Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach

What Do My (Online) Friends Think? A Topic Modeling Approach to Identifying Patterns of Response to Self-Injurious Behaviors on Reddit

OBJECTIVE

Approximately 17% of adolescents and young adults will engage in non-suicidal self-injury (NSSI) at least once in their lifetime, leading the World Health Organization to identify self-injury as one of the top five public health concerns for adolescents. Despite the widespread prevalence of this behavior, NSSI continues to be heavily stigmatized in both medical and community settings, deterring many engaged in NSSI from seeking informal support from friends and family as well as formal psychological or psychiatric treatment. In contrast to the low rates of in-person help-seeking for NSSI, online support groups are highly utilized by those engaged in NSSI. Thus, an empirical study of responses to frequent, voluntary disclosure of NSSI on social media is needed to better understand how these communities meet the needs of those who self-injure.

METHOD

The current project used latent Dirichlet allocation to identify frequent and favored themes in response to self-injury content in the largest self-injury group on Reddit (over 100,000 members). Reddit, the 9th most visited website in the world, is a chat-based social media platform that has 430+ million active users and billions of site visits, with current estimates suggesting that ∼63% of the U.S. population are Reddit users.

RESULTS

Identified themes included: (1) recovery encouragement; (2) provision of social and instrumental support; and (3) daily realities of living with NSSI. Responses that encouraged recovery received more upvotes on Reddit than any other type of comment.

CONCLUSION

These results can inform evidence-based, person-centered, dimensional treatments for NSSI.

A study of the interactive mediating effect of ADHD and NSSI caused by co-disease mechanisms in males and females

Background

Non-suicidal self-injury (NSSI), of which the predisposing factors are complex and diverse, profoundly affects the physical and mental health of young people. Therefore, this work established an NSSI intermediary network model considering the interaction of multiple factors. A mediating effect between attention-deficit/hyperactivity disorder (ADHD) and NSSI, considering the influence of comorbidities, such as depression, anxiety, and impulsive personality, was proposed based on sex differences.

Methods

A total of 2,689 middle school students in Ningbo City, Zhejiang Province, China, were randomly sampled and participated in this study. Data regarding their demographic characteristics, attention deficit, hyperactivity/impulsivity, NSSI, anxiety, depression, internet addiction, and other comorbid symptoms were collected and analyzed. After initially screening the data, variables were assessed for significance using a single-factor inter-group difference analytic method, and a binary logistic regression analysis was performed. The intermediary effect of factors influencing NSSI in males and females was also analyzed.

Results

The overall NSSI rate was 15.16%. The results showed that the impact of individual impulsivity characteristics (impulsiveness, the ADHD with hyperactivity/impulsivity subtype) on NSSI behavior was not significant (regression results, P > 0.05). The degree of association between ADHD with attention deficit and ADHD with comprehension deficit subtypes, and other comorbid symptoms (depression, anxiety, and internet addiction disorder) and NSSI, with odds ratios (ORs) of 7.6/6.42/436.68/3.82/1.86, and 95% bootstrap confidence intervals (CIs) of 4.64, 12.87/3.46, 12.67/137.42, 2659.13/2.32, 6.37/1.31, 2.82, respectively. The results also showed significant effects of ADHD subtypes on comorbid symptoms and the path effects of NSSI (P < 0.01). Among them, the mediating effect was the strongest when anxiety was the mediating variable, and the mediating effect of girls was higher than that of boys.

Conclusion

The results of this work demonstrated the influence of ADHD symptoms on NSSI behavior. Among patients with ADHD, patients with subtypes with obvious attention deficit characteristics were more likely to exhibit NSSI behavior, whereas the hyperactive impulse subtype had no direct impact on NSSI. We conclude that adolescent impulsivity may not be directly related to NSSI behavior and that impulsive characteristics jointly affect NSSI behavior through a series of NSSI comorbid symptoms. Notably, the probability of symptom onset and the degree of comorbidity was significantly higher in girls than in boys of the same age, and girls were more prone to NSSI behavior. These findings provide effective theoretical support for the prevention and treatment of adolescent NSSI behavior.

Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis

Background

Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents.

Methods

Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities.

Results

A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 "feeling bad, failing or letting yourself or your family down", D-1 "little interest or pleasure" and D-4 "feeling tired" were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 "frequent thinking about self-injury", which connects the NSSI to the depression comorbid network.

Conclusion

This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.

Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis

NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N = 14,588; F = 60.7%; age = 23.35 ± 7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r = -.24), and it was non-significant when self-report measures of NSSI (r = -.11) utilized. The association between DT and NSSI was significant and negative across the general population (r = -.47), university students (r = -.17), and inpatients (r = -.27); surprisingly, it was significant and positive among adolescents or high school students (r = .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.

Non-suicidal self-injury in Chinese population: a scoping review of prevalence, method, risk factors and preventive interventions

Non-suicidal self-injury behavior (NSSI) is a serious public health concern that requires immediate attention. Despite the high prevalence of NSSI among the Chinese population, there is a significant gap in research on the comprehensive picture of this field. Therefore, a scoping review was conducted to investigate the prevalence, methods, risk factors, and preventive intervention programs related to NSSI in China. The review found that the estimated lifetime prevalence of NSSI among Chinese youth population is alarmingly high at 24.7% (N = 1,088,433). Common methods of NSSI include scratching, hitting, and biting. Additionally, the review synthesized 249 risk factors based on the biopsychosocial-ecological framework, highlighting the urgent need for intervention. However, only 12 empirical studies focus on NSSI prevention or intervention programs were included. These findings underscore the necessity for more clinical practices and larger studies to identify effective interventions and ultimately alleviate the burden of NSSI on the Chinese population.

Funding

This review was supported by Humanity and Social Science Youth foundation of Ministry of Education (22YJCZH018), Science and Technology Innovation 2030 (STI2030-Major Projects:2021ZD0200702), National Natural Science Foundation of China (81825009), and Shuimu Tsinghua Scholar. No funding agencies were involved in the data collection, data analysis, and writing of this paper.

Cognitive-emotional networks in students with and without a history of non-suicidal self-injury

BACKGROUND

Contemporary models of non-suicidal self-injury (NSSI) suggest that emotional vulnerabilities, negative self-schemas, and beliefs about NSSI work together to differentiate students who self-injure from those who do not. However, it is unclear how these mechanisms are differentially related among students with and without a history of NSSI. Considering this, we used a network analysis approach to explore how students with and without a history of NSSI vary in processing their emotional experiences in relation to their self-concepts and beliefs about NSSI.

METHOD

A sample of 480 university students (M_age = 21.18, SD = 2.43; 73.5 % female) completed self-report measures about their perceived emotional experiences (e.g., emotional reactivity, emotion regulation difficulties), self-concepts (e.g., self-esteem, self-efficacy), and NSSI.

RESULTS

A network comparison test revealed that students with a history of NSSI perceived themselves to have difficulties regulating particularly intense, unwanted negative emotions. In light of this, students with a history of NSSI expected some benefits of NSSI (e.g., emotion regulation) regardless of potential barriers (e.g., pain). Conversely, for students without a history of NSSI, expecting NSSI to have aversive outcomes was tied to expecting NSSI to have few benefits.

LIMITATIONS

The cross-sectional design limits inferences to be made about the network structures.

CONCLUSIONS

Students with and without a history of NSSI appear to differ in their cognitive processing of negative emotions and strategies used to deal with these emotions.

[Psychopathological correlates of depression with non-suicidal self-harm in non-psychotic mental illnesses of adolescence]

OBJECTIVE

To determine the main clinical and psychopathological features of the relationship between depressive states and non-suicidal self-injury (NSSI) in mental illnesses of the non-psychotic register in adolescence.

MATERIAL AND METHODS

Clinical data of 128 patients (77 males and 51 females), who presented with depressive states and NSSI in non-psychotic mental disorders during adolescence, were analyzed. The patients were examined at the Clinic of the Mental Health Research Center during the period 2020-2023. The mean age of the patients was 19±4.1 years.

RESULTS

Based on the data from studying depression and NSSI in adolescence, we developed a typology, identifying three variants of affect and auto-aggressive activity interactions. The affect-dominant type (25.8%) was characterized by a predominance of affective pathology (p<.05), with the occurrence of impulsive NSSI (45.5%) and demonstrative NSSI (30.3%) (p<0.05). The personality-dominant type (43.0%) was based on pathocharacterological abnormalities (60.0%), where NSSI were represented by impulsive (25.5%), depersonalizing (27.3%), and addictive variants (32.7%) (p<0.05). The reciprocal type (31.3%) exhibited pronounced polymorphism, combining high affect variability with a tendency towards auto-aggressive behavior of varying severity and manifestations of NSSI (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%) followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%), followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05).

CONCLUSION

Three types of correlation between depression and NSSI were identified, the formation of which was due to the pathoplastic influence of the age factor, nosological affiliation and a certain, including pathological personality structure. Statistically significant regularities between variants of NSSI and types of their interrelation were revealed. The results can be considered as differential diagnostic and prognostic markers of their further trajectories and, therefore, contribute to the creation of new therapeutic strategies, timely diagnosis and earlier intervention.

Neural Signatures of Error Processing in Depressed Adolescents with Comorbid Non-Suicidal Self-Injury (NSSI)

Non-suicidal self-injury (NSSI), as a highly prevalent psychiatric symptom in adolescents and young adults, is defined as the deliberate destruction of body tissue without suicidal intent. Impulsivity and dysfunctional response inhibition have been suggested to play a central role in adolescents' vulnerability to self-harm. To investigate the potentially distinct neurobiology of NSSI, we used a well-established Go/No Go task in which activation of the inferior frontal gyrus (IFG) and dorsal anterior cingulate cortex (dACC) is interpreted as a neural correlate of processing failed response inhibition. Task-based functional magnetic resonance imaging data were obtained from 14 adolescents with a diagnosis of major depression and a history of NSSI (MD-NSSI), 13 depressed adolescents without NSSI (MD-only), and 14 healthy controls (HC). In line with hypotheses of dysfunctional response inhibition, we observed increased rates of commission errors in MD-NSSI along with significantly reduced error-related activations of the dACC and IFG. Intact response inhibition, as reflected by low commission error rates not different from HC, was observed in MD-only, along with increased activation of the error-processing network. Our findings support the hypothesis of a distinct neurobiological signature of NSSI. Further research on biomarkers of NSSI could focus on behavioral and neural correlates of failed response inhibition.

Key factors selection on adolescents with non-suicidal self-injury: A support vector machine based approach

Comparing a family structure to a company, one can often think of parents as leaders and adolescents as employees. Stressful family environments and anxiety levels, depression levels, personality disorders, emotional regulation difficulties, and childhood trauma may all contribute to non-suicidal self-injury (NSSI) behaviors. We presented a support vector machine (SVM) based method for discovering the key factors among mazy candidates that affected NSSI in adolescents. Using SVM as the base learner, and the binary dragonfly algorithm was used to find the feature combination that minimized the objective function, which took into account both the prediction error and the number of selected variables. Unlike univariate model analysis, we used a multivariate model to explore the risk factors, which better revealed the interactions between factors. Our research showed that adolescent education level, anxiety and depression level, borderline and avoidant personality traits, as well as emotional abuse and physical neglect in childhood, were associated with mood disorders in adolescents. Furthermore, gender, adolescent education level, physical abuse in childhood, non-acceptance of emotional responses, as well as paranoid, borderline, and histrionic personality traits, were associated with an increased risk of NSSI. These findings can help us make better use of artificial intelligence technology to extract potential factors leading to NSSI in adolescents from massive data, and provide theoretical support for the prevention and intervention of NSSI in adolescents.

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.

Loneliness in Personality Disorders

PURPOSE OF REVIEW

Loneliness is a common experience in patients with personality disorders (PDs) that are characterized by impairment in self (identity, self-direction) and interpersonal functioning (empathy, intimacy). Here, we review studies assessing the association of loneliness with PD or PD traits including DSM-5's Alternative Model of PD (AMPD).

RECENT FINDINGS

The number of loneliness studies varied greatly among different PDs with most studies conducted in borderline PD. Across PDs, loneliness was associated with the severity of psychopathological symptoms and with several AMPD trait domains. Consequently, loneliness may contribute to PD severity and further impair personality functioning. Loneliness and PD share intra- and interpersonal factors (i.e., increased rejection sensitivity, information processing biases, social withdrawal) and common origins in childhood maltreatment that may explain their close association. Future research needs to investigate mechanisms on how loneliness and core characteristics of PD mutually reinforce each other in order to therapeutically address loneliness in PD.

The role of impairments in self-other distinction in borderline personality disorder: A narrative review of recent evidence

Impairments in maintaining a differentiated sense of "self" and "other" are thought to be a central feature of borderline personality disorder (BPD). However, studies directly focusing on self-other distinction (SOD) in BPD are scarce, and these findings have not yet been integrated with novel insights into the neural mechanism involved in SOD. Here, we present a narrative review of recent behavioral and neuroimaging findings focusing on impairments in SOD in BPD. Behavioral findings of SOD at the embodied level provide preliminary evidence for impairments in multisensory integration in BPD. Furthermore, both behavioral and neuroscientific data converge to suggest that SOD impairments in BPD reflect an inability to shift between self and other representations according to task demands. Research also suggests that disruptions in infant-caregiver synchrony may play a role in the development of these impairments. Based on these findings, we present a new, integrative model linking impairments in SOD to reduced neural and behavioral synchrony in BPD. The implications of these findings for future research and clinical interventions are outlined.