages) relative to participants in the neutral induction condition. Moreover, these findings could not be attributed to a greater preference for the high sugar beverage among participants in the negative affect condition. Additionally, lower levels of positive affect post-induction across all participants (regardless of condition) were associated with greater consumption of the high sugar beverage, and high sugar beverage consumption was significantly positively associated with post-consumption positive affect. Results provide evidence for an affect-regulating function of sugar consumption following social rejection.

The Screen for Nonsuicidal Self-Injury: Development and initial validation among veterans with psychiatric disorders

INTRODUCTION

Nonsuicidal self-injury (NSSI) is associated with significant impairment and is a robust predictor of suicidal ideation, attempts, and death by suicide; however, the present lack of a brief screening instrument for NSSI coupled with consistent underidentification of NSSI in male adults has led to concerning rates of missed identification of NSSI.

METHODS

The Screen for Nonsuicidal Self-Injury (SNSI) is a brief, 10-item screen designed to identify individuals currently engaging in NSSI with an emphasis on behaviors more frequently endorsed by male adults. The present study examined the development and validation of the SNSI.

RESULTS

In a sample of veterans (N = 124) with complex psychiatric presentations, SNSI scores demonstrated good internal consistency and strong construct validity with area under the curve (AUC) estimates of 0.85-0.93 for the identification of NSSI disorder. SNSI scores also demonstrated good convergent (rs 0.59-0.90) and external validity (rs = 0.25-0.42), and excellent predictive validity identifying future NSSI Suicide and Life-Threatening Behavior disorder (AUC = 0.88) and NSSI behaviors (AUC = 0.90). Importantly, SNSI performance was not affected by participants' race, sex assigned at birth, or age.

CONCLUSION

The SNSI is an efficient screen to identify patients engaging in NSSI who are likely to benefit from more comprehensive assessment and treatment programs.

Self-injury motives: A person-centered examination

INTRODUCTION

People report multiple motives for nonsuicidal self-injury (NSSI), but few studies have examined how these motives relate to one another. This study identified person-centered classes of NSSI motives, their NSSI and psychopathological correlates, and their utility in predicting future NSSI across two samples.

METHODS

Participants were adolescents and young adults (aged 15-35) with recent NSSI recruited from online forums (n = 155, Sample 1) or the community (n = 127, Sample 2). Participants completed measures of NSSI, emotion regulation difficulties, borderline personality disorder (BPD), depression, and reported on their NSSI over 12 months.

RESULTS

Latent profile analyses yielded five classes in each sample: low interpersonal, self-punishment/interpersonal, moderate intra/interpersonal, high intra/interpersonal, and mainly interpersonal motives. Classes were not associated with lifetime NSSI characteristics, but highly motivated participants reported more severe depression and BPD symptoms, and greater emotion dysregulation than low-motivated participants. Those in the mainly interpersonal (Sample 1) and self-punishment/interpersonal (Sample 2) motives classes reported greater NSSI frequency during follow-up.

CONCLUSIONS

This study identified five classes of NSSI motives. Participants who report multiple motives for NSSI may be more clinically severe, whereas those who report strong desires to communicate with others or punish themselves may be at the highest risk for more frequent NSSI over time.

Substance Use Frequency Relates to Suicidal Ideation Through Perceived Burdensomeness and to Suicide Attempts Through Capability for Suicide

BACKGROUND

Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequency of substance use is indirectly related to suicidal ideation and suicide attempts through core ITS variables (i.e., burdensomeness, thwarted belongingness, and suicide capability).

METHODS

An online sample of Mechanical Turk workers (N = 365) completed measures assessing substance use frequency, burdensomeness, thwarted belongingness, suicide capability, suicidal ideation, and suicide attempts.

RESULTS

After controlling for relevant clinical and demographic covariates, substance use frequency was indirectly related to suicidal ideation through burdensomeness but not thwarted belongingness. Substance use frequency was indirectly related to suicide attempts through suicide capability only.

LIMITATIONS

The cross-sectional design precludes conclusions about the precise nature and direction of the relations examined. The use of a community sample limits generalizability to more severe substance using samples.

CONCLUSIONS

Results highlight the relevance of distinct ITS factors in the relation between substance use frequency and both suicidal ideation and suicide attempts. Results may inform specific targets for novel interventions aimed at reducing suicide risk among substance-using individuals.HighlightsSubstance use frequency was indirectly related to SI through burdensomeness.Substance use frequency was not indirectly related to SI through thwarted belongingness.Substance use frequency was indirectly related to SA only through suicide capability.

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 Roles of Emotion Regulation Self-Efficacy and Emotional Avoidance in Self-Injurious Thoughts and Behaviors

Little research has examined the role of emotion regulation self-efficacy (ERSE; i.e., beliefs in one's own ability to regulate emotions) in self-injurious thoughts and behaviors (SITBs) or the factors that may underlie this relation. This study investigated whether low ERSE relates to SITBs both directly and indirectly through avoidance of negative emotions. Participants (N = 364) completed measures of ERSE, emotional avoidance, suicide attempt history, nonsuicidal self-injury (NSSI), and current severity of suicidal ideation through Amazon's Mechanical Turk. Low ERSE was significantly associated with history of suicide attempts, recent NSSI, and current severity of suicidal ideation both directly and indirectly through avoidance of negative emotions. Furthermore, low ERSE was significantly associated with a greater number of SITB types both directly and indirectly through emotional avoidance.

Implicit Associations of Nonsuicidal Self-Injury with Relief in Posttraumatic Stress and Depressive Disorders

OBJECTIVE

Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives.

METHOD

A subset of participants from our previous study (N = 109) completed diagnostic interviews and the laboratory-based DSH-Relief Implicit Association Test (IAT).

RESULTS

Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder.

CONCLUSIONS

Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.

Affective states and nonsuicidal self-injury (NSSI): Results from an ecological momentary assessment study of veterans with NSSI disorder

BACKGROUND

The affective states most strongly associated with nonsuicidal self-injury (NSSI) remain poorly understood, particularly among veterans. This study used ecological momentary assessment (EMA) to examine relationships between affect ratings and NSSI urges and behaviors among veterans with NSSI disorder.

METHODS

Participants (N = 40) completed EMA entries via mobile phone for 28 days (3722 total entries). Entries included intensity ratings for five basic affective states, as well as NSSI urges and behaviors, during the past 4 hours.

RESULTS

Bivariate analyses indicated that each affect variable was significantly associated with both NSSI urges and behaviors. Angry/hostile and sad were most strongly associated with both NSSI urges and behaviors. A multivariate regression revealed that angry/hostile, disgusted with self, and happy (inversely related) were contemporaneously (within the same period) associated with NSSI behaviors, whereas all five basic affective states were contemporaneously associated with NSSI urges. In a lagged model, angry/hostile and sad were associated with subsequent NSSI urges but not behaviors.

CONCLUSIONS

Findings highlight the relevance of particular affective states to NSSI and the potential utility of targeting anger in treatments for NSSI among veterans. There is a need for future EMA research study to further investigate temporal relationships between these variables.

The role of sleep disturbance in the associations of borderline personality disorder symptom severity to nonsuicidal self-injury and suicide risk among patients with substance use disorders

This study sought to examine the explanatory role of sleep disturbance in the associations of borderline personality disorder (BPD) symptom severity to nonsuicidal self-injury (NSSI) and suicide risk within an at-risk sample of patients with substance use disorders (SUDs), as well as whether emotion regulation (ER) difficulties account for significant variance in the relations of sleep disturbance to NSSI and suicide risk. Patients in a residential SUD treatment facility (N = 166) completed a diagnostic interview and questionnaires. Results revealed significant indirect relations of BPD symptom severity to both NSSI frequency and suicide risk through sleep disturbance. In addition, ER difficulties accounted for significant variance in the relation of sleep disturbance to NSSI frequency (but not suicide risk). Findings highlight the relevance of sleep disturbance to the association between BPD symptoms and both suicidal and nonsuicidal self-injury and suggest the potential utility of interventions aimed at improving sleep quality among individuals with BPD pathology.

The impact of stay-at-home orders on vulnerability assessments and precautionary intentions during a pandemic

In 2020, a novel emerging infectious disease - COVID-19 - became a global pandemic and prompted unprecedented social distancing measures. We examined the associations of voluntary stay-at-home (SAH) orders during the COVID-19 pandemic with vulnerability assessments and precautionary intentions (e.g. social distancing, hand washing). A quasi-experimental study using an online adult sample was conducted in U.S. states with and without voluntary SAH orders during the COVID-19 pandemic. Self-report surveys assessed vulnerability assessments and precautionary intentions. Participants living in states with SAH orders showed inflated vulnerability assessments for contracting COVID-19, and this association was stronger for affect-laden than cognitively-based assessments. Moreover, only affect-laden vulnerability assessments were uniquely associated with precautionary intentions and accounted for the relationship between SAH orders and precautionary intentions. Our study was among the first to explore the impact of voluntary SAH orders on vulnerability assessments and precautionary intentions. Results are discussed in terms of their implications for health behavioral models and applications for promoting self-protective actions during a pandemic.

The roles of borderline personality disorder symptoms and dispositional capability for suicide in suicidal ideation and suicide attempts: Examination of the COMT Val158Met polymorphism

There is a need to identify the subset of individuals with borderline personality disorder (BPD) symptoms at greatest risk for transitioning from suicidal ideation to a suicide attempt. Contemporary models of suicide risk propose that the capability for suicide is necessary for moving from suicidal ideation to a suicide attempt. Few studies have examined dispositional capability factors for suicide, especially among individuals with BPD symptoms. One candidate may be the catechol-o-methyltransferase (COMT) Val158Met polymorphism given its influence on pain sensitivity and fear. This study examined the interactive relation of BPD symptoms and the COMT Val158Met polymorphism to suicidal ideation and suicide attempts. Fifty-nine treatment-seeking patients were recruited. Participants were administered a series of clinical interviews to evaluate BPD symptoms and suicidal thoughts and behaviors. Saliva samples were collected for genotyping. The relation between BPD symptoms and suicidal ideation was not influenced by the Val158Met polymorphism. However, among Val/Val carriers, the probability of a lifetime suicide attempt increased as BPD symptom severity increased. Findings provide preliminary support for the Val/Val variant as a dispositional factor that may increase risk for suicide attempts in BPD; however, results must be interpreted with caution until replication of findings occurs in larger samples.

Nonsuicidal Self-Injury Disorder, Borderline Personality Disorder, and Lifetime History of Suicide Attempts among Male and Female Veterans with Mental Health Disorders

BACKGROUND

Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans.

METHODS

Participants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts.

RESULTS

BPD, Χ²=11.1, p<0.001, and NSSID, Χ²=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001.

LIMITATIONS

Causality cannot be determined from cross-sectional analyses.

CONCLUSION

These findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.

Adherence to Social Distancing Guidelines Throughout the COVID-19 Pandemic: The Roles of Pseudoscientific Beliefs, Trust, Political Party Affiliation, and Risk Perceptions

BACKGROUND

Adherence to COVID-19 social distancing guidelines varies across individuals.

PURPOSE

This study examined the relations of pseudoscientific and just world beliefs, generalized and institutional trust, and political party affiliation to adherence to COVID-19 social distancing guidelines over three months, as well as the explanatory role of COVID-19 risk perceptions in these relations.

METHODS

A U.S. nationwide sample of 430 adults (49.8% women; mean age = 40.72) completed a prospective online study, including an initial assessment (between March 27 and April 5, 2020), a 1 month follow-up (between April 27 and May 21, 2020), and a 3 month follow-up (between June 26 and July 15, 2020). We hypothesized that greater pseudoscientific and just world beliefs, lower governmental, institutional, and dispositional trust, and Republican Party affiliation would be associated with lower initial adherence to social distancing and greater reductions in social distancing over time and that COVID-19 risk perceptions would account for significant variance in these relations.

RESULTS

Results revealed unique associations of lower governmental trust, greater COVID-19 pseudoscientific beliefs, and greater trust in the Centers for Disease Control and Prevention (CDC) to lower initial adherence to social distancing. Whereas greater COVID-19 risk perceptions and CDC trust were associated with less steep declines in social distancing over time, both Republican (vs. Democratic) Party affiliation and greater COVID-19 pseudoscientific beliefs were associated with steeper declines in social distancing over time (relations accounted for by lower COVID-19 risk perceptions).

CONCLUSIONS

Results highlight the utility of public health interventions aimed at improving scientific literacy and emphasizing bipartisan support for social distancing guidelines.

Examining the role of stigma and disability-related factors in suicide risk through the lens of the Interpersonal Theory of Suicide

Research has largely not identified processes contributing to the relationship between physical disability and suicide risk. This cross-sectional research is aimed at examining the associations among felt stigma, perceived burdensomeness, disability severity, and perceptions about future suicidal ideation and attempts. Adults (N = 127) with physical disabilities recruited through online and printed advertisements completed self-report measures and semi-structured interviews. We anticipated that felt stigma would be associated with individuals' perceived likelihood of future suicidal ideation and attempts indirectly through perceived burdensomeness, and that these relationships would be moderated by the impact of disability on three important life domains. Results from a series of moderated mediation analyses partially supported study hypotheses and indicated indirect relationships of stigma to suicide-related perceptions. However, disability severity in the three examined domains did not moderate these indirect relationships. Felt stigma and perceived burdensomeness may contribute to self-perceptions of suicide risk among individuals with physical disabilities.

Drinking to cope as a mechanism between sleep problems and heavy episodic drinking among trauma survivors

Objective: Women who have experienced trauma report high rates of heavy episodic drinking (HED) and sleep problems. Prior work suggests that poor sleep exacerbates heavy alcohol use; however, potential mechanisms for this association are unclear. Consistent with the self-medication model, one possibility may be that women with a history of trauma are drinking at increased rates in order to cope with the affective consequences of poor sleep. To examine this possibility, the current study tested the role of drinking to cope motives as a mediator of prospective associations between sleep problems and HED among women who have experienced trauma. Method: Community women reporting a history of trauma (N = 414, M_age = 21.8, 59.9% White, 36.2% Black) completed self-report measures at baseline and 4 month and 8 month follow-ups. Measures of trauma exposure (Life Events Checklist [LEC]) and sleep problems (Cohen-Hoberman Inventory of Physical Symptoms-Revised [CHIPS-R]) were taken from baseline, drinking motives (Revised Drinking Motives Questionnaire) at 4 months, and HED at 8 months. Results: Findings supported an indirect association between sleep problems and later HED through increased drinking to cope motives (b = .05, 95% CI [.018, .108], β = .05). Conclusion: As hypothesized, drinking to cope accounted for associations between sleep problems and later HED. Findings underscore the potential value in addressing drinking to cope motives as a means of reducing HED, particularly among women with a history of trauma who are sleeping poorly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A machine learning approach to modeling PTSD and difficulties in emotion regulation

Despite evidence for the association between emotion regulation difficulties and posttraumatic stress disorder (PTSD), less is known about the specific emotion regulation abilities that are most relevant to PTSD severity. This study examined both item-level and subscale-level models of difficulties in emotion regulation in relation to PTSD severity using supervised machine learning in a sample of U.S. adults (N=570). Participants were recruited via Amazon's Mechanical Turk (MTurk) and completed self-report measures of emotion regulation difficulties and PTSD severity. We used five different machine learning algorithms separately to train each statistical model. Using ridge and elastic net regression results in the testing sample, emotion regulation predictor variables accounted for approximately 28% and 27% of the variance in PTSD severity in the item- and subscale-level models, respectively. In the item-level model, four predictor variables had notable relative importance values for PTSD severity. These items captured secondary emotional responding, experiencing emotions as out-of-control, difficulties modulating emotional arousal, and low emotional granularity. In the subscale-level model, lack of access to effective emotion regulation strategies, lack of emotional clarity, and emotional nonacceptance subscales had the highest relative importance to PTSD severity. Results from analyses modeling a probable diagnosis of PTSD based on DERS items and subscales are presented in supplemental findings. Findings have implications for developing more efficient, targeted emotion regulation interventions for PTSD.

Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems

Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use problems (i.e., prescription opioid misuse, apprehension about prescription opioid use, and opioid cravings) through motives for opioid use (i.e., coping, enhancement, social, and conformity motives) among 68 patients endorsing prescription opioid misuse in a residential correctional substance use disorder (SUD) treatment facility. Participants completed measures of BPD pathology, motives for opioid use, and opioid use problems. Findings revealed significant indirect relations of BPD pathology to opioid misuse through coping and enhancement motives, apprehension about opioid use through coping, enhancement, and social motives, and opioid cravings through coping motives within this SUD sample. Results illustrate the relevance of both emotion- and interpersonal-related motives for opioid use to opioid use problems among patients with BPD pathology in SUD treatment.

Emotion dysregulation across levels of substance use

Emotion dysregulation has shown to be of importance in the onset and maintenance of psychiatric disorders, including substance use disorders. How difficulties in emotion regulation differ across levels of substance use, and whether these relations are influenced by co-occurring psychiatric disorders, is less clear. This study aimed to identify difficulties in emotion regulation across the spectrum of substance use and evaluate the influence of co-occurring psychiatric symptoms. Self-reported emotion regulation difficulties, substance use, and other psychiatric symptoms were assessed in one community sample (n = 843) and two inpatient clinics, with substance use disorder populations (n = 415). Data were merged and analyzed with regression models and correlations. Emotion dysregulation was distributed across different levels of substance use, and significantly associated with substance use severity and frequency. High substance use severity and frequency was significantly associated with high scores on the emotion dysregulation facet specifically involving difficulties controlling impulsive behaviors. Psychiatric symptoms did not significantly influence the association between substance use and emotion dysregulation. Results indicate an association between emotion dysregulation and the frequency and severity of substance use, and also suggest that difficulties controlling impulsive behaviors may be a potentially useful treatment target for individuals with substance dependence.

Prospective interactive influence of financial strain and emotional nonacceptance on problematic alcohol use during the COVID-19 pandemic

Background: Researchers have highlighted the risk for alcohol use problems in the context of COVID-19, although the factors associated with this risk remain unclear.Objectives: This study examined the prospective relation of baseline financial strain (reported at the beginning of the pandemic) to problematic alcohol use one month later, as well as the moderating role of emotional nonacceptance. We hypothesized that financial strain would be more strongly associated with problematic alcohol use one month later among participants with high (vs. mean or low) levels of nonacceptance.Methods: Shortly after COVID-19 was declared a pandemic by the WHO and national emergency by the U.S. President (on March 11 and 13, 2020, respectively), a U.S. nationwide community sample completed a prospective online study, including an initial assessment from March 27-April 5, 2020 and a one-month follow-up from April 27-May 21. Measures included the Family Economic Strain Scale, Difficulties in Emotion Regulation Scale, and Alcohol Use Disorders Identification Test. Participants included 254 adults reporting some alcohol use (50.4% women; mean age = 41.8).Results: Baseline financial strain was significantly positively associated with problematic alcohol use one month later only among participants with high (b =.06, SE =.03, p =.037) versus mean (b =.01, SE =.02, p =.677) or low (b = -.04, SE =.02, p =.110) emotional nonacceptance.Conclusion: Individuals experiencing financial strain in the context of COVID-19 may be at risk for problematic alcohol use if they are not accepting of their emotional distress.

Characterizing Sexual Violence in Intimate Relationships: An Examination of Blame Attributions and Rape Acknowledgment

Rape by an intimate partner frequently involves a precedence of sexual consent between victim and perpetrator, often does not include the use of physical force, and may not fit societal definitions of rape. Given these unique characteristics, women who are assaulted by an intimate partner may be less likely to acknowledge the experience as a rape. In turn, they might make fewer blame attributions toward themselves and their perpetrators than victims of rape by a nonpartner. Consistent with these expectations, results from 208 community women reporting rape in adulthood revealed the presence of indirect effects of perpetrator type (nonpartner vs. intimate partner) on both behavioral self-blame and perpetrator blame through rape acknowledgment, even when controlling for both victim substance use at the time of the assault and coercion severity. Compared with women who experienced a rape by a nonpartner, women who experienced rape in the context of a marital or dating relationship were less likely to blame themselves or the perpetrator for the assault, in part because they were less likely to label their experience as a rape. Overall, these findings highlight the unique nature of intimate partner rape and provide further information about the relatively underresearched area of sexual violence in intimate relationships.

Thwarted belongingness and perceived burdensomeness explain the associations of COVID-19 social and economic consequences to suicide risk

OBJECTIVE

The social and economic consequences of COVID-19 and related public health interventions aimed at slowing the spread of the virus have been proposed to increase suicide risk. However, no research has examined these relations. This study examined the relations of two COVID-19 consequences (i.e., stay-at-home orders and job loss) to suicide risk through thwarted belongingness, perceived burdensomeness, and loneliness.

METHOD

Online data from a nationwide community sample of 500 adults (mean age = 40) from 45 states were collected between March 27 and April 5, 2020. Participants completed measures assessing thwarted belongingness, perceived burdensomeness, loneliness, and suicide risk, as well as whether they (a) were currently under a stay-at-home order and (b) had experienced a recent job loss due to the pandemic.

RESULTS

Results revealed a significant indirect relation of stay-at-home order status to suicide risk through thwarted belongingness. Further, whereas recent job loss was significantly correlated with suicide risk, neither the direct relation of job loss to suicide risk (when accounting for their shared relations to perceived burdensomeness) nor the indirect relation through perceived burdensomeness was significant.

CONCLUSIONS

Results highlight the potential benefits of interventions targeting thwarted belongingness and perceived burdensomeness to offset suicide risk during this pandemic.

Predicting engagement in nonsuicidal self-injury (NSSI) over the course of 12 months: the roles of borderline personality disorder pathology and emotional consequences of NSSI

BACKGROUND

Despite theories that negative reinforcement in the form of relief from negative emotions maintains nonsuicidal self-injury (NSSI), no studies have examined the extent to which specific emotional consequences of NSSI predict the maintenance of NSSI over time or explain the greater risk for NSSI found among individuals with borderline personality disorder (BPD) pathology. This study examined whether specific emotional consequences of NSSI relate to the continuance of NSSI behavior over a 12-month period and explain the relation of baseline BPD pathology to future NSSI.

METHODS

Participants with a history of recent repeated NSSI (N = 84) completed baseline measures of BPD pathology, NSSI, and the emotional antecedents and consequences of NSSI, including self-conscious emotions, undifferentiated negative affect, anger, emptiness, sadness, and anxiety; follow-up data on NSSI were collected every three months for one year.

RESULTS

Of the emotional consequences of NSSI examined here, only self-conscious emotions significantly predicted the presence and frequency of NSSI during the 12-month follow-up period. Likewise, whereas BPD pathology was not directly associated with later NSSI, both overall BPD pathology and the specific BPD feature of identity problems were indirectly related to the presence of 12-month NSSI through the greater frequency of post-NSSI self-conscious emotions.

LIMITATIONS

Emotional consequences of NSSI were assessed using a retrospective self-report measure. Only frequency, and not intensity, of emotions before and after NSSI were assessed.

CONCLUSIONS

Results suggest a distinct role of post-NSSI self-conscious emotions in the maintenance of NSSI among individuals with and without BPD pathology.

The psychometric properties and clinical utility of the Norwegian versions of the deliberate self-harm inventory and the inventory of statements about self-injury

Deliberate self-harm (DSH) is a widespread transdiagnostic health problem with increasing prevalence among adolescences, and young adults. It is therefore essential to effectively chart the epidemiology of DSH, as well as to assess the efficacy of interventions designed to modify this behavior. The aim was to translate and analyze the psychometric properties of the Norwegian versions of two instruments designed to assess DSH: the Deliberate Self-harm Inventory (DSHI) and the Inventory of Statements About Self-Injury (ISAS), as well as to assess the prevalence of DSH within a nonclinical Norwegian adult population. Of the 402 participants who completed a questionnaire packet comprising the DSHI, ISAS, general questions about DSH, and other related measures, 30.6% reported some form of DSH. Those with a history of DSH reported greater difficulties with emotion regulation than those without. Participants with and without a history of DSH did not differ in unrelated constructs, including social desirability. The frequency of specific DSH behaviors was in accordance with previous research, with cutting being the most frequent. The factor structure of DSH functions in the Norwegian ISAS was generally comparable to the factor structure of the English version. Overall, results indicate that: a) the Norwegian versions of the DSHI and ISAS behave as expected and in accordance with prior research in other languages and other populations, and b) both the DSHI and ISAS have high internal consistency and adequate construct, convergent, and discriminant validity, and may be applied to evaluate DSH in adult Norwegian populations.

Beyond the Force-Substance Dichotomy: Examining the Experience of Combined and Incapacitated Type Rapes and Their Relation to PTSD Symptoms

Prior research has examined how posttraumatic stress disorder (PTSD) symptoms are influenced by the experience of different types of rape, defined according to the method of coercion used. This work, which classifies rape experiences as either forcible or substance-involved, has yielded mixed findings regarding differences in PTSD symptoms as a function of rape type. Based on recent evidence indicating significant heterogeneity within substance-involved rapes, the present study utilized a novel four-group conceptualization of rape type to examine differences in PTSD symptom severity and associated factors across rape type. Using a sample of 161 community women with experiences of adult rape, we examined four rape types based on method of coercion: forcible-only rape (i.e., involving only force/threat of force; n = 48), impaired rape (i.e., substance-related impairment was present, but the participant remained conscious; n = 56), combined rape (i.e., both force/threat of force and substance-related impairment were present; n = 29), and incapacitated rape (i.e., the participant was intoxicated to the point of unconsciousness; n = 28). We compared these groups on PTSD symptom severity within each symptom cluster, as well as on assault characteristics and consequences, including peritraumatic fear and injury, acknowledgment, and self-blame. Combined type rapes were associated with significantly more severe PTSD symptoms than forcible-only and impaired type rapes. Differences among the groups were also found for peritraumatic fear and injury, and rape acknowledgment. Utilizing a dichotomous approach to rape type overlooks the complexity of women's experiences. Differences in PTSD symptom severity as a function of the proposed four-group conceptualization of rape type highlight the importance of assessing method of coercion when treating rape-related PTSD. Likewise, differences across rape types in peritraumatic fear and rape acknowledgment highlight the potential utility of type-specific targets of intervention.

INTEGRATING SOCIAL COMPARISON INTO THE UNDERSTANDING OF EMOTION REGULATION IN BORDERLINE PERSONALITY

Introduction: Theory and research suggest the need to expand research on emotion regulation (ER) within borderline personality disorder (BPD). This research examined the relations of BPD symptoms to interpersonal (venting, reassurance-seeking) and socially-oriented (social comparison) ER strategies (in addition to acceptance and avoidance), and explored the role of trait social comparison orientation (SCO) in these relations.

Methods: In Study 1, a nationwide community sample of women completed questionnaires. In Study 2, a university sample of young women completed questionnaires and an online social interaction task (following which they reported on the strategies they used to regulate emotions during the task).

Results: Results revealed significant indirect relations of BPD symptoms to venting and reassurance-seeking through trait SCO, reassurance-seeking and social comparison through upward SCO, and the in-vivo use of downward social comparison and avoidance strategies during the social interaction task through upward SCO.

Discussion: Results highlight the relevance of trait SCO (particularly upward SCO) to socially-oriented ER strategies among women with heightened BPD symptoms.

The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety

The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective risk assessments (worry about risk for contracting/dying from COVID-19) and intolerance of uncertainty to later health anxiety dimensions. A U.S. community sample of 364 participants completed online self-report measures at a baseline assessment (Time 1) and one month later (Time 2). Time 1 intolerance of uncertainty was uniquely associated with the Time 2 health anxiety dimension of body vigilance. Time 1 affective risk assessments and intolerance of uncertainty were uniquely associated with later perceived likelihood that an illness would be acquired and anticipated negative consequences of an illness. The latter finding was qualified by a significant interaction, such that affective risk assessments were positively associated with anticipated negative consequences of having an illness only among participants with mean and low levels of intolerance of uncertainty. Results speak to the relevance of different risk factors for health anxiety during the COVID-19 pandemic and highlight targets for reducing health anxiety risk.

Expanding our understanding of the relationship between nonsuicidal self-injury and suicide attempts: The roles of emotion regulation self-efficacy and the acquired capability for suicide

OBJECTIVE

Although past literature has emphasized the role of acquired capability in the relationship between nonsuicidal self-injury (NSSI) and suicide attempts, support for the indirect relationship of NSSI to suicide attempts through acquired capability is limited. Thus, research examining other factors that may underlie this relationship is needed. Across two studies, this research examined the indirect relationships of NSSI frequency to suicide attempts through both acquired capability and emotion regulation self-efficacy (ERSE).

METHOD

Two large samples of adults (one nationwide community sample and one clinical sample of patients with substance use disorders) completed questionnaires and/or interviews.

RESULTS

Results revealed significant indirect relationships of NSSI frequency to lifetime suicide attempts through ERSE, but not acquired capability, within both samples.

CONCLUSIONS

Results highlight the relevance of ERSE to both suicide attempts and the NSSI-suicide attempt relationship, and suggest the potential utility of interventions aimed at increasing ERSE among individuals with repeated NSSI.

Psychological Outcomes Associated with Stay-at-Home Orders and the Perceived Impact of COVID-19 on Daily Life

The COVID-19 pandemic has resulted in the widespread implementation of extraordinary physical distancing interventions (e.g., stay-at-home orders) to slow the spread of the virus. Although vital, these interventions may be socially and economically disruptive, contributing to adverse psychological outcomes. This study examined relations of both stay-at-home orders and the perceived impact of COVID-19 on daily life to psychological outcomes (depression, health anxiety, financial worry, social support, and loneliness) in a nationwide U.S. community adult sample (N = 500; 47% women, mean age = 40). Participants completed questionnaires assessing psychological outcomes, stay-at-home order status, and COVID-19's impact on their daily life. Being under a stay-at-home order was associated with greater health anxiety, financial worry, and loneliness. Moreover, the perceived impact of COVID-19 on daily life was positively associated with health anxiety, financial worry, and social support, but negatively associated with loneliness. Findings highlight the importance of social connection to mitigate negative psychological consequences of the COVID-19 pandemic.

The BDNF Val66Met Polymorphism Moderates the Relationship Between Posttraumatic Stress Disorder and Trauma Script-evoked Attentional Bias to Cocaine Cues Among Patients with Cocaine Dependence

There is extensive variability in cocaine-related attentional bias (AB) following trauma script exposure among cocaine-dependent (CD) patients with posttraumatic stress disorder (PTSD). Therefore, research is needed to identify the specific PTSD-CD patients most likely to exhibit an AB to cocaine cues. A common polymorphism in brain-derived neurotrophic factor (BDNF), Val66met, is associated with risk for stimulant addiction, and thus, was examined as a moderator of the association between PTSD and cocaine-related AB following trauma script exposure in this study. Adult CD patients with (n = 17) and without (n = 28) PTSD were exposed to a personalized trauma script, followed by a visual dot-probe task assessing cocaine-related AB. Task response times were used to examine traditionally calculated AB scores, as well as trial level bias scores (TL-BS) that more accurately model the temporal dynamics of AB. PTSD-CD patients homozygous for the BDNF Val/Val genotype exhibited greater bias for attending to cocaine-related stimuli following trauma script exposure than those carrying the Met allele. The PTSD by BDNF interaction did not predict response time variability on trials for which only neutral stimuli were presented, thus increasing confidence that the observed effect is specific to cocaine-related stimuli. PTSD-CD patients homozygous for the BDNF Val/Val genotype may be at particularly high risk for negative clinical outcomes (e.g., relapse, treatment dropout) as a function of prolonged attentional engagement with cocaine cues when exposed to trauma reminders.