Cognitive and Emotion‐Regulatory Mediators of the Relationship Between Behavioral Approach System Sensitivity and Nonsuicidal Self‐Injury Frequency

Abstract

Non-suicidal self-injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS-relevant cognitive style of self-criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N=177) with high and moderate BAS levels completed measures of self-criticism, positive emotion regulation, brooding, and both lifetime and last year frequency of NSSI. Results indicated that self-criticism and positive emotion dampening independently mediated the relationship between BAS and last year frequency of NSSI. Self-criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion-regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.

Subjective pain during NSSI as an active agent in suicide risk

“…” Potential NSSI acts included: cutting self, carving skin, burning self, swallowing something to make them self sick, pinching self, banging head, poking self, scratching/scraping self, biting self, pulling own hair, inserting objects into skin, hitting/punching self, and “anything else to hurt [them]self”. In order to reduce variability in NSSI frequency estimates, number of lifetime NSSI acts were categorized (Whitlock et al, 2013; Burke et al, 2015) by the following frequencies: 1 act, 2–4 acts, 5–10 acts, 11–20 acts, 21–49 acts, and 50 or more acts. To examine number of NSSI methods, a sum was created based on each (different) NSSI behavior endorsed.…”

Suicide risk characteristics among aborted, interrupted, and actual suicide attempters

“…If participants answer positively to any of the 17 prompts, they are instructed to document the number of times they have engaged in each NSSI method endorsed. In order to minimize the variability in NSSI frequency, we classified endorsed NSSI frequency into categories (0, 1, 2–5, 6–20, 21–50, and 51+ NSSI acts; Burke et al, 2015; Cohen et al, 2015; Whitlock et al, 2013). Number of NSSI methods was calculated by summing positively endorsed methods.…”

Impact of Non-Suicidal Self-Injury Scale: Initial Psychometric Validation

“…This scale was adapted from the Skin Picking Impact Scale (SPIS; Keuthen et al, 2001), which was designed to reliably and validly measure the impairment and distress associated with clinically significant repetitive skin picking resulting in skin lesions. Similar to skin-picking, NSSI is self-injurious and repetitive in nature and is often associated with immediate tissue damage, as well as permanent scarring and physical disfigurement (Burke et al, 2015). Given these similarities, we hypothesized that the items from the SPIS also would characterize psychosocial impairment associated with NSSI.…”

“…In line with these conjectures, in addition to the negative psychological sequelae of NSSI, engagement in NSSI also has been linked to interpersonal difficulties (Adrian, Zeman, Erdley, Lisa & Sim, 2011; Tatnell, Kelada, Hasking, & Martin, 2014). Evidence suggests that NSSI may predict relationship problems, specifically among females (Burke et al, 2015; Lundh et al 2011). Consistent with these findings, many engaging in NSSI report that their self-injury often upsets family and friends, with a subset of self-injurers reporting that the negative effect their self-injury has on others is motivation to cease NSSI (Deliberto & Nock, 2008; Turner et al, 2013; Young et al, 2007).…”

“…Indeed, approximately 50% of those reporting a history of NSSI endorse bearing at least one scar from the behavior (Burke et al, 2015). Given that scarring from self-inflicted injury may serve as tangible evidence of mental health issues, which remain highly stigmatizing in the United States and in many parts of the world (Hinshaw & Stier 2008), it is unsurprising that scarring secondary to NSSI is a concern for many self-injurers (Bachtelle & Pepper, 2015; Lewis & Mehrabkhani, 2015).…”