Non-suicidal Self-injury Cessation Research Articles

Persistence and Cessation of Nonsuicidal Self-Injury Under Psychotherapy

Abstract: This study examines factors associated with recovery from nonsuicidal self-injury, comparing the characteristics of nonsuicidal self-injury behavior, clinical history, and psychological features of one group of patients who recovered from nonsuicidal self-injury within 12 months of psychotherapy and one group of patients who did not. Both groups received three components of treatment: feedback on psychological assessment results, psychoeducation on stress and emotional control, and acquisition of stress-coping skills. The Rorschach Comprehensive System was used for the measurement of participants’ psychological characteristics. Results indicated that the nonrecovery group ( N = 14) remembered significantly fewer self-harm episodes than the recovery group ( N = 16). The Rorschach showed differences in variables indicative of thinking and cognitive problems: PTI positivity and X-% were significantly higher in the nonrecovery group, while X+%, XA%, and WDA% were significantly lower in the nonrecovery group. Results suggest that the recovery group interrupted self-injury behaviors in a relatively short period by acquiring self-understanding and coping skills. Additional treatment for thinking, cognitive deficits, and dissociation may be necessary for the nonrecovery group.

Predictors of continuation and cessation of non-suicidal self-injury in adolescents

Predictors of continuation and cessation of non-suicidal self-injury in adolescents

What’s Different About Those Who Have Ceased Self-Injury? Comparison Between Current and Lifetime Nonsuicidal Self-Injury

ABSTRACTS Objective The current study aimed to investigate the sociodemographic and psychological variables as well as the function of NSSI related to the cessation of NSSI by analyzing the difference between those currently engaged in nonsuicidal self-injury (NSSI) and those who have stopped NSSI behaviors. Methods A total of 490 adults with a history of NSSI (359 females) were assigned to one of two groups: NSSI engagement within the last 12 months or “current NSSI” (n = 402) vs. no episode of NSSI in the previous 12 months or “lifetime NSSI” (n = 88). Results There were no significant group differences in sex or socioeconomic status, while individuals with current NSSI were slightly younger than those who had ceased NSSI behavior. Regarding the functions of NSSI, the current NSSI group endorsed more intrapersonal functions. Moreover, the participants who had ceased NSSI behavior reported significantly less perceived stress, dysfunctional attitudes, alexithymia, emotion reactivity, and suicidal ideation. On the other hand, the lifetime NSSI group showed greater psychological resources such as self-esteem, distress tolerance, and resilience. Conclusions We revealed apparent differences in NSSI functions, clinical symptoms, and psychological resources depending on the maintenance and cessation of NSSI. This study highlights the need for a better understanding of the factors that stop as well as those that continue NSSI behaviors. HIGHLIGHTS The lifetime NSSI group reported more intrapersonal NSSI functions. The current NSSI group suffered from more clinical symptoms. Individuals who ceased NSSI had more psychological resources.

Stop self-injuring, then what? Psychosocial risk associated with initiation and cessation of nonsuicidal self-injury from adolescence to early adulthood.

Nonsuicidal self-injury (NSSI) typically begins in adolescence and remits by early adulthood, but few prospective studies have investigated the long-term impact of NSSI initiation and cessation on young people's wellbeing. We examined changes in psychosocial risk associated with NSSI onset and offset in an accelerated longitudinal study of 662 adolescents (12-18 years old) who were followed biennially for 10 years. Of the 133 participants who reported NSSI, 100 had stopped engaging in NSSI by the study's end. NSSI initiation was associated with concurrent increases in depression, anxiety, externalizing symptoms, peer victimization, alcohol, tobacco and illicit substance use, and concurrent declines in physical self-concept, parent, and peer support. As NSSI persisted, youth experienced further increases in anxiety and cannabis use, and declines in physical self-concept. NSSI cessation was associated with concurrent increases in alcohol, cannabis, and tobacco use. With sustained cessation, however, youth experienced gradual improvements in depression, anxiety, externalizing symptoms, peer victimization, as well as gradual reductions in alcohol and tobacco use. By early adulthood, participants who reported ongoing NSSI worked fewer hours and were more likely to delay medical treatment for financial reasons versus those without NSSI histories, and reported less environmental mastery versus those who had discontinued NSSI. Youth who had discontinued NSSI, in turn, reported less environmental mastery and self-acceptance versus youth who never engaged in NSSI. These results contextualize NSSI cessation alongside indicators of psychological, social, and behavioral wellbeing, and underscore the persistence of psychosocial vulnerability after NSSI has resolved. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Stop Self-Injuring, Then What? Psychosocial Risk Associated With Initiation and Cessation of Nonsuicidal Self-Injury From Adolescence to Early Adulthood

Supplemental Material for Stop Self-Injuring, Then What? Psychosocial Risk Associated With Initiation and Cessation of Nonsuicidal Self-Injury From Adolescence to Early Adulthood

Self-injury recovery: A person-centered framework.

Growing interest has been paid to the concept of non-suicidal self-injury (NSSI) recovery. In research, and sometimes clinical practice, the focus has been on NSSI cessation, with recovery operationalised with reference to the time since someone last self-injured. Yet, perspectives from people with lived experience of NSSI indicate that recovery is much more complex. Drawing on recent empirical work, and the voices of people with lived experience of NSSI, we outline a new framework for conceptualizing NSSI recovery. We argue that recovery is nonlinear and multifaceted, comprising: Realistic Expectations and Setbacks; Normalizing Thoughts and Urges; Fostering Self-efficacy; Identifying Strengths; Finding Alternatives; Addressing Underlying Adversities; Addressing and Accepting Scarring; Navigating Disclosures; and Self-acceptance. In presenting research and clinical implications of this new framework, we propose that this framing offers a more complete understanding of NSSI recovery-one conducive to optimizing wellbeing and promoting resilience among individuals with lived experience.

Prospective Interpersonal and Intrapersonal Predictors of Initiation and Cessation of Non-Suicidal Self-Injury among Chinese Adolescents.

(1) Purpose: Non-suicidal self-injury (NSSI) possibly emerges as well as remits in adolescence. To explore the development and transition of NSSI, this study examined the association between a wide range of interpersonal and intrapersonal predictors of NSSI initiation and cessation. (2) Methods: Chinese adolescents (N = 913) completed self-reported surveys at baseline and at a six-month follow-up. The sample included 625 adolescents who reported no NSSI and 288 adolescents who reported engagement in NSSI at baseline. (3) Results: Among the adolescents without NSSI at baseline, 24.3% engaged in NSSI at follow-up (NSSI initiation group). Among the adolescents with NSSI at baseline, 33.3% reported no NSSI at follow-up (NSSI cessation group). Loneliness, beliefs about adversity, problem behavior, and prosocial behavior were the significant factors in predicting subsequent NSSI initiation. None of the potential predicting factors were associated with subsequent NSSI cessation. (4) Conclusions: These results indicate the importance of intrapersonal factors in Chinese culture, which could be used to identify at-risk adolescents and to design interventions.

Predictors of non-suicidal self-injury cessation in adults who self-injured during adolescence

Most studies of non-suicidal self-injury (NSSI) investigate individuals who are currently self-injuring. The current study aimed to identify factors associated with continuation or cessation of NSSI from adolescence to adulthood. Adult participants (n = 724) completed an online cross-sectional survey of their experiences of NSSI in adolescence, the functions served by NSSI, and measures of current role functioning and psychological well-being. The functions of NSSI in adolescence significantly predicted cessation or continuation of NSSI in adulthood. Intrapersonal functions of NSSI increased the likelihood of ongoing self-harm, whereas interpersonal functions of NSSI increased the likelihood of cessation of self-harm in adulthood. Cessation of NSSI was also associated with increasing age and having previously received mental health treatment. Participants who had ceased NSSI in adulthood reported lower rates of psychological distress, greater life satisfaction, were more likely to be engaged in work and had achieved a higher level of education overall. The study was cross-sectional and relied on retrospective accounts of those participants who had ceased NSSI. The vast majority of participants were female and Australian, so generalizability beyond this population must consider this limitation. Many individuals who engage in NSSI in adolescence successfully cease self-harming by adulthood. Cessation of NSSI is associated with better psychological well-being and higher role functioning. Ongoing NSSI from adolescence to adulthood is likely where NSSI serves intrapersonal functions. Clinical intervention must be a priority in such cases.

Understanding self-injury recovery: Views from individuals with lived experience.

Nonsuicidal self-injury (NSSI) recovery has typically been conceptualized through the lens of formal frameworks or as the cessation of NSSI. These understandings, however, have been developed largely devoid of views from those with lived NSSI experience, who may offer novel and critical insights. To advance the conception of NSSI recovery, the current study elicited such views. Two hundred and thirty-three emerging adults with a history of NSSI (77% female, mean age = 18.9 years), responded to open-ended questions regarding recovery. Results were thematically analyzed using an inductive approach. Responses yielded seven themes: (a) recovery is complete NSSI cessation; (b) recovery is more than cessation; (c) recovery involves lingering NSSI features; (d) recovery involves developing resilience; (e) recovery is a process; (f) evolution in understanding recovery; and (g) recovery is a subjective experience. Recovery seems to be multifarious, nonlinear, and subjective. Conceptual and clinical implications are discussed.

Applying a cognitive-emotional model to nonsuicidal self-injury.

The recently proposed cognitive-emotional model of nonsuicidal self-injury (NSSI) draws on emotion regulation models and social cognitive theory to understand the onset, maintenance, and cessation of NSSI. We tested the prediction of the model that the relationship between emotional reactivity and NSSI is moderated by specific cognitions about self-injury (i.e., self-efficacy to resist NSSI, NSSI outcome expectancies), emotion regulation, and rumination. A sample of 647 university students aged 17-25years (M=19.92, SD=1.78) completed self-report measures of the constructs of interest. As expected, we found that emotional reactivity was positively related to NSSI, particularly for people who had weak self-efficacy to resist NSSI. However, emotional reactivity was negatively related to NSSI for people who were more likely to use expressive suppression to regulate emotion. Implications for the theoretical understanding of NSSI are discussed.

The Role of Basic Need Satisfaction in the Onset, Maintenance, and Cessation of Non-Suicidal Self-Injury: An Application of Self-Determination Theory

The present study applied self-determination theory to examine the onset, maintenance, and cessation of non-suicidal self-injury (NSSI) in adolescents. Specifically, the study examined the relationship between the basic psychological needs of autonomy, competence, and relatedness, and NSSI status. Participants were classified into the NSSI Maintain (n = 30), NSSI Start (n = 44), NSSI Stop (n = 21), or Control (n = 98) groups based on NSSI status over 2 time points within a 12-month period. Repeated measures multiple analysis of variance was employed. Satisfaction of the need for competence decreased over time in all adolescents. Adolescents who maintained NSSI behavior reported significantly lower levels of need satisfaction compared to adolescents reporting no history of NSSI engagement, and adolescents who began NSSI over the course of the study reported significantly lower levels of need satisfaction compared to those reporting no history of NSSI engagement. The findings suggest that need satisfaction varies as a function of NSSI status.

Nonsuicidal self-injury: a condition for further study.

Nonsuicidal self-injury: a condition for further study.

Predictors of self-injury cessation and subsequent psychological growth: results of a probability sample survey of students in eight universities and colleges.

BackgroundFactors affecting non-suicidal self-injury cessation are poorly understood. The aim of this study was to identify differences between individuals with current and past non-suicidal self-injury (NSSI) in a large probability sample of university students using quantitative and qualitative methods. Predictors of psychological growth related following NSSI cessation were also examined.MethodThe sample included 836 students who participated in a larger online study of well-being at eight U.S. colleges and who reported current or past history of repeated NSSI. The average age of respondents used in analysis was 21.3 years. They were 78.3 % female and 21.7 % male and were 70.7 % Caucasian, 1.4 % African American/Black, 5.5 % Hispanic, 7.8 % Asian/Asian American and 14.7 % other. Analyses tested differences in demographics, NSSI characteristics (e.g. lifetime frequency, number of NSSI functions, NSSI disclosure), formal help-seeking, psychosocial factors, and mental health and trauma histories.ResultsIndividuals with current NSSI status were more likely to be female and slightly younger, to report higher NSSI lifetime frequency, more NSSI forms and functions, thinking of themselves as a “self-injurer”, and current psychological distress. Individuals with current NSSI status were less likely to report that self-injury interfered with life, that therapy was useful in stopping, perceiving social support, having a sense of meaning in life, access to more emotion regulation strategies, and life satisfaction. Qualitative data suggested that cessation may be attributable to changes in ability to regulate emotion (62.6 %), self-awareness (38.7 %), and important relationships to others (36.0 %). Psychological growth after stopping NSSI was predicted by more severe NSSI (form and perceived NSSI dependence), having talked about NSSI with others and higher numbers of confidantes, perceived life satisfaction, and a history of suicide action.ConclusionsThese findings add to the still nascent body of literature examining processes related to NSSI cessation. Our results point to the importance of help-seeking and social support, as well as psychosocial processes in stopping NSSI.

Longitudinal Analysis of Adolescent NSSI: The Role of Intrapersonal and Interpersonal Factors

Non-suicidal self-injury (NSSI) occurs in approximately 10 % of adolescents. To establish effective prevention and intervention initiatives, it is important to understand onset, maintenance and cessation of NSSI. We explored whether the relationships between interpersonal factors (i.e. attachment, social support) and NSSI were mediated by intrapersonal factors (i.e. emotion regulation, self-esteem, self-efficacy). Participants were 1973 students (1414 female and 559 male) aged between 12 and 18 years (M = 13.89, SD = 0.97) recruited from 40 Australian high schools. Participants completed a questionnaire at two time-points with a 12-month interval. At baseline, 8.3 % of adolescents engaged in NSSI, increasing to 11.9 % at follow-up. Family support was most salient in onset, maintenance and cessation of NSSI. Attachment anxiety was related to NSSI onset. Of the intrapersonal variables, self-esteem and self-efficacy were significant in predicting onset of NSSI. Self-esteem, self-efficacy and cognitive reappraisal mediated the relationship between attachment anxiety and NSSI onset. A combination of interpersonal and intrapersonal variables contributes to the onset, maintenance and cessation of NSSI in adolescence. Perceived family support appears to be an important safeguard against NSSI. Strategies targeting family functioning and teaching cognitive reappraisal techniques to adolescents may reduce the number engaging in NSSI.

Predictors of Continuation and Cessation of Nonsuicidal Self-Injury

This paper reports the first prospective study of risk factors for continuation of nonsuicidal self-injury (NSSI) during adolescence. We examined whether NSSI became more severe among those continuing to self-injure 1 year later, as well as characteristics and predictors of continuation, relative to cessation, drawn from a sample of 1,973 community-based adolescents from five states in Australia. Multiple sociodemographic and psychosocial factors were assessed in a series of sequential logistic regressions. Of those reporting NSSI at follow-up (12% total sample), 4.1% (95% CI: 3.3%-5.0%; n = 80) continued from baseline and an additional 4.1% had stopped this behavior by follow-up (95% CI: 3.3%-5.1%, n = 81; 3.8% new cases). Frequency, potential lethality and number of methods of NSSI increased among adolescents continuing to self-injure. These individuals also had overall higher frequency and more serious wounds compared with those who had stopped self-injuring, possibly providing parameters to differentiate these groups. Continuation of NSSI was associated with higher frequency (OR = 1.06; 95% CI = .99-1.13, p = .08), lower cognitive reappraisal (OR = .86; 95% CI = .78-.95, p = .004) and higher emotional suppression (OR = 1.10; 95% CI = .98-1.22, p = .09) relative to cessation at T1. These findings may assist to better identify young people more likely to continue self-injuring and also highlight potentially modifiable factors to inform early intervention initiatives.

Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame

ObjectiveAlthough child maltreatment is associated with later non-suicidal self-injury (NSSI), the mechanism through which it might lead to NSSI is not well understood. The current retrospective case–control study examined associations between child maltreatment and later NSSI, and investigated the mediating roles of dissociation, alexithymia, and self-blame. MethodsParticipants were 11,423 Australian adults (response rate 38.5%), randomly selected from the Australian Electronic White Pages, aged between 18 and 100 (M=52.11, SD=16.89), 62.2% female. Data were collected via telephone interviewing. Main outcome measures were reported history of child maltreatment (sexual abuse, physical abuse, neglect) and reported 12-month NSSI. Dissociation, alexithymia, and self-blame were examined as potential mediating variables in the relationship between child maltreatment and later NSSI. All analyses were conducted using logistic regression and adjusted for age and psychiatric diagnosis. ResultsResults differed by gender. Compared to no child maltreatment, physical abuse (OR 2.75, 95% CI 1.68–4.51) and neglect (OR 2.56, 95% CI 1.65–3.99) independently increased the odds of NSSI among females. Physical abuse (OR 2.69, 95% CI 1.44–5.03) increased the odds of NSSI among males. Sexual abuse did not independently increase the odds of NSSI for males or females. For females, self-blame had the greatest effect on the child maltreatment–NSSI relationship (OR decreased by 14.6%, p<.000), although dissociation and alexithymia also partially mediated the relationship. For males, dissociation had the greatest effect (OR decreased by 12.9%, p=.003) with self-blame also having a relatively strong effect. ConclusionsThe results indicate that child maltreatment, and in particular, physical abuse, is strongly associated with the development of subsequent NSSI and may be partially mediated by dissociation, alexithymia, and self-blame for females and dissociation and self-blame for males. Altering attributional style (through cognitive therapy or emotion focussed therapy) and improving the capacity to regulate emotions (through dialectical behaviour therapy) may contribute to reduction or cessation of NSSI.