Engagement In Nonsuicidal Self-injury Research Articles

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.

Evaluating the Effectiveness of a Brief Mindfulness Activity in University Students With Non-Suicidal Self-Injury Engagement

Current theoretical frameworks posit that engagement in non-suicidal self-injury (NSSI) is due to an inability to regulate one’s emotions. In turn, mindfulness-based interventions have been shown to enhance emotion regulatory processes in those who engage in NSSI. Objective. The purpose of the present study was to determine whether a brief mindfulness activity was differentially effective at increasing state mindfulness and decreasing stress following a stress induction task in university students with versus without a history of NSSI engagement. Method. The sample consisted of two groups of participants who identified as women: participants with a history of NSSI engagement (NSSI; n = 57; Mage =20.09, SD = 2.05) and participants without (no-NSSI; n = 87; M age=20.22, SD = 1.94). All participants were asked to complete pre-intervention measures of state mindfulness and stress and were randomly assigned to either a mindfulness activity (body scan) or control task condition. Following the completion of their respective activities, a Stroop stress induction task was conducted and participants completed post-intervention measures of state mindfulness and stress. Results. Two 3-way mixed ANOVAs (Time X NSSI status X Condition) were conducted and revealed significant time by condition interactions for both state mindfulness, Wilk’s Λ = .93, F(1, 140) = 10.70, p = .001, ηp 2 = .07, and stress, Wilk’s Λ = .97, F(1, 140) = 4.21, p = .04, ηp 2 = .03. As such, both groups (NSSI/no-NSSI) demonstrated similar increases in state mindfulness and decreases in stress in response to the brief mindfulness activity following the stress induction. Implications for future research and practice will be discussed. HIGHLIGHTS The brief mindfulness activity effectively increased state mindfulness. The brief mindfulness activity effectively decreased stress. Benefits were experienced similarly among both groups (NSSI/no-NSSI).

Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know.

Purpose of ReviewThe current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research.Recent FindingsWhile there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously.SummaryIt is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.

Self-Critical and Self-Punishment Cognitions Differentiate Those With and Without a History of Nonsuicidal Self-Injury: An Ecological Momentary Assessment Study

The aim of this study was to examine trait, state, and temporal instability measures of self-critical and self-punishment cognitions to evaluate their respective roles in nonsuicidal self-injury (NSSI). Participants were university students with a history of NSSI (n = 64) and those with no history of NSSI (n = 59). At baseline, participants completed measures assessing history of NSSI behavior, as well as trait measures of self-criticism and self-punishment. After completion of baseline procedures, participants subsequently participated in a 10-day ecological momentary assessment protocol in which self-critical and self-punishment cognitions were assessed in real time three times daily. Employing bivariate and multivariate frameworks, our results demonstrate that both trait and state levels of self-critical and self-punishment cognitions robustly differentiate between young adults with and without a lifetime history of NSSI. The present results also confirm that the temporal instability of these cognitive states also meaningfully differentiate between groups, such that those who exhibit greater fluctuations in these cognitive states are more likely to have a history of NSSI. The current findings suggest that trait, state, and temporal instability of negative self-focused cognitions may be vulnerability factors for engagement in NSSI.

Predictors of nonsuicidal self-injury: The independent contribution of benign masochism and antisocial personality

The present research examined the relationships between engagement in nonsuicidal self-injury (NSSI), benign masochism, and antisocial personality traits. Because both benign masochists and individuals who engage in self-injury find pleasure in experiencing pain, we expected a positive relationship between benign masochism and NSSI. We further anticipated NSSI to be positively related to antisocial personality traits due to the shared propensity for aggression and violence. In fact, two studies showed that benign masochism, Machiavellianism, psychopathy, everyday sadism, and trait aggression were positively related to mild forms of injurious self-harm behaviors. Although benign masochism and antisocial personality traits were positively correlated, they independently contributed to an increased risk of engagement in NSSI. Vulnerable narcissism was also positively correlated, whereas a measure of grandiose narcissism revealed less conclusive evidence. Overall, the tendencies to go against oneself in a benign form and to go against others are both predictive of the propensity to engage in mild forms of self-harming behaviors.

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.

Using the MMPI-2-RF to Assess Risk of Nonsuicidal Self-Injury among College Students

Nonsuicidal self-injury (NSSI), the deliberate destruction of one’s own body tissue without suicidal intent, is a prevalent problem linked to adverse outcomes. Many assessment tools designed to assess for NSSI risk are limited by their behavioral focus, which does not cover the numerous affective, cognitive, and interpersonal correlates. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a widely used inventory of personality and psychopathology that assesses a range of empirical correlates of NSSI risk. The purpose of this study was to investigate the utility of the MMPI-2-RF for assessing these NSSI-related constructs. On the basis of a review of the literature and item content, we pre-identified MMPI-2-RF measures of constructs associated with NSSI risk. Correlations between scores on these scales and the number of methods of NSSI identified several meaningful results, including some small but consistent gender differences in these associations. Zero-inflated negative binomial regression analyses indicated that scores on some expected MMPI-2-RF scales independently predicted NSSI variability. Relative risk ratio analyses demonstrated the potential clinical utility of MMPI-2-RF scale scores for assessing risk of engagement in NSSI. These findings indicate that the MMPI-2-RF may be a useful tool for assessing risk for NSSI among college students.

Nonsuicidal self-injury scar concealment from the self and others

Despite the high prevalence of nonsuicidal self-injury (NSSI) and resultant physical scarring, few studies have explored the occurrence and psychological implications of concealing NSSI scars. This study examines NSSI scar concealment from the self and others, as well as the cognitive, affective, and self-injury-related correlates of these concealment practices. This study aimed to characterize the extent to which individuals who engage in concealment practices have a history of, or desire to engage in, treatment for NSSI specifically geared towards NSSI scarring. Adults with at least one NSSI scar (N = 278) completed online questionnaires measuring NSSI engagement and scarring, scar concealment behaviors, scar-related cognitions, as well as symptoms of anxiety and depression, and recent suicidal ideation and NSSI urges. Results indicate that the degree of scar concealment from the self and from others is associated with greater experiences of negative scar-related cognitions, higher levels of anxiety and depressive symptomatology, and higher severity of NSSI urges. These correlations persisted after accounting for NSSI severity indices, including extent of NSSI scarring, suggesting that scar concealment practices may be important clinical indicators of current distress and potential future self-injury. Future research should explore the extent to which scar concealment practices are longitudinally associated with distress and risk for NSSI maintenance.

Online disinhibition and internet communication of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is of concern given the increased risk for suicide attempt. Prevalence rates of NSSI are highest among adolescents and young adults. These groups also exhibit the highest rates of Internet use. Previous research suggests that online communication of NSSI can serve as both a risk and protective factor related to NSSI engagement. This study explored online disinhibition in the context of NSSI e-communities as a potential factor that could contribute to opposing NSSI outcomes. The study sample consisted of 200 individuals 18years or older (M=21.76, SD=5.24) recruited from social networking sites (i.e., Reddit, LiveJournal). These participants provided self-report of their NSSI histories and degree of online disinhibition. Those who engaged in Internet communication of NSSI at the highest level endorsed more online disinhibition than those less involved with NSSI content. Furthermore, within this group of high communicators, increased toxic disinhibition predicted lower lifetime frequency of NSSI. This study suggests that online behavior, including toxic disinhibition, may contribute to NSSI outcomes. Online disinhibition and its relationship to NSSI should be an area of continued research. Cyberbullying may be an additional construct of interest in future studies of NSSI e-communication.

Impact of Negative Life Events and Social Support on Nonsuicidal Self-Injury Among Chinese Middle School Students.

The field of nonsuicidal self-injury (NSSI) is dominated by research conducted with Caucasian majority samples in Western countries such as North America and Europe. Far less NSSI-related research is conducted in non-Western cultures, even though NSSI behavior is a growing issue in China where studies have found that NSSI among youth occurs at a higher prevalence and has an earlier onset as compared to Western studies. Based on the data collected from middle school students in Xi’an, China, this article tries to figure out the predictive factors that are related to adolescents’ NSSI using gender analysis, specially negative life events and social support, and the following conclusions are drawn: (a) There is no significant gender difference in the prevalence of NSSI of middle school students. (b) Negative life events are the risk factors of middle school students’ NSSI engagement. Individuals with higher scores of negative life events are more likely to have NSSI. (c) Social support is a protective factor of middle school students’ NSSI, which has main effect and also as a moderator to NSSI, individuals received more social support are less likely to engage in NSSI.

School-Based Prevention Targeting Non-Suicidal Self-injury: A Pilot Study.

Non-suicidal self-injury (NSSI) is prevalent in adolescence and is associated with increased risk for a variety of subsequent negative mental health outcomes, necessitating an evidence-based preventive approach. This pilot study examines the potential iatrogenic effects and feasibility of an evidence-based school program for the prevention of NSSI. Differences are examined between a general in-classroom prevention program (Happyles) and this program combined with a 1-h in-classroom psychoeducation module on NSSI (HappylesPLUS) in terms of primary (e.g., delay in NSSI onset and decrease in NSSI frequency, urges, probability of future engagement) and secondary outcomes (e.g., psychological distress, emotion regulation, help-seeking, and stigma) using a mixed-method design. A total of 651 secundary school pupils (Mage = 12.85 years; 49.8% female versus 50.2% male) were assigned to the Happyles program and HappylesPLUS. Participants filled out validated self-report questionnaires pre (T0) and post (T1, 6 weeks after T0) the school prevention program, including the Youth Outcome Questionnaire (YOQ), the Brief Non-Suicidal Self-Injury Assessment Test (BNSSI-AT), the Difficulties in Emotion Regulation Scale (DERS), the Attitudes Toward Seeking Professional Psychological Help Scale—Short Form (ATSPPH-SF), and the Peer Mental Health Stigmatization Scale (PMHSS). Qualitative semi-structured interviews (at T2,6 weeks after T1) were conducted with participants with and without a history of NSSI. Overall, results show no iatrogenic effects of the NSSI-focused psychoeducation module. In terms of our primary outcome, both groups reported a reduced likelihood of future NSSI engagement from T0 to T1. Regarding secondary outcome measures, we also observed increased emotional awareness in both groups. The qualitative data suggest that the addition of the NSSI-specific module to the Happyles program may have direct benefits to some students with lived experience, such as increased help-seeking behavior for NSSI. Findings of this pilot study show that incorporating NSSI-specific modules into evidence-based school prevention programs is feasible and does not lead to iatrogenic effects. Future work is needed to evaluate the potential (longer-term) benefits of incorporating NSSI-focused modules to evidence-based mental health programs in the prevention of NSSI.

Self-Stigma Toward Nonsuicidal Self-Injury: An Examination of Implicit and Explicit Attitudes.

Evidence suggests that individuals without a history of nonsuicidal self-injury (NSSI) are likely to view NSSI as a stigmatized behavior. However, there is limited evidence evaluating the presence of self-stigma among individuals who have engaged in NSSI. We recruited a university sample (n=351) and employed implicit and explicit measures to examine the degree of stigmatization toward those with NSSI scarring, as compared to nonintentional disfigurement (i.e., accidental scarring) and to tattoos (i.e., a culturally sanctioned form of intentional tissue alteration). We examined the extent to which bias is related to indicators of NSSI severity among those with a history of NSSI. We provide evidence that negative biases toward NSSI may represent the effects of self-stigma. However, findings suggest that biases were generally attenuated among participants with a history of NSSI as compared to those without. Participants who had lower levels of NSSI explicit bias were more likely to have a history of more severe engagement in NSSI; however, no significant relationships were found between implicit bias and NSSI severity indicators. We present a theoretical rationale for attenuated biases among individuals with a history of NSSI and discuss implications of this research for NSSI recovery.

What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up

This study examined the longitudinal associations between non-suicidal self-injury (NSSI) in early adolescence and various positive and negative aspects of mental health in young adulthood. The participants were a cohort of regular school students (n = 1064) in grades 7–8 from a Swedish municipality. Nine hundred and ninety-one of these completed an 11-page questionnaire (T1: Mage = 13.7; 50.3% girls); 1 year later, 984 students completed the questionnaire again (T2: Mage = 14.8; 51.1% girls); and 10 years later, 557 took part (T3: Mage = 25.3; 59.2% women). The prevalence of any NSSI (≥ 1 instance) decreased from about 40% in adolescence to 18.7% in young adulthood, while the prevalence of repetitive NSSI (≥ 5 instances) decreased from about 18 to 10%. Compared to individuals who reported no NSSI as adolescents, and controlling for gender and psychological difficulties in adolescence, adolescents with stable repetitive NSSI (i.e., repetitive NSSI at both T1 and T2) showed significantly higher levels of stress, anxiety, NSSI, and difficulties in emotion regulation 10 years later. Even infrequent and unstable repetitive NSSI in adolescence was associated with negative outcomes in young adulthood. These results suggest that stable repetitive NSSI in adolescence is a strong risk factor for mental health problems in young adulthood and that occasional engagement in NSSI in adolescence is an indicator of vulnerability for poorer mental health in young adulthood.

Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization

Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients’ reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.

Non-suicidal self-injury among male service members: Descriptive information and a preliminary examination of external correlates

Previous literature has identified nonsuicidal self-injury (NSSI) as a common and noteworthy behavior, particularly given its association with psychopathology and suicide. However, the research on NSSI among males has resulted in mixed findings. Additionally, few studies have examined NSSI among service members and only one study to date has examined NSSI specifically among male service members. The present study examined descriptive statistics and clinical correlates of NSSI among male service members. Results indicated that the most common method of NSSI among this group was burning oneself with a cigarette, followed closely by cutting, and burning oneself with a lighter. NSSI engagement was associated with common correlates of NSSI such as increased emotion dysregulation, depression, impulsivity, and capability for suicide as well as decreased distress tolerance and a greatly likelihood to have experienced recent suicidal ideation. NSSI was also associated with grit, narcissism, and masculinity, some of which may be particularly important and valued in military culture. Overall, results suggest important similarities and differences among NSSI in service members relative to previously studied samples. Future research should continue to examine NSSI among male service members to ensure treatments are effectively targeting and addressing aspects of the behavior.

White Matter Microstructure in Adolescents and Young Adults With Non-Suicidal Self-Injury.

BackgroundNon-suicidal self-injury (NSSI) is a growing public health concern that commonly begins in adolescence, and can persist into young adulthood. A promising approach for advancing our understanding of NSSI in youth is to examine white matter microstructure using diffusion magnetic resonance imaging (dMRI).MethodThe present study examined whole-brain group differences in structural connectivity (as measured by generalized fractional anisotropy [GFA]) between 28 female adolescents and young adults ages 13–21 years with NSSI and 22 age-matched healthy controls (HC). We also explored the association between clinical characteristics including NSSI severity and duration, impulsivity, emotion regulation and personality traits within the NSSI group and GFA of the uncinate fasciculus and cingulum.ResultsCompared to the HC group, participants with NSSI had lower GFA in several white matter tracts, including the uncinate fasciculus, cingulum, bilateral superior and inferior longitudinal fasciculi, anterior thalamic radiation, callosal body, and corticospinal tract. When controlling for depressive symptoms, the NSSI group showed an association between NSSI duration (time since initiating NSSI behavior) and lower GFA in the left cingulum. Higher levels of attentional impulsivity were related to lower GFA in the left uncinate fasciculus within the NSSI group.ConclusionsWe found evidence suggesting widespread white matter microstructure deficits in adolescents and young adults with NSSI versus HC. We also report inverse associations between white matter integrity and clinical characteristics (duration of NSSI and attentional impulsivity). These white matter microstructural deficits may represent a possible neurobiologically-based vulnerability to developing maladaptive coping mechanisms, such as NSSI. Additionally, results suggest that this white matter disorganization may either worsen with prolonged engagement in NSSI or predict persistent NSSI; thereby highlighting the importance of early intervention targeting this behavior.

Self-criticism longitudinally predicts nonsuicidal self-injury in eating disorders

ABSTRACTDialectical Behavior Therapy (DBT) has long been successfully applied to such behaviors such as nonsuicidal self-injury (NSSI) and more recently, bulimic behaviors. However, it is less clear how patients experiencing these comorbid symptoms may benefit from this treatment modality. Self-criticism, defined as a highly negative attitude towards the self, has been implicated in both EDs and NSSI and is amenable to DBT; thus, further examination of this construct may be beneficial in informing DBT treatment approaches. However, research has only examined these relationships cross-sectionally and no published research has examined self-criticism as a longitudinal predictor of NSSI and ED symptoms. Thus, this study examined self-criticism as a potential driving factor of NSSI in EDs in order to inform treatments, particularly DBT. Data were collected from 92 treatment-seeking adults at ED treatment facilities in the United States. Participants self-reported ED pathology, NSSI engagement, and self-criticism at baseline and a two-month follow-up. A path analysis revealed that self-criticism at baseline was associated with NSSI frequency at follow-up over and above baseline NSSI and ED symptomology. Self-criticism at baseline was not associated with ED pathology at follow-up. Self-criticism longitudinally predicted NSSI, but not ED pathology, in an ED sample. As such, it may be important for clinicians to assess for self-criticism and consider treatments that target both self-criticism and self-injury, like DBT, for this population.

Resilience and non-suicidal self-injury in LGBTQIA+ people: Targets for prevention and intervention

Identifying as LGBTQIA+ is associated with greater risk of non-suicidal self-injury (NSSI); understanding why may aid in decreasing NSSI and associated risks in this vulnerable population. We examined discrimination, psychological distress, ‘outness’, resilience, and NSSI in 330 young adults (18–30) from the Australian LGBTQIA+ community. Individuals reporting NSSI reported more depression, anxiety and stress, and less resilience than those who had not engaged in NSSI. Perceived discrimination was not associated with NSSI engagement, however people identifying as queer reported more discrimination than other LGBTQIA+ participants. Additionally, not being ‘out’ in the workplace was associated with NSSI. Building resilience and social support within and for the LGBTQIA+ community may be beneficial in addressing LGBTQIA+ mental health and NSSI.

The Influence of Substance Use on Engagement in Non-Suicidal Self-Injury (NSI) in Adults

Background: Adults engaging in non-suicidal self-injurious (NSI) behaviors often report the use of substances; however, little research explores the relationship between substance abuse and NSI. Thus, this study examined the influence of substance use on patterns of NSI among adults. Objectives: This study seeks to answer the following questions: (a) Is AOD use predictive of more frequent self-injurious behaviors? and (b) Does the use of AODs predict injuring more severely than expected? Methods: An observational cross-sectional design was used to examine the relationship between drug use and NSI behaviors. Participants were recruited through Amazon Mechanical Turk (Mturk). Results: Results indicated opiates, barbiturates and sedatives all had a small but statistically significant influence on the frequency of NSI behaviors, while marijuana, PCP and anti-anxiety medications had a small but statistically significant relationship to severity. Conclusion/Importance: This study indicates that future research should take into account substance use patterns in adults engaging in NSI behaviors.

Association between Emotion Dysregulation and Distinct Groups of Non-Suicidal Self-Injury in Taiwanese Female Adolescents.

Background: Previous studies revealed that female adolescents are more likely than males to engage in non-suicidal self-injury (NSSI) to regulate negative emotions; however, the dimensions of emotion regulation that are associated with NSSI behavior in adolescents require further examination. The present study aimed to identify Taiwanese female adolescent clusters with NSSI engagement frequency and to evaluate the association of specific forms of emotion dysregulation with NSSI. Methods: The participants were 438 female adolescents (mean age = 15.23 years, SD = 1.24, range between 13 and 18) recruited from 11 high schools. Self-report questionnaires assessing NSSI, difficulties in emotion regulation, and positive and negative affect were administered, and 37% of respondents reported a history of NSSI. Results: The analysis of NSSI frequency yielded three groups: severe, moderate, and non-NSSI. High negative affect, low positive affect, and difficulties in all aspects of emotion regulation differentiated female adolescents in the severe NSSI group from their counterparts in the non-NSSI group. The moderate and severe NSSI groups were further distinguished by age of onset, negative affect, emotion regulation strategies, and impulse control. Adolescents classified in the severe group reported earlier onset of NSSI, higher negative affect, less emotion regulation strategies, and more difficulty with impulse control. Conclusions: The results indicate that assessments of NSSI and emotion regulation should be incorporated in youth mental health screening. The clinical implications of NSSI behavior intervention require further discussion.