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.     

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.     

Motivations for Self‐Injury,Affect, and Impulsivity: A Comparison of Individuals with Current Self‐Injury to Individuals with a History of Self‐Injury

Individuals who report nonsuicidal self‐injury (NSSI) are characterized by the tendency to act rashly while experiencing distress (negative urgency), the tendency to act without thinking, and endorsement of both social and affect regulation motives for the behavior. However, very little research has identified characteristics that distinguish current self‐injurers from those with a history of the behavior. The purpose of this study was to compare individuals with current self‐injury to a history of self‐injury on impulsivity‐related personality traits, motives for self‐injury, and distress. Among a sample of 429 undergraduates, 120 reported self‐injury. Among these 120 individuals, 33 endorsed self‐injury within the past month, with a mean frequency of 4.77 acts of NSSI. Within the self‐injury group, current self‐injurers reported higher endorsement of affect regulation motives for NSSI, and higher levels of current negative affect than individuals with a history of self‐injury. There were no differences between current and former self‐injurers on measures of impulsivity, endorsement of social motives for NSSI, or positive affect. We propose that individuals who use NSSI to regulate negative affect may be more likely to repeatedly engage in this behavior over time.     

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.     

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.     

Impulsivity and Nonsuicidal Self-Injury: Examining the Role of Affect Manipulation

The assessment of impulsivity is complicated by the construct’s multi-faceted nature and poor correspondence between self-report and behavioral measures. These complications extend to populations anecdotally described as impulsive, including individuals who engage in nonsuicidal self-injury (NSSI). Research suggests that self-injurers report impulsivity, primarily negative urgency. Thus, negative affect may be an important prerequisite for increased impulsive behaviors. The present laboratory study examined self-report impulsivity differences between individuals with and without a history of NSSI and if self-injurers demonstrated behavioral impulsivity when experiencing negative affect. Undergraduates with (N?=?54) and without (N?=?61) a history of NSSI participated in a two-part laboratory-based study that investigated the role of affect manipulation in impulsivity and NSSI. Participants were randomly assigned to either a negative or a neutral-relaxing mood induction. Participants completed self-report measures of impulsivity, NSSI, and negative affect. A behavioral measure of impulsivity was administered during Session 1 (prior to a mood induction task) and again during Session 2 (following a mood induction task) to determine whether affect had an effect on behavioral impulsivity task performance. Self-injurers reported higher negative urgency and lack of perseverance but did not display impulsivity on the behavioral task, even under conditions of negative affect.     

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.     

Rates of Non-Suicidal Self-Injury: A Cross-Sectional Analysis of Exposure

Research on the social influences associated with rates of non-suicidal self-injury (NSSI) is scarce and limited to studies of contagion within inpatient and residential treatment settings. Using an archival dataset that included 1,965 college students, the current study examined whether exposure to acts of NSSI and/or suicidal behavior in others was associated with increased rates of NSSI. Results supported hypotheses in that participants who knew someone who had engaged in NSSI only, or knew someone who engaged in both NSSI and suicidal behavior were more likely to have engaged in NSSI compared to those not exposed. The findings provide preliminary, albeit indirect, evidence of the potential for social modeling to influence rates of NSSI within college students. Directions for future studies are offered.     

累积环境风险与大学生自伤的关系:情绪调节策略的作用

通过两个子研究分别考察累积环境风险与大学生自伤行为间的关系模式,并探讨注意分散与认知重评两种情绪调节策略对高风险大学生自伤意图的缓解作用。研究1在1066名大学生中采用问卷调查,探索累积环境风险对大学生自伤行为的作用及模式。基于研究1的结果,研究2选取符合高风险背景的62名大学生为被试,采用实验室实验对两种情绪调节策略的作用予以考察。本研究结果表明：累积环境风险对男女大学生自伤行为均有显著的正向作用,且均符合非线性“正加速模式”,但男生群体随累积风险数量增加而引发的自伤行为增长速度明显快于女生。对于高环境风险背景下的大学生,注意分散和认知重评两种策略均能降低其自伤倾向性与自伤认同,但不能降低其自伤意念。这提示应重视对经历了高环境风险的大学生进行情绪调节策略等方面的干预,以减少其采取自伤行为的倾向性。     

Emotional responding in NSSI: examinations of appraisals of positive and negative emotional stimuli,with and without acute stress

Non-suicidal self-injury (NSSI) is commonly used by young adults to regulate emotional responses. Yet, experimental examination of how people who self-injure appraise and respond to emotional stimuli is limited. We examined appraisals of, and responses to, emotive images in young adults who did and did not self-injure, and assessed whether these were impacted by exposure to a stressor. Study 1 (N?=?51) examined whether participants differed in their appraisals of emotional images. Study 2 (N?=?78) assessed whether appraisals of images changed after exposure to the Trier Social Stress Test. Ratings of emotional valence and arousal were collected in both studies; skin conductance was measured as an indicator of physiological arousal in Study 2. In Study 1 participants reporting NSSI rated positively valenced images as less pleasant than participants not reporting NSSI. In Study 2, after acute stress, participants reporting NSSI displayed dampened physiological reactions to positive images whereas participants who did not self-injure displayed heightened physiological reactions to these and rated them as more pleasant. Individuals who self-injure seem less able to engage in strategic mood repair after exposure to stress compared to people who do not self-injure.     

Major life events and major chronic difficulties are differentially associated with history of major depressive episodes

Major life events have been found to precede onsets of a 1st lifetime episode of depression more commonly than subsequent recurrences. Despite general empirical support for this finding, few data directly address how the role of major life events may change over successive recurrences. Further, little research has examined major chronic difficulties in relation to a 1st lifetime episode versus a recurrence of depression. The present study tested the associations between major life events and major difficulties in relation to lifetime history of depressive episodes in a sample of 96 individuals diagnosed with major depression. Using investigator-based measures of life stress, the authors found that, whereas major life events were associated with fewer lifetime episodes, major chronic difficulties were related to more prior episodes. These findings are discussed in terms of underlying mechanisms that may account for the changing role of major life stress over successive recurrences of depression.     

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.     

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.     

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。     

Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions

The aims of the present study were to determine the prevalence of non-suicidal self-injury (NSSI) in different eating disorder (ED) groups and morbid obesity, and to investigate whether NSSI in different ED/obesity groups co-occur with impulsivity. We assessed 535 individuals (365 ED and 170 obese patients) by means of a single item assessing lifetime NSSI and the Barratt Impulsivity Scale, which measures different dimensions of impulsivity. The results showed that 19.1% of the ED patients engaged in at least one act of NSSI during their life-time. NSSI was more prevalent in Bulimia Nervosa, Binge Eating Disorder, Eating Disorder Not Otherwise Specified compared to Anorexia Nervosa, Restrictive type and morbid obesity. Finally, ED/obese patients who engaged in NSSI scored significantly higher on the attentional, motor and non-planning subscales than patients without NSSI. The implications of these findings for the treatment of NSSI in binge/purging ED patients are discussed.     

Self-injury and readiness to recover: Preliminary examination of components of the stages of change model

The purpose of this study was to examine non-suicidal self-injury (NSSI) recovery through the lens of the transtheoretical model of stages of change. To do this, a content analysis of online posts about NSSI from 73 participants (M_age = 19.4; SD_age = 5.49) with a history or NSSI was performed. Specifically, two rubrics were used. The first examined stages of change and the other positive and negative views toward NSSI recovery. Results indicated that a preponderance of posts was in the precontemplation (39.7%) and contemplation (52.1%) stages. Individuals in the contemplation stage mentioned significantly more disadvantages than advantages to change compared to those in the precontemplation stage. Overall, the current study provides preliminary evidence for the utility of stages of change when conceptualizing NSSI recovery. Implications for research and practice are addressed.     

The Interactive Effects of Impulsivity and Negative Emotions on Adolescent Nonsuicidal Self‐injury: A Latent Growth Curve Analysis

This study employed latent growth curve analysis to evaluate the interactive effects of two specific facets of impulsivity (i.e., negative urgency [NU] and premeditation [PRE]) and negative emotions (NE) on the developmental trajectory of nonsuicidal self‐injury (NSSI) among 3,453 (57% females) Chinese community adolescents. Participants completed questionnaires assessing NSSI, NU, PRE, and NE (i.e., depression, anxiety, and stress) at three waves of time. The initial levels of NE and NU significantly predicted the initial level of NSSI. Changes in NE and NU significantly predicted change in NSSI. Moreover, the initial levels of NU and PRE significantly moderated the relationship between the initial levels of NE and NSSI, such that among individuals with higher NU or less PRE, the three NE were associated with a higher level of NSSI. Additionally, among individuals with a faster increase in NU, depression and anxiety were associated with a faster increase in NSSI. These findings suggest that adolescents with trait impulsivity, especially in the form of NU, are more vulnerable to the engagement in NSSI.     

Emotion Dysregulation Mediates the Relationship Between Child Maltreatment and Non-Suicidal Self-Injury

One risk factor for non-suicidal self-injury (NSSI) in adolescents is exposure to traumatic experiences, particularly child maltreatment. However, the mechanisms through which childhood maltreatment predicts NSSI are largely unknown. Emotion dysregulation (ED) is likely an important mechanism in this relationship. Therefore, this study examined the relationship between childhood maltreatment, ED, and NSSI in a sample of adolescent inpatients (n = 53). Results demonstrated that child physical and emotional maltreatment, but not child sexual abuse, was significantly associated with NSSI frequency. More specifically, ED mediated the relationship between child physical and emotional maltreatment and NSSI frequency. Findings support the importance of ED as a mediating factor in the relationship between childhood maltreatment and NSSI behaviors and highlight the need for teaching emotion regulation skills to youth affected by trauma.     

青少年自伤行为的机制及影响因素:基于情绪管理的视角

青少年是自伤的高危人群,这与自伤的情绪管理功能密切相关。基于情绪管理视角,生物社会模型、回避体验模型和情绪管理模型分别从不同侧面揭示了情绪管理在自伤发生中的核心地位。综合目前关于自伤的心理学及跨学科研究成果发现,青少年自伤的影响因素主要包括基因与脑等生物学因素、家庭与学校环境中的人际因素,以及个体的人格特征。其中,基因、脑与家庭环境对青少年自伤的影响尤为关键。今后应在纵向研究、基因与环境交互作用以及脑成像技术融合等方面对自伤进行进一步探讨。