青少年非自杀性自伤行为持续和停止的预测性因素

非自杀性自伤是指个体在没有自杀意图的情况下故意伤害自己的身体,且不被社会所认可的行为,是个体未来自杀意图、自杀行为以及长期心理障碍等问题的重要风险因素。青少年作为高发人群,非自杀性自伤行为会对其身心健康造成严重危害,且具有明显的社会“传染”效应。因此了解对青少年非自杀性自伤行为的持续或停止具有预测作用的因素,有助于为该行为的早期预防及干预提供新视角。 通过梳理国内外采用纵向追踪、回溯性研究等方法的相关文献,并基于Nock的整合理论模型,将青少年非自杀性自伤行为的持续或停止具有预测作用的因素划分为生理机制、个人特质和社会因素三类。在生理机制上,青少年非自杀性自伤行为的持续或停止存在一定的神经生物学基础,如当青少年体内的β-内啡肽水平、杏仁核-额叶之间的静息态功能连接(RSFC)处于异常状态时,个体为恢复体内平衡,可能会对非自杀性自伤行为产生依赖,进而将该行为持续下去。在个人特质上,情绪调节存在缺陷的青少年更易出现并维持非自杀性自伤行为,而善于接受自己的情绪反应且能够使用适应性情绪调节策略的青少年在未来更易停止该行为;具有边缘型人格障碍、冲动型人格特征、低自尊水平、高自我批评与自我惩罚水平等特点的青少年通常会在较长时间内持续非自杀性自伤行为,相反,具有高自尊水平、对逆境持积极信念、低自我惩罚水平等特点的青少年则更可能停止该行为;青少年所依赖的非自杀性自伤功能也会影响该行为的发展进程,因自我功能(如情绪调节、自我惩罚等)而依赖于非自杀性自伤的青少年有很大的可能性长时间维持这一行为,而因人际功能(如引起他人关注、融入群体等)而依赖于非自杀性自伤的青少年在一段时间后更有可能停止该行为。在社会因素上,如同伴欺凌、不良家庭关系等风险因素可能会削弱个体应对痛苦的能力,进而诱发或加剧青少年的非自杀性自伤行为,反之,有效的社会支持资源(如同伴支持、家庭支持、心理咨询与治疗等)则有助于青少年非自杀性自伤行为的停止。 目前国内外相关研究多集中于非自杀性自伤行为的流行、研究方法、相关影响因素和功能等领域,对非自杀性自伤行为持续或停止的理论和实践探讨相对较少,未来相关研究应注意采用多样化的研究方法及非自杀性自伤行为测量技术,拓展研究领域(如性格、认知取向等),同时还应关注不同的年龄群体及文化背景差异,以进一步明确对非自杀性自伤行为发展进程具有显著预测作用的风险因素和保护性因素,并深入探究各因素之间的交互作用。     

儿童抑郁的相关家庭因素

由于儿童的身心发展特点,他们往往比成人更易出现抑郁等情绪障碍,并更易受到 情绪障碍的不良影响,而家庭环境与儿童的抑郁倾向有着密切的关系。该文从心理行为层面 简要回顾了近年来儿童抑郁及其相关家庭环境方面的研究,包括儿童抑郁的影响因素、调节 性因素及其作用机制,并结合当前脑科学研究在抑郁的神经生理机制方面的一些新发现,对 心理行为层面和神经生理层面研究的整合问题进行了探讨。     

情绪唤醒影响记忆巩固过程的神经生理机制

白鼠和人类都对情绪唤醒的经历有更好的记忆。情绪唤醒影响记忆巩固的神经生理机制主要有以下几种方式:(a)情绪唤醒或急性应激,会引发个体内部应激激素的释放,从而增强其记忆巩固过程。(b1)杏仁核的激活对情绪唤醒影响记忆巩固过程十分重要,杏仁核内部去甲肾上腺素(NE)的释放影响记忆巩固过程。(b2)杏仁核投射到负责不同类型记忆加工的脑区,如海马和皮层,从而影响记忆。(c)应激激素影响记忆巩固的过程中,杏仁核内NE的激活在这一过程中扮演着重要角色。综上,情绪唤醒影响记忆巩固的过程,涉及到激素调节、神经调节及二者的共同作用。     

早期应激对情绪调节的影响及其神经机制

在个体生命早期遭遇的长期或重大的应激经历会显著增加个体罹患抑郁、焦虑等心理疾患的风险, 而情绪调节能力的损伤是引发这些心理疾患的重要因素之一。以人类为对象的行为实验和调查研究表明, 早期应激不仅会影响日常生活中情绪调节策略的使用, 还会对情绪调节能力造成影响, 其影响方向可能与早期应激的严重程度有关。目前, 大部分研究表明严重的早期应激会损伤情绪调节能力, 但中度的早期应激也可能提高情绪调节能力。更为整合性的研究表明情绪调节能力中介了早期应激和各类疾患之间的关系。进一步, 我们从神经层面上阐述了早期应激对情绪调节相关脑区和神经环路的影响。未来研究应当注意控制无关变量, 进一步探究不同早期应激对于情绪调节的影响。     

抑郁个体对社会反馈的加工：研究现状及存在问题

抑郁症伴随着严重的社会功能障碍。本文以“社会反馈”这一重要社会性信息为切入点,综述了抑郁症患者及抑郁倾向人群对社会反馈的体验、期待及情绪调节障碍的研究现状,发现抑郁个体对社会奖赏存在快感缺失,对社会排斥、社会拒绝等负性反馈表现出过敏化,对社会奖赏的期待降低,且可能存在情绪调节困难。目前此领域存在社会与非社会反馈神经机制的异同不清楚、异常脑区与社会反馈加工障碍的因果关系难以确定以及无法排除抑郁症患者和抑郁倾向人群存在不同社会反馈加工模式的可能性等问题。     

情绪通路异常与认知情绪偏差:慢性痛与抑郁症共病的神经心理机制

慢性疼痛与抑郁症具有高度共病性,但迄今尚无成熟理论能够阐释二者共病的神经心理机制。对慢性痛与抑郁的脑机制研究提示,慢性痛和抑郁常常涉及到相似的情绪脑区活动的异常改变;与此相对应的是,行为学研究发现,疼痛患者与抑郁患者在加工疼痛或抑郁相关信息时表现出了模式相似的认知情绪偏差(CAB)。近年来,越来越多证据趋于一致,指出慢性痛和抑郁共有的情绪通路异常变化可能导致了相似的信息加工异常,是二者共病的神经心理基础,而认知情绪偏差则在行为上反映了这种变化,并且很可能是共病发生、发展及维持的重要因素。     

毒品成瘾者情绪加工及应对方式的特点:基于负性情绪的视角

负性情绪是导致个体毒品成瘾及复吸的主要心理因素。毒品成瘾者在情绪加工过程中会夸大负性刺激,产生负性化偏向,提高负性情绪的唤醒度,最终导致其产生更多负性情绪体验。而当毒品成瘾者体验到诸如焦虑、抑郁、压力等负性情绪时,他们却更倾向于使用毒品来缓解或逃避负性情绪带来的不愉快体验。研究表明,毒品成瘾者这种负性情绪加工异常的根本原因在于长期毒品滥用所导致的个体大脑情绪回路相关脑区的受损,如杏仁核、海马、额叶等。未来研究应更进一步探讨成瘾者负性情绪加工与毒品成瘾之间的关系;并对戒断者在负性情绪加工能力的恢复方面做进一步探索,开展更多的关于如何改善成瘾者及戒断者对负性情绪应对方式的研究,从而更为有效抑制个体对毒品形成的心理依赖及强迫的药物渴求行为。     

儿童抑郁的相关家庭因素

由于儿童的身心发展特点,他们往往比成人更易出现抑郁等情绪障碍,并更易受到情绪障碍的不良影响,而家庭环境与儿童的抑郁倾向有着密切的关系。该从心理行为层面简要回顾了近年来儿童抑郁及其相关家庭环境方向的研究,包括儿童抑郁的影响因素、调节性因素及其作用机制,并结合当前脑科学研究在抑郁的神经生理机制方面的一些新发现,对心理行为层面和神经生理层面研究的整合问题进行了探讨。     

胚胎期可卡因、吗啡暴露影响子代成瘾相关行为的神经发育机制

孕期使用毒品可影响胎儿大脑的正常发育,导致脑内神经递质系统异常以及行为的改变.近年来不断有研究证据提示,胚胎期接触可卡因、吗啡等成瘾药物,可以影响神经细胞的增殖、迁移或凋亡等发育过程,使中脑皮层边缘系统中多巴胺、GABA、谷氨酸等神经元形态、受体功能以及突触可塑性发生改变,从而导致子代的学习记忆和成瘾易感性等行为异常.本文将从行为、神经发育、递质系统以及脑功能等层面归纳胚胎期用药对成瘾相关行为影响机制的重要研究进展,并试图提出可能的研究展望.     

亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响：挫败感和人生意义感的作用

基于生态系统理论和动机-意志整合模型,采用问卷法以930名青少年(年龄=15.24±1.66岁)及其父母为研究对象,构建一个有调节的中介模型,从家长与孩子双视角分析孩子体验到的亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响路径。结果显示：(1)相比低亲子关系-低教育卷入一致的个体,高亲子关系-高教育卷入的青少年有着更低水平的挫败感,且相比于低亲子关系-高教育卷入的青少年,有着高亲子关系-低教育卷入的个体表现出更低水平的挫败感;(2)挫败感在亲子关系-教育卷入与青少年抑郁、自伤和自杀意念之间起部分中介作用;(3)人生意义感调节该中介模型后半段,即挫败感对青少年抑郁、自伤和自杀意念的影响,具体表现为随着人生意义感的增加,挫败感对抑郁、自伤和自杀意念的影响逐渐减小。研究从家庭关系中家长与孩子双视角,揭示了挫败感和人生意义感的中介与调节作用,为青少年抑郁、自伤和自杀意念的发生机制提供更多解释路径。     

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.     

Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors

The question of why some people do things that are intentionally harmful to themselves continues to puzzle scientists, clinicians, and the public. Prior studies have demonstrated that one fairly extreme, direct form of self-harm, non-suicidal self-injury (NSSI), is maintained by both automatic (i.e., intrapersonal) as well as social (i.e., interpersonal) reinforcement. However, the majority of theoretical and empirical papers on this topic focus almost exclusively on the automatic functions. The purpose of this paper is to provide a more comprehensive analysis of the social functions of NSSI. Evidence is presented supporting the notion that NSSI is maintained by social reinforcement in at least a substantial minority of instances. Moreover, an elaborated theoretical model of the social functions of NSSI is outlined that proposes that this behavior represents a high intensity social signal used when less intense communication strategies fail (e.g., speaking, yelling, crying). The model further proposes that NSSI can serve not only as a signal of distress that is reinforced primarily by the caregiving behavior it elicits from others, but that it can also serve as a signal of strength and fitness that is reinforced by warding off potential threats (e.g., peer victimization), and in some cases can strengthen affiliation with others. Support for this theoretical model is drawn from diverse literatures including psychology, evolutionary biology, and cultural anthropology. The paper concludes with specific recommendations for empirical tests of the proposed model of the social functions of NSSI, as well as other harmful behaviors such as alcohol and drug use.     

Late adolescent nonsuicidal self-injury: the roles of coping style, self-esteem, and personality pathology

This study examined the relationship between late adolescent nonsuicidal self-injury (NSSI) and coping style, self-esteem, and personality pathology. Participants were 302 late adolescent (18-19-year-old) college students who completed questionnaires on self-esteem, coping style, personality disorder symptoms, and NSSI. Participants who engaged in NSSI reported more personality pathology, more maladaptive coping styles, less rational coping, and lower self-esteem than did non self-harming participants. As hypothesized, total NSSI correlated with several personality disorders, emotional coping style, and inversely related to self-esteem and adaptive coping styles. Regression equations tested several mediation models to determine whether self-esteem or coping style mediates the relationship between personality disorder symptoms and NSSI. Emotional coping and self-esteem each fully mediated the relationship between various personality disorders and NSSI in the anticipated direction. Results also indicate self-esteem, rational, detached, and emotional coping partially mediate the relationship between several personality disorders and NSSI.     

Self-Criticism Impacts Emotional Responses to Pain

Nonsuicidal self-injury (NSSI) is associated with numerous negative outcomes (e.g., suicide attempts), making it a focus of great clinical concern. Yet, mechanisms reinforcing NSSI remain unclear. The benefits and barriers model proposes that NSSI engagement is determined by both benefits of and barriers to NSSI. Benefits include mood improvement, a function reported by most who engage in NSSI; barriers include a desire to avoid pain and bodily harm. Self-criticism is generally understood as a trait lowering desire to avoid pain and bodily harm, thus decreasing that specific barrier. However, recent research demonstrated that self-criticism may also increase NSSI benefits. Highly self-critical people may view NSSI and pain in the context of feeling deserving of pain and punishment—thus, pain may improve mood for self-critical individuals. We tested whether self-criticism impacted emotional responding to pain among adult females with (n = 44) and without (n = 65) NSSI histories. After a negative mood induction, participants rated their moods before, during, and after self-administered pain. In participants with and without NSSI histories, self-criticism was positively correlated with mood improvements during pain. Thus, regardless of NSSI history, self-criticism impacted emotional responses to pain. Together, results suggest that self-criticism may not only decrease an important NSSI barrier but also enhance NSSI benefits, specifically leading to more mood improvement during pain.     

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.     

Assessing the Functions of Non-suicidal Self-injury: Psychometric Properties of the Inventory of Statements About Self-injury (ISAS)

The present study reports the psychometric properties of the Inventory of Statements About Self-injury (ISAS), a measure designed to comprehensively assess the functions of non-suicidal self-injury (NSSI). The ISAS assesses 13 functions of NSSI, as well as the frequency of 12 NSSI behaviors. The ISAS was administered to 235 young adults from a college population who had performed at least one NSSI behavior. Consistent with previous research, ISAS functions comprised two factors representing interpersonal and intrapersonal functions. In addition, the ISAS factors exhibited excellent internal consistency and expected correlations with both clinical constructs (e.g., borderline personality disorder, suicidality, depression, anxiety) and contextual variables (e.g., tendency to self-injure alone). Findings support the reliability and validity of the ISAS. The ISAS may be useful in research and treatment contexts as a comprehensive measure of NSSI functions.     

Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N = 106; 82.1 % female) and inpatient (N = 174; 75.9 % female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6–12 months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.     

Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.     

Adolescent non-suicidal self-injurious behavior: The latest epidemic to assess and treat

Non-suicidal self-injury (NSSI) among adolescents is a serious and prevalent problem. This article reviews the epidemiological data as well as the existing treatments for adolescents who engage in NSSI. The authors also present the unique features of dialectical behavior therapy, the gold-standard evidence-based treatment for adults who engage in NSSI, and discuss its promise as an effective treatment for adolescents who engage in NSSI. Finally, the authors present a clinical vignette of an adolescent engaging in NSSI and how DBT works to target this maladaptive behavior.This article reviews first the epidemiological data and then the existing treatments for adolescents engaging in non-suicidal self-injurious behavior (NSSI). Next, the authors present the unique features of one particular therapy, called dialectical behavior therapy, for adolescents who engage in NSSI. Finally, the article concludes with a clinical vignette in which dialectical behavior therapy is applied to an adolescent engaging in NSSI.     

Nonsuicidal Self-Injury in Adolescents Placed in Youth Welfare and Juvenile Justice Group Homes: Associations with Mental Disorders and Suicidality

Nonsuicidal self-injury (NSSI) is a frequent phenomenon in adolescents, however there is a lack of studies on the prevalence of NSSI in adolescents placed in youth welfare and juvenile justice group homes. The goal of the present study is to investigate the prevalence rates of NSSI and mental disorders in adolescents living in the youth welfare system, as well as how occasional and repetitive NSSI differ with respect to mental disorders, suicidality, and gender. The sample consisted of 397 adolescents aged 12 to19 years (mean age = 15.98, SD = 1.77, 65.7% male) placed in youth welfare and juvenile justice group homes. NSSI, suicidality, and mental disorders were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS-PL). Lifetime prevalence rates of occasional and repetitive NSSI were 21.9% and 18.4%, respectively and 85.6% of the sample endorsed a lifetime mental disorder. Occasional and repetitive NSSI were significantly associated with depressive, conduct, and substance use disorders (d = 0.50–0.67) among both genders. Prevalence rates of repetitive NSSI in youth welfare and juvenile justice institutions are higher than in the general population and males who engage in NSSI are at particularly high risk of suicidality. Due to the high prevalence of NSSI and its related problems, NSSI should be routinely assessed in this vulnerable population and staff should be trained in recognizing and handling NSSI as well as supporting adolescents in improving their emotion regulation skills.