Measures Of Nonsuicidal Self-injury Research Articles

The role of testosterone and cortisol levels in nonsuicidal selfinjury in adolescents.

Nonsuicidal selfinjury (NSSI) is an important problem in adolescence, which is thought to serve several reinforcement functions (positive vs. negative, automatic vs. social). While the psychological mechanisms involved in NSSI are relatively well known, there is an important gap in the knowledge regarding the underlying biological mechanisms. This study examined the role of testosterone (T) and cortisol (C) in the frequency and reinforcement functions of NSSI. A total of 423 adolescents (age range = 13-17; 54.4% girls) from Basque Country (Spain) provided saliva samples to determine T and C levels and completed measures of NSSI 6 months later in 2017-2018. The results showed that T but not C was significantly associated with higher NSSI frequency and the four types of NSSI functions. In addition, C moderated the predictive association between T and NSSI for automatic negative reinforcement, such that this association was significant only when C was high. Participant sex did not moderate any association between hormones and NSSI. These preliminary results suggest that testosterone levels can affect NSSI behaviors in adolescence, thus helping to explain the increase in NSSI during this stage. Moreover, in situations in which NSSI serves to alleviate negative internal states, high levels of cortisol can be involved.

Self-other representations, emotion regulation and psychological distress as pathways to non-suicidal self-injury in emerging adults

ABSTRACT Theoretical models of non-suicidal self-injury (NSSI) have highlighted the complex interaction between underlying psychosocial vulnerabilities, but, there is limited empirical support for these conceptualizations. The aim of the study was to examine affective, cognitive and interpersonal factors predicting NSSI among emerging adults. A sample of 1,574 emerging adults aged 18–25 years, drawn from 19 colleges via multi-stage sampling completed measures of NSSI, emotion regulation, experiential avoidance, psychological distress, self-criticism, brooding-rumination, attachment style and perceived social support. The results indicated that 22.40% had engaged in one or more self-injuring behaviours in the past 12 months, with cutting skin, hitting self and severely scratching self as the most commonly endorsed methods. Exploratory structural equation modelling identified differential pathways to NSSI, with difficulties in regulating emotions emerging as the only direct predictor of NSSI. Two latent constructs reflecting relationally based affective and cognitive structures: a negative self-other representation, and attachment style of considering relationships as secondary to achievement were identified. These differentially, and indirectly impacted NSSI engagement through psychological distress and difficulties in emotion regulation. The implications for interventions to expand beyond addressing emotion regulation deficits, and include other affective, cognitive and relational vulnerabilities are discussed.

Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis.

NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N= 14,588; F = 60.7%; age =23.35 ±7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r= -.24), and it was non-significant when self-report measures of NSSI (r =-.11) utilized. The association between DT and NSSI was significant and negative across the general population (r= -.47), university students (r= -.17), and inpatients (r= -.27); surprisingly, it was significant and positive among adolescents or high school students (r= .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.

Changes in the suicide risk behaviors of American college students over time: An analysis of three universities.

Suicide-related behaviors are prevalent among college students, and several mental health problems associated with increased suicide risk have increased over time. Furthermore, notable cultural events (e.g., political changes, COVID-19) have occurred in the past decade, which likely impact trends in suicide-related behaviors. The current study examined how the prevalence of nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts has changed from 2012 to 2022 across three different universities. Archival datasets from multiple years of college student survey data were compiled, and different measures of NSSI, SI, and suicide attempts were dichotomized to assess prevalence. Chi-square goodness-of-fit tests were used to identify changes in suicide-related behaviors across time. Results indicated significant increases in the prevalence of most behaviors across each university, with most increases occurring after 2018. Despite sharing a general trend of increased suicide-related behaviors, each university differed considerably in their respective trends between various timepoints, suggesting that unique factors may differentially contribute to growing risk among college students. Overall, the current study identifies increasing trends in suicide-related behaviors over the past decade and highlights the value of investigating these behaviors at the university level.

Longitudinal Associations Between Nonsuicidal Self-Injury, Depressive Symptoms, Hopelessness, and Emotional Dysregulation in Adolescents

Nonsuicidal self-injury (NSSI) in adolescents has been associated with increased depressive symptomatology, hopelessness, and emotional dysregulation; however, few studies have examined longitudinal associations between NSSI and these problems. This study examines the longitudinal relationships among these variables in community adolescents and whether the pattern of relationships varies between boys and girls. The participants were 785 adolescents (57.1% girls) aged 13 to 18 years (M = 15.64; SD = 1.08) who completed self-reported measures of NSSI, depression, hopelessness, and emotional dysregulation at least once at two moments separated by 1 year. The longitudinal model was tested through structural equation modeling and multiple group analysis. NSSI predicted increased depressive symptoms, hopelessness, and emotional dysregulation; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms; and emotional dysregulation predicted depressive symptoms and hopelessness. The pattern was similar for girls and boys, although girls scored higher on all variables. The results underscore the important bidirectional associations between NSSI and other risk factors throughout adolescence. These findings will support prevention and interventions for NSSI and internalizing symptoms in adolescents in school and clinical settings.

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

Background and objectivesTheoretical models of non-suicidal self-injury (NSSI) propose that individuals who self-injure may find their attention more strongly captured by negative emotion, and that this intensifies distress which leads to episodes of NSSI. Elevated perfectionism is associated with NSSI, and when an individual is highly perfectionistic, a focus on perceived flaws/failures may increase risk of NSSI. We explored how history of NSSI and trait perfectionism are associated with different types of attention bias (engagement vs. disengagement) to stimuli that differ in emotional valence (negative vs positive) and perfectionism relevance (relevant vs irrelevant). MethodsUndergraduate university students (N = 242) completed measures of NSSI, perfectionism, and a modified dot-probe task to measure attentional engagement with and disengagement from both positive and negative stimuli. ResultsThere were interactions between NSSI and perfectionism in attention biases. Amongst individuals who engage in NSSI, those with elevated trait perfectionism exhibit speeded responding to and disengagement from emotional stimuli (both positive and negative). Furthermore, individuals with a history of NSSI and elevated perfectionism were slower to respond to positive stimuli, and faster to negative stimuli. LimitationsThis experiment was cross-sectional in design so does not provide information about temporal ordering of these relationships, and given the use of a community sample, would benefit from replication in clinical samples. ConclusionsThese findings lend support to the emerging idea that biased attention plays a role in how perfectionism is associated with NSSI. Future studies should replicate these findings using other behavioural paradigms and diverse samples.

Reciprocal associations between peer problems and non-suicidal self-injury throughout adolescence.

Peer problems have emerged as important predictors of Non-Suicidal Self-Injury (NSSI) development during adolescence. However, the possibility that adolescents who engage in NSSI may, in turn, be at increased risk for experiencing difficulties with their peers has rarely been examined. This study investigated the reciprocal associations between peer problems (e.g. peer victimization, friendship stress and loneliness) and NSSI throughout adolescence, distinguishing between- and within-person effects. Participants were 866 adolescents (54.5% females; Mage = 13.12 years, SD = 0.78), who took part in six waves of data collection. Adolescents completed self-report measures of NSSI, friendship stress and loneliness and they took part in a peer nomination procedure to assess peer victimization. Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were used to estimate within-person cross-lagged effects between each peer problem and NSSI from Grade 7 to 12. After accounting for between-person associations between peer problems and NSSI, results indicated that higher-than-usual levels of NSSI predicted higher-than-usual levels of adolescents' own friendship stress, loneliness and peer victimization at the subsequent time point. Yet, sensitivity analyses revealed that most of these effects were strongly attenuated and explained by within-person fluctuations in depressive symptoms. No within-person cross-lagged effects from peer problems to NSSI were found. Findings highlight that the associations between peer problems (i.e. friendship stress, loneliness) and NSSI may be largely explained by shared underlying factors; yet, some evidence also suggests that NSSI engagement may increase adolescents' risk to experience difficulties in the relationships with their peers, in part via increases in depressive symptoms.

Self-injury motives: A person-centered examination.

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. 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 12months. 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. 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.

Childhood trauma and non-suicidal self-injury: Mental pain and depression as mediators in university and community samples?

This research investigated the mediating effects of psychache (i.e., unbearable mental pain) and depression on the relationship between childhood trauma and non-suicidal self-injury (NSSI). University undergraduate (n = 428) and community (n = 533) samples completed previously validated measures of NSSI, childhood trauma, psychache, and depression. Using parallel mediation analyses, psychache independently mediated all significant links between any type of childhood trauma and NSSI, whereas depression only did so for emotional abuse within the community sample. Results indicate that the link between childhood trauma and NSSI may have the potential to be reduced by interventions targeting psychache.

Psychometric properties of the persian version of the inventory of statements about self-injury (ISAS)

BackgroundNon-suicidal self-injury (NSSI) is a serious public health problem prevalent among adolescents and young adults. The present study examines the factor structure, internal consistency, and validity of the Persian version of the Inventory of Statements About Self-injury (ISAS), a self-report measure designed to comprehensively assess non-suicidal self-injury (NSSI).MethodsA total of 655 Iranian school-attending adolescents completed study measures online, and 246 youth (37.70 %) (M age = 15.38, SD ± 0.50; 53 % female) reported a history of NSSI at least once during their lifetime.ResultsConfirmatory factor analysis supported the proposed two-factor model of ISAS (i.e., Interpersonal and Intrapersonal dimensions), which were internally consistent and yielded direct associations with converging correlates (e.g., depression, anxiety, irritability, and anger).ConclusionsFindings indicated that the Persian version of the ISAS has sound psychometric properties and is a valid and reliable self-report measure of NSSI.

Latent Class Analysis of Nonsuicidal Self-Injury Among Justice-Involved Juveniles: Association With Motivational and Emotional Aspects of Self-Harm Behavior

Significantly higher rates of nonsuicidal self-injury (NSSI) have been discovered among justice-involved juveniles. Our study aimed to discriminate homogeneous subgroups of justice-involved youth with different self-harm behavior characteristics based on latent class analysis. A total of 244 adolescents (92.6% boys; Mage = 16.99, SD = 1.28) in Hungarian juvenile detention centers completed measures of NSSI and dissociation. High-NSSI (Class 1; 9%), moderate-NSSI (Class 2; 42.6%), and low-NSSI (Class 3; 48.4%) profiles were detected relating to different forms of NSSI. Multiple comparisons showed that girls were members of Class 1 and 2 at higher rates and these subgroups showed significantly higher dissociation proportions than Class 3. Our findings pointed out diversity in self-harm profiles with different characteristics in terms of methods and severity of self-harm, experienced emotions, and other emotion regulation tendencies among justice-involved adolescents. These results suggest sophisticated treatment approaches to match variations in severity and presentation.

Examining decentering as a moderator in the relation between non-suicidal self-injury and suicide ideation via cognitive-affective factors.

Given the high prevalence of self-injury but low treatment-seeking among young adults, brief, accessible interventions might help reduce risk of self-injurious thoughts and behavior in this population. This cross-sectional study examined the moderating effects of decentering-a cognitive-affective regulation strategy-in the relation between non-suicidal self-injury (NSSI) and suicide ideation via cognitive-affective factors that increase risk for both NSSI and suicide ideation. College students (N=125, 79% women), ages 18-27, pre-screened for moderate levels of depression and anxiety, completed self-report measures of NSSI, decentering, rumination, hopelessness, depressive symptoms, and suicide ideation. Young adults with past-year non-suicidal self-injury scored lower on decentering than their peers without NSSI. Decentering was associated with lower levels of all cognitive-affective risk factors and moderated the relation between NSSI and rumination, but not the relation between NSSI and hopelessness and depressive symptoms. Decentering moderated the indirect effect of past-year non-suicidal self-injury on past-week suicide ideation via rumination, but not via hopelessness or depressive symptoms. Decentering is a potential cognitive-affective regulation strategy for targeting factors that increase risk of self-injurious thoughts and behaviors. Future studies should examine decentering as a buffer against risk using designs that allow for conclusions about temporal order of effects.

Psychological inflexibility processes and nonsuicidal self-injury: Concurrent and prospective associations.

The aim of this study was to examine concurrent and 3-month prospective associations between a multidimensional measure of psychological inflexibility and nonsuicidal self-injury (NSSI) among participants with a self-harm history. Participants completed measures of NSSI, psychological inflexibility, negative urgency, and depression at baseline (N = 106, Mage = 34.70, SD = 9.43, 66% women), and were again assessed at follow-up (N = 86). Participants currently engaging in NSSI reported significantly higher psychological inflexibility as compared to those who have ceased NSSI. After controlling for covariates, psychological inflexibility was concurrently associated with NSSI recency and longitudinally predicted perceived likelihood of future NSSI. Psychological inflexibility was not associated with new NSSI acts after including baseline covariates. Finally, psychological inflexibility subscales demonstrated differential relationships with various NSSI functions. Results highlight the psychological inflexibility model's utility in understanding NSSI and have implications for future research that may inform clinical practice.

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

Objective Non-suicidal self-injury (NSSI), the deliberate and self-inflicted damage of body tissue, typically serves an emotion regulation function. Both negative and positive affectivity have been associated with NSSI, as has low distress tolerance. In the current study, we tested whether relationships between both negative and positive affectivity and NSSI are moderated by the four facets of distress tolerance (tolerance, absorption, appraisal, regulation) captured by the Distress Tolerance Scale. Methods A sample of 531 university students completed well-validated measures of NSSI, negative affectivity, positive affectivity, and distress tolerance. Results Findings indicate that negative and positive affectivity, as well as the appraisal (i.e. negative perceptions of distress) and absorption (i.e. allocation of attention to distress) facets of distress tolerance, were directly associated with NSSI. Positive affectivity and appraisal also interacted in differentiating participants with recent, lifetime and no history of NSSI. Specifically, the association between negative perceptions of distress and self-injury was weaker at high levels of positive affectivity. Positive affectivity and absorption also interacted to differentiate between individuals with no history of NSSI and individuals who recently engaged in NSSI. Specifically, positive affectivity was negatively associated with self-injury, but only among individuals who allocate less attention to their distress. Conclusions Considering the independent roles of negative and positive affectivity alongside specific facets of distress tolerance and their interactions with emotional experience, may enhance understanding of NSSI. Prevention and intervention initiatives that assist regulation of negative affectivity, increase positive affectivity, and improve distress tolerance, may reduce the likelihood of engaging in self-injury. Highlights Negative and positive affectivity are independently associated with NSSI Appraisal and absorption facets of distress tolerance are associated with NSSI Positive affectivity moderates associations between appraisal and absorption and NSSI

Pain perception, distress tolerance and self-compassion in Turkish young adults with and without a history of non-suicidal self-injury

Individuals with a history of non-suicidal self-injury (NSSI) tend to have altered pain perception and difficulty in regulating their emotions. Previous work on NSSI has relied heavily on retrospective self-report data and clinical Western samples. The present study explored pain perception, emotional reactivity, distress tolerance and self-compassion in a sample of non-clinical Turkish young adults with and without a history of self-injury by employing a multi-method, laboratory-based design. Participants were 70 Turkish young adults (34 with a history of NSSI and 36 controls). Pain was induced by the cold pressor test before and after a distressing card-sorting task. Skin conductance was recorded throughout the entire procedure. Measures of NSSI, emotion dysregulation and self-compassion were also administered. Although the groups were comparable in pain threshold and physiological reactivity to pain, participants with NSSI had increased pain tolerance and reported more subjective distress during the distressing task. Pain perception did not change as a function of distress and both groups were similar in physiological reactivity to distressing stimuli. Participants who self-injure reported less self-compassion and more difficulty in regulating emotions than controls. These findings illustrate that participants with a history of NSSI have altered pain perception and experience more subjective distress during a stressful task. Individuals who self-injure may benefit from interventions targeting emotion regulation and self-compassion.

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.

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans

BackgroundTransgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. MethodData analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. ResultsResults of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. LimitationsThe limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. ConclusionNSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.

Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients.

Background: Non-suicidal self-injury (NSSI) is a risk factor for suicide attempts (SA). Both attachment disturbances and cognitive and emotional problems (e.g., emotional pain) have been associated with SA history. This study sought to determine differential contributions of attachment styles and cognitive and emotional states associated with SA to lifetime NSSI occurrence among adults hospitalized for suicide risk.Sampling and Methods: Adult psychiatric inpatients (n = 200) were assessed for attachment style, cognitive and emotional states, and lifetime NSSI within 72 h of hospitalization. Binary logistic regression and mediation analyses were performed.Results: Preoccupied attachment and emotional pain at admission were independently associated with lifetime NSSI. Emotional pain partially mediated the relationship between preoccupied attachment and lifetime NSSI.Limitations: The cross-sectional nature of the study and the use of a dichotomous (yes/no) measure of NSSI, not specifically designed for its assessment.Conclusions: Preoccupied attachment and emotional pain are associated with NSSI and may be useful targets for assessing risk of NSSI.

A longitudinal study investigating bidirectionality among nonsuicidal self-injury, self-criticism, and parental criticism

Previous research has indicated that both self-criticism and parental criticism may be associated with engagement in nonsuicidal self-injury (NSSI). However, much less is known about the temporal sequencing of these relationships (i.e., do self-criticism and parental criticism predict NSSI across time, or does NSSI predict self-criticism and parental criticism across time?). Undergraduate students (N = 1132; 70.5% female; Mage = 19.06) from a midsized Canadian university completed measures of NSSI, self-criticism, maternal criticism, and paternal criticism at two time points (one year apart). An autoregressive cross-lagged path analysis revealed that there was a significant unidirectional relationship between NSSI and self-criticism, such that greater NSSI frequency predicted greater self-criticism across time, but self-criticism did not predict greater NSSI frequency across time. In addition, both maternal and paternal criticism were not significantly associated with NSSI frequency when examining either direction of effects. Overall, our results challenge the notion that self-criticism is a risk factor for NSSI engagement, and instead, suggest that it may be a consequence of NSSI engagement. Intervention programs may benefit from recognizing that individuals who engage in NSSI may subsequently criticize themselves.

Body image as a predictor of nonsuicidal self-injury in women: A longitudinal study

ObjectivesTo determine whether Body Image Dissatisfaction (BID) predicted NonSuicidal Self-Injury (NSSI) cross-sectionally and longitudinally, independent of comorbidity between NSSI and Disordered Eating (DE). Another aim was to determine whether BID could predict number of NSSI methods present. MethodAdult females completed measures of NSSI and DE (n = 283); and a longitudinal sample (n = 106) completed these measures again one year later. ResultsBID was a small yet significant predictor of NSSI both cross-sectionally and longitudinally. Poorer BID significantly explained a greater number of NSSI methods cross-sectionally and longitudinally. ConclusionsBID explains unique variance in NSSI (including increased number of methods), and is not a function of comorbidity with DE. This has the potential to influence theory, as well as inform early intervention initiatives for BID in females. Further research is required to determine other variables implicated in this relationship, as well as whether these findings are applicable to other groups such as adolescents and males.