In Eating‐Disordered Inpatient Adolescents,Self‐Criticism Predicts Nonsuicidal Self‐Injury

We examined the role of depressive traits—self‐criticism and dependency—in nonsuicidal self‐injury (NSSI) and suicidal ideation among inpatient adolescents with eating disorders. In two studies (N = 103 and 55), inpatients were assessed for depressive traits, suicidal ideations, and NSSI. In Study 2, motivation for carrying out NSSI was also assessed. In both studies, depression predicted suicidal ideation and self‐criticism predicted NSSI. In Study 2, depression and suicidal ideation also predicted NSSI. The automatic positive motivation for NSSI was predicted by dependency and depressive symptoms, and by a two‐way interaction between self‐criticism and dependency. Consistent with the “self‐punishment model,” self‐criticism appears to constitute a dimension of vulnerability for NSSI.     

Cognitive and Emotion‐Regulatory Mediators of the Relationship Between Behavioral Approach System Sensitivity and Nonsuicidal Self‐Injury Frequency

Nonsuicidal self‐injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS‐relevant cognitive style of self‐criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N = 177) with high and moderate BAS levels completed measures of self‐criticism, positive emotion regulation, brooding, and both lifetime and last‐year frequency of NSSI. Results indicated that self‐criticism and positive emotion dampening independently mediated the relationship between BAS and last‐year frequency of NSSI. Self‐criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion‐regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.     

How Many Times and How Many Ways: The Impact of Number of Nonsuicidal Self‐Injury Methods on the Relationship Between Nonsuicidal Self‐Injury Frequency and Suicidal Behavior

Several variables have been proposed as heavily influencing or explaining the association between nonsuicidal self‐injury (NSSI) and suicidal behavior. We propose that increased comfort with bodily harm may serve as an incrementally valuable variable to consider. We sought to indirectly test this possibility by examining the moderating role of number of NSSI methods utilized on the relationship between NSSI frequency and lifetime number of suicide attempts, positing that increased variability in methods would be indicative with a greater general comfort with inflicting harm upon one's own body. In both a large sample of emerging adults (n = 1,317) and a subsample with at least one prior suicide attempt (n = 143), results were consistent with our hypothesis. In both samples, the interaction term was significant, with the relationship between NSSI frequency and suicidal behavior increasing in magnitude from low to mean to high levels of NSSI methods. Although frequency of NSSI is robustly associated with suicidal behavior, the magnitude of that relationship increases as an individual engages in a wider variety of NSSI methods. We propose that this may be due to an increased comfort with the general concept of damaging one's own body resulting from a broader selection of methods for self‐harm.     

Nonsuicidal Self‐injury in Asian Versus Caucasian University Students: Who,How, and Why?

The correlates of nonsuicidal self‐injury (NSSI) among Asian and Caucasian university students; differences in the rates, frequency, forms, severity, and emotional contexts of NSSI among self‐injuring students; and whether Asian students who are highly oriented toward Asian culture differed from those less oriented toward Asian culture in NSSI characteristics were investigated. University students (N = 931), including 360 Caucasian students (n = 95, 26.4%, with a history of ≥ 1 episode of NSSI) and 571 Asian students (n = 107, 18.7%, with a history of NSSI), completed questionnaires assessing NSSI, acculturation, and putative risk factors for NSSI. Caucasian students were more likely to report NSSI, particularly cutting behavior, self‐injured with greater frequency and versatility, and reported greater increases in positively valenced, high arousal emotions following NSSI, compared to Asian students. Among Asian students, obsessive–compulsive symptoms, experiential avoidance, and anger suppression increased the likelihood of reporting a history of NSSI. Among Caucasian students, lack of emotional clarity and anger suppression increased likelihood of NSSI. Finally, some tentative findings suggested potentially important differences in rates and frequency of NSSI among Asian students who were highly oriented toward Asian culture compared with those less oriented toward Asian culture.     

Factors Associated with Current Versus Lifetime Self‐Injury Among High School and College Students

We sought to identify factors associated with current versus lifetime nonsuicidal self‐injury (NSSI) and factors that show consonant and distinct relationships with current NSSI for adolescents and young adults. Data came from a population‐based survey of high school students (n = 9,985) and a national survey of college students (n = 7,801). Among both samples, factors associated with current NSSI included male gender, younger age, greater depressive symptoms, more hopelessness, and being the victim of a verbal or physical assault. For high school students, greater anxiety, and for college students, identifying as non‐White, negative perceptions of one's weight, a same‐sex sexual experience, and involvement in dating violence also distinguished the groups. Findings suggest that clinical and research assessments of lifetime NSSI might not extend to current behavior, and some differences exist in the factors associated with current behavior between adolescents and young adults. Clinical practice and prevention programming efforts should target certain intrapersonal and interpersonal factors associated with current NSSI among younger students during stressful transition periods in their lives, such as entering high school or college, when they might consider initiating or continuing this behavior.     

Suicidal Behavior Outcomes of Childhood Sexual Abuse: Longitudinal Study of Adjudicated Girls

Childhood sexual abuse (CSA) histories are prevalent among adolescent girls in the juvenile justice system (JJS) and may contribute to their high rates of suicidal behavior. Among 166 JJS girls who participated in an intervention trial, baseline CSA and covariates were examined as predictors of suicide attempt and nonsuicidal self‐injury (NSSI) reported at long‐term follow‐up (7–12 years later). Early forced CSA was related to lifetime suicide attempt and NSSI history and (marginally) to postbaseline attempt; effects were not mediated by anxiety or depressive symptoms. Findings suggest that earlier victimization and younger entry into JJS are linked with suicide attempt and NSSI.     

Does Overgeneralized Autobiographical Memory Facilitate or Inhibit Intrusive Images? Its Relation to Depressive Symptoms

People with high levels of depressive symptoms experience overgeneralized autobiographical memory (OGM) in voluntary recall and intrusive images in involuntary recall. The present study examined the relationship between OGM and intrusive images and the influence of depressive symptoms on this relationship over 1 week. Fifty‐three students completed self‐report questionnaires, autobiographical memory test, and the trauma film paradigm. Subsequently, they reported intrusive images from the trauma film in a diary for 1 week. Hierarchical multiple regression showed that individuals with higher levels of depressive symptoms experienced more intrusive images than did individuals with low depressive symptoms. An interaction effect between negative memory specificity and depressive symptoms revealed that number of intrusive images was related to high negative memory specificity (i.e. low OGM) in individuals with higher levels of depressive symptoms. These results support the functional avoidance strategy of OGM in analogue trauma stimuli, especially in individuals with higher depressive symptoms.Copyright © 2017 John Wiley & Sons, Ltd.     

Risk‐Related and Protective Correlates of Nonsuicidal Self‐Injury and Co‐Occurring Suicide Attempts among Incarcerated Women

Individual and environmental correlates of nonsuicidal self‐injury (NSSI) and co‐occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co‐occurring SA in incarcerated samples.     

Body Regard as a Moderator of the Relation between Emotion Dysregulation and Nonsuicidal Self‐Injury

Despite research documenting a strong association between emotion dysregulation and nonsuicidal self‐injury (NSSI), the moderators of this association have received little attention. Thus, it remains unclear why some individuals with heightened emotion dysregulation engage in NSSI and others do not. Body regard (i.e., how one perceives, experiences, and cares for the body) may be one such moderator, explaining the risk for NSSI among some individuals with emotion dysregulation. The current study used structural equation modeling within a sample of 398 undergraduates (26% reporting NSSI, mean frequency = 25.16, SD = 40.5) to test the interactive effect of emotion dysregulation and body regard on NSSI frequency when controlling for negative affect and borderline personality disorder symptoms. The interaction model provided a strong fit to the data and showed that emotion regulation was associated with NSSI only when low levels of body regard were present. Results suggest that body regard may be important to understanding who engages in NSSI within the context of emotion dysregulation. Possible mechanisms underlying the interaction between body regard and emotion dysregulation are discussed along with treatment and prevention implications.     

The Importance of High Distress Tolerance in the Relationship between Nonsuicidal Self‐Injury and Suicide Potential

Research has indicated that nonsuicidal self‐injury (NSSI) and suicidal behavior are strongly related to one another, with a sizable portion of individuals with a history of NSSI also reporting a history of nonlethal suicide attempts. Nonetheless, little research has examined possible moderators of this relationship. One potentially important construct is distress tolerance (DT), which has been shown to be negatively associated with NSSI and positively associated with the acquired capability for suicide. In this study, 93 adult inpatients (54.8% male) receiving treatment for substance use disorders completed a structured interview assessing prior suicidal behavior and questionnaires assessing DT, NSSI, and psychopathology. Results indicated that DT moderates the relationship between NSSI frequency (but not number of NSSI methods) and suicide potential (a continuum ranging from no prior suicidal behavior to suicidal behavior with minimal bodily harm to highly lethal suicidal behavior), ΔR² = .04; p < .023; f² = .06, with this relation increasing in strength at higher levels of DT. These results are consistent with an emerging line of research indicating that high levels of DT facilitate suicidal behavior in at‐risk populations and suggest that the capacity to tolerate aversive physiological and affective arousal might be vital to engagement in serious or lethal suicidal behavior.     

Nonsuicidal Self‐Injury in College Students: The Role of Perfectionism and Rumination

A paucity of research exists examining personality and cognitive characteristics that may contribute to nonsuicidal self‐injury (NSSI). The purpose of the current study was to clarify the contribution of perfectionism and rumination, along with depression and anxiety, to NSSI within a sample of 170 college students. Group comparisons revealed that participants with a history of NSSI endorsed significantly more rumination and depressive and anxious symptoms then non‐NSSI controls. Results regarding perfectionism were mixed, with NSSI participants differing from controls on select aspects of perfectionism. Results suggest higher levels of depression and anxiety and a ruminative cognitive style may increase vulnerability for NSSI; however, further research is needed to clarify the contribution of perfectionism.     

Compassion‐Based Meditation in African Americans: Self‐Criticism Mediates Changes in Depression

This study examines self‐criticism as a mechanism through which compassion meditation reduces depressive symptoms in low‐income African American men and women (N  = 59) who had recently attempted suicide. After completing several measures, including the Levels of Self‐Criticism Scale and Beck Depression Inventory‐II , participants were randomly assigned to receive either a six‐session compassion meditation (CM ) group (Grady Compassion and Meditation Program) or a six‐session support group. As predicted, path analysis results showed that treatment condition led to changes in self‐criticism from pre‐ to posttreatment, with those receiving CM showing greater reductions in levels of self‐criticism than those randomized to the support group. Path analyses also revealed that changes in self‐criticism fully mediated the link between condition and changes in depressive symptoms. These findings highlight the importance and value of targeting levels of self‐criticism in compassion‐based interventions to reduce the depressive symptoms of suicidal African Americans.     

En Route to Depression: Self‐Esteem Discrepancies and Habitual Rumination

Dual‐process models of cognitive vulnerability to depression suggest that some individuals possess discrepant implicit and explicit self‐views, such as high explicit and low implicit self‐esteem (fragile self‐esteem) or low explicit and high implicit self‐esteem (damaged self‐esteem). This study investigated whether individuals with discrepant self‐esteem may employ depressive rumination in an effort to reduce discrepancy‐related dissonance, and whether the relationship between self‐esteem discrepancy and future depressive symptoms varies as a function of rumination tendencies. Hierarchical regressions examined whether self‐esteem discrepancy was associated with rumination in an Australian undergraduate sample at Time 1 (N = 306; M_age = 29.9), and whether rumination tendencies moderated the relationship between self‐esteem discrepancy and depressive symptoms assessed 3 months later (n = 160). Damaged self‐esteem was associated with rumination at Time 1. As hypothesized, rumination moderated the relationship between self‐esteem discrepancy and depressive symptoms at Time 2, where fragile self‐esteem and high rumination tendencies at Time 1 predicted the highest levels of subsequent dysphoria. Results are consistent with dual‐process propositions that (a) explicit self‐regulation strategies may be triggered when explicit and implicit self‐beliefs are incongruent, and (b) rumination may increase the likelihood of depression by expending cognitive resources and/or amplifying negative implicit biases.     

Self-injury and disordered eating: expressing emotion dysregulation through the body

Previous research has suggested that emotion dysregulation, body‐related concerns, and depressive symptoms are associated with nonsuicidal self‐injury (NSSI) and disordered eating (DE) separately and in combination. However, it has been difficult to ascertain to what extent these constructs contribute to NSSI and DE given the relatively small number of studies examining their co‐occurrence, particularly among nonclinical samples. Based on responses to self‐report questionnaires, college‐aged women who completed the study were divided into three groups: NSSI only; DE only; and NSSI + DE based on clinical cutoff criteria. Results support hypotheses that emotion dysregulation is a shared vulnerability and that body‐related concerns and depression exhibit unique patterns of association across the three groups. It appears that NSSI is best understood as a response to negative affective states relative to DE, which is best understood as a set of behaviors motivated by body image concerns. The presence of both NSSI and DE is primarily influenced by emotion dysregulation and the dominant difficulties linked to each behavior; depression and body dissatisfaction. These findings suggest that treatment and prevention efforts should emphasize emotion regulation skills and differentially target body concerns or depressive symptoms according to the primary behavioral dysfunction that is present.     

Depression Mediates the Relationship Between Distress Tolerance and Nonsuicidal Self‐Injury Among Adolescents: One‐Year Follow‐Up

Through a one‐year follow‐up design, this study examined whether distress tolerance would increase the risk for nonsuicidal self‐injury (NSSI), mediated through depression in a representative sample of adolescents. Participants (N  = 2,170) were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1,832 students were followed‐up one year later (T2). Structure equation modeling results revealed that after controlling NSSI measured at T1, NSSI (T2) was significantly predicted by distress tolerance (T1) and fully mediated through depression (T2). The mediating role of depression in the relationship between distress tolerance and NSSI are discussed.     

Acculturation,self‐construal,mental and physical health: An explorative study of East Asian students in Germany

The present study explores acculturation and its associated aspects of two East Asian student groups with different levels of exposure to German culture (100 international students from East Asian countries [IS]; 61 second generation students of East Asian descent [SGS]). First, we investigated the relationships between acculturation, self‐construal, depressive and somatic symptoms, and differences between the student groups in these variables. Second, the four acculturation types (integration, assimilation, separation and marginalization) were examined regarding their relationship to self‐construal and health outcomes. The results showed that the acculturation dimensions (mainstream, heritage) were relevant to the level of depressive symptoms for IS which was not the case for SGS. Furthermore, IS reported more somatic symptoms whereas there was no difference between the two groups in the level of depressive symptoms. In the analysis of acculturation types, assimilated and integrated students were characterized by high independent self‐construal, while separated and integrated students showed high interdependent self‐construal. Assimilated students displayed the least depressive symptoms of all acculturation groups. This study highlights different characteristics of East Asian students in acculturation, self‐construal and health outcomes, and discusses the complexity of the relationships between acculturation types and health.     

Nonsuicidal Self‐Injury in Adolescents: Characterization of the Disorder and the Issue of Distress and Impairment

Nonsuicidal self‐injury disorder (NSSID) is a condition in need of further study to assess the validity of the potential diagnosis and its suggested criteria. This study examined the NSSID diagnosis and investigated the distress/impairment criterion by comparing community adolescents who met all criteria for NSSID (n = 186) to adolescents with five or more nonsuicidal self‐injury (NSSI) episodes (n = 314), and to a group of adolescents who met all criteria but negated that their NSSI caused them any distress or impairment, thus failing to meet criterion E (n = 29). The NSSID group delimited from the ≥ 5 NSSI group by reporting significantly more frequent and severe self‐injurious thoughts and behaviors, as well as having more experiences of negative life events and higher levels of trauma symptoms. There were also some differences between the NSSID group and adolescents without distress/impairment, which together contribute valuable information on the potential NSSID diagnosis, as well as the discussion of criterion E.     

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.     

The role of emotion reactivity and gender in the relationship between psychopathology and self-injurious behavior

The goal of the present study was to examine emotion reactivity, a broad construct that consists of an individual’s sensitivity, intensity, and persistence of emotional reactions, as a mediator of the relationship between two types of psychopathology (depression symptoms and borderline personality disorder (BPD) symptoms) and history of self-injurious behavior (non-suicidal self-injury (NSSI) and suicide attempts (SA)). We also examined gender as a potential moderator of this relationship. Participants (N = 1914) completed measures of emotion reactivity, psychopathology, and self-injurious behavior. Results using a series of mediated path analyses indicated that emotion reactivity mediated the relationship between (1) depressive symptoms and NSSI in females only, (2) depressive symptoms and SA in females only, and (3) probable BPD diagnosis and NSSI in both genders. Emotion reactivity did not mediate the relationship between probable BPD diagnosis and SA in either gender. Our findings suggest that emotion reactivity is a possible pathway through which depression and self-injurious behavior relate, especially in women. We temper these findings, however, within the context of relatively modest observed effects.     

Identifying Risk for Self‐Harm: Rumination and Negative Affectivity in the Prospective Prediction of Nonsuicidal Self‐Injury

Research suggests nonsuicidal self‐injury (NSSI) may function as a maladaptive strategy to regulate negative emotions, and individuals high in trait negative affectivity (NA) may be particularly at risk. Rumination, a cognitive emotion regulation strategy, may amplify negative affect, increasing the likelihood of NSSI. The current study found that high NA and high rumination interacted to predict both likelihood of engagement in NSSI and frequency of NSSI. This study provides support for the joint contribution of cognitive and temperamental factors impacting the relationship between NA and NSSI and suggests that interventions targeted at maladaptive emotion regulation strategies may help inform individualized treatment.