The Incremental Utility of Emotion Regulation But Not Emotion Reactivity in Nonsuicidal Self‐Injury

This study assessed the incremental utility of emotion reactivity and emotion regulation in relation to nonsuicidal self‐injury (NSSI). Participants included 379 college students aged 18–22 who completed self‐report measures of emotion regulation, emotion reactivity, and NSSI. Emotion regulation was significantly related to NSSI both ignoring and controlling for reactivity, but the reverse was not true. Participants' use of NSSI for affect regulation appeared to moderate this relation. Findings support emotion regulation deficits as a target for intervention over and above heightened emotion reactivity, especially in those who use NSSI to regulate negative affect.     

Nonsuicidal Self‐Injury,Stress, and Self‐Differentiation

The authors surveyed 458 young adults and examined the relationships among stress, self‐differentiation, and nonsuicidal self‐injury (NSSI). They conducted multiple regression analyses to explore whether characteristics of self‐differentiation (i.e., emotional reactivity and “I position”) were related to NSSI after controlling for the effects of stress, as well as whether emotional reactivity and I position served as mediators in the stress–NSSI relationship. I position and emotional reactivity both contributed statistically significant variance to NSSI after accounting for stress. Moreover, both I position and emotional reactivity served as partial mediators in the stress–NSSI relationship. The authors discuss counseling and research implications.     

Similarities and Differences in the Functions of Nonsuicidal Self‐Injury (NSSI) and Sex as Self‐Injury (SASI)

Differences and similarities were studied in the functions of two different self‐injurious behaviors (SIB): nonsuicidal self‐injury (NSSI) and sex as self‐injury (SASI). Based on type of SIB reported, adolescents were classified in one of three groups: NSSI only (n = 910), SASI only (n = 41), and both NSSI and SASI (n = 76). There was support for functional equivalence in the two forms of SIB, with automatic functions being most commonly endorsed in all three groups. There were also functional differences, with adolescents in the SASI only group reporting more social influence functions than those with NSSI only. Adolescents reporting both NSSI and SASI endorsed the highest number of functions for both behaviors. Clinical implications are discussed, emphasizing the need for emotion regulation skills.     

Self‐Criticism as a Transdiagnostic Process in Nonsuicidal Self‐Injury and Disordered Eating: Systematic Review and Meta‐Analysis

Nonsuicidal self‐injury (NSSI) and disordered eating (DE) are highly comorbid and may be regarded as belonging to a spectrum of self‐harm behaviors. We investigated self‐criticism as a transdiagnostic correlate of these behaviors, in keeping with etiological theories of both NSSI and DE. We reviewed the literature and meta‐analyzed the relation of self‐criticism to both NSSI (15 studies; 17 effect sizes) and DE (24 studies; 29 effect sizes). Results showed equivalent, moderate‐to‐large effects for the relation of self‐criticism to NSSI (r = .38; CI: .29–.46) and DE (r = .40; CI: .34–.45). The relation of NSSI to self‐criticism generalized across multiple potential moderators. DE behavior type moderated the relation of self‐criticism to DE, with a stronger relation emerging for purging than restriction. Findings support self‐criticism as a possible candidate for transdiagnostic pathways to self‐harm.     

Psychiatric and Self‐Injury Profiles of Adolescent Suicide Attempters versus Adolescents Engaged in Nonsuicidal Self‐Injury

To better delineate the unique correlates of self‐injurious behaviors (SIB), psychiatric profiles of mutually exclusive groups of adolescents who made a suicide attempt (SA) versus those engaged in nonsuicidal self‐injury (NSSI) were examined. Contrary to hypotheses, the NSSI group endorsed earlier onsets of SIB and suicidal ideation (SI), as well as higher rates of depression and anxiety compared with their SA counterparts. Future work is warranted to understand the role of SI, including duration of SI and anxiety in the development of NSSI, and to identify risk and resiliency factors useful in predicting an adolescent's SIB status.     

The Relationship Between Nonsuicidal Self‐Injury and Suicidal Ideation

This correlational study was conducted with 403 undergraduate college students from 2 universities. The authors used path analysis and bootstrap regression to analyze the relationships between variables. Locus of control and family connectedness related to current nonsuicidal self‐injury (NSSI) engagement. However, when entered into the same regression, the variables current NSSI engagement and current NSSI number of methods used mediated all other relationships with suicidal ideation. Implications to current theories and clinical practice are provided.     

Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents

Prospective predictors of persistent nonsuicidal self‐injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy‐one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow‐up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow‐up, but not at baseline, also predicted persistence. These results suggest that helping high‐risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.     

Predictors of Unintentionally Severe Harm During Nonsuicidal Self‐Injury

This study aimed to identify predictors of unintentionally severe injury during nonsuicidal self‐injury (NSSI). The authors examined 3 potential predictors in a sample of 102 college students: addictive qualities of NSSI, impulsivity, and dissociation. Both impulsivity and addictive qualities of NSSI were associated with unintentionally severe injury during NSSI. In a logistic regression, only addictive qualities of NSSI emerged as a significant predictor of unintentionally severe injury during NSSI. Implications for counseling and research are discussed.     

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.     

The Relationship Between Nonsuicidal Self‐Injury Age of Onset and Severity of Self‐Harm

This study examined how age of nonsuicidal self‐injury (NSSI ) onset relates to NSSI severity and suicidality using decision tree analyses (nonparametric regression models that recursively partition predictor variables to create groupings). Those with an earlier age of NSSI onset reported greater NSSI frequency, NSSI methods, and NSSI ‐related hospital visits. No significant splits were found for suicide ideation or attempts, although those with an earlier onset were more likely to have a suicide plan. Overall, findings suggest that onset of NSSI before age 12 is associated with more severe NSSI and may be a crucial age for prevention efforts.     

Problem Clarity as a Moderator between Trait Affect and Self‐Perceived Creativity

Empirical studies on the relationship between affect and creativity often produce conflicting results. This inconsistency has led us to believe that the relationship between affect and creativity may be better understood by looking at potential moderators. Our study looked specifically at trait affect and self‐perceived creativity. Using the Affect Infusion Model (AIM) theory with problem clarity as the potential moderator, we hypothesized that when individuals are faced with problems that lack clarity, trait affect has greater sway over their self‐perceived creativity. Our results provided evidence that problem clarity moderated the relationship between positive trait affect and self‐perceived creativity; the positive relationship between positive trait affect and self‐perceived creativity is stronger when problem clarity is low and weaker when problem clarity is high. No moderating effect was found in the relationship between negative trait affect and self‐perceived creativity.     

Naturalistic Recovery From Nonsuicidal Self‐Injury: A Phenomenological Inquiry

The authors conducted a phenomenological inquiry of 12 individuals who recovered from nonsuicidal self‐injury without psychotherapeutic or medical intervention. Results indicated that participants’ naturalistic recovery emanated from their recognition of serious physical damage, corrective interpersonal influences, and movement from unhealthy to healthy surroundings. Implications of these findings for clinical practice and future research are discussed.     

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.     

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.     

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.     

Conceptualizing Nonsuicidal Self‐Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice

Nonsuicidal self‐injury (NSSI) may be characterized as a process addiction for some individuals who self‐injure. The authors review findings on the addictive features of NSSI, including compulsivity, loss of control, continued use despite negative consequences, and tolerance.     

Adolescents' Reward‐related Neural Activation: Links to Thoughts of Nonsuicidal Self‐Injury

Adolescence is a critical developmental period marked by an increase in risk behaviors, including nonsuicidal self‐injury (NSSI). Heightened reward‐related brain activation and relatively limited recruitment of prefrontal regions contribute to the initiation of risky behaviors in adolescence. However, neural reward processing has not been examined among adolescents who are at risk for future engagement for NSSI specifically, but who have yet to actually engage in this behavior. In the current fMRI study (N = 71), we hypothesized that altered reward processing would be associated with adolescents' thoughts of NSSI. Results showed that NSSI youth exhibited heightened activation in the bilateral putamen in response to a monetary reward. This pattern of findings suggests that heightened neural sensitivity to reward is associated with thoughts of NSSI in early adolescence. Implications for prevention are discussed.     

Lifetime and 12‐Month Nonsuicidal Self‐Injury and Academic Performance in College Freshmen

We examined whether nonsuicidal self‐injury (NSSI) is associated with academic performance in college freshmen, using census‐based web surveys (N = 7,527; response = 65.4%). NSSI was assessed with items from the Self‐Injurious Thoughts and Behaviors Interview and subsequently linked with the administratively recorded academic year percentage (AYP). Freshmen with lifetime and 12‐month NSSI showed a reduction in AYP of 3.4% and 5.9%, respectively. The college environment was found to moderate the effect of 12‐month NSSI, with more strongly reduced AYPs in departments with higher‐than‐average mean departmental AYPs. The findings suggest that overall stress and test anxiety are underlying processes between NSSI membership and academic performance.     

Examining Intent to Die and Methods for Nonsuicidal Self‐Injury and Suicide Attempts

Nonsuicidal self‐injury (NSSI) is linked to suicidal behavior and future suicide attempts, but the process of NSSI‐to‐suicide attempts remains unclear. Additionally, little is known about how having a history of NSSI may relate to reports of intent to die during a suicide attempt. The current study examined methods of NSSI and suicide attempts, as well as intent to die, in a sample of 1,232 young adults, 54 of whom reported at least one suicide attempt. Cutting and overdose were the predominant methods of NSSI and suicide attempts, respectively, with the two often co‐occurring. Individuals with both NSSI and suicide attempt history were significantly more likely to report an intent to die than those with suicide attempt history only.