Psychometric properties of the functions and addictive features scales of the Ottawa Self-Injury Inventory: a preliminary investigation using a university sample

Nonsuicidal Self-Injury and Suicidal Beliefs in Adolescent Inpatient

Background and Objectives: Although nonsuicidal self-injury (NSSI), by definition, excludes suicidal intent, numerous studies show associations between NSSI and suicidal phenomena in clinical and outpatient adolescent samples. Given the growing interest in the relationship between NSSI and suicidal phenomena, the present study aimed to investigate the relationship between NSSI and suicidal beliefs in adolescent psychiatric inpatients. Materials and Methods: The study sample included 50 adolescent inpatients at a specialized facility, with a mean age of 15.44 ± 1.39, who fulfilled DSM-5 criteria for NSSI. For study purposes, we use the Ottawa Self-Injury Inventory (OSI) and Brief Suicide Cognitions Scale (B-SCS). Statistical data processing was performed in the R software 4.3.0 (R Core Team, Vienna, Austria). Results: Of all NSSI functions, the Internal ER function score was the highest (18.72 ± 7.08), followed by External ER (8.10 ± 3.11), Social Influence (5.88 ± 5.37), and Sensation Seeking (3.44 ± 2.98). The mean Craving (C) score was 14.06 ± 7.51. The mean value of the B-SCS score was 19.54 ± 5.24. It was found that the B-SCS score is significantly related to Internal ER (r = 0.441, p < 0.001) and Craving (r = 0.297, p = 0.036). The multivariable model shows that internal ER function and participants' age are significantly related to the B-SCS score. Conclusion: Despite the limitations of the study, it is emphasized that cognitions occurring across the fluid suicidal belief system alone do not fully capture the complexity of suicide, but assessing the suicidal belief system in NSSI inpatient adolescents could nevertheless provide helpful information for identifying individuals who may have an elevated vulnerability to experiencing suicidal ideas and behaviors over time.

Alteration of prefrontal cortex and its associations with emotional and cognitive dysfunctions in adolescent borderline personality disorder

The neurobiological mechanism of borderline personality disorder (BPD) in adolescents remains unclear. The study aimed to assess the alterations in neural activity within prefrontal cortex in adolescents with BPD and investigate the relationship of prefrontal activity with emotional regulation and cognitive function. This study enrolled 50 adolescents aged 12-17 years with BPD and 21 gender and age-matched healthy control (HC) participants. Study assessment for each participant included a brain resting-state functional MRI (rs-fMRI), clinical assessment questionnaires such as Borderline Personality Features Scale (BPFS), Difficulties in Emotion Regulation Scale (DERS), Ottawa Self-Injury Inventory and Childhood Trauma Questionnaire (CTQ) and cognitive testing with Stroop Color-Word Test (SCWT). Fractional amplitude of low-frequency fluctuations (fALFF) and seed-based functional connectivity (FC) were obtained from rs-fMRI analysis. Correlation analysis was also performed to evaluate the associations of the neuroimaging metrics such as fALFF and FC with clinical assessment questionnaire and cognitive testing scores. Adolescents with BPD showed increased fALFF values in the right inferior frontal gyrus and decreased activity in the left middle frontal gyrus as compared to the HC group (p < 0.05, cluster size ≥ 100, FWE correction). In adolescents with BPD, increased fALFF in the right inferior frontal gyrus was related to the BPFS (emotional dysregulation), DERS-F (lacking of emotional regulation strategies) and Ottawa Self-Injury Inventory-4 C scores (internal emotional regulation function of self-injurious behavior). The reduced fALFF in the left middle frontal gyrus was associated with the SCWT-A (reading characters) and the SCWT-B (reading color) scores. Additionally, the fALFF values in the left middle frontal gyrus and the right inferior frontal gyrus were related to the CTQ-D (emotional neglect) (p < 0.05). The left middle frontal gyrus exhibited increased FC with the right hippocampus, left inferior temporal gyrus and right inferior frontal gyrus (voxel p < 0.001, cluster p < 0.05, FWE correction). The increased FC between the left middle frontal gyrus and the right hippocampus was related to the SCWT-C (cognitive flexibility) score. We observed diverging changes in intrinsic brain activity in prefrontal cortex, and neural compensatory changes to maintain function in adolescents with BPD. In addition, decreased neural function was closely associated with emotional dysregulation, while increased neural function as indicated by brain activity and FC was associated with cognitive dysfunction. These results indicated that alterations of intrinsic brain activity may be one of the underlying neurobiological markers for clinical symptoms in adolescents with BPD.

Measurement properties of tools used to assess self-harm in autistic and general population adults

Autistic people are at increased risk of experiencing self-harm compared to the general population. However, it is unclear which tools are being used to assess self-harm in autistic people, or whether existing tools need to be adapted for this group. This two-stage systematic review aimed to identify tools used to assess self-harm in autistic and general population adults, evaluate these tools on their measurement properties, and make recommendations for their appropriate use in research and clinical practice. Four databases were systematically searched (PsycINFO, Embase, MEDLINE and Web of Science). Eight frequently used self-harm assessment tools were identified and assessed for risk of bias, criteria for good measurement properties, and quality of evidence using the COSMIN checklist. Of these, two tools had sufficient evidence of internal consistency (ISAS, QNSSI), and one had been frequently used with autistic adults (NSSI-AT). These three tools may have potential for use with autistic adults but require further investigation for content validity and measurement properties in the autistic population. More research and potential adaptations to current self-harm assessment tools are recommended in order to better conceptualise and understand self-harm and its measurement in autism.

The relationship between mobile phone addiction and non-suicidal self-injury: Findings from six universities in Shaanxi province, China

BACKGROUND

Although the development and application of mobile phones have changed various aspects of people's lives, excessive use of mobile phones has also raised physical and mental health concerns. However, the relationship between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) is unclear.

METHODS

A cross-sectional study was conducted (2022) among students from six universities to assess the relationship between MPA and NSSI. A Mobile Phone Addiction Tendency Scale (MPATS) was used to assess MPA, while NSSI was assessed via The Ottawa Self-Injury Inventory. Binary logistic regression models were used to assess the relationship between MPA and NSSI.

RESULTS

A total of 18,723 college students (6531 males [34.9 %] and 12,192 females [65.1 %]) were included in the final analyses. The prevalence of NSSI during the past 12 months was 6.5 %. Furthermore, 5553 participants (29.7 %) met the MPA criteria (MPATS score ≥ 48), and the average MPATS score was 39.5 ± 13.0. MPA was associated with increased odds of NSSI after adjusting for socio-demographic characteristics, health-related characteristics, and relevant psychosocial variables (OR, 1.29; 95 % CI, 1.13-1.46). Moreover, gender did not affect the association of MPA and MPATS score with NSSI (P for interaction>0.05). The restricted cubic splines regression showed that a monotonically increasing risk of NSSI was associated with increasing MPATS score (P for non-linearity = 0.474).

CONCLUSIONS

MPA is associated with increased odds of NSSI among college students, indicating that early examination, prevention, and intervention for MPA may prevent and control NSSI.

The use of optical coherence tomography (OCT) and OCT angiography in borderline personality disorder compared to health control subjects

BACKGROUND

Optical coherence tomography (OCT) or OCT angiography (OCTA) has been investigated in few research studies of psychiatric disorders. No research has been done using OCT or OCTA in patients with borderline personality disorder (BPD).

METHODS

OCTA measured foveal avascular zone (FAZ), macular vessel density (MVD), and peripapillary vessel density (PVD). OCT measured the peripapillary retinal fiber layer (RNFL) and central retinal thickness (CRT). The study utilized the Ottawa Self-Injury Inventory, Hamilton Anxiety Rating Scale (HAMA), and Global Assessment of Functioning (GAF) to assess the symptom characteristics of individuals with BPD.

RESULTS

Fifty-nine eyes of BPD patients and 58 eyes of normal subjects were analyzed, MVD of the superficial retinal capillary plexus declined noticeably in most subfields (p < 0.05). Significant differences were observed in the whole inner ring and outer ring index between BPD and HC groups (p < 0.05). The patients with BPD exhibited lower RNFL and CRT, the difference was significant (p < 0.05). CRT indicated a significant negative correlation with the Ottawa Self-Injury Inventory (p < 0.05). In addition, we observed that there was a negative correlation identified between the MVD of the inner ring and HAMA (p < 0.05). Meanwhile, the MVD of the outer ring was positively correlated with GAF (p < 0.05). The areas under the receiver operating characteristic curves (AUROCs) for distinguishing BPD and HC eyes in OCTA were the highest for fovea MVD (0.679), followed by outer ring MVD (0.669), inner ring MVD (0.641), FAZ (0.579). In OCT, CRT was highest for BPD (0.711), followed by RNFL (0.625).

CONCLUSION

The OCT and OCTA can non-invasively detect microvascular and morphology changes of the retina in BPD patients compared to healthy control subjects.

Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults

Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case-control design. A total of 548 outpatients (12 to 22 years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinical interviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512-3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378-3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351-6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653-3.690, p < 0.0001). Nearly 3 out of 5 patients (12-22 years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.

Association of white matter microstructural alteration with non-suicidal self-injury behavior and visual working memory in adolescents with borderline personality disorder

BACKGROUND

Non-suicidal self-injurious behavior (NSSI) is the core characteristic of adolescent borderline personality disorder (BPD) and visual working memory is involved in the pathological processes of BPD. This study aimed to investigate alterations in white matter microstructure and their association with NSSI and visual working memory in adolescents with BPD.

METHODS

53 adolescents diagnosed with BPD and 39 healthy controls (HCs) were enrolled. White matter microstructure was assessed with the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging (DTI). Correlation analysis was performed to assess the association between FA/MD and core features of BPD. A mediation analysis was performed to test whether the effects of white matter alterations on NSSI could be mediated by visual working memory.

RESULTS

Adolescents with BPD showed a reduced FA and an increased MD in the cortical-limbic and cortical-thalamus circuit when compared to the HCs (p < 0.05). Increased MD was positively correlated with NSSI, impulse control and identity disturbance (p < 0.05), and was negatively correlated with the score of visual reproduction. Reserved visual working memory masked the effects of white matter microstructural alterations on NSSI behavior.

CONCLUSIONS

White matter microstructural deficits in the cortical-limbic and cortical-thalamus circuits may be associated with NSSI and visual working memory in adolescents with BPD. Reserved visual working memory may protect against NSSI.

Altered gray matter volume and functional connectivity in adolescent borderline personality disorder with non-suicidal self-injury behavior

BACKGROUND AND OBJECTIVES

Non-suicidal self-injury (NSSI) behavior is one of the characteristics of borderline personality disorder (BPD) in adolescents. Prior studies have shown that adolescents with BPD may have a unique pattern of brain alterations. The purpose of this study was to investigate the alterations in brain structure and function including gray matter volume and resting-state functional connectivity in adolescents with BPD, and to assess the association between NSSI behavior and brain changes on neuroimaging in adolescents with BPD.

METHODS

53 adolescents with BPD aged 12-17 years and 39 age-gender matched healthy controls (HCs) were enrolled into this study. Brain magnetic resonance imaging (MRI) was acquired with both 3D-T1 weighted structural imaging and resting-state functional imaging. Voxel-based morphometry (VBM) analysis for gray matter volume and seed-based functional connectivity (FC) analysis were performed for assessing gray matter volume and FC. Clinical assessment for NSSI, mood, and depression was also obtained. Correlative analysis of gray matter alterations with self-injury or mood scales were performed.

RESULTS

There were reductions of gray matter volume in the limbic-cortical circuit and default mode network in adolescents with BPD as compared to HCs (FWE P < 0.05, cluster size ≥ 1000). The diminished gray matter volumes in the left putamen and left middle occipital gyrus were negatively correlated with NSSI in adolescents with BPD (r = - 0.277 and P = 0.045, r = - 0.422 and P = 0.002, respectively). Furthermore, there were alterations of FC in these two regions with diminished gray matter volumes (voxel P < 0.001, cluster P < 0.05, FWE corrected).

CONCLUSIONS

Our results suggest that diminished gray matter volume of the limbic-cortical circuit and default mode network may be an important neural correlate in adolescent BPD. In addition, the reduced gray matter volume and the altered functional connectivity may be associated with NSSI behavior in adolescents with BPD.

Experiencing stress impact on adolescent repetitive nonsuicidal self-injury: The Mediating role of emotion dysregulation and maladaptive cognitive schemas

BACKGROUND

Repetitive nonsuicidal self-injury (R-NSSI) is a growing concern in adolescents and is associated with various mental health problems. However, little is known about the potential psychology and addiction mechanisms of R-NSSI in adolescents. This study aimed to examine the mediating effects of emotion dysregulation and maladaptive cognitive schemas based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the integrated model of NSSI among adolescents who repeatedly engage in NSSI.

METHODS

This longitudinal study was conducted in two waves with 6-month lags. A total of 3925 adolescents (Mage = 13.22 ± 0.86 years, 42 % female) were recruited from three middle schools. Relevant questionnaires were used to evaluate stressful life events, emotion dysregulation, maladaptive cognitive schemas, NSSI, and NSSI addictive features. The structural equation modeling approach was conducted separately for adolescents who engaged in occasional NSSI (O-NSSI) and those who engaged in R-NSSI.

RESULTS

Results showed that emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI frequency, and both maladaptive cognitive schemas and emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI addictive features in adolescents who engaged in R-NSSI but not in those who engaged in O-NSSI.

LIMITATIONS

The main limiting factor is self-reported data.

CONCLUSIONS

These findings contribute to the understanding of the psychological and addictive mechanisms involved in R-NSSI. Both emotion dysregulation and maladaptive cognitive schemas could be a suitable therapeutic target to reduce R-NSSI in the context of stress during adolescence.

Early maladaptive schemas are associated with self-injury thoughts and behavior in adolescents

BACKGROUND

Early maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care.

METHODS

The participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants' EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs' associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff's Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression.

RESULTS

The differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs.

CONCLUSIONS

The present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.

Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review

Nonsuicidal self-injury (NSSI) refers to the direct, deliberate infliction of harm to one's body tissue without the intention to die. The prevalence of NSSI has increased significantly globally in recent years and has become an important public health problem affecting the health of people, especially adolescents. The occurrence of NSSI in adolescents is the result of the interaction of different factors. Many scholars have proposed various theoretical models to explain the mechanism of NSSI behavior based on previous research on the influencing factors of NSSI. Moreover, advances have been made in genetic and neuroimaging mechanisms related to NSSI. Understanding the genetic and neuroimaging mechanisms of NSSI is important for both describing and treating the disorder. This literature review discusses the progress made on the risk factors, theoretical models, and biological mechanisms of NSSI.

Relationship between borderline personality features, emotion regulation, and non-suicidal self-injury in depressed adolescents: a cross-sectional study

OBJECTIVE

Non-suicidal self-injury (NSSI) is common among adolescents and has been linked to mental disorders and suicide in addition to physical injuries. According to the empirical avoidance model, adolescents with NSSI have stronger emotional affect and poorer emotional regulation than those without NSSI, and these constitute core features of borderline personality disorder (BPD). The relationship between borderline personality features, emotional regulation, and NSSI in the population is unclear. This study explored these associations to provide a theoretical basis for the treatment of NSSI in the future.

METHODS

Depressed adolescents (n = 1192) were evaluated using Chinese versions of the Function Assessment of Self-mutilation Scale, Emotional Regulation Questionnaire for Children and Adolescents, and Borderline Personality Features Scale for Children.

RESULTS

The majority of depressed adolescents (71.3%, 850/1192) had demonstrated NSSI in the past year, with cutting or scratching being the most common form (57.4%). Pearson correlation analysis with NSSI as a fixed factor (NSSI = 1, no NSSI = 2) revealed a negative correlation between NSSI and borderline personality features (r = -0.314, P < 0.01) but a positive correlation between NSSI and emotional regulation capacity (r = 0.159, P < 0.01), which was positively correlated with the expression suppression dimension (r = 0.079, p < 0.01); however, there was no significant correlation between the cognitive reappraisal dimension and expression suppression (r = 0.022, p > 0.05). The occurrence of NSSI was also positively correlated with borderline personality features in general (r = 0.314, p < 0.01). These results were statistically significant. Emotional regulation played a mediating role between borderline personality traits and NSSI in adolescents with depression (effect value = 0.151).

CONCLUSION

Borderline personality features and emotional regulation ability were significantly correlated with NSSI in depressed adolescents. Borderline personality symptoms not only directly influenced NSSI risk in adolescents with depression, but also indirectly influenced NSSI risk through emotional regulation.

Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors

BACKGROUND

Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China.

METHODS

We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking.

RESULTS

The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it.

LIMITATIONS

This was an online survey.

CONCLUSIONS

The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.

Alteration of surface morphology and core features in adolescents with borderline personality disorder

BACKGROUND

Accurate early diagnosis of adolescent borderline personality disorder (BPD) is critical for prompt treatment. The aim of this study was to assess the alteration of brain surface morphology and to evaluate its relationship with core features in adolescent BPD.

METHODS

A total of 52 adolescents with BPD aged 12-17 years and 39 age- and sex-matched healthy controls (HCs) were prospectively enrolled into the study. Brain magnetic resonance imaging (MRI) was obtained with both 3D-T1 weighted structural sequence and resting-state functional data. The structural data was analyzed for surface morphology parameters including the local gyrification index (LGI), mean curvature and surface area. The functional MRI data was analyzed for seed-based functional connectivity (FC). Correlative analysis of surface morphology and core features of adolescent BPD was performed.

RESULTS

Adolescents with BPD showed the following altered surface morphology in the limbic-cortical circuit when compared to the HCs: (1) reduced LGI in the left fusiform and right superior temporal gyrus; (2) reduced mean curvature in the left precentral gyrus and right rostral anterior cingulate cortex, and increased mean curvature in the bilateral pericalcarine; and (3) reduced surface area in the left paracentral gyrus, left pars triangularis, right insula and right lateral orbitofrontal gyrus (P < 0.05, FWE correction). In addition, these brain regions with altered surface morphology were significantly correlated with several core features including the mood instability, self-identity problems, and non-suicidal self-injury behavior in adolescents with BPD (P < 0.05). Furthermore, there was enhanced functional connectivity among these altered brain regions within the limbic-cortical circuit (voxel P < 0.001, cluster P < 0.05, FWE corrected).

CONCLUSIONS

Adolescents with BPD had significant alterations of brain surface morphology in the limbic-cortical circuit, which was correlated with core BPD features. These results implicated the surface morphology parameters and FC alterations may potentially serve as neuroimaging biomarkers for adolescents with BPD.

Do Cortisol and Dehydroepiandrosterone Influence Motivational Factors for Non-Suicidal Self-Injury in Female Adolescents?

Non-suicidal self-injury (NSSI) is a significant public health issue that particularly affects female adolescents usually emerging during puberty, with a subsequent reduction and even remission in the phenomenon later in life. The dysregulation of the hormonal stress response, particularly cortisol and dehydroepiandrosterone sulfate (DHEA-S), whose levels increase markedly during pubertal adrenarche, has been associated with the development and maintenance of a wide range of emotional disorders. Our study aims to investigate whether different cortisol-DHEA-S response patterns could be associated with the main motivational moderators to engage NSSI as well as with urgency and motivation to stop NSSI in a sample of female adolescents. We found significant correlations between stress hormones and several factors that support and sustain NSSI, specifically: cortisol levels and distressing/upsetting urge (r = 0.39 and a p = 8.94 × 10^-3) and sensation seeking (r = -0.32 and a p = 0.04), as well as cortisol/DHEA-s ratio and external emotion regulation (r = 0.40 and a p = 0.01) and desire to stop NSSI (r = 0.40 and a p = 0.01). Cortisol and DHEA-S may play a role in NSSI through the regulation of stress responses and affective states. Such results could have implications for the development of new and improved treatment and prevention plans for NSSI.

Changes in emotion-related EEG components and brain lateralization response to negative emotions in adolescents with nonsuicidal self-injury: An ERP study

Nonsuicidal self-injury (NSSI) is a serious risk behavior in adolescents and is a high risk factor for suicide, while negative emotions can lead to increased NSSI behaviors. In this study, we investigated the altered behavioral performance and neural reactivity of adolescents with NSSI by using a two-choice oddball paradigm when exposed to negative emotional stimuli, and analyzed the brain lateralization effect. Our data indicated that adolescents with NSSI exhibit more pronounced N250, P300, and LPP components during negative emotional face stimulation, as evidenced by a smaller N250 wave amplitude, larger P300 wave amplitude, steeper LPP waveform, and faster fallback baseline; and the presence of brain lateralization responses in both the N250 component and the LPP component. These results suggested that adolescents with NSSI showed significant alterations in cognitive EEG components associated with emotional processing during negative emotional face stimulation, particularly in EEG components representing inhibitory control, and there was a lateralization effect on emotional processing in the brain, with different processing stages and different dominance of the left and right brain.

High-risk group and functional subtypes of non-suicidal self-injury in young adults with mental disorders

BACKGROUND

Identifying high-risk groups of non-suicidal self-injury (NSSI) with multiple risk factors and different functional subtypes contribute to implementing person-centered interventions.

METHODS

We investigated NSSI profiles among a sample of 258 psychiatric inpatients aged 18-25 years. All participants completed well-validated measures of internal personal and external environmental characteristics. One-hundred and ninety patients reported a lifetime history of NSSI and completed an additional NSSI assessment. A k-means cluster analysis was conducted to extract characteristics of risk factors and functional subtypes. Independent sample t-test, analysis of variance and χ ² test were used to test the difference of demographic statistical factors, risk factors and functional scores among groups with different frequency of NSSI.

RESULTS

The clustering of risk factors analyses supported 4-clusters. The proportion of repeat NSSI patients was the highest (67.1%) in the group with unfavorable personal and unfavorable environmental characteristics. Functional subtype clustering analyses supported 5-clusters. Among patients with repeated NSSI, those with depression were mainly accompanied by the "Sensation Seeking" subtype (39.7%), bipolar disorder mainly supported the "Anti-suicide" subtype (37.9%), and eating disorders were mostly "Social Influence" subtype (33.3%). There was an interaction between functional subtypes and mental disorders.

LIMITATIONS

All participants were in treatment in a psychiatric service and the results may not be generalizable to a community sample. The data included retrospective self-report which may be inaccurate due to recall bias.

CONCLUSION

It is necessary to identify high-risk groups of NSSI who with unfavorable personal and environmental characteristics and clinical interventions need to consider the heterogeneity of patients' functional subtypes of NSSI.

Multicenter analysis on the non-suicidal self-injury behaviors and related influencing factors-A case study of left-behind children in northeastern Sichuan

BACKGROUND

Few studies have been conducted focusing on the non-suicidal self-injury (NSSI) incidence rate and influencing factors among left-behind children in northeastern Sichuan, China. In this study, we investigated the incidence rate of the NSSI behaviors, levels of anxiety and depression in left-behind children in northeastern Sichuan, and relevant sociodemographic factors.

METHODS

The NSSI behaviors were identified using the Ottawa Self-injury Inventory (Chinese version). Its incidence rate and related influencing factors were evaluated by Cluster sampling; the Depression Anxiety Stress Scale-21 Items (DASS-21) was adopted to assess the levels of anxiety, depression, and stress.

RESULTS

A total of 9450 adolescents met the inclusion criteria, including 543 with NSSI behaviors, and the prevalence of NSSI was 5.7 %. There were 3596 left-behind children, and 243 of them had NSSI behaviors, the NSSI incidence in left-behind children was 6.8 %. There were 5854 non-left-behind children, and the NSSI incidence in non-left-behind children was 5.1 %. Left-behind children's NSSI behaviors were remarkably correlated with five risk factors: being female (OR = 2.411, 95%CI = 1.773-3.279), parents' divorce (OR = 1.742, 95%CI = 1.262-2.404), elder age (OR = 1.120, 95%CI = 1.028-1.219), severe depression (OR = 1.212, 95%CI = 1.148-1.281), and high anxiety (OR = 1.170, 95%CI = 1.093-1.251).

LIMITATIONS

This is a cross-sectional study, we cannot probe into the causality between NSSI behaviors and corresponding risk factors. Reporting and recalling biases may be unavoidable as questionnaires are performed by self-rating scales and retrospective reports.

CONCLUSION

The NSSI behaviors are common in left-behind children in northeastern Sichuan. This study proposes that prevention and intervention measures are necessary for the healthy growth of such children.

Changes in microstates of first-episode untreated nonsuicidal self-injury adolescents exposed to negative emotional stimuli and after receiving rTMS intervention

Background

Nonsuicidal self-injury (NSSI) is a common mental health threat in adolescents, peaking in adolescence with a lifetime prevalence of ~17%-60%, making it a high-risk risk factor for suicide. In this study, we compared changes in microstate parameters in depressed adolescents with NSSI, depressed adolescents, and healthy adolescents during exposure to negative emotional stimuli, and further explored the improvement of clinical symptoms and the effect of microstate parameters of repetitive transcranial magnetic stimulation (rTMS) in depressed adolescents with NSSI, and more evidence was provided for potential mechanisms and treatment optimization for the occurrence of NSSI behaviors in adolescents.

Methods

Sixty-six patients with major depressive disorder (MDD) exhibiting NSSI behavior (MDD + NSSI group), 52 patients with MDD (MDD group), and 20 healthy subjects (HC group) were recruited to perform neutral and negative emotional stimulation task. The age range of all subjects was 12-17 years. All participants completed the Hamilton Depression Scale, the Patient Health Questionnaire-9, the Ottawa Self-Injury Scale and a self-administered questionnaire to collect demographic information. We provided two different treatments to 66 MDD adolescents with NSSI; 31 patients received medication and completed post-treatment scale assessments and EEG acquisitions, and 21 patients received medication combined with rTMS and completed post-treatment scale assessments and EEG acquisitions. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline, using the EEGLAB toolbox in MATLAB. Use the Microstate Analysis Toolbox in EEGLAB for segmentation and computation of microstates, and calculate a topographic map of the microstate segmentation of the EEG signal for a single subject in each dataset, and four parameters were obtained for each microstate classification: global explained variance (GEV), mean duration (Duration), average number of occurrences per second (Occurrence), and average percentage of total analysis time occupied (Coverage), which were then statistically analyzed.

Results

Our results indicate that MDD adolescents with NSSI exhibit abnormalities in MS 3, MS 4, and MS 6 parameters when exposed to negative emotional stimuli compared to MDD adolescents and healthy adolescents. The results also showed that medication combined with rTMS treatment improved depressive symptoms and NSSI performance more significantly in MDD adolescents with NSSI compared to medication treatment, and affected MS 1, MS 2, and MS 4 parameters in MDD adolescents with NSSI, providing microstate evidence for the moderating effect of rTMS.

Conclusion

MDD adolescents with NSSI showed abnormal changes in several microstate parameters when receiving negative emotional stimuli, and compared to those not receiving rTMS treatment, MDD adolescents with NSSI treated with rTMS showed more significant improvements in depressive symptoms and NSSI performance, as well as improvements in EEG microstate abnormalities.

Smaller putamen volumes are associated with greater problems in external emotional regulation in depressed adolescents with nonsuicidal self-injury

The functions of nonsuicidal self-injury (NSSI) consist of social and emotional aspects (Social influence, Sensation seeking, Internal and External emotion regulation). Previous studies have indicated that dysfunction in reward-related brain structures especially the striatum might drive this habitual behavior. However, no studies to date have investigated the associations between striatum and different functions for adolescents engaging in NSSI behaviors. Here, we recruited 35 depressed adolescents with recent NSSI behaviors and 36 healthy controls and acquired structural brain images, depressive symptoms, social, academic and family environments assessments, in addition to NSSI functions in patients only. Subcortical volumes and cortical thickness were estimated with FreeSurfer. Mixed linear regressions were performed to examine associations between striatal structures (caudate, putamen, nucleus accumbens, pallidum) and NSSI functions, with age, sex, total intracranial volume, hemisphere and depression severity included as covariates. Effect of environmental factors and potential associations with cortical thickness and other subcortical volumes were also tested. We found that, among the four functions, external emotional regulation represented the main function for NSSI engagement. Increased external emotion regulation was significantly associated with smaller putamen volume. No environmental factors biased the association with putamen. No associations with other cortical or subcortical regions were observed. Our findings suggested that smaller putamen might be a biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions. The results have potentially clinical implications in early identification and brain intervention of NSSI in youth.

Internalized Homophobia, Body Dissatisfaction, Psychological Distress, and Nonsuicidal Self-Injury Among Young Sexual Minority Men in China

Purpose: Sexual minority men (SMM) have been shown to be at high risk of nonsuicidal self-injury (NSSI). Internalized homophobia, body dissatisfaction, and psychological distress have been found to be related to NSSI among SMM, but few studies have focused on the mechanisms underlying these associations. Thus, the current study was conducted to examine the association between internalized homophobia and NSSI, and whether body dissatisfaction and psychological distress mediate this relationship among young SMM in China. Methods: In total, 264 young SMM (mean age, 22.00 ± 2.86 years) in Henan Province, China, participated in the study. A set of questionnaires were used to assess participants' internalized homophobia, body fat dissatisfaction, muscularity dissatisfaction, psychological distress, and NSSI. Correlation and mediation analyses were used to examine the data. Results: Internalized homophobia correlated positively with NSSI (r = 0.24, p < 0.001) among young SMM in China. This relationship was partly mediated by body fat dissatisfaction, muscularity dissatisfaction, and psychological distress. Conclusion: The study findings suggest that internalized homophobia is a risk factor for NSSI among young SMM in China, and that body fat and muscle dissatisfaction and psychological distress underlie the association between internalized homophobia and NSSI. In developing interventions targeting NSSI among SMM, the findings of the current study should be considered to improve intervention outcomes.

Body dissatisfaction and non-suicidal self-injury among Chinese young adults: a moderated mediation analysis

OBJECTIVE

Extensive evidence from Western societies supports the role for body dissatisfaction in the etiological models of non-suicidal self-injury (NSSI). However, research of the underlying mechanisms of this relationship has been limited, especially in China. Therefore, the aim of this study was to examine the association between body dissatisfaction and NSSI among college students in China. Possible mediating roles for psychological distress and disordered eating, as well as a moderating role for self-compassion, were also examined.

METHODS

College students (n = 655, M_age = 20.32 years, SD = 1.02) were recruited from Henan province, China. Each participant completed questionnaires regarding body dissatisfaction, psychological distress, disordered eating, and self-compassion.

RESULTS

A close to medium positive relationship between body dissatisfaction and NSSI was revealed with r = 0.24 (p < .001). The relationship was found to be fully mediated by psychological distress and disordered eating. The mediation role for disordered eating was found to be further moderated by self-compassion, suggesting that self-compassion acted as a buffer against the relationship between disordered eating and NSSI.

CONCLUSION

These findings indicate that body dissatisfaction, psychological distress, disordered eating, and self-compassion may play important roles in Chinese young adults' NSSI. Researchers and practitioners need to pay closer attention to the underlying mechanisms of how body dissatisfaction links to NSSI to deepen the understanding of their linkage as well as to provide appropriate interventions.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Examining Nonsuicidal Self-Injury Features as Motivational Moderators in the Relationship Between Hopelessness and Suicide Ideation

OBJECTIVE

Nonsuicidal self-injury (NSSI) is a robust predictor of suicide ideation and attempts, but it is not clear how and why this connection is so strong. Using the Integrated Motivational-Volitional Model of suicide as a framework, select features of NSSI were examined as motivational moderators between hopelessness and suicide ideation.

METHOD

Data were collected from 420 emerging adults (mean age = 18.9; 84% female, 92% white), all of whom had past-year NSSI. Participants completed self-report measures that assessed NSSI and suicide history, effectiveness of NSSI in achieving functions, and hopelessness; they also completed the self-injury Implicit Association Test (IAT).

RESULTS

Moderation analyses revealed that none of the interactions were significant. Additional analyses tested unconditional effects of all predictor variables and found hopelessness, self-rated future likelihood of engaging in NSSI, effectiveness of NSSI in achieving intrapersonal functions, and self-injury IAT scores were each significantly associated with suicide ideation.

CONCLUSIONS

These results reinforce the important role of hopelessness, perceived effectiveness of NSSI in achieving intrapersonal functions, acknowledgement of future NSSI, and self-identification with NSSI as potential indicators of increased suicide risk, while also emphasizing further study of other possible moderating factors.HIGHLIGHTSFeatures of NSSI did not moderate the hopelessness-suicide ideation relationship.Features of NSSI did associate with increased suicide ideation frequency.Future likelihood of, implicit association with, and intrapersonal effectiveness of NSSI were important.

Sexual Minority Stigma and Nonsuicidal Self-Injury Among Sexual Minorities: the Mediating Roles of Sexual Orientation Concealment, Self-Criticism, and Depression

Introduction

Nonsuicidal self-injury (NSSI), a significant predictor of suicide, is more frequent in sexual minorities (e.g., lesbian, gay, and bisexual) than in heterosexuals. The Minority Stress Model proposed that sexual minority stigma (SMS) may lead to maladaptive behaviors, including NSSI. However, the potential mechanism underlying the relationship between SMS and NSSI remains unclear. Therefore, the current study will examine the relationship between SMS and NSSI, and explore the serial mediating roles of sexual orientation concealment (SOC), self-criticism, and depression.

Methods

A total of 666 individuals who self-identified as sexual minorities (64.0% male, M age = 24.49 years, SD = 6.50) completed questionnaires of SMS, SOC, self-criticism, depression, and NSSI, in 2020.

Results

The findings indicated that (1) SMS, SOC, self-criticism, depression, and NSSI were positively correlated; (2) SOC, self-criticism, and depression independently played partial mediating roles between SMS and NSSI; and (3) SOC, self-criticism, and depression played serial mediating roles between SMS and NSSI.

Conclusions

The current study supported the relation between SMS and NSSI among Chinese sexual minorities, and also implied a potential mechanism underlying the relation. Specifically, SMS was related to increased NSSI by higher SOC, self-criticism, and depression. SOC had dual-edged effects on NSSI.

Policy Implications

To reduce NSSI and other psychological problems among sexual minorities, policy makers should take more measures to eliminate SMS. Specifically, policy makers are encouraged to provide more support for changing sexual minorities' living environment, such as repealing bills that could cause SMS and popularizing the knowledge about sexual orientation.

Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm

BACKGROUND & AIMS

Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially.

METHODS

To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI.

RESULTS

A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous.

DISCUSSION & CONCLUSION

Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.

Relationship between thyroid hormone and sex hormone levels and non-suicidal self-injury in male adolescents with depression

OBJECTIVE

Non-suicidal self-injury (NSSI) is the intentional and repeated direct injury to one's bodily tissues or organs without the intent to die, which is not socially sanctioned and does not result in death. This study will be the first to explore the relationship between NSSI behavior and thyroid hormone and sex hormone levels in male adolescents with depression.

METHODS

Among the inpatients in the children's ward of Shandong Mental Health Center, eighty male patients with first-episode depressive disorder were randomly selected. Forty male adolescent depressed patients with NSSI behaviors were set as the NSSI group, and forty male adolescent depressed patients without NSSI behaviors were set as the No-NSSI group. Their thyroid hormones (free triiodothyronine, free thyroxine, and thyroid stimulating hormone) and sex hormones (estradiol, progesterone, and testosterone) were measured, and the severity of self-injury in the NSSI group was assessed using the Adolescent Self-Injury Questionnaire. The NSSI group was tested again after 6 weeks of sertraline treatment for biological indicators and assessed by the Self-Injury Questionnaire to compare the hormonal differences between the NSSI group and the No-NSSI group and compare the differences of each index before and after treatment in the NSSI group.

RESULTS

T3/T4 (p = 0.001) and FT3 (p = 0.023), TSH levels (p < 0.001) were lower in the NSSI group than in the No-NSSI group before treatment, and FT4 (p = 0.036) and T (p < 0.001) levels were higher than in the No-NSSI group. T3/T4 levels were higher in the NSSI group after treatment (p < 0.001). FT4 (p < 0.001) and T (p = 0.001) levels and self-injury questionnaire scores (p < 0.001) decreased after treatment in the NSSI group. In the NSSI group at baseline, FT4 levels were negatively correlated with self-injury questionnaire scores (r = -0.459, p = 0.003) and testosterone levels were positively correlated with self-injury questionnaire scores (r = 0.383, p = 0.015), and in the NSSI group after treatment, FT4 difference was negatively correlated with self-injury questionnaire score reduction rate (r = -0.037, p = 0.019), and testosterone difference was positively correlated with self-injury questionnaire score reduction rate (r = 0.424, p = 0.006). Logistic regression analysis showed that low TSH and high testosterone levels were independent risk factors for the development of non-suicidal self-harming behaviors in male adolescent depressed patients.

CONCLUSION

Changes in thyroid hormone and sex hormone levels may be associated with non-suicidal self-injurious behavior in male adolescent depressed patients.

Altered Neural Reactivity in Adolescents With Nonsuicidal Self-Injury During Exposure to Self-Injury Related Cues: Electrophysiological Evidence From a Two-Choice Oddball Paradigm

BACKGROUND

Nonsuicidal self-injury (NSSI) may be a type of addiction, that is characterized by cue reactivity. We aimed to explore the behavioral performance and neural reactivity during exposure to self-injury cues in adolescents with NSSI and major depressive disorder (MDD).

METHODS

Eighteen MDD patients, 18 MDD patients with NSSI, and 19 healthy controls (HC) were recruited to perform a two-choice oddball paradigm. All subjects were 12-18 years old. Neutral cues and self-injury related cues separately served as deviant stimuli. Difference waves in N2 and P3 (N2d and P3d) were derived from deviant waves minus standard waves. Accuracy cost and reaction time (RT) cost were used as behavioral indexes, while the N2d and P3d were used as electrophysiological indexes; the N2d reflects early conflict detection, and the P3d reflects the process of response inhibition.

RESULTS

No significant main effects of group or cue or an effect of their interaction were observed on accuracy cost and P3d latency. For RT cost, N2d amplitude, and N2d latency, there was a significant main effect of cue. For P3d amplitude, there was a significant main effect of cue and a significant group × cue interaction. In the NSSI group, the P3d amplitude with self-injury cues was significantly larger than that with neutral cues. However, there was no such effect in the MDD and HC groups.

CONCLUSIONS

Adolescents with NSSI showed altered neural reactivity during exposure to self-injury cue. Further studies with larger sample sizes are needed to confirm our results.

Self-Injury Is My Drug: The Functions of Describing Nonsuicidal Self-Injury as an Addiction

ABSTRACT

Adolescents and emerging adults who engage in nonsuicidal self-injury (NSSI) often participate in online activity regarding their self-injury. Of particular importance are the potential benefits and risks associated with online NSSI activity, including how individuals describe their NSSI experiences. One way that individuals describe these experiences is by discussing NSSI as an addiction. Accordingly, we used thematic analysis to explore why individuals may use addiction references to describe their NSSI experiences. To do this, we examined 71 posts from a popular NSSI social network. Four themes emerged: difficulty inherent in stopping, authentication, warn others, and communicate the plight of the behavior. Findings highlight a number of avenues for research as well as implications for clinicians working with clients who self-injure perceive NSSI as an addiction. Mental health professionals can leverage their understanding of clients' perceptions of NSSI to better serve this population.

Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults

Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann-Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.

Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics

More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; M_age = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; M_age = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.

Clinical assessment of non-suicidal self-injury: A systematic review of instruments

There has been an increase in the number of assessment instruments for non-suicidal self-injury (NSSI). However, previous reviews are inconsistent and do not provide a comprehensive psychometric assessment of the instruments. This study aimed to systematically assess and compare the psychometric properties of clinically relevant instruments to measure NSSI in any population. Through a systematic review guided by COSMIN and PRISMA, two searches were conducted in English and Spanish in February 2020 in 13 databases including grey literature. Of the 7,813 initial records, 152 validations were extracted. From these, 83 instruments (22 versions or adaptations) were excluded for not measuring NSSI, having no potential clinical utility or not including psychometric properties. Finally, 26 (22 versions, 35 adaptations and 19 creations) instruments measuring NSSI were included. Predominantly, the studies were North American self-reports in English for community adolescents, adaptations or versions emanating from a small number of instruments. Twenty-six indicators were categorized to assess NSSI. The most frequent instruments are structured interviews, and their indicators were related to NSSI function and topography. Evidence of validity and reliability was positive but limited. Despite the high number of instruments and diversity of evaluations, we found no instrument with sufficient evidence for clinical assessment. Findings broadly overview NSSI assessment instruments' current use and future improvement in clinical and research settings.

Electromyographic evidence of reduced emotion mimicry in individuals with a history of non-suicidal self-injury

Engaging in facial emotion mimicry during social interactions encourages empathy and functions as a catalyst for interpersonal bonding. Decreased reflexive mirroring of facial expressions has been observed in individuals with different non-psychotic disorders, relative to healthy controls. Given reports of interpersonal relationship difficulties experienced by those who engage in non-suicidal self-injury (NSSI), it is of interest to explore facial emotion mimicry in individuals with a history of this behaviour (HNSSI). Among other things, this will enable us to better understand their emotion regulation and social interaction challenges. Surface facial electromyography (fEMG) was used to record the reflexive facial mimicry of 30 HNSSI and 30 controls while they passively observed a series of dynamic facial stimuli showing various facial expressions of emotion. Beginning with a neutral expression, the stimuli quickly morphed to one of 6 prototypic emotional expressions (anger, fear, surprise, disgust, happiness, or sadness). Mimicry was assessed by affixing surface electrodes to facial muscles known to exhibit a high degree of electrical activity in response to positive and negative emotions: the corrugator supercilii and the zygomaticus major. HNSSI participants, relative to controls, exhibited significantly less electrical activity in the corrugator muscle in response to viewing angry stimuli, and significantly less of an expected relaxation in muscle activity in response to viewing happy stimuli. Mirroring these results, greater endorsement of social influence as a motivator for engaging in NSSI was associated with less mimicry, and greater endorsement of emotion regulation as a motivator was associated with greater incongruent muscle response when viewing happy faces. These findings lend support to the theory that social interaction difficulties in HNSSI might be related to implicit violations of expected social rules exhibited through facial mimicry nonconformity.

Self-Injury as an Addictive Disorder

Self-injury is a mental health-related behavior people engage in to feel pain because they feel numb, to experience physical pain to ease their psychological pain, or to experience an emotional release. Self-injury is more common in patients with other co-occurring anxiety or mood disorders. An addictive component to self-injury has been identified related to an increase in dopamine levels from the self-injury, which then disrupts normal dopamine production similar to substance use disorders. Instruments are available to help identify patients who self-injure along with questions that should be asked in the course of a mental health assessment and physical examination. Patients with self-injury should be treated for any underlying mental health disorder as well as for self-injury, which includes therapy strategies and medications. Nurses can play a vital role in identifying and treating this disorder, which carries risk factors including infection, accidental death, and a higher risk of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 13-16.].

Clinical characteristics and functions of non-suicide self-injury in youth

Purpose

Little is known about the clinical characteristics and motivations for engaging in non-suicide self-injury (NSSI) behaviors in adolescence. The aim of this study was to examine the prevalence, characteristics and functions of NSSI among adolescents in community settings, and to explore risk factors related to this behavior.

Subjects and methods

Two hundred and seventy-five adolescents aged 12 to 17 were recruited randomly from different High Schools in Israel. They completed self-report questionnaires assessing NSSI (Ottawa Self-Injury Inventory), depression (Children's Depression Inventory – CDI) and impulsivity (Barratt Impulsiveness Scale – BIS-II).

Results

In the past year, 20.7% of the participants reported engaging NSSI at least once. Among them, 42.1% declared they are still engaging in NSSI at the present. Motives for NSSI were internal emotion regulation reasons, external emotion regulation reasons for social influences. In addition, the NSSI group reported significantly higher levels of depressive, impulsivity and suicidal ideations. Depressive symptoms were found as significant predictors of NSSI in the future.

Discussion and conclusions

High rates of NSSI among community adolescents were found. Depression, impulsivity and suicidal ideation were found significantly related to NSSI. Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents.

Invalidating Caregiving Environments, Specific Emotion Regulation Deficits, and Non-suicidal Self-injury

This study examined the indirect effects of distinct aspects of invalidating caregiving environments (i.e., paternal maltreatment, maternal maltreatment, and perceived alienation) on non-suicidal self-injury (NSSI) via six specific emotion regulation difficulties. We hypothesized that specific emotion regulation deficits would mediate associations between invalidating environments and NSSI. Participants included 114 young adults (57 self-injurers; 57 age- and sex-matched comparison participants) aged 17-25 years. Three parallel mediation models tested hypotheses. Results showed that maternal maltreatment, paternal maltreatment, and perceived alienation indirectly predicted NSSI through poor emotional clarity. Maternal maltreatment uniquely predicted NSSI through limited access to regulation strategies. Lastly, maternal maltreatment and perceived alienation were both linked to greater difficulties engaging in goal-directed behavior during emotional upsets; however, contrary to hypotheses, this particular deficit was associated with decreased odds of engaging in NSSI. Findings illustrate how different aspects of invalidating environments and specific emotion regulation deficits may be implicated in NSSI engagement.

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.

Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit[Formula: see text]

BACKGROUND. Between 4% to 70% of inpatients engage in self-harming behaviors and effective interventions are needed to address this population. AIM. This article reviews literature from 2007 to 2017 to address treatment and management strategies specific for the treatment of nonsuicidal self-injury in the inpatient psychiatric setting. METHODS. Cochrane, PsycINFO, PubMed, and CINAHL were searched for relevant articles with 34 studies reviewed for applicability to the question, and 9 parsed into a summary of Findings table. RESULTS. Therapeutic approaches that show promise include cognitive behavioral therapy, dialectical behavior therapy, and mentalization as well as medications that act on the serotonergic, dopaminergic, and opioid systems. Effective models of care aim toward enhancing therapeutic relationships with staff, providers, and most important, encouraging the internal shift toward recovery within the patient. CONCLUSIONS. More research with controlled designs in the inpatient setting is needed, however, regardless of which approach is used, the impact of the individual caregiver on the patient's recovery is key.

Non-suicidal self-injury in Shanghai inner bound middle school students

Background

Non-suicidal self-injury (NSSI) behaviour is very common among adolescents. Its prevalence and behavioural characteristics may vary according to regional and cultural differences. Investigation of NSSI locations and diagnosis of adolescents with NSSI are relatively lacking in China.

Aims

The study objective was to determine the prevalence and features of NSSI among middle school students in Shanghai.

Methods

The participants were from grade 6 to 8 selected from three junior schools in Jing’an District. Consenting students completed the Ottawa Self-Injury Inventory to determine the prevalence and characteristics of NSSI. Those who indicated NSSI within the past month were administered the Mini-International Neuropsychiatric Interview for Children and Adolescents to assess for emotional disorders.

Result

The result shows 510 participants (21.7%; mean age 13.51 (0.97) years old; 56.7% female) reported at least one instance of NSSI during the previous 12 months. NSSI was significantly more common in girls than boys (24.9% vs 18.5%; χ²=14.03, p=0.00). Commonly reported reasons for NSSI were for internal and external emotion regulation (87.9%, 82.3%) and social influence (57.8%). Anxiety disorders were the most common (28.9%) disorder associated with NSSI.

Conclusion

The rate of NSSI of middle school students in Shanghai inner bound is similar to those reported in North American and European youth. It is essential that school mental health professionals are aware of how to manage NSSI within the school setting.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study

Background

Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted.

Methods

One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out.

Discussion

We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome.

Trial registration

ClinicalTrials.gov, NCT03350594. Registered on 22 November 2017. IDRCB number 2016-A00818-43.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3347-y) contains supplementary material, which is available to authorized users.

Self-Inflicted Injury-Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP-SI): a new surveillance tool for detecting self-inflicted injury events in emergency departments

OBJECTIVES

To assess the performance of the Canadian Hospitals Injury Reporting and Prevention Program's newly developed self-harm surveillance tool (CHIRPP-SI) designed to improve emergency department (ED) hospital surveillance of youth self-inflicted injury (SI).

METHODS

This was a prospective, single-centre cohort study from February 2015 to September 2015. Eligible participants were aged 6-17.99 years and presented to the ED with a primary mental health complaint. The frequency of SI cases was extracted from three data sources (CHIRPP-SI, medical chart, and the National Ambulatory Care Reporting System Metadata (NACRS)). Cohen's kappa statistic was used to examine the level of agreement between data sources.

RESULTS

Of the 250 participants who received a medical chart review, 70 completed the CHIRPP-SI. Of those who did not complete the CHIRPP-SI, 86% (n = 154) reported no SI related to their presentation, 12% (n = 22) declined to participate without specifying self-injury status, and 2% (n = 4) were unable to be interviewed prior to discharge. The three sources of surveillance data varied considerably; the medical chart captured the highest frequency of individuals reporting SI related to their ED visit (33.6%), followed by the CHIRPP-SI (28.0%), and the NACRS database (8.4%). The CHIRPP-SI captured the method of SI and the place of occurrence in 100% of individuals, and the bodily location harmed in 98.6% of individuals.

CONCLUSIONS

Study findings highlight the disparity between different sources of data, in relation to the capture of paediatric SI, presenting to hospital EDs. If greater details of SI events are to be identified, surveillance tools such as the CHIRPP-SI should be considered.

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.

Examining the role of borderline personality traits in the relationship between major depression and nonsuicidal self-injury

BACKGROUND

Depression and borderline personality disorder (BPD) are highly comorbid conditions that are both associated with nonsuicidal self-injury (NSSI).

AIMS

The purpose of this study was to determine if depression is associated with NSSI after controlling for BPD traits. A distinction was made between NSSI for emotional regulation and NSSI for interpersonal motives.

METHOD

Logistic regression analyses were conducted on cross-sectional data from a general population sample of 7370 adults who completed the 2007 Adult Psychiatric Morbidity Survey. Depressive symptoms were assessed with the revised Clinical Interview Schedule. NSSI and motives for NSSI were also assessed during clinical interviews. BPD traits were assessed with the participant-completed Structured Clinical Interview for DSM-IV Axis II Personality Disorders.

RESULTS

Participants in a major depressive episode were more likely to have engaged in emotional-regulation NSSI and interpersonal NSSI than participants without depression. After controlling for BPD traits depression remained associated with emotional-regulation NSSI, whereas the association with interpersonal NSSI became nonsignificant. There were statistically significant relationships between depression and both types of NSSI occurring indirectly through BPD traits.

CONCLUSIONS

BPD traits account for a significant portion of the cross-sectional relationship between depression and past NSSI that varies in size depending on the motive for NSSI. People with depression are more likely to have engaged in NSSI for emotional regulation even in the absence of prominent BPD traits. In contrast, BPD traits may be more prominent in people with depression who have engaged in interpersonal NSSI.

The functions and addictive features of non-suicidal self-injury: A confirmatory factor analysis of the Ottawa self-injury inventory in a university sample

The Ottawa Self-Injury Inventory (OSI) is a comprehensive self-report measure of non-suicidal self-injury (NSSI). In an effort to build on past research and further validate the OSI, this study presents a confirmatory factor analysis of the OSI's subscales measuring the functions and addictive features of NSSI using a university sample. Participants were 316 university students aged 17-25 years (84.8% female) who had engaged in NSSI at least once in their lifetime. Consistent with past research, results confirmed the four-factor structure of the Functions items (Internal Emotion Regulation, Social Influence, External Emotion Regulation, Sensation Seeking), as well as the single-factor structure of Addictive Features items. Correlations calculated between the obtained factors and indicators of NSSI severity revealed that higher endorsement of NSSI's Internal Emotion Regulation functions, External Emotion Regulation functions, and Addictive Features were associated with more frequent lifetime NSSI, recent (past 6 months) NSSI, and greater distress regarding NSSI urges; greater endorsement of NSSI's Sensation Seeking functions was also linked with more frequent lifetime NSSI. Results provide further support for the OSI's psychometric properties in a university sample, and offer additional evidence for links between specific NSSI functions and addictive features and more severe manifestations of the behavior.

The mediating role of coping strategy in the association between family functioning and nonsuicidal self-injury among Taiwanese adolescents

OBJECTIVE

Nock's (2009) integrated theoretical model suggests that both intrapersonal and interpersonal factors contribute to the development of nonsuicidal self-injury (NSSI). Based on this model, the present study examined the roles of family functioning and coping strategy in predicting NSSI, as well as the mediating effect of coping strategy in the relationship between family functioning and NSSI. Gender differences on the associations of these variables were also examined.

METHOD

A sample of 1,989 secondary school students (52.0% females) in Taiwan was assessed by self-report measures of perceived family functioning, coping strategy, and NSSI.

RESULTS

Results showed that both family functioning and avoidance/emotion-focused coping strategy predicted NSSI. Additionally, the association between family functioning and NSSI was mediated by avoidance/emotion-focused coping strategy. Gender differences were not found on the associations among these study variables.

CONCLUSIONS

These data provided evidences that the Nock's (2009) integrated theoretical model may help to explain how coping strategy mediates the effect of family functioning on NSSI. The implications of the findings for future research and intervention were discussed.

A psychometric analysis of the Ottawa self-injury inventory-f

OBJECTIVE

This study seeks to evaluate the psychometric properties of the Ottawa Self-Injury Inventory-Functions (OSI-F) for assessing nonsuicidal self-injury (NSSI), a condition for further study in the DSM-5.

PARTICIPANTS

Participants included 345 students who indicated a history of self-injury in a university counseling center over six semesters from August 2009 to May 2012.

METHOD

Participants completed the OSI-F as a measure on the psychological intake for the university counseling center.

RESULTS

Factor analysis, Cronbach's alpha coefficients, independent sample t tests, and correlations were examined and demonstrated adequate reliability and validity.

CONCLUSIONS

A three-factor solution emerged from the restructured OSI-F relating to Affect Regulation, Exhilaration, and Release. Affect regulation dimensions were predictive of continuing to self-injure and related to depression, anxiety, and overall mental health. Additionally, women were more likely to attribute self-injuring to affect regulation.

Self-harm - an overview of the tools used to assess non-suicidal self-harming behaviors

Introduction: Non-Suicidal Self-Injury (NSSI) is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.

The aim of the work is to present and discuss the most commonly used scales for NSSI assessment.

Method: A review of available literature was made using the databases Medline / PubMed, using the key words: “self injury”, “self-mutilation”, “non-suicidal,”, “NSSI”, “self-harm” and time descriptors: 2005-2017

Results: Available tools were divided into three groups: I- scale of self-assessment made by the patient, II- assessment made by the clinician, and III- auxiliary scale.

Conclusions: None of the available scales covers the complexity of the NSSI phenomenon. For the overall NSSI assessment, several NSSI assessment tools are suggested, taking into account both self-assessment scales and clinical evaluation.

Functions of Nonsuicidal Self-Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, ; Joiner, Sachs-Ericson, Wingate, Brown, Anestis, & Selby, ) wherein painful and provocative experiences (e.g., nonsuicidal self-injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, ; Smith, ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; M_age  = 18.69, range 18-22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI (β = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts (β = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.