Abstract

Although emotional avoidance may be a critical factor in the pathway from psychological distress to self-injury and/or suicidality, little is known about the relative importance of differing functional coping dynamics and experiential avoidance between people with self-injury histories of differing intent (e.g., Non-Suicidal Self-Injury only vs. Non-Suicidal Self-Injury plus Suicidal Behaviour; NSSI vs. NSSI + SB). A community-based survey (N = 313; female, 81%; ages 16–49 years, M = 19.78, SD = 3.48) explored self-reported experiential avoidance and functional coping dynamics in individuals with (i) no self-injury history (controls); (ii) a history of NSSI only; and (iii) a history of NSSI + SB. Jonckheere-Terpstra trend tests indicated that avoidance coping was higher in the NSSI and NSSI + SB groups than in controls. Emotion regulation was higher in controls than those with a history of self-injury (NSSI and NSSI + SB). Approach and reappraisal coping demonstrated significant ordered effects such that control participants were higher in these coping dynamics than those with a history of NSSI only, who, in turn, were higher than those with a history of NSSI + SB (Control > NSSI > NSSI + SB). Endorsement of the reappraisal/denial facet of experiential avoidance was most pronounced in those with a history of NSSI + SB (Control < NSSI < NSSI + SB). No significant ordered effects were observed for other dimensions of experiential avoidance. Understanding how the endorsement of functional coping dynamics and which components of experiential avoidance vary between groups with differing self-injury intent histories has important implications for treatment planning.

Highlights

  • Suicidal behaviours are strongly related to psychological distress [1,2]

  • Given that (i) functionality has been outlined as differentiating non-suicidal self-injury from suicidal behaviour [8] and (ii) the endorsement of functional coping dynamics have been demonstrated to differentiate individuals with and without a lifetime history of self-injury [9], the current study explores ordered effects in functional coping dynamics

  • All participants who indicated positively to an ISAS assessed form of non-suicidal self-injury (NSSI) and have never engaged in suicidal behaviours were included in the “NSSI” group, regardless of the number of reported episodes of NSSI

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Summary

Introduction

Suicidal behaviours are strongly related to psychological distress [1,2]. Notions of avoidance and escape motives, related to this distress, are established in suicide science. Depiction of suicidality as an expression of avoidance is arguably congruent with concepts of suicide as escape from negative self-evaluation [3], conceptualization of “egression”—the ultimate escape [4] and the escape drive outlined in the Cry of Pain model [2].Research suggests that appraisals of an aversive internal experience as both (i) unbearable and (ii) needing to be extinguished are most relevant to suicidal behaviour, rather than the distress per se [1]. Some have argued the centrality of avoidance. Res. Public Health 2017, 14, 575; doi:10.3390/ijerph14060575 www.mdpi.com/journal/ijerph

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