Non-suicidal Self-injury Outcomes Research Articles

Are the functions of non-suicidal self-injury associated with its persistence and suicide risk in university students? Insights from a network analysis.

To date, a number of intra- and interpersonal functions of non-suicidal self-injury (NSSI) have been identified. Yet, their association with persistence of NSSI and suicide risk remains unknown. The study aimed to investigate which functions of NSSI are associated with its persistence and suicide risk in university students using a network analysis. Altogether, 830 university students reporting a lifetime history of NSSI were enrolled. The persistence of NSSI was defined as its presence over preceding 12 months. Persistent NSSI was directly connected to the nodes representing two functions of NSSI: affect regulation and self-punishment. Suicide risk was directly connected to the anti-suicide function of NSSI. The shortest pathway from persistent NSSI to suicide risk led through depressive symptoms. Other likely pathways (three mediating nodes) led through the functions of NSSI (affect regulation or self-punishment, anti-dissociation, and anti-suicide). Depressive symptoms had the highest centrality. However, it did not differ significantly compared to some functions of NSSI (marking distress, anti-dissociation, toughness, and affect regulation). In university students, persistent NSSI might be directly associated with its functions related to affect regulation and self-punishment, while suicide risk might be directly associated with the anti-suicide function. The observations posit a role of intrapersonal functions in shaping the outcomes of NSSI. Depressive symptoms and some NSSI functions might be the most promising targets for interventions in this population.

Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review.

The following databases were searched for relevant articles in July 2020: PubMed, EMBASE, CINAHL Plus, and PsycINFO. Studies were included if they sampled young persons aged 10-25years old with a history of NSSI, assessed parenting behavior or style, and tested associations between parenting and NSSI outcomes. A total of 26 studies were included in this review. Among parenting behaviors, low parental support, high psychological control, and high reactive control were more consistently associated with NSSI. Conversely, the evidence for behavioral control is equivocal. There is some evidence that invalidating parenting is also associated with NSSI. Consistent with the wider adolescent psychopathology literature, parenting that is perceived to be supportive, less psychologically controlling and reactive/punitive were less likely to be associated with NSSI. However, these results were largely based on child reports of parenting. Limitations and directions for future research are discussed.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility.

Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

Comparing the roles of behaviour-specific beliefs in the associations between alexithymia and both non-suicidal self-injury and risky drinking: A multi-method assessment of expectancies

• Alexithymia was indirectly associated with both NSSI and risky drinking through behaviour-specific refusal self-efficacy. • Alexithymia was indirectly associated with NSSI through stronger affect regulation expectancies and weaker communication expectancies. • Alexithymia was not indirectly associated with risky drinking through drinking expectancies. • Lab-based measures of affect regulation (NSSI) and sexual enhancement expectancies were stronger predictors of NSSI and risky drinking respectively than equivalent questionnaire-measured expectancies. • Clinically, the current results support interventions that challenge behaviour specific thoughts and beliefs for individuals with high levels of alexithymia. Introduction Alexithymia, a trait encompassing difficulties identifying and describing one's feelings, and a tendency to focus externally, is positively associated with both non-suicidal self-injury (NSSI) and risky drinking. The relationships between alexithymia and both behaviours are well researched, however, it is unclear whether both associations are explained by similar behaviour-specific expectancies . The primary aim of the present research was to investigate and compare the indirect relationships between alexithymia and both behaviours through NSSI and drinking specific expectancies and refusal self-efficacy. The secondary aim was to compare lab-based and questionnaire-based measures of expectancies. Methods A sample of 259 students (80.31% female, M age =19.98; SD = 1.49) answered a series of questionnaires and completed lab-based expectancy tasks to measure the variables of interest. Results Alexithymia was indirectly associated with both NSSI and risky drinking through behaviour-specific refusal self-efficacy. Thus, students with high levels of alexithymia may believe they are incapable of resisting engaging in self-injury or consuming alcohol in circumstances that warrant them to place attention on and/or appraise their feelings. Further, alexithymia was indirectly associated with NSSI through stronger affect regulation and weaker communication expectancies. However, alexithymia was not indirectly associated with risky drinking through drinking-specific expectancies. Limitations Cross-sectional methods preclude conclusions regarding temporal ordering. Conclusion Theoretically, these findings suggest that anticipated outcomes of NSSI and risky drinking may be different for university students. Clinically, the current results support interventions that challenge behaviour specific thoughts and beliefs for students who have difficulties identifying and describing feelings.

Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics.

More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; Mage = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; Mage = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.

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.

Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults’ Non-Suicidal Self-injury

Objective Clinical phenomena often feature skewed distributions with an overabundance of zeros. Unfortunately, empirical methods for dealing with this violation of distributional assumptions underlying regression are typically discussed in statistical journals with limited translation to applied researchers. Therefore, this investigation compared statistical approaches for addressing highly skewed data as applied to the evaluation of relations between child maltreatment and non-suicidal self-injury (NSSI). Method: College students (N = 2,651; 64.2% female; 85.2% nonwhite) completed the Child Abuse and Trauma Scale and the Functional Assessment of Self-Mutilation. Statistical models were applied to cross-sectional data to provide illustrative comparisons across predictions to a) raw, highly skewed NSSI outcomes, b) natural log, square-root, and inverse NSSI transformations to reduce skew, c) zero-inflated Poisson (ZIP) and negative-binomial zero-inflated (NBZI) regression models to account for both disproportionate zeros and skewness in the NSSI data, and d) the skew-t distribution to model NSSI skewness. Results: Child maltreatment was significantly and positively related to NSSI frequency in the raw, transformation, and zero-inflated models, but this relation was negative in the skew-t model. Conclusions: These findings highlight the importance of using zero-inflated models rather than transformation approaches to address data skew. Moreover, whereas the skew-t distribution has been used to model skewed non-clinical data, this study suggests that the skew-t approach may not be well-suited to address skewed clinical data.

Knowledge of parental nonsuicidal self-injury in young people who self-injure: the mediating role of outcome expectancies

ABSTRACT Many dysregulated behaviours, used to cope with intense or unwanted emotion, can be learned in an interpersonal context. Nonsuicidal self-injury (NSSI) is potentially one such behaviour. In this study we explored whether knowing a parent self-injured was related to NSSI among young adults, and whether such an association was associated with thoughts and beliefs about NSSI. Specifically we tested the roles of anticipated outcomes of NSSI, and belief in the ability to resist urges to self-injure, in this relationship. A sample of 669 university students, aged between 17 and 30 years (M = 20.77, SD = 2.31), completed self-report measures of the constructs of interest. Of the sample 43 (6.4%) were aware of a parent self-injuring; this was associated with a threefold increase in history of NSSI reported by participants. This relationship was mediated by expectations that NSSI would relieve negative affect, and weaker expectations of resulting physical pain. The relationship between pain expectancies and NSSI was moderated by self-efficacy to resist NSSI. The results suggest that knowledge of parental NSSI may be a risk factor for NSSI among their children, and that cognitions about NSSI could be a potential mechanism explaining this relationship.

Relations of anxiety sensitivity dimensions to nonsuicidal self-injury frequency and versatility among patients with substance use disorders.

Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self-injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic background, negative affectivity). AS dimensions were expected to account for additional unique variance in NSSI outcomes. Participants included 204 patients (50.5% female) with substance use disorders in residential treatment. In this sample, 37.2% reported a history of NSSI. The hierarchical regression models revealed a unique positive association between AS social concerns and NSSI outcomes when adjusting for model variables. In contrast, AS physical concerns were uniquely negatively associated with NSSI outcomes. Findings provide support for AS social concerns as a vulnerability for engagement in NSSI behaviors and highlight this particular AS dimension as a potential treatment target for NSSI prevention and intervention programs.

Does nonsuicidal self-injury prospectively predict change in depression and self-criticism?

Few studies have investigated nonsuicidal self-injury (NSSI) as a predictor of outcomes other than suicidal self-injury, severely limiting our understanding of this behavior's full range of consequences. Three independent studies were used to examine the prospective association between NSSI and two outcomes: depressive symptoms and self-criticism. Data were collected from samples of (1) adults with past-month NSSI, (2) adults with lifetime NSSI, and (3) adults with past-year NSSI. Studies included one-month and six-month follow-up periods. Results were tested in an internal meta-analysis. Results suggested that NSSI did not prospectively predict changes in self-criticism. No changes in depressive symptoms were seen over shorter follow-up periods; however, NSSI predicted increases in depressive symptoms at six-month follow-up in one sample. The internal meta-analysis indicated a null relationship between NSSI and prospective internalizing symptoms. Future research should replicate these findings and examine a broader range of outcomes of NSSI to better understand its complex relationship to psychopathology.

The Non‐Suicidal Self‐Injury Expectancy Questionnaire: Factor structure and initial validation

BackgroundModels of non‐suicidal self‐injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI‐related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire.MethodsA total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students.ResultsPrincipal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self‐Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self‐efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity.ConclusionsThe questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.

The unique contribution of acceptance without judgment in predicting nonsuicidal self-injury after 20-weeks of dialectical behaviour therapy group skills training

The current research tested whether four dimensions of mindfulness – acceptance without judgment, observing, describing and acting with awareness – predicted frequency of nonsuicidal self-injury (NSSI) and mediate the relationship with NSSI outcomes during 20-weeks of Dialectical Behaviour Therapy (DBT) skills training for borderline personality disorder (BPD). Eighty-four self-harming individuals with BPD were randomized to either DBT skills training or to a waitlist control group. A series of regressions revealed no relationship between dimensions of mindfulness and NSSI at baseline. There was a significant effect of DBT skills training on NSSI. As well, mediation analysis indicated that acceptance without judgment, specifically, mediated the relation between DBT skills training and change in frequency of NSSI.