Borderline personality features predict alcohol use problems

This study assessed the relation between BPD features and problems associated with alcohol use 2 years later in young adults. Approximately 5,000 nonclinical young adults were screened for BPD features, and two cohorts of participants completed the laboratory phase of the study at Time 1 (total N = 421) and then again 2 years later at Time 2 (total N = 356). Measures included self-report and interview-based assessments of personality disorders, psychopathology in biological parents, Axis I psychopathology, and alcohol use problems. BPD features were found to significantly predict alcohol use problems 2 years later after controlling for parents' substance use disorders, Axis I psycho-pathology (including alcohol abuse/dependence), and non-BPD personality disorders. In addition, the BPD subscale that assesses impulsivity was found to be significantly associated with alcohol use problems once all predictors were entered into the model.     

Interpersonal Features and Functions of Nonsuicidal Self‐injury

Etiological models of nonsuicidal self‐injury (NSSI) suggest interpersonal features may be important to understand this behavior, but social functions and correlates have not been extensively studied. This study addresses existing limitations by examining interpersonal correlates and functions of NSSI within a stratified random sample of 1,243 predominantly Caucasian college students (mean age = 21.52, SD = 4.15 years). Participants completed an anonymous online survey assessing NSSI features, perceived social support, and disclosure experiences. Approximately 15% of the students endorsed NSSI. Interpersonal reasons were endorsed proportionally more often for initiating rather than repeating the behavior. Individuals with repetitive NSSI reported significantly lower perceived social support from family members and fewer individuals to seek advice from than single‐act and control participants. Fifty‐nine percent had disclosed their NSSI, but rarely to mental health professionals. Conversations with others about NSSI were rated as being mostly unhelpful. These results emphasize the importance of interpersonal features and functions of NSSI, suggesting treatments should focus on strengthening interpersonal bonds alongside emotion regulation. Improving responses to disclosures of NSSI is needed to promote communication about this behavior and perceived helpfulness of such conversations.     

Peer Influence and Nonsuicidal Self Injury: Longitudinal Results in Community and Clinically-Referred Adolescent Samples

Research suggests that adolescents’ engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents’ NSSI was examined at baseline and one year later. Adolescents’ nominated best friend reported their own levels of NSSI. In Study 2, adolescents’ NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents’ perceptions of their friends’ engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends’ self-injurious behavior on adolescents’ own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents’ NSSI was associated with increasing perceptions of their friends’ engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence.     

Non-Suicidal Self-Injury Among Ethnically and Racially Diverse Emerging Adults: Do Factors Unique to the Minority Experience Matter?

This study investigated clinically-significant non-suicidal self-injury (NSSI), defined as five or more lifetime episodes of NSSI, among racially and ethnically diverse emerging adults with a focus on factors unique to the minority experience. Seven hundred and nine emerging adults at an urban university, 85 % of whom were non-White, completed questionnaires assessing NSSI, racism, ethnic identity, Borderline Personality Disorder (BPD) characteristics such as impulsive behavior, emotion and interpersonal dysregulation and identity disturbance, suicidal behavior, and current depression and anxiety symptoms. Overall, 13 % of the sample reported a history of clinically-significant NSSI. Asian and White emerging adults reported significantly higher rates of NSSI than Hispanics and Blacks. Logistic regression analyses revealed positive relationships between BPD characteristics and NSSI and current anxiety and NSSI, which were not attenuated by increased ethnic identification. Experience with racism did not predict NSSI in the multivariate model. These findings are discussed as they pertain to current understanding and prevention of NSSI among racial and ethnic minority emerging adults.     

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.     

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.     

The associations between non-suicidal self-injury and borderline personality disorder features among Chinese adolescents

This study examined the relative importance of four major BPD features, that is, affective instability, disturbed interpersonal relationship, unstable sense of self, and behavioral impulsivity, in explaining the presence, initiation, repetition, and discontinuation of non-suicidal self-injury (NSSI) among a 2-year follow-up sample of 4,782 (68.5% girls) Hong Kong Chinese secondary school students. Affective instability, disturbed interpersonal relationship and behavioral impulsivity were significantly associated with the presence of NSSI both concurrently and longitudinally. These three BPD features were also related to the future initiation of NSSI. On the other hand, only behavioral impulsivity made a significant contribution to the repetition of NSSI. Additionally, a lower level of affective instability was also associated with quitting NSSI. We discussed some possible mechanisms underlying the effects of different BPD features on different developmental stages of NSSI.     

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.     

Structural relations between borderline personality disorder features and putative etiological correlates

This study assessed the structural relations between borderline personality disorder (BPD) features and purported etiological correlates. Approximately 5,000 18-year-old nonclinical young adults were screened for BPD features, and 2 cohorts of participants (total N = 421; approximately one half of whom endorsed significant borderline features) completed the laboratory phase of the study. Measures included self-report and interview-based assessments of BPD psychopathology, personality, psychopathology in biological parents, and childhood physical and sexual abuse. Significant relations between BPD features and purported etiological correlates of BPD were found. A multivariate model that included parental psychopathology, childhood abuse, and personality factors provided an adequate fit to the data and supported the contention that the personality traits disinhibition and negative affectivity underlie BPD features.     

The role of affective instability and impulsivity in predicting future BPD features

Models of borderline personality disorder (BPD) suggest that extreme levels of affective instability/emotional dysregulation, impulsivity, or the combination of these two traits account for the symptoms characteristic of BPD. The present study utilized longitudinal data to evaluate the ability of Personality Assessment Inventory-Borderline Features (PAI-BOR; Morey, 1991) subscale scores to predict BPD features two years later as a test of these models of BPD. Participants were 156 male and 194 female young adults who completed the PAI-BOR at age 18 and again two years later. Three models were compared: (a) Wave 1 affective instability scores predicting Wave 2 BPD features (AI model); (b) Wave 1 self-harm/impulsivity scores predicting Wave 2 BPD features (IMP model); and (c) both Wave 1 affective instability and self-harm/impulsivity scores predicting Wave 2 BPD features (AI-IMP model), all controlling for stabilities and within-time covariances. Results indicated that the AI model provided the best fit to the data, and improved model fit over a baseline stabilities model and the other models tested. These results are consistent with Linehan's theory (1993) that emotional dysregulation drives the other BPD symptoms.     

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.     

Frequency of Nonsuicidal Self‐Injury in Adolescents: Differences in Suicide Attempts,Substance Use,and Disordered Eating

The relationship between frequency of nonsuicidal selfinjury (NSSI) and suicide attempts, substance use, and disordered eating was assessed in a community sample of 4,839 adolescents, 922 of whom reported NSSI in the past year. It was expected that the engagement in risk behaviors would significantly increase as NSSI frequency increased. Participants completed the Youth Risk Behavior Survey (Centers for Disease Control and Prevention, 2009) and were subdivided into five NSSI frequency groups: none, 1 time, 2–3 times, 4–5 times, and 6 or more times. A one‐way MANOVA found significant mean differences for all variables across NSSI frequency groups. The no NSSI group was significantly lower than all other groups on all variables. For suicide attempts, all frequency groups were significantly different from each other, with attempt frequency increasing with each increase in NSSI frequency. The six or more group reported significantly more substance use and disordered eating than all other groups. Overall, adolescents with more frequent NSSI represent a group at risk for concurrent unhealthy behaviors and suicide attempts.     

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.     

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.     

Impulsivity and emotion dysregulation in Borderline Personality Disorder

This study examined the association of borderline personality disorder (BPD) and negative emotional states with impulsivity in the laboratory. Undergraduate participants who were high in BPD features (high-BPD; n = 39) and controls who were low in BPD features (low-BPD; n = 56) completed measures of negative emotional state before a laboratory measure of impulsivity--a passive avoidance learning task. Controlling for psychopathology, high-BPD participants committed a greater number of impulsive responses than did low-BPD participants. Negative emotional state moderated the effect of BPD on impulsive responses. High-BPD participants who were in a negative emotional state committed fewer impulsive responses than high-BPD participants who were low in negative emotional state. Fear, nervousness, and shame negatively correlated with impulsivity among high-BPD participants but not among low-BPD participants. In addition, high-BPD participants reported greater emotion dysregulation in a variety of domains, compared with low-BPD participants.     

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.     

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.     

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.     

Psychological, cognitive, and interpersonal correlates of attributional change in adolescents

Examined the role of attributional style in adolescent's psychological functioning. Specifically, we examined the cross-sectional correlates of attributional style, as well as the correlates of changes in attributional style over time. A sample of 841 adolescents with either maladaptive or adaptive attributional styles completed a battery of self-report measures at 2 points in time, 1 year apart. Measures assessed depressive symptoms and suicidality, cognitive functioning (self-esteem, pessimism, coping skills), and interpersonal functioning (social competence, conflict with parents, social support from family and friends). Results indicated that attributional style is associated with multiple depression-related variables. In addition, youth experienced significant changes in their attributional styles over time (from adaptive to maladaptive and vice versa). Finally, changes in attributional style were associated with changes in psychological symptoms and other psychosocial variables. Results are discussed in terms of their implications for the prevention and treatment of adolescent depression.