Aberrant pain perception in direct and indirect non-suicidal self-injury: an empirical test of Joiner's interpersonal theory

Neural responses to social decision-making and their associated factors among nonsuicidal self-injured adolescents: An event-related potentials study

OBJECTIVE

The neuroelectrophysiology mechanisms of the connection between nonsuicidal self-injury (NSSI) and impairment of social decision-making function remain unknown. As the event-related potentials (ERPs) technique has been widely used in neurobiology research because of its advantage of high temporal resolution, we conducted this study to explore the ERPs of decision-making function among adolescents with NSSI.

METHOD

This study was designed to compare patients with mood disorder plus NSSI with mood disorder patients without NSSI using a 2:1 ratio. Participants aged 12-18 years were recruited from the outpatient department of psychiatry at Nanfang Hospital. Sociodemographic and psychological data were collected. The Ultimatum Game, a task examining individuals' social decision-making, was conducted with the ERP technique to record participants' neural responses. The associations between ERPs characteristics and psychological factors were examined by using correlation analysis and regression analysis.

RESULTS

In total, 90 participants were eligible, with 60 in the NSSI group and 30 in the non-NSSI group. N1 latency in the unfair condition was positively correlated with Difficulties in Emotion Regulation Scale scores (r = 0.257), whereas P2 latency in the fair condition was correlated with agreeableness personality (r = 0.250). Regression analysis revealed that N1 latency in the unfair condition was positively associated with NSSI (ORs ranged 1.07-1.10), whereas P2 latency in the fair condition was negatively associated (ORs ranged 0.95-0.97).

CONCLUSION

NSSI patients tended to exhibit impairment in decision-making function including initial cognitive value judgment, attentional allocation, and working memory process. ERPs characteristics including N1 latency and P2 latency may be predictors of NSSI.

Acquired Capability for Suicide: An Evolutionary Concept Analysis

While virtually all suicide attempters experience ideations, not all who think about suicide will attempt or die by suicide. The ideation-to-action framework has led to new theories distinguishing suicide ideators from suicide attempters. The framework suggests that suicide progresses on a spectrum of thoughts and behaviors with different identifiers and explanations. The concept of acquired capability for suicide (ACS), conceptualized by the Interpersonal Psychological Theory of Suicide, is the first to explain the movement from ideation to action. This concept analysis of ACS is timely and relevant for greater clarification of the role ACS has in the movement from ideation to action. Rodgers' evolutionary concept analysis method is used. The six-step evolutionary method highlights the concept's attributes, antecedents, and consequences and provides a basis for further inquiry and development rather than a final definition.

Sexual Activity as Self-Injury: A Scoping Review

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

Comparing self-harming intentions underlying eating disordered behaviors and nonsuicidal self-injury: Replication and extension in adolescents

OBJECTIVE

Eating disorder (ED) behaviors are often characterized as indirect forms of self-harm. However, recent research has found less clear demarcations between direct self-harming behaviors (e.g., nonsuicidal self-injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating.

METHOD

A total of 117 adolescents between ages 12-14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. The t-tests and linear effects models were conducted to compare self-harming thoughts and intentions across behaviors.

RESULTS

Participants reported at least some intent to hurt themselves physically in the moment and in the long-term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self-harming knowledge and intentions were most frequently reported with NSSI and longer-term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors.

DISCUSSION

This study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non-zero self-harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment.

PUBLIC SIGNIFICANCE STATEMENT

This study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self-injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self-harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self-harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

Self-Injurious Behavior and Its Characteristics in a Sample of Mexican Adolescent Students

Adolescence is a difficult stage, a period of risk for developing disorders, including depression and self-injurious behavior. A non-random sample was drawn (n = 563) from first-year high school students (32.8%) 185 males and 378 females (67.14%) from public schools in Mexico. The age range was 15 and 19 years, with a mean age of 15.63 (SD = 0.78). According to the results, the sample was divided into n1 = 414 (73.3%) adolescents without self-injury (S.I.) and n2 = 149 (26.4%) S.I. adolescents. In addition, results were obtained on methods, motives, time, and frequency of S.I., and a model was generated in which depression and first sexual experience obtained the highest Odd Ratio and d values in their relationship with S.I. Finally, we contrasted the results with earlier reports and concluded that depression is an important variable in S.I. behavior. Early S.I. detection will prevent the aggravation of S.I. and suicide attempts.

Heterogeneity of non-suicidal self-injury behavior in adolescents with depression: latent class analysis

BACKGROUND

Non-suicidal self-injury (NSSI) by adolescent patients with depression has become a serious public health problem. This cross-sectional study aims to identify subgroups of adolescents based on NSSI and explore the factors related to these subgroups.

METHODS

The study recruited 326 in- and out-patient adolescents (263 girls and 63 boys) aged 12 to 18 years (mean = 14.7, SD = 1.6) who had self-injured in the past year. Latent class indicators included 12 NSSI variables, as well as suicidal ideation. Logistic regression examined associations between identified classes and related factors.

RESULTS

In this study, two distinct subgroups were identified: a "high suicidal ideation NSSI group" (n = 129, 39.6%) and a "low suicidal ideation NSSI group" (n = 197, 60.4%). Depression (OR = 1.10; 95% CI, 1.05-1.16), female (OR = 2.01; 95% CI, 1.09-3.69), left-behind experience (OR = 2.08; 95% CI, 1.17-3.71), single-parent family (OR = 1.84; 95% CI, 1.11-3.04) and peer victimization (OR = 1.04; 95% CI, 1.02-1.05) increases the probability of belonging to the "high suicidal ideation NSSI group". A high level of perceived social support (OR = 0.99; 95% CI, 0.97-0.99) was a protective factor towards NSSI.

CONCLUSIONS

This study identifies two subgroups of NSSI and the factors associated with each subgroup. The early identification of high-risk groups for major NSSI in adolescents diagnosed with depression is possible due to the identification of correlating factors. Different treatment plans can be developed for different subtypes of NSSI to improve the effectiveness of prevention and intervention, promoting the healthy physical and mental development of adolescents with depression.

Exploring the association of addiction-related genetic factors with non-suicidal self-injury in adolescents

Background

Non-suicidal self-injury (NSSI) is self-injurious behavior without suicidal intent commonly seen in the adolescent population and poses a serious threat to the life safety of adolescents. Related researches suggest a possible correlation between addiction and the occurrence of NSSI. This study aimed to explore the correlation between addiction and NSSI from a molecular biological perspective by analyzing the differential expression of addiction-related genes in NSSI patients.

Methods

(1) The association between addiction and non-suicidal self-injury in a Chinese adolescent population was verified with the help of questionnaires on substance and non-substance addictions and non-suicidal self-injury among 1,329 adolescents in China, (2) Screening for key genes associated with addiction by bioinformatics analysis, and (3) RT-qPCR experiment was performed to validate key genes and Receiver Operating Characteristic curves were plotted for target genes.

Results

(1) Substance and non-substance addictions were all significantly correlated with non-suicidal self-injury, (2) Four target genes: SERPINA3, SLC14A1, RPS6 and RPS3A were screened by bioinformatics technique, and (3) Relative quantitative analysis by RT-qPCR revealed that the expression levels of SLC14A1 (p < 0.01), RPS6 (p < 0.05) and RPS3A (p < 0.01) were significantly higher in NSSI patients than in healthy controls.

Conclusion

(1) The significant association between addiction and NSSI exists in the Chinese adolescent population and (2) Addiction-related genes SLC14A1, RPS6, and RPS3A are differentially expressed in adolescents with NSSI. The genes have the potential to become biological markers for the diagnosis of NSSI.

Suicidality in adolescents with onset of anorexia nervosa

OBJECTIVES

The mortality rate in patients with anorexia nervosa (AN) is 5 to 10 times higher than in general population and, suicide is one of the main causes of death. We evaluated the prevalence of suicidality (ideation, self-injurious behaviour, suicidal attempts) in 100 adolescents with onset of AN and we explored the correlation between suicidality, severity of AN symptoms and psychiatric comorbidity.

METHODS

We subdivided AN patients into restrictive (R-AN; n = 66) and restrictive atypical (A-AN; n = 34), according to the European Guidelines criteria. Assessment was performed using the eating disorder inventory 3rd version, the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version interview, and the Columbia-suicide severity rating scale. Fisher's exact test and Mann-Whitney test (with correction for multiple testing) were used to compare the distribution of categorical and continuous variables between R-AN and A-AN patients, and between patients with vs. without suicidal behaviours.

RESULTS

Twenty-seven patients (27%) presented suicidality as clinical feature, expressed as at least one of the following: suicidal ideation (24%), self-cutting (19%), and suicidal attempt (6%). Patients with suicidality showed greater severity of psychiatric symptoms related to AN psychopathology and presented psychiatric comorbidity, especially depression, more often than patients who did not reported suicidality (70,4% vs 29,6%). No significant differences in terms of suicidal behaviours and AN-specific psychopathology were found between R-AN and A-AN.

CONCLUSIONS

Suicidality in adolescent patients with R-AN and A-AN seems to be related to ED symptoms. These data highlight the importance of screening for suicidality among adolescents at onset of AN, and confirms that A-AN should not be considered a milder disease.

LEVEL OF EVIDENCE

Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).

Painfully bored: the role of negative urgency and history of Non-Suicidal Self-Injury in Self-Administering painful stimuli

The current study aims to examine the causal effect of boredom on non-suicidal self-injury (NSSI), expanding prior experimental research by including an anger induction to compare to a boredom induction, and additionally measuring whether participants specifically seek painful stimulation. In a sample of mostly undergraduate students (N = 146), emotional state was manipulated through video induction, and NSSI behavior was simultaneously measured, operationalized through self-administration of electric shocks. Participants’ pain thresholds were measured beforehand. NSSI history and negative urgency were included as potential moderators. Results showed that boredom increased both frequency and intensity of self-administered electric shocks, especially in participants with an NSSI history. Negative urgency was not a significant moderator. No causal anger-NSSI link was found, possibly due to the anger induction not being sufficiently effective. Clinical implications are considered through suggestions of boredom coping skills training as an intervention strategy in NSSI populations.

Synergistic effect of chronic pain and nonsuicidal self-harm on pain sensitivity

Abnormalities in pain processing have been observed in patients with chronic pain conditions and in individuals who engage in self-harm, specifically nonsuicidal self-injurious behaviors (NSSI). Both increased and decreased pain sensitivity have been described in chronic pain patients, while decreased pain sensitivity is consistently observed in individuals with NSSI. The objective of the study was to identify the differential effects of chronic pain and NSSI on experimental pain sensitivity, specifically pressure pain threshold, in depressed patients. Moreover, the role that hopelessness may play between depression severity and pain sensitivity was also examined. Depressed patients with and without chronic pain, and with and without lifetime self-harm behaviors were analyzed into four groups. Group 1 (N = 42) included depressed patients with both Chronic pain ( +) and Self-harm ( +), Group 2 (N = 53) included depressed patients with Chronic pain ( +) but no Self-harm (-), Group 3 (N = 64) included depressed patients without Chronic pain (-), but Self-harm ( +), and Group 4 (N = 81) included depressed patients with neither Chronic pain (-) nor Self-harm (-). Healthy controls (N = 45) were also recruited from the community. Depressed patients with both Chronic pain ( +) and Self-harm ( +) reported higher pressure pain threshold measures when compared with the other groups. Mediation analysis indicated that hopelessness mediates the relationship between depression severity and pressure pain threshold. Our findings suggest that a multiprong approach including adequate mental health services and pain control for depressed patients with comorbid chronic pain and nonsuicidal self-harm is needed to yield effective outcomes.

Assessing Physical Pain Perception and Psychological Distress Tolerance through the MMPI-2-RF: A Comparison of Multimethod Measures

While transdiagnostic factors are important domains in clinical assessment and treatment, there is little research to link such constructs to widely accepted and utilized broadband assessments such as the Minnesota Multiphasic Personality Inventory, 2nd edition - Restructured Form (MMPI-2-RF). A handful of studies suggest the ability of the MMPI-2-RF scales to capture variance in transdiagnostic constructs; however, this literature relies solely on self-report criterion measures, despite evidence that self-report and behaviorally-indexed correlates of psychopathology may measure varied aspects of the intended construct and can often yield differing results. The current study investigated MMPI-2-RF scales' ability to assess two widely examined transdiagnostic constructs, distress tolerance and pain perception, across both self-report and behavioral indicators. The sample included 115 undergraduate students who completed a valid MMPI-2-RF and multimethod measures of pain perception and distress tolerance. The results aligned with prior research in areas of internalizing symptoms, psychopathy, and suicide risk factors in self-report, but not behaviorally-based, assessment. Implications of this inconsistency, the association between clinical assessment and transdiagnostic constructs, and the heterogeneity of the distress tolerance and pain perception constructs are discussed.

[Pain perception and nonsuicidal self-injurious behavior]

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives

Nonsuicidal self-injury (NSSI) involves deliberate and intentional injury to body tissue that occurs in the absence of suicidal intent. Typical examples here might include self-cutting, burning, or self-hitting. Behavior of this kind is fundamentally unsettling as well as perplexing. It is also the case that self-harming behavior of any kind runs counter to a fundamental survival instinct. In the past, behaviors such as these were viewed as self-mutilation and considered to be a form of attenuated suicide. Much has changed over time, culminating in the entry of NSSI Disorder into DSM-5 as a condition in need of further study. In this review we describe the evolution of the NSSI construct and consider current issues in its diagnosis and assessment.

Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality

Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables.  Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

Evaluating the Interpersonal-Psychological Theory of Suicide among Latina Adolescents using Qualitative Comparative Analysis

The Interpersonal-Psychological Theory of Suicide (IPTS) has emerged as an empirically supported theory of suicide risk, yet few studies have utilized IPTS to examine the suicidal behaviors of Latina adolescents. In this study, we explore the cultural and developmental appropriateness, as well as the explanatory fit, of IPTS within a sample of Latina adolescents. Data for this project were drawn from qualitative interviews conducted with Latina adolescents with (n=30) and without (n=30) histories of attempted suicide. We employed a deductive qualitative approach to define and compare core constructs of IPTS (perceived burdensomeness, thwarted belongingness, and acquired capability), and then use qualitative comparative analysis to evaluate how core constructs were linked with the occurrence of a suicide attempt. Consistent with IPTS, perceived burdensomeness, thwarted belongingness, and acquired capability were present in 20 of the 30 adolescents who had attempted suicide, and absent in 22 of the 30 adolescents with no lifetime history of suicidal behaviors. Notably, alternative combinations of IPTS constructs were found in 10 cases of adolescents who attempted suicide, suggesting a need to adjust IPTS to fit the developmental and cultural contexts of Latina teens. Although our results suggest predominantly positive support for IPTS, participants varied in terms of how their experiences resonated with the conceptual definitions put forward by the theory. Ultimately, our findings point to the ways in which developmental tensions are exacerbated by broader sociocultural dynamics, contributing to a broader understanding of suicide risk among ethnic minority adolescents.

An examination of individual forms of nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) is a growing public health concern, and there is an increasing need to better characterize and identify severe NSSI behavior. One readily accessible, yet understudied, avenue for improving the assessment of NSSI severity is through the examination of individual forms, or methods, of the behavior. The present study aimed to address this gap in the literature by investigating the relationship between 12 different NSSI methods with three NSSI severity indicators and three distinct suicidal thoughts and behaviors among 1,436 undergraduate students with a history of NSSI (70.90% female, M age = 20.69, SD = 3.32). Results across six decision tree analyses highlighted the use self-hitting / punching, in addition to cutting oneself, as the most informative NSSI methods for differentiating outcome severity. Gender differences were only found for the outcome of suicidal ideation. The present study provides preliminary evidence that the examination of individual NSSI methods may be useful in identifying individuals at risk for negative correlates of NSSI, including NSSI-related hospital visits, unintended serious injury, and suicidal behavior. Upon replication in longitudinal work, findings have important clinical utility by providing a potential marker of prognosis and the need for higher levels of care.

Examining Patterns of Change in the Acquired Capability for Suicide Among Eating Disorder Patients

OBJECTIVE

Several models of suicidal behavior posit that, to transition from suicidal ideation to attempting suicide, individuals must have an acquired capability for suicide (ACS), comprised of fearlessness about death (FAD) and pain tolerance. ACS is hypothesized to increase monotonically through exposure to painful and provocative experiences. However, recent research suggests that ACS can decrease, bringing into question the hypothesis of monotonic increase. This study examined the nature of change in ACS over time within a sample of patients with eating disorder (ED). We predicted that there would be two classes of change in ACS: one high and increasing and one moderate and stable.

METHOD

One hundred female patients with ED reported on ACS at admission and weekly during treatment.

RESULTS

Growth mixture modeling to test models of FAD and pain tolerance identified that, for both factors, a one-class intercept-only model was the best-fitting model, suggesting that patients entered treatment with midlevel ACS and experienced no significant linear change over the course of treatment.

CONCLUSIONS

Acquired capability for suicide demonstrated stability in this study; results highlight the need for additional research examining ACS across different timescales and in varied populations.

A Preliminary Test of the Interpersonal-Psychological Theory of Suicide in Women Seeking Shelter From Intimate Partner Violence

Women seeking shelter from intimate partner violence (IPV) are at greater risk of suicide ideation and attempts compared with women in the general population. A theoretically grounded understanding of suicide risk in shelter-seeking women is critical to improve assessment and management of suicide risk in this population. The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideation results from hopelessness about thwarted belongingness and perceived burdensomeness. However, suicide ideation does not progress to death by suicide unless one has acquired the capability for suicide (i.e., pain tolerance and fearlessness about death) via repeated exposure to painful and fearsome events. The present study provides a preliminary test of the IPTS in a sample of 134 women seeking shelter from IPV. First, we examined factors theoretically related to suicide ideation, demonstrating that only at high levels of hopelessness was perceived burdensomeness associated with suicide ideation. The study also examined factors theoretically related to the acquired capability for suicide (ACS), indicating that physical partner violence perpetration was associated with ACS. These findings suggest that perceived burdensomeness, particularly in the context of increased hopelessness, is important in the assessment and treatment of suicide ideation. Furthermore, violence perpetration may indicate greater risk of the capability to die by suicide among women seeking shelter from IPV.

Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed

OBJECTIVE

Eating disordered (ED) behaviors (i.e., binge eating, compensatory behaviors, restrictive eating) and nonsuicidal self-injury (NSSI; intentional and nonsuicidal self-harm) are highly comorbid and share several similarities, including consequent pain and physical damage. However, whereas NSSI is considered direct self-harm, ED behaviors are considered indirect self-harm. These distinctions stem from theoretical understanding that NSSI is enacted to cause physical harm in the moment, whereas ED behaviors are enacted for other reasons, with consequent physical harm occurring downstream of the behaviors. We sought to build on these theoretically informed classifications by assessing a range of self-harming intentions across NSSI and ED behaviors.

METHOD

Study recruitment was conducted via online forums. After screening for inclusion criteria, 151 adults reported on their intent to and knowledge of causing physical harm in the short- and long-term and suicide and death related cognitions and intentions when engaging in NSSI and specific ED behaviors.

RESULTS

Participants reported engaging in ED and NSSI behaviors with intent to hurt themselves physically in the moment and long-term, alongside thoughts of suicide, and with some hope and knowledge of dying sooner due to these behaviors. Distinctions across behaviors also emerged. Participants reported greater intent to cause physical harm in the moment via NSSI and in the long-run via restrictive eating. NSSI and restrictive eating were associated with stronger endorsement of most suicide and death-related intentions than binge eating or compensatory behaviors.

CONCLUSIONS

Findings shed light on classification of self-harming behaviors, casting doubt that firm boundaries differentiate direct and indirectly self-harming behaviors.

Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.

Psychometric Properties of the Interpersonal Outcome Expectancies for Thinness (IOET) Scale: Evidence for Validity, Reliability, and Utility in the Study of Eating Disturbances in Females

Introduction: Interpersonal context is believed to represent a powerful factor that often fosters and sustains eating disturbances in females. The present study focused on the development of a measure tapping into positive interpersonal expectancies predicated on being thin believed to be positively involved in eating disorders in females, namely, the Interpersonal Outcome Expectancies for Thinness (IOET).

Method: In Study 1, a total of 361 U.S. female college students completed the IOET for factor analysis. In Study 2, to assess for construct validity, an independent sample of 184 U.S. female college students completed a test battery including the IOET and measures of eating attitudes and disturbances, positive and negative affectivity, and general optimism.

Results: In Study 1, results from an exploratory factor analysis indicated a one-factor solution for the IOET accounting for 76.70% of the total variance. In Study 2, the IOET was found to possess good test-retest reliability (6-week) in a subset sample of U.S. female participants. Moreover, in support for construct validity, we found IOET scores were positively associated with scores on measures of eating disturbances (e.g., bulimic symptoms) and negative affectivity. Additionally, IOET scores were negatively associated with scores on a measure of general optimism. Finally, in support of utility, the IOET was found to add incremental validity to the prediction of eating disturbances, even after accounting for general optimism and affectivity.

Discussion: The present findings provide promising evidence for the validity, reliability, and utility of the IOET as a measure of a maladaptive cognitive schema associated with eating disorders in females. Implications for the theory and clinical assessments were discussed.

Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury

OBJECTIVE

To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics.

METHODS

A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models.

RESULTS

11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040).

CONCLUSIONS

Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

Assessing Non-Suicidal Self-Injury in the Laboratory

The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings.

The role of emotion dysregulation: A longitudinal investigation of the interpersonal theory of suicide

Emotion dysregulation is considered to be transdiagnostic in nature, given its association with a variety of problem behaviors. Of concern, emotion dysregulation also may be associated with key components of the Interpersonal Theory of Suicide (ITS), namely suicidal desire and acquired capability for suicide (ACS; heightened fearlessness toward death and pain tolerance). ITS suggests that experiencing suicidal desire in conjunction with ACS leads to greater risk for suicide attempts. The present 4-wave longitudinal study tested bidirectional associations among emotion dysregulation, NSSI, ACS, and suicidal desire. Emotion dysregulation was associated with both desire and capability for suicide over time. Specifically, emotion dysregulation was associated with (1) higher levels of suicidal desire, (2) higher levels of NSSI, which in turn predicted higher ACS, and (3) lower ACS, suggesting that individuals with emotion dysregulation may find thoughts of death and pain more aversive. Thus, there are two separate paths for how emotion regulation leads to ACS, one path in which emotion dysregulation indirectly leads to ACS through NSSI, and one path in which emotion dysregulation protects against the development of ACS (note that higher levels of ACS alone are not sufficient to lead to a suicide attempt - suicidal desire also is required).

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample

The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.

Pain and self-harm: A systematic review

BACKGROUND

A growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal.

METHODS

A keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review.

RESULTS

There is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies.

LIMITATIONS

The current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis.

CONCLUSIONS

The evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.

Non-suicidal self-injury and life stress: A systematic meta-analysis and theoretical elaboration

Recent years have seen a considerable growth of interest in the study of life stress and non-suicidal self-injury (NSSI). The current article presents a systematic review of the empirical literature on this association. In addition to providing a comprehensive meta-analysis, the current article includes a qualitative review of the findings for which there were too few cases (i.e., <3) for reliable approximations of effect sizes. Across the studies included in the meta-analysis, a significant but modest relation between life stress and NSSI was found (pooled OR=1.81 [95% CI=1.49-2.21]). After an adjustment was made for publication bias, the estimated effect size was smaller but still significant (pooled OR=1.33 [95% CI=1.08-1.63]). This relation was moderated by sample type, NSSI measure type, and length of period covered by the NSSI measure. The empirical literature is characterized by several methodological limitations, particularly the frequent use of cross-sectional analyses involving temporal overlap between assessments of life stress and NSSI, leaving unclear the precise nature of the relation between these two phenomena (e.g., whether life stress may be a cause, concomitant, or consequence of NSSI). Theoretically informed research utilizing multi-wave designs, assessing life stress and NSSI over relatively brief intervals, and featuring interview-based assessments of these constructs holds promise for advancing our understanding of their relation. The current review concludes with a theoretical elaboration of the association between NSSI and life stress, with the aim of providing a conceptual framework to guide future study in this area.

Subjective pain during NSSI as an active agent in suicide risk

Non-suicidal self-injury (NSSI) has been identified as a correlate and predictor of suicidal ideation and attempts. Given the high-rates of NSSI presence among adolescents and young adults, it is important to identify specific characteristics of NSSI that might place individuals who engage in this behavior at highest risk for suicidal behavior. NSSI is thought to increase the acquired capability for suicide via habituation to self-harm, though the NSSI characteristics most responsible for this relationship are unclear. The current study examined three characteristics of NSSI (frequency, number of methods, and subjective pain) that may help to elucidate this risk relationship. University students (N=997) with a history of NSSI completed measures assessing lifetime NSSI frequency, number of NSSI methods employed, and subjective experience of pain during NSSI, as well as suicide attempt (SA) history. Results indicated that NSSI frequency, number of NSSI methods, and subjective pain experienced during NSSI were each positively associated with SA history. Further, subjective pain experienced during NSSI moderated the relationship between NSSI frequency and SA history, such that the association between NSSI frequency and SA history was stronger for individuals who experienced lower levels of subjective pain.

Conceptualizing the neurobiology of non-suicidal self-injury from the perspective of the Research Domain Criteria Project

Non-suicidal self-injury (NSSI) commonly starts in adolescence and is associated with an array of negative outcomes. Neurobiological research investigating NSSI is in its early stages and most studies have examined this behavior within the context of specific diagnoses. However, the Research Domain Criteria (RDoC) initiative encourages researchers to examine brain-behavior relationships across diagnoses. This review on the neurobiology associated with NSSI is organized using the domains proposed by RDoC: Negative Valence, Positive Valence, Cognitive, Social Processes, and Arousal/Regulatory Systems. Evidence of neurobiological anomalies is found in each of these domains. We also propose future research directions, especially in regard to human development. Future NSSI studies should address this behavior independent of diagnosis, examine relevant constructs across multiple units of analysis, and assess how systems change across development and course of illness. These advances will be essential for guiding neurobiologically informed intervention and prevention strategies to target NSSI. In doing so, we may prevent the associated negative outcomes across the lifespan.

Death Anxiety and Pain Catastrophizing Among Male Inmates With Nonsuicidal Self-Injury Behavior: A Comparative Study

Most of the studies concerning nonsuicidal self-injury behaviors of persons deprived of liberty were on female participants. This cross-sectional comparative study compared the levels of death anxiety, pain catastrophizing, dissociative experiences, and state-trait anger among male inmates with nonsuicidal self-injury behaviors and noninjuring controls. The results indicated high levels of death anxiety, dissociation, and pain catastrophizing in both groups of participants and the absence of significant differences between the groups. The implications of the results suggest the need of taking into consideration these variables in the behavior management plans used with inmates who engage in self-injurious behavior.

Interpersonal violence, alcohol use, and acquired capability for suicide

Acquired capability for suicide (ACS), defined as pain tolerance and fearlessness about death, is theorized as necessary to enact suicide. This study examined the associations of interpersonal violence and alcohol use with ACS in 502 college students. General fearlessness/pain tolerance was positively associated with male gender and alcohol use. Fearlessness about death was positively associated with male gender and general physical violence perpetration. However, these risk factors did not explain variance in ACS beyond male gender and history of suicide attempts/nonsuicidal self-injury. These findings add to the understanding of ACS correlates.

Pain analgesia among adolescent self-injurers

Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12-19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem.

Gender-differences in risk factors for suicidal behaviour identified by perceived burdensomeness, thwarted belongingness and acquired capability: cross-sectional analysis from a longitudinal cohort study

Background

The Interpersonal-Psychological Theory of Suicidal Behavior (IPT) is supported by recent epidemiological data. Unique risk factors for the IPT constructs have been identified in community epidemiological studies. Gender differences in these risk factors may contribute substantially to our understanding of suicidal risk, and require further investigation. The present study explores gender differences in the predictors and correlates of perceived burdensomeness, thwarted belongingness and acquired capability for suicide.

Methods

Participants (547 males, 739 females) aged 32–38 from the PATH through Life study, an Australian population-based longitudinal cohort study (n=1,177) were assessed on perceived burdensomeness, thwarted belongingness and acquired capability for suicide using the Interpersonal Needs Questionnaire and Acquired Capability for Suicide Survey, and on a range of demographic, social support, psychological, mental health and physical health measures. Gender differences in the predictors of the IPT constructs were assessed using linear regression analyses.

Results

Higher perceived burdensomeness increased suicide ideation in both genders, while higher thwarted belongingness increased suicide ideation only in females. In females, thwarted belongingness was uniquely related to perceived burdensomeness, while greater physical health was significantly associated with greater thwarted belongingness in males but not in females. There were trends suggesting greater effects of being single and greater perceived burdensomeness for men, and stronger effects of less positive friendship support for women associated with greater thwarted belongingness.

Conclusions

Men and women differ in the pattern of psychological characteristics that predict suicide ideation, and in the factors predicting vulnerability. Suicide prevention strategies need to take account of gender differences.