青少年自伤网络展示的动机及其影响

自我伤害行为是一种复杂且危险的心理病理行为,它会给个体的身心带来不同程度的损害。自伤是在多种因素的共同作用下产生,且在青少年中发生率最高。随着互联网的普遍使用,网络已经成为青少年生活中不可或缺的部分,近年来研究者开始关注到青少年的自伤网络展示行为。研究显示,许多自伤青少年会在网络上展示自己的自伤行为;个体一般是在多种动机的作用下对自己的自伤行为或经历进行展示;这些展示的内容既可能会让更多的人模仿或强化自伤,也可能会为自伤者提供社会支持,有助于他们减少自伤行为。     

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.     

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.     

Non-Suicidal Self-Injury Among Male Adjudicated Adolescents: Psychosocial Concerns,Coping Responses,Diagnoses, and Functions

Non-suicidal self-injury (NSSI) refers to self-inflicted physical injury without suicidal intent. NSSI is particularly common in forensic settings and associated with several psychosocial concerns, coping responses, diagnoses, and functions, but little information is available regarding NSSI in adjudicated male adolescents. The present study examined the frequency and types of NSSI among adjudicated male adolescents (n?=?103) and assessed the relationships between NSSI history, psychosocial concerns, coping responses, diagnoses, and functions within this population. Approximately two-thirds (66%) reported NSSI history. Participants with NSSI history reported poorer social adaptation and greater alienation and boredom, aggression, and emotional lability than controls. Youth with high-frequency NSSI were also more likely to utilize emotional discharge as an unhealthy coping response than controls. In addition, participants with high-frequency NSSI were more likely than controls to meet criteria for a mood or anxiety disorder. Function of NSSI primarily surrounded anxiety reduction/affect regulation, punishment, dissociation reduction, and social/sensation-seeking. NSSI appears to be prevalent among male adjudicated youths, and the findings suggest that the relationship between NSSI history, psychosocial concerns, coping responses, and functions is nuanced and could inform more calibrated assessment and treatment strategies.     

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.     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.     

Emotional Dysregulation and Interpersonal Difficulties as Risk Factors for Nonsuicidal Self-Injury in Adolescent Girls

The purpose of this study was to examine a model of factors that place psychiatrically hospitalized girls at risk for non-suicidal self-injury (NSSI). The role of familial and peer interpersonal difficulties, as well as emotional dysregulation, were examined in relationship to NSSI behaviors. Participants were 99 adolescent girls (83.2% Caucasian; M age = 16.08) admitted to a psychiatric hospital. Structural equation modeling indicated the primacy of emotional dysregulation as an underlying process placing adolescents at risk for NSSI and mediating the influence of interpersonal problems through the family and peer domains. When family and peer relationships were characterized by conflict and lack of support for managing emotions, adolescents reported more dysregulated emotion processes. Family relational problems were directly and indirectly related to NSSI through emotional dysregulation. The indirect processes of peer relational problems, through emotional dysregulation, were significantly associated with NSSI frequency and severity. The findings suggest that the process by which interpersonal difficulties contribute to NSSI is complex, and is at least partially dependent on the nature of the interpersonal problems and emotion processes.     

Non-Suicidal Self-Injury and Adolescents Attachment with Peers and Mother: The Mediating Role of Identity Synthesis and Confusion

Non-suicidal self-injury (NSSI) is highly prevalent in adolescents. Secure attachment with family and peers can reduce vulnerability to NSSI and can optimize the outcomes of developmental challenges such as identity formation. Problems experienced in these developmental processes and contexts can increase vulnerability to NSSI. Hence, the present study examined associations between attachment with mother and peers, identity formation, and NSSI, using self-report questionnaires in 528 high school students (Mean age = 15.0 years, SD = 1.84, 11–19 years, 50.4 % females). The lifetime prevalence of NSSI was found to be 14.2 %. Mediation analyses indicated that peer trust had a significant negative indirect effect on NSSI via identity synthesis and confusion. The positive association between peer alienation and NSSI was partially mediated by a lack of identity synthesis. Further, the pathways from maternal trust and alienation to NSSI were fully mediated by both identity confusion and synthesis. Clinical implications and suggestions for future research are discussed.     

The Best Friend and Friendship Group Influence on Adolescent Nonsuicidal Self-injury

This study examined associations of peer socialization and selection, over time, with nonsuicidal self-injury (NSSI) among 5,787 (54.2 % females) Chinese community adolescents. Both effects were tested using two aspects of adolescents’ friendship networks: the best friend and the friendship group. Participants completed questionnaires assessing NSSI, depressive symptoms and maladaptive impulsive behaviors at two waves of time over a 6-month period. Results showed that even after controlling for the effects of depressive symptoms and maladaptive impulsive behaviors, the best friends’ engagement in NSSI still significantly predicted adolescents’ own engagement in NSSI. Adolescents’ friendship groups’ NSSI status also significantly predicted their own NSSI status and frequency. Additionally, adolescents with NSSI tended to join peer groups with other members also engaging in NSSI.     

Peer influence and adolescent nonsuicidal self-injury: A theoretical review of mechanisms and moderators

Nonsuicidal self-injury (NSSI) is an increasingly prevalent health risk behavior among adolescents and represents a significant public health concern. Although researchers have identified numerous antecedents or risk factors that precede engagement in NSSI behaviors, few studies have examined the role of peer influence processes. Yet, recent research suggests that adolescents may be more likely to engage in NSSI when close friends or other peers engage in similar behaviors. The following paper reviews past research on peer influence effects, including potential mechanisms and moderating variables. Methodological considerations for future research on peer influence and NSSI are discussed.     

Poor Sleep as a Risk Factor for Nonsuicidal Self-Injury in Adolescent Girls

The purpose of this study was to examine the relation between poor sleep and nonsuicidal self-injury (NSSI), and to test the hypothesis that poor sleep is a risk factor for the development of NSSI in young adolescents. Questionnaire data were used from a 2-wave longitudinal study of a community sample of 881 young Swedish adolescents. The results showed that 7 % of the girls reported poor sleep (never or seldom sleeping well), and 20–26 % of the girls reported repeated NSSI (at least 5 instances). Poor sleep was associated prospectively with NSSI among girls, but not among boys. Of girls who responded that they seldom or never slept well at T1, 77 % reported repeated NSSI 1 year later. Poor sleep at T1 was found to predict the incidence of new cases of repeated NSSI in girls at T2, independently of their degree of psychopathology. No similar relationship between poor sleep and NSSI was found in boys. The present results suggest that screening for poor sleep in adolescents may serve to identify a subgroup of girls at risk for developing NSSI. It is concluded that poor sleep in young girls should be taken seriously, even in the absence of other self-reported psychological problems, and that interventions targeted at sleep disturbances may be important for prevention.     

Self-Cutting and Suicidal Ideation among Adolescents: Gender Differences in the Causes and Correlates of Self-Injury

In recent years, non-suicidal self-injury (NSSI) among adolescents has been identified as alarmingly common place. Some studies have suggested that more than one in eight adolescents have engaged in self-cutting or other self-injuring behaviors. Even more of a concern is that self-injury often foreshadows suicide or suicide attempts. With self-cutting common in middle and high schools, understanding the antecedents and correlates of such behavior may help counselors and others public health officials identify troubled students and initiate preventative measures. This study utilizes data from 2,639 high school students from the Delaware Youth Risk Behavior Survey to investigate the gender differences in NSSI and suicidal ideation. Overall, 13% reported engaging in NSSI within the past year, with females reporting significantly higher rates (17%) of NSSI than males (9%). Results indicate that there are significant gender differences in NSSI and suicidal thoughts based upon previous victimization experiences, reported substance use, depression, health behaviors, and sexual orientation.     

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.     

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.     

Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents

Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13–19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.     

Cognitive and Social Factors Associated with NSSI and Suicide Attempts in Psychiatrically Hospitalized Adolescents

Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1 % female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n?=?45), SA only (n?=?24) or both NSSI and SA (NSSI+SA; n?=?79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed.     

Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism

We examined the relation between child maltreatment and non-suicidal self-injury (NSSI). Participants were 86 adolescents who completed measures of child maltreatment, self-criticism, perceived criticism, depression, and NSSI. Analyses revealed significant, small-to-medium associations between specific forms of child maltreatment (physical neglect, emotional abuse, and sexual abuse) and the presence of a recent history of NSSI. Emotional and sexual abuse had the strongest relations with NSSI, and the data supported a theoretical model in which self-criticism mediates the relation between emotional abuse and engagement in NSSI. Specificity for the mediating role of self-criticism was demonstrated by ruling out alternative mediation models. Taken together, these results indicate that several different forms of childhood maltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associated with NSSI. Future research is needed to test the temporal relation between maltreatment and NSSI and should aim to identify additional pathways to engagement in NSSI.     

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.     

Longitudinal Analysis of Adolescent NSSI: The Role of Intrapersonal and Interpersonal Factors

Non-suicidal self-injury (NSSI) occurs in approximately 10 % of adolescents. To establish effective prevention and intervention initiatives, it is important to understand onset, maintenance and cessation of NSSI. We explored whether the relationships between interpersonal factors (i.e. attachment, social support) and NSSI were mediated by intrapersonal factors (i.e. emotion regulation, self-esteem, self-efficacy). Participants were 1973 students (1414 female and 559 male) aged between 12 and 18 years (M?=?13.89, SD?=?0.97) recruited from 40 Australian high schools. Participants completed a questionnaire at two time-points with a 12-month interval. At baseline, 8.3 % of adolescents engaged in NSSI, increasing to 11.9 % at follow-up. Family support was most salient in onset, maintenance and cessation of NSSI. Attachment anxiety was related to NSSI onset. Of the intrapersonal variables, self-esteem and self-efficacy were significant in predicting onset of NSSI. Self-esteem, self-efficacy and cognitive reappraisal mediated the relationship between attachment anxiety and NSSI onset. A combination of interpersonal and intrapersonal variables contributes to the onset, maintenance and cessation of NSSI in adolescence. Perceived family support appears to be an important safeguard against NSSI. Strategies targeting family functioning and teaching cognitive reappraisal techniques to adolescents may reduce the number engaging in NSSI.     

Nonsuicidal Self‐Injury among Adolescents: A Training Priority for Primary Care Providers

Primary care providers were surveyed to determine how prepared they feel to address nonsuicidal self‐injury (NSSI) among adolescents, their interest in training on NSSI, and factors associated with routinely asking about NSSI when providing health supervision. Participants included family medicine physicians (n = 260), pediatricians (n = 127), family nurse practitioners (n = 96), and pediatric nurse practitioners (n = 54). Almost 50% felt unprepared to address NSSI, and over 70% wanted training in this area. Overall, relative to other areas of mental health care, clinicians felt least prepared to address and wanted more training on NSSI. Just 27% reported they routinely inquired about NSSI during health supervision. Factors associated with routinely asking about NSSI were identifying as female (OR = 2.37; 95% CI = 1.25–4.49), feeling better prepared to address NSSI (OR = 1.51; 95% CI = 1.04–2.20), and more frequently using a psychosocial interview to identify adolescents in distress (OR = 1.23; 95% CI = 1.02–1.48). Teaching clinicians to assess NSSI within a psychosocial interview may increase screening for and identification of the behavior among adolescents in primary care.