Maintenance Of Non-suicidal Self-injury Research Articles

Alterations of the endocannabinoid system in adolescents with non-suicidal self-injury as a function of childhood maltreatment

Non-suicidal self-injury (NSSI) is a highly prevalent phenomenon in adolescence, often associated with prior traumatic experiences. The development and maintenance of NSSI is associated with dysregulation of the stress response, and evidence suggests that the hypothalamic-pituitary-adrenal (HPA) axis plays an important role. The endocannabinoid system is a neuromodulatory system in close functional interaction with the HPA axis. Several studies have reported alterations of the endocannabinoid system in adult patients with post-traumatic stress disorder. However, the role of the endocannabinoid system in children and adolescents with NSSI is less clear, and previously no study examined endocannabinoids in youth with experiences of maltreatment. N-arachidonyl ethanolamide (AEA) and 2-arachidonyl glycerol (2-AG) were quantified alongside sociodemographic and clinical characteristics in n = 148 adolescents (12–17 years of age). Analyses addressed group differences comparing healthy controls (HC, n = 38), patients with NSSI without (NSSI − CMT, n = 42) and with a history of childhood maltreatment (NSSI + CMT, n = 68). We show that AEA is reduced in adolescents with NSSI independent of childhood maltreatment. Further, we present first evidence for a negative association between AEA and NSSI frequency as well as AEA and the severity of childhood maltreatment. This is the first study providing evidence for alterations in the endocannabinoid system in children and adolescents engaging in repetitive NSSI. Findings from the study support current endocannabinoid-hypotheses on the neurobiology of trauma and adversity, extending existing findings of altered endocannabinoid signaling following exposure to traumatic events to a well-powered sample of children and adolescents.

Does the need for uniqueness lead to non-suicidal self-injury? The mediation of depression and the moderation of gender.

Based on the integrated theoretical model of the development and maintenance of non-suicidal self-injury (NSSI) and gender role theory, this study investigated the longitudinal impact of the need for uniqueness on NSSI among adolescents, and the mediating role of depression and the moderating role of gender. A total of 1,166 middle school students (Mean age = 13.04, SDage = 0.78, range = 11-16) from a city in central China was recruited to complete the Need for Uniqueness Scale, Depression Scale, and Adolescent Self-Injury Questionnaire at two waves. The participants included 475 boys and 457 girls. Convenience sampling was used, and a longitudinal study (2 time points with a 6-month interval) was conducted to test our hypotheses. SPSS 25.0 was used to evaluate reliability, and to calculate descriptive statistics and Pearson correlation. PROCESS version 3 was used to test longitudinal relationships among the need for uniqueness, depression and NSSI, and construct a moderated mediation model. Results revealed that T1 need for uniqueness in adolescents was significantly positively associated with T2 NSSI and T2 depression, and T2 depression was significantly positively associated with T2 NSSI. After controlling for gender, T1 need for uniqueness positively predicted T2 NSSI. Furthermore, the mediation analysis demonstrated that the pathway linking T1 need for uniqueness to T2 NSSI through T2 depression was statistically significant. Moreover, gender moderated the indirect effect from T2 depression to T2 NSSI in the association between T1 need for uniqueness and T2 NSSI. Compared to boys in the same situation, girls who are susceptible to depression were more likely to commit NSSI. This study demonstrated that the need for uniqueness in adolescents longitudinally predicts NSSI through the mediating role of depression and gender moderates the indirect effect from depression to NSSI. The current study not only suggests that the need for uniqueness is a risk factor for NSSI among adolescents, but also provides an empirical basis for the prevention and intervention of NSSI.

An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury

Objective Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. Method The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. Results Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. Conclusion The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI. HIGHLIGHTS Emotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI). Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI. Emotion regulation difficulty may make people engage in NSSI to regulate emotions.

Individuals’ accounts and explanations of continued engagement in non-suicidal self-injury: a qualitative study

ABSTRACT Non-suicidal self-injury (NSSI) is the deliberate damage of bodily tissue which occurs without suicidal intent. NSSI is a common behavior among young people and a frequent focus in clinical practice. Many models of the aetiology and maintenance of NSSI are focused on emotion regulation. The role that cognition plays in the behavior is less well understood. We used thematic analysis to explore how individuals explain or attribute their engagement in NSSI. The study identified several ways of thinking that may be play a role in why people engage in NSSI. Specifically, five themes were generated: Limited Controllability, Benefits, Limited Resources, Stability, and Changing Meaning and Significance. Implications for research and practice are discussed.

Borderline personality disorder symptoms as mediational mechanisms linking childhood trauma and nonsuicidal self-injury among women with bulimia nervosa.

Nonsuicidal self-injury (NSSI) frequently co-occurs with eating disorders, especially bulimia nervosa (BN). Theoretical models and empirical evidence show many overlapping risk factors for the onset and maintenance of NSSI and BN. However, among those with BN, it remains unclear what distinguishes those who do versus do not engage in NSSI. The primary objective of the present study was to identify factors predicting NSSI among women with BN. Specifically, we tested four domains of borderline personality disorder as mediators between childhood trauma and NSSI. Using structural equation modeling we tested a parallel mediation model to predict NSSI among women with BN (N=130). Childhood trauma (measured by the Childhood Trauma Questionnaire at baseline) was the independent variable. The four parallel mediators (measured at baseline via the Diagnostic Interview for Borderlines, Revised) were lifetime negative affect, impulsive actions, atypical cognitions (e.g., odd thinking, unusual perceptual experiences, quasi-psychotic thinking), and interpersonal problems. The dependent variable was instances of NSSI during a subsequent two-week ecological momentary assessment protocol. Childhood trauma was significantly associated with all four mediators (all p values < .01), but only atypical cognitions predicted NSSI (p=.03). The indirect path from childhood trauma to NSSI, through atypical cognitions was significant (path coefficient=.001, SE < .001, p=.01). Among women with BN, childhood trauma was associated with atypical cognitions, which in turn predicted NSSI. Atypical cognitions may be a mechanism for NSSI in this population.

A Multidimensional Assessment of Emotion Regulation in Adolescent Non-Suicidal Self-Injury

The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.

Measurement Invariance of Perfectionism Measures in Students with and without a History of Non-Suicidal Self-Injury.

Perfectionism is a transdiagnostic process which may be implicated in the onset and maintenance of non-suicidal self-injury. No study has evaluated whether reported differences in perfectionism between individuals with and without a history of self-injury represent genuine group differences or measurement artefacts. The present study reports an investigation of the measurement invariance of two common scales of perfectionism, the Frost Multidimensional Perfectionism Scale-Brief (FMPS-Brief) and the Clinical Perfectionism Questionnaire (CPQ), among university students (Mage = 20.48, SDage = 2.22, 75.3% female, 22.8% male) with and without a history of self-injury (total n = 711). Results revealed full residual error invariance for the two-factor model of FMPS-Brief, while the bifactor model of the FMPS-Brief and the two-factor model of the CPQ demonstrated partial metric invariance. Accounting for partial metric invariance, the bifactor model of the FMPS-Brief also demonstrated partial residual error invariance. The current findings suggest that observed differences using the FMPS-Brief reflect genuine differences in perfectionism between individuals with and without a history of self-injury. Further, while researchers using the bi-factor model can have confidence that the general factor can adequately assess group differences, differential item functioning should be considered if using the strivings and concerns factors. Finally, in the current data, the CPQ did not perform as expected in baseline model fit and future research should replicate assessments of measurement invariance in this measure.

Deviant Peer Affiliation and Non-Suicidal Self-Injury among Chinese Adolescents: Depression as a Mediator and Sensation Seeking as a Moderator.

Non-suicidal self-injury (NSSI) is an emerging health problem among adolescents. Although previous studies have shown that deviant peer affiliation is an important risk factor for this behavior, the reasons for this relationship are unclear. Based on the integrated theoretical model of the development and maintenance of NSSI and the social development model of delinquency prevention, this study tested whether depression mediated the relationship between deviant peer affiliation and NSSI and whether this mediating effect was moderated by sensation seeking. A sample of 854 Chinese adolescents (31.50% male; Mage = 16.35; SD = 1.15) anonymously completed questionnaires on the study variables. Results of regression-based analyses showed that depression mediated the association between deviant peer affiliation and NSSI, and this effect was stronger among adolescents who reported high sensation seeking. The results demonstrate the role of individual differences in the link between affiliation with deviant peers and NSSI, and have implications for preventing and treating this risky behavior.

Measurement Invariance of Three Brief Measures of Rumination in Young Adults With and Without a History of Self-Injury

Abstract. Rumination is central to understanding the onset and maintenance of non-suicidal self-injury. Yet, no study has evaluated whether reported differences in rumination between people with and without a history of self-injury represent genuine group differences. The present study reports an investigation into the measurement invariance of three common measures of rumination in university students with and without a history of self-injury (total N = 1,519). Results revealed configural invariance for the Ruminative Responses Scale (RRS), the Ruminative Thought Style Questionnaire (RTSQ), and the Repetitive Thinking Questionnaire (RTQ). Additionally, the RTSQ and RTQ supported metric invariance, while the RRS supported partial metric invariance. Further, the RTQ demonstrated partial scalar invariance while the RTSQ demonstrated full scalar invariance. The current findings suggest that observed differences using the RTSQ and RTQ reflect genuine differences in rumination between people with and without a history of self-injury, while researchers using the RRS are advised to account for differential item functioning.

Guided Internet-delivered cognitive behaviour therapy for perfectionism in a non-clinical sample of adolescents: A study protocol for a randomised controlled trial

BackgroundPerfectionism is elevated across a range of psychopathologies and has been shown to impede treatment outcomes. There is also evidence suggesting elevated perfectionism may contribute to the onset and maintenance of non-suicidal self-injury. There is a growing body of evidence suggesting that Internet-delivered cognitive-behavioural therapy for perfectionism reduces perfectionism and symptoms of psychological disorders and that reductions are maintained at 3-month and 6-month follow-up. There may also be reductions in non-suicidal self-injury, although no study has investigated this potential benefit. Given that associations between perfectionism and psychopathology are observed across both adults and adolescents, the need for the development of interventions targeting adolescents is essential for early intervention and prevention. MethodsThe present study will employ a randomised controlled trial to examine the efficacy of 8-week guided Internet-delivered cognitive-behavioural therapy for perfectionism in adolescents compared to a waitlist control group. The primary outcome is perfectionism, and secondary outcomes include symptoms of psychological disorders, well-being, and non-suicidal self-injury. Outcomes will be assessed at pre-intervention, post-intervention, 1-month follow-up, 3-month follow-up, and 6-month follow-up. A minimum of 240 participants will be recruited online through social media, Australian universities, and schools across Australia. Generalised linear mixed models will be used to test for changes in outcomes between the intervention group and the waitlist control. DiscussionThe outcomes of this trial will contribute to the literature on perfectionism and psychopathology in adolescents, as well as the efficacy of guided Internet-delivered interventions for adolescents. Trial registrationThe trial was registered on the 20th of June 2019 at the Australia New Zealand Clinical Trials Registry (ACTRN12619000881134). Trial statusThis is protocol version 1.0. Participant recruitment began on 31 July 2019 and is still actively running with an anticipated completion date in the fourth quarter of 2020.

Assessing Attentional Bias Toward Nonsuicidal Self-Injury Cues in Young Adults with Histories of Engaging in Self-Harm

Nonsuicidal self-injury (NSSI) is a prevalent behavior among young people maintained by complex transdiagnostic processes. This study sought to investigate whether NSSI attentional bias—the preferential allocation of attentional resources to environmental NSSI cues—is one such transdiagnostic process experienced by young adults with histories of NSSI. Participants were 39 young adults who completed a dot probe task designed to measure attentional bias to NSSI cues and negatively-valenced cues. Participants also provided NSSI urge and affect ratings during the task. Paired samples t-tests were conducted to determine if participants exhibited a significant attentional bias to NSSI cues and negatively-valenced cues compared to neutral cues, and to test whether NSSI urge ratings following the dot probe task increased from baseline levels. Participants exhibited a significant attentional bias to NSSI cues presented for 200 ms and a significant attentional bias to negative cues presented for 200 ms. The urge to engage in NSSI was elicited by NSSI cues, but not by negative cues. These findings indicate exposure to NSSI cues elicits both attentional bias and NSSI urge, a unique process that differs from a mere generalized attentional bias to negative affective stimuli known to be exhibited by individuals with other forms of psychopathology, such as anxiety or depressive disorders. These results provide preliminary evidence for possible avenues of intervention as it relates to the role of exposure to NSSI cues in the maintenance of NSSI, including managing cue-elicited urge and tolerating changes in affective states.

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

Emotional experience is argued to contribute to the initiation and maintenance of nonsuicidal self-injury (NSSI). We investigated whether individuals with/without a history of NSSI differed in their dispositional experience of negative and positive emotion, as well as their state responses to negatively and positively valenced movie clips. Undergraduates (n=214, Mage =21.33, 73.8% female, 35.5% reporting NSSI) completed measures of NSSI and dispositional emotional experience. Participants also viewed a sad and amusing movie clip and provided sadness/amusement ratings at seven time-points. Relative to participants with no history of self-injury, participants reporting NSSI indicated more reactivity, intensity, and perseveration of dispositional negative emotion; however, differences were negated after adjusting for mental illness. Unexpectedly, individuals with a history of NSSI responded less intensely to the sad clip, although they demonstrated perseveration of sadness over time. Participants reporting NSSI also indicated less reactivity, intensity, and perseveration of dispositional positive emotion and, in response to the amusing film, reported less amusement at all time-points. Considering different dimensions of negative and positive emotion may enhance understanding of NSSI. Future research should disentangle which dimensions of emotional experience are unique to NSSI and which are shared with mental illness more generally.

Trajectories of non-suicidal self-injury in adolescent girls following inpatient hospitalization.

This study explored the growth of non-suicidal self-injury (NSSI) frequency over 2.5 years in a clinical sample of adolescent girls. Following a functional model of NSSI, the contribution of emotion dysregulation, peer victimization, and psychological maladjustment were evaluated as the predictors of NSSI trajectories. Participants of 99 girls (Mage = 16.03 years) were admitted for psychiatric hospitalization, who responded to questionnaires assessing NSSI, emotion dysregulation, relational and overt peer victimization, and internalizing and externalizing symptoms. NSSI was also assessed at 6 months and 2.5 years following the baseline assessment. Linear mixed modeling estimated NSSI frequency over time. The findings highlight the stable nature of NSSI and the contribution of emotion dysregulation and internalizing symptoms to NSSI patterns. Peer victimization and externalizing behavior problems were not the significant predictors. Developing interventions targeting these NSSI predictors early in girls' development may prevent the emergence and maintenance of NSSI.

Non-suicidal Self-Injury in Adolescence: The Role of Shame, Self-Criticism and Fear of Self-Compassion

Non-suicidal self-injury (NSSI) is a serious and relatively prevalent problem in adolescence. Although several studies have identified risk factors for the aetiology and maintenance of NSSI, little is known about the impact of individual and contextual variables in such pervasive behaviors among adolescents. This paper aims to test whether specific internal traits characterized by shame, self-criticism and fear of self-compassion impact on NSSI, through their effect in daily peer hassles and depression. Participants are 782 adolescents with 12–18 years-old from middle and secondary schools (years of education’s mean = 9.46). This study has a cross-sectional design. Self-report measures include external shame, self-criticism, fear of self-compassion, daily peer hassles, depressive symptoms and NSSI. External shame, hated self and fear of self-compassion indirectly predict NSSI, through their effect in daily peer hassles and depression. The most pathological form of self-criticism (hated self) is strongly associated with NSSI. These findings contribute to clarification of the paths through which the belief that one is seen negatively by others, the hostile self-to-self relationship and the inability to direct compassion for self may increase NSSI. Daily peer hassles and current depressive symptoms seem to play an important role in the association between internal traits and NSSI. Preventive and intervention actions for reducing NSSI in adolescence should address not only interpersonal difficulties but also self-to-self relationship.

Emotion Regulation in Adolescents with Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a prevalent and impairing condition that was newly included in DSM-5 in the section III criteria for further research. Difficulties in emotion regulation play an important role in the development and maintenance of NSSI. This study investigated the emotion regulation in female adolescents with NSSI according to DSM-5 (n=55), clinical control adolescents with mental disorders without NSSI (n=30), and nonclinical control adolescents (n=58) using self-report questionnaires and interviews. As expected, results indicated that adolescents with NSSI have significantly more difficulties in emotion regulation compared to healthy controls. In addition, adolescents with NSSI reported also significantly more difficulties in impulse control, lack of emotional clarity, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies compared to nonclinical and clinical controls. Adolescents with NSSI felt significantly more often sadness compared to clinical controls (d=0.66) and compared to other emotions. Adolescents with NSSI indicated significantly less often happiness compared to nonclinical controls (d=1.83). Results support that adolescents with NSSI have difficulties in emotion regulation and that these difficulties are even more pronounced than in adolescents with other mental disorders. Clinical implications will be discussed.

A Longitudinal Person-Centered Examination of Nonsuicidal Self-injury Among University Students

Little is known about the development and maintenance of nonsuicidal self-injury (NSSI) over time; however, identifying individuals at risk for NSSI onset or its recurrent engagement is of critical importance for developing effective prevention and intervention strategies. To address this important gap in the literature, we used a person-centered approach to study patterns of change among self-injurers (i.e., new beginners, recovered injurers, relapsers, desisters, and persistent injurers). Undergraduate students (N = 666, 71.1 % female, M age = 19.15) from a mid-sized Canadian university participated in the two-wave study (assessments were 1 year apart). Participants completed the Inventory of Statements about Self-Injury (ISAS, Klonsky and Glenn in J Psychopathol Behav Assess 31:215-219, 2009) at Time 1, and a measure of past year NSSI frequency 1 year later. Participants also completed several measures of psychosocial risk (e.g., problem behaviors, problems with parents) at both time points. Consistent with Nock's (Ann Rev Clin Psychol 6:339-363, 2010) model on the development of NSSI over time, individuals who continued to engage in NSSI across the university years (i.e., persistent injurers) reported greater levels of psychosocial risk as compared to those in the other groups. Moreover, a discriminant function analysis revealed that new beginners, relapsed injurers, and persistent injurers were differentiated from recovered injurers and desisters by increases over time in problem behaviors, problems with parents, internalizing behaviors, and suicidal ideation. Our findings provide new insight into the course of NSSI engagement across the university years, and offer clinicians ways to discriminate among individuals with varying longitudinal patterns of NSSI (i.e., on measures of psychosocial risk, and motivations to stop self-injuring).

The Role of Trauma Symptoms in Nonsuicidal Self-Injury

Reports of traumatic events by individuals who engage in nonsuicidal self-injury (NSSI) are common; yet, evidence for the relation between traumatic events and NSSI is inconclusive. This review explores the thesis that trauma symptoms, rather than the experience of a traumatic event per se, underlie this relation, specifically suggesting that trauma symptoms might serve as a mediator. The literature indicates that self-injury plays an important functional role in coping with trauma symptoms such that self-injury can provide an escape from intrusive thoughts and aversive emotional states, as well as end dissociation and periods of numbness through the generation of feelings. Additionally, trauma symptoms have been shown to mediate the relation between the occurrence of traumatic events and NSSI. Taken together, trauma symptoms may play an important role in the development and maintenance of NSSI. The review concludes with treatment implications and future directions for research.

Why Do People Hurt Themselves?

Nonsuicidal self-injury (NSSI) is a prevalent but perplexing behavior problem in which people deliberately harm themselves without lethal intent. Research reveals that NSSI typically has its onset during early adolescence; most often involves cutting or carving the skin; and appears equally prevalent across sexes, ethnicities, and socioeconomic statuses. Less is known about why people engage in NSSI. This article presents a theoretical model of the development and maintenance of NSSI. Rather than a symptom of mental disorder, NSSI is conceptualized as a harmful behavior that can serve several intrapersonal (e.g., affect regulation) and interpersonal (e.g., help-seeking) functions. Risk of NSSI is increased by general factors that contribute to problems with affect regulation or interpersonal communication (e.g., childhood abuse) and by specific factors that influence the decision to use NSSI rather than some other behavior to serve these functions (e.g., social modeling). This model synthesizes research from several different areas of the literature and points toward several lines of research needed to further advance the understanding of why people hurt themselves.