A laboratory examination of pain threshold and tolerance among nonsuicidal self-injurers with and without self-punishing motivations.

Abstract

Nonsuicidal self-injury (NSSI), which refers to self-directed destruction of bodily tissue in the absence of suicidal intent (e.g., cutting, carving, burning) is a widespread health concern. Recent research suggests that individuals who engage in NSSI have heightened tolerances for pain relative to noninjurers, but little attention has been given to how self-injurers overcome the pain involved in self-directed injury. Understanding the process through which self-injurers tolerate pain, however, may have important implications for prevention and intervention efforts, as heightened tolerance for pain has been associated with increased suicidal risk. In the present study, we addressed this gap in the literature by examining whether self-punishment motivations for engaging in NSSI were associated with increased pain thresholds and tolerances among 82 undergraduate students (i.e., 31 self-injurers with self-punishment motivations, 25 self-injurers without self-punishment motivations, 26 age-matched controls). Following a stressful task, self-injurers who engaged in NSSI to self-punish tolerated pain significantly longer and rated this pain as less aversive than self-injurers without self-punishment motivations and the comparison group of noninjurers. Our findings, therefore, suggest that willingness to tolerate painful stimulation may be an important part of the self-injury experience among individuals who engage in NSSI to self-punish. Moreover, our findings suggest that motivational factors underlying NSSI should be integrated into theories on the link between NSSI and pain sensitivity.

Pain and self-harm: A systematic review

“…Of these, two included measures of psychiatric symptomatology (Glenn et al, 2014;Hamza et al, 2014), but only Glenn and colleagues (2014) reported the results: 64.6% of the sample met the criteria for at least one psychiatric disorder, with anxiety, mood disorders, and alcohol and substance use disorders being the most prevalent. There was no effect of psychiatric symptomatology upon pain threshold or endurance.…”

“…The majority of participants within the community sample studies endorsed cutting and self-hitting as the most common types of NSSI (Franklin et al, 2010;Glenn et al, 2014;Hamza et al, 2014) and within the latter two studies, self-pinching, severe scratching as well as self-hitting were also reported. Little information was given by Bohus et al…”

“…There was great variation in pain outcome variables investigated within the case-control studies: three measured both threshold and tolerance (Bohus et al, 2000;Glenn et al, 2014;Hamza et al, 2014) and the other 4 either threshold or tolerance only. One study estimated pain tolerance from pain intensity ratings (Magerl et al, 2012).…”

“…Bohus et al (2000) specifically define the behaviours of participants included within their study as being of non-suicidal intent, although lifetime or current suicidal behaviour is not mentioned in their exclusion criteria. Similarly, the three studies using community samples specify behaviours included as being NSSI, but do not assess whether participants have also engaged in self-harm with the intention of ending their life (Franklin et al, 2010;Glenn et al, 2014;Hamza et al, 2014).…”

“…Little information is reported by Magerl et al (2012) regarding recruitment of BPD patients, however all but two were inpatients at the time of participation. Four recent case-control studies used community samples (Franklin et al, 2010;Glenn et al, 2014;Hamza et al, 2014;McCoy et al, 2010).…”