Self-Criticism and Depressive Symptoms Mediate the Relationship Between Emotional Experiences With Family and Peers and Self-Injury in Adolescence

Although the relationship between negative childhood experiences, peer victimization, depressive symptoms, and Non-Suicidal Self-Injury (NSSI) is widely recognized, the mechanisms involved are not fully understood, especially among adolescents. This study aims to test the mediating role of both self-criticism and depressive symptoms in the relationship between memories of negative or positive experiences, current peer victimization, and NSSI. The sample consists 854 Portuguese adolescents, 451 female and 403 male, with ages between 12 and 18 years (M = 14.89; SD = 1.79), from middle and secondary schools. Participants answered self-report measures. Results from path analysis showed that memories of negative experiences, the absence of positive memories with family in childhood and peer victimization indirectly impact on NSSI through self-criticism and depressive symptoms. In addition, these stressful experiences led to depressive symptoms through self-criticism. Lastly, the most severe form of self-criticism indirectly impacts on NSSI through depressive symptoms, even though it also has a strong direct effect. It suggests that negative experiences with parents and peer victimization, as well as the absence of positive memories with family, have a negative impact on NSSI when these experiences are linked with a sense of self-hatred and depressive symptoms.     

Introduction to the Special Issue on Interoception and Suicidality

Empirically informed theories of suicide highlight the importance of identifying factors that lead from suicide ideation to suicidal behavior. Interoceptive dysfunction may be one such differentiating factor. Interoceptive dysfunction refers to a disconnection from the internal sensations of the body, which can cause difficulty in truly understanding and knowing one’s own body. Specifically, interoceptive dysfunction may lead to such disconnection from the self that the body comes to be seen as “other” and potentially even “nonhuman.” A burgeoning body of research supports these theoretical links and also highlights the need for methodologically rigorous studies that employ careful measurement of these constructs. Thus, this special section is devoted to articles that advance the understanding of the relationship between interoception and suicidality. A more nuanced understanding of the relationship between interoceptive dysfunction and suicidality is critical for improving suicide prevention and treatment efforts.     

Interoception,Pain Tolerance,and Self-Injurious Behaviors: A Multidimensional Assessment

Impairments in interoception have been linked to self-injurious behaviors, and capability for suicide may account for this relationship. However, past studies have relied primarily on self-report and unidimensional measures. The present study aimed to replicate and extend previous findings by examining the relationship between interoceptive dysfunction, pain tolerance, and self-injurious behaviors using a multidimensional and multi-method approach. A sample of 245 undergraduate students (M_age = 19.27 years, SD = 2.81; 73.7% female, 72.% White/European American), who reported lifetime suicidal ideation on a screening survey completed a battery of self-report measures, four counterbalanced pain tolerance tasks, and a clinical interview assessing their self-injurious behaviors. A tendency to stay attuned to bodily sensations was significantly related to decreased pain tolerance. Only trust in one’s body was significantly related to decreased presence of lifetime suicide attempts. No other facets of interoception or pain tolerance were significantly associated with self-injurious behaviors. Overall, these findings contrast with previous findings that capability for suicide may account for relations between interoceptive dysfunction and self-injurious behaviors. Nonetheless, the results of this study provide important information on the factor structure of interoceptive dysfunction and pain tolerance, and highlight the importance of careful selection of measures and operationalization of key constructs, particularly interoceptive dysfunction and pain tolerance.     

Perceived Parental Rearing Style, Self-Esteem and Self-Criticism as Predictors of Happiness

This study set out to determine to what extent three recalled parental (care, discouragement of behavioural freedom, denial of psychological autonomy), self-esteem, and self-criticism predicted self-rated happiness in a normal, non-clinical, population of young people in their late teens and early 20s. Three hundred and sixty-five participants completed four questionnaires: Parental Bonding Instrument (Parker, Tupling and Brown: 1979, British Journal of Medical Psychology 55, pp. 1–10), Rosenberg Self-Esteem Scale (Rosenberg: 1965, Society and the Adolescent Self-Image (Princeton University Press, Princeton, NJ)), Self-Criticism Questionnaire (Brewin, Firth-Cozens, Furnham and McManus: 1992, Journal of Abnormal Psychology 101, pp. 561–566), and the Oxford Happiness Inventory (Argyle, Martin and Crossland: 1989, Recent Advances in Social Psychology: An International Perspective (Elsevier, North Holland)). Regressions showed self-esteem (the positive five items) to be the most dominant and powerful correlate of happiness. Maternal care was a significant correlate of both self-esteem and self-criticism. Maternal care was the only direct correlate of happiness when paternal and maternal rearing styles were examined together suggesting that the warmth showed by mothers towards their children was particularly beneficial in increasing the offsprings' scores on self-reported happiness. This revised version was published online in August 2006 with corrections to the Cover Date.     

Variability in the Functions of Nonsuicidal Self-Injury: Evidence From Three Real-Time Monitoring Studies

Despite functional models of nonsuicidal self-injury (NSSI) helping to explain why people engage in this perplexing behavior, we still lack an understanding of some of the key properties of NSSI functions. Here, we address three unanswered questions about NSSI functions: how much do distinct NSSI functions (1) vary between people over time, (2) vary within people over time, and (3) simultaneously co-occur over time? Data were drawn from three ecological momentary assessment (EMA) studies of self-injurious adult psychiatric outpatients (n = 7), community-based adolescents (n = 15), and community-based adults (n = 9). Across the three studies, there was a total of 271 NSSI episodes (all with corresponding functions captured by EMA). The vast majority (27 of 31; 87%) of participants exhibited unique patterns of NSSI functions during the monitoring periods, indicating high variability between people. The vast majority (26 of 31; 84%) of participants also showed changes in NSSI functions over time, indicating high variability within people. Although it was most common for only one function to be reported for a given NSSI episode, participants endorsed more than one function for 22% to 43% of NSSI episodes, indicating that different functions did simultaneously co-occur. These results underscore that reinforcement processes for NSSI differ from person-to-person, and are both time-varying and multifaceted, which has implications for personalized assessment and treatment of this clinical phenomenon.     

Mixture Modeling of Nonsuicidal Self-Injury and Binge Eating: Behaviors and Motives

Nonsuicidal self-injury (NSSI) and binge eating frequently co-occur. These behaviors are often used to alleviate distress. Previous studies examining this co-occurrence have used a variable-centered approach. The current study used a person-centered approach (mixture modeling) to examine how individuals cluster in groups based on their past-month NSSI, past-month objective and subjective binge episodes (OBEs and SBEs, respectively), and endorsement of coping motives for NSSI and eating in two large samples of emerging adults. Validators included self-report measures of emotion regulation, impulsivity, and negative affect. In Study 1, additional validators included lifetime history of mental health treatment and suicide attempts. In Study 2, additional validators included child abuse history. In both Study 1 and Study 2, a three-class solution provided the most interpretable fit with classes characterized as (a) low psychopathology; (b) the presence of OBEs and NSSI, and endorsement of NSSI coping motives; and (c) the presence of SBEs and NSSI, and endorsement of high levels of NSSI coping motives. In both studies, eating motives were equivalent in Classes 2 and 3, but NSSI motives were most strongly endorsed by Class 3. In Study 1, Class 2 endorsed higher rates of lifetime suicide attempts than Class 3. In Study 2, both Class 2 and Class 3 endorsed higher rates of child abuse than Class 1, although they did not differ from each other. The class structure and validator analysis were consistent across samples and measures. Results suggest that binge eating and NSSI tend to cluster together in otherwise healthy emerging adults.     

Prospective prediction of nonsuicidal self-injury: a 1-year longitudinal study in young adults

Nonsuicidal self-injury (NSSI) has become a significant public health problem. Although numerous studies have examined cross-sectional psychological correlates of NSSI, there has been little research examining predictors of NSSI over time. The present study examined cross-sectional and longitudinal correlates of NSSI in 81 young adult self-injurers (M age = 19, 74.1% female, 51.9% Caucasian), 51 of whom were followed up 1 year later. At baseline, participants completed self-report measures of NSSI, Axis-I disorders, borderline personality disorder (BPD), and impulsivity, as well as an implicit measure of NSSI attitudes and identity. One year later, participants completed a Timeline Followback Method whereby they indicated their engagement in NSSI over the previous 12 months. Analyses replicated many known cross-sectional correlates of NSSI, including symptoms of several Axis-I disorders and BPD. However, many of these same variables failed to predict the course of NSSI over the 1-year follow-up. The only variables to prospectively predict NSSI were past NSSI (i.e., frequency, methods, and recency of NSSI), participants’ behavioral forecast of their engagement in future NSSI, and BPD features. Findings suggest that many cross-sectional correlates of NSSI may not be useful for predicting subsequent NSSI. Instead, NSSI severity and BPD features appear to best predict continued engagement in NSSI.     

Composite Trauma and Mental Health Diagnosis as Predictors of Lifetime Nonsuicidal Self-Injury History in an Adult Online Sample

Some research indicates that trauma history might be related to nonsuicidal self-injury (NSSI), but the exact nature of this relationship is unknown. Therefore, we created and tested a structural equation model for the relationships between composite trauma, NSSI, mental health diagnosis, and gender in a community sample of 296 U.S. adults recruited through Amazon Mechanical Turk. Composite trauma and mental health diagnosis were significantly predictive of an NSSI history. The pathway between NSSI and gender was not significant. It is important to consider multiple domains of trauma, in the form of composite lifetime trauma, as risk factors for NSSI.     

Why Do People Hurt Themselves?: New Insights Into the Nature and Functions of Self-Injury

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

A Brief Report on Predicting Self-Harm: Is It Gender or Abuse that Matters?

Self-harm, which consists of nonsuicidal self-injury and attempted suicide, is a public health problem that is not well understood. There is conflicting evidence on the role of gender in predicting self-harm. Abuse history also is a potentially relevant factor to explore, as it is related to both gender and self-harm. In this study, we hypothesized that abuse history, as opposed to gender, would predict self-harm. Three hundred and ninety-seven undergraduates completed a self-report survey that assessed abuse history, nonsuicidal self-injury, and attempted suicide. The results suggested that abuse history predicted nonsuicidal self-injury and attempted suicide. These findings can inform clinical interventions as they reinforce the importance of including abuse history in the conceptualizations and treatment of self-harm.     

自我批评与青少年自伤:有调节的中介效应

采用情绪调节量表、自我批评量表、心理痛苦量表和自伤行为量表对914名中学生进行测查,从中筛选出311名有自伤行为的青少年进行统计分析,探讨自我批评与青少年自伤行为的关系,并在此基础上提出一个有调节的中介模型,考察心理痛苦的中介作用和认知重评的调节作用。结果表明:(1)在控制了性别和是否独生子女的影响后,自我批评可以显著正向预测青少年的自伤行为,心理痛苦在二者之间起中介作用;(2)自我批评通过心理痛苦对自伤行为的间接效应受到认知重评的调节,认知重评可以减弱自我批评对自伤行为的间接影响。     

Emotion Differentiation as a Protective Factor Against Nonsuicidal Self-Injury in Borderline Personality Disorder

Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.     

Every scar tells a story: Insight into people’s self-injury scar experiences

Scarring, a common and salient consequence of non-suicidal self-injury (NSSI), remains an under-explored issue in the field. Thus, the current investigation explored NSSI scar perspectives using online testimony from members of a popular NSSI message board; focus was attenuated to a series of message board posts pertinent to people’s experiences with scars resulting from NSSI. Data (message board posts) were collected using the website’s search function. A total of 53 posts involving discussion of people’s NSSI scar perceptions and experiences were retained. A thematic analysis of the data indicated that individuals viewed their scars in a number of ways. Many viewed scars in a resilient manner, often in the context of a self-narrative. Others, however, were unaccepting of their scars (e.g. expressed feelings of shame, hatred, or disgust). For some, they were able to gradually accept their scars but only after a period of difficulty. And, finally, some individuals expressed mixed feelings toward their scars (e.g. a love/hate relationship). Hence, scars stemming from NSSI seem to differentially impact individuals who self-injure. Possible implications for research and clinical practice are discussed.     

Nonsuicidal Self-Injury Is Associated With Attenuated Interoceptive Responses to Self-Critical Rumination

Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior. Those with a history of NSSI often report high levels of self-critical rumination (SCR), a form of negatively valenced introspective self-referential processing. It is plausible that this overly analytical style of relating to the self might hinder the ability to process interoceptive signals, thereby increasing the capacity to engage in behaviors that cause bodily harm. Two studies investigated whether trait or state SCR influenced aspects of interoception in those with and without a history of NSSI. In Study 1 (N = 180), irrespective of NSSI history, trait SCR was associated with finding attending to the heartbeat unpleasant. However, no associations were observed for interoceptive confidence, or metacognitive insight into their interoceptive abilities (confidence–accuracy correspondence). Trait SCR was associated with having higher interoceptive accuracy, but only in those without a history of NSSI. In Study 2 (N = 98), irrespective of NSSI history, state self-criticism led to a more negative interoceptive valence, and reduced participants’ metacognitive insight. In those without a history of NSSI, state self-criticism also increased interoceptive accuracy—an effect attenuated in those with NSSI. These findings suggest that those with NSSI are characterized by a blunted interoceptive response to negatively valenced self-focused attention.     

Proximal Predictors of Depressive Symptomatology: Perceived Losses in Self-Worth and Interpersonal Domains and Introjective and Anaclitic Mood States

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Self-Criticism,Neediness, and Distress in the Prediction of Suicide Ideation: Results from Cross-Sectional and Longitudinal Studies

The aim of the present study was to test whether the maladaptive personality traits of self-criticism and neediness predict suicide ideation when controlling for general distress. Further, potential interactive effects on suicide ideation of the two traits and distress were also evaluated. Two studies with nonclinical samples were conducted. The first investigation was cross-sectional and involved a final sample of 202 community adults while the second study was longitudinal with a final sample of 207 college students. Results of Study 1 demonstrated that self-criticism, but not neediness, associated with suicide ideation and, in doing so, also interacted with distress. Neediness also tended to interact with self-criticism in the prediction of suicide ideation. Results from Study 2 were similar and confirmed the Study 1 results. Changes in self-criticism, but not changes in neediness, predicted changes in suicide ideation after statistically controlling for changes in distress. Changes in the interaction between self-criticism and distress predicted changes in suicide ideation and changes in the interaction between self-criticism and neediness tended to predict changes in suicide ideation. Results are discussed with regard to their implications for psychological intervention.     

老年慢性疼痛患者疼痛接受与疼痛程度的相关关系

了解老年慢性疼痛患者疼痛接受与疼痛程度,探讨两者的相关关系.采用简易慢性疼痛接受问卷（CPAQ-8）中文版、简化McGill疼痛问卷（SF-MPQ）与一般情况调查表对335例老年疼痛患者进行调查.结果纳入有效样本308例,SF-MPQ总体平均分为（50.24±23.35）分,中文版CPAQ-8总体平均得分（21.74±5.97）分.老年慢性疼痛患者的受教育程度、疼痛期、疼痛部位及疼痛点数目等差异有统计学意义（P＜0.05）.疼痛接受与疼痛程度呈负相关（P＜0.01）,即接受程度越高者,其疼痛程度越低.     

Relationships Between Physical Symptoms,Emotional Distress,and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.     

Learning from Physical Pain to Help with the Management of Emotional Pain

There may be important similarities between chronic emotional pain and chronic physical pain. Both forms of chronic pain may promote negative beliefs about the self and the future. Chronic emotional pain and chronic physical pain both serve to disrupt patients’ focus from their actions and goals. Techniques used for the treatment of physical pain may be translated into the treatment of emotional pain. Four core strategies are reviewed including: (1) reducing catastrophic interpretations, (2) increasing tolerance by promoting acceptance, (3) cultivating positive expectations, and (4) remaining flexible in movements and attitudes. Patients can learn to tolerate limitations while pursuing their goals. Clinicians can help patients to reduce emotional pain by making a series of small changes in their thoughts and behavior.     

Concordance Between Mothers' and Children's Reports of Somatic and Emotional Symptoms in Patients with Recurrent Abdominal Pain or Emotional Disorders

Mother–child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominal pain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominal pain reported more child somatic and depressive symptoms than did their children, and mothers of children with emotional disorders reported more child depressive symptoms than did their children. Higher levels of maternal distress were associated with greater mother-child discordance in the direction of mothers reporting more child symptoms than did their children. No significant child age or sex differences were found in concordance patterns.