Search

Background Methods Results Conclusions Many people who engage in non‐suicidal self‐injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI.Semi‐structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis.A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self‐compassion and self‐acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self‐injury. Creating a life guided by personal values promoted independence, choice, and self‐esteem.The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self‐injure while promoting a person‐centred approach. [ABSTRACT FROM AUTHOR]

Objective: Experiential avoidance, an individual's unwillingness to experience uncomfortable internal feelings/emotions, has been found to be associated with history of self-injury. This association is mainly found in studies that use global measures of experiential avoidance. However, experiential avoidance is purported to be a multidimensional construct. This study aims to test both unidimensional and multidimensional measures of experiential avoidance and their associations with self-injury. Method: University students (n = 632, M = 25.01, SD = 7.13, 78.8% female, 70.9% with lived experience of self-injury) completed well-validated self-report measures of self-injury, experiential avoidance (The Brief and the Multidimensional Experiential Avoidance Questionnaire). Results: As expected, all sub-scales of multidimensional measure of experiential avoidance were highly correlated with the global score for experiential avoidance. The global measure of experiential avoidance differentiated individuals with no history, with past history, and recent history of self-injury. When assessed using the multidimensional measure, only the sub-factors behavioural avoidance and repression and denial differentiated those with no history of self-injury from those with recent history and those with recent history from those with past history of self-injury. Conclusion: Findings raise the possibility that associations between experiential avoidance and self-injury may be down to two specific aspects of experiential avoidance, namely 1) behavioural avoidance and 2) repression/denial. If true, this will have important theoretical, clinical, and measurement implications for research into self-injury. Key Points: What is already known about this topic: Self-injury is prevalent among university students. Experiential avoidance is associated with non-suicidal self-injury. Experiential avoidance is a multi-dimensional construct. What this topic adds: Despite the knowledge that experiential avoidance is a multidimensional construct, most studies utilise unidimensional measures to capture the construct. This study explores experiential avoidance from a unidimensional and multidimensional approach. Experiential avoidance is associated with non-suicidal self-injury, however, when we look at the specific aspects of experiential avoidance, only behavioural avoidance and repression/denial retain the association. Understanding the specific aspects of experiential avoidance that are associated with engagement in self-injury can assist in providing more targeted clinical interventions. [ABSTRACT FROM AUTHOR]

Background: Non‐suicidal self‐injury (NSSI) is a significant public health concern. Research and treatment interventions largely focus on stopping self‐injury. People who self‐injure do not necessarily equate recovery to cessation. Qualitative accounts allow greater understanding of personal recovery narratives. This study aimed to synthesise personal conceptualisations of NSSI recovery. Methods: Participants had lived experience of NSSI and discussed their recovery. Papers not written in English or had a quantitative design were excluded. Four databases (PsycInfo, CINAHL, Medline and Web of Science) were systematically searched. The quality of each paper was assessed using the CASP quality assessment tool. Data were synthesised using a meta‐ethnographic approach. Results: Thirteen studies comprising 159 participants were included. Three overarching themes were developed. While ceasing NSSI was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non‐linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis. Conclusions: This was the first qualitative synthesis of personal conceptualisations of NSSI recovery. The findings highlighted the personal and multifaceted nature of NSSI recovery and supported person‐centred models of self‐injury recovery. Clinical implications include the importance of expanding self‐injury recovery beyond cessation within research and clinical practice, and for collaborative and person‐centred approaches to be embraced when supporting those who self‐injure. [ABSTRACT FROM AUTHOR]

Background: As nonsuicidal self‐injury (NSSI) has become an increasing public health concern, the last few years have seen the emergence of efforts to address NSSI recovery. Although many recovery efforts adopt a medical view of self‐injury and focus on cessation of the behaviour, recovery can mean many different things to different people. In this study, we provide initial empirical validation of the self‐injury recovery framework, by assessing whether different recovery profiles exist. Methods: Our sample comprised 733 participants with lived experience of NSSI (M age = 24.54, sd = 6.39). Participants completed self‐report measures of constructs related to NSSI recovery and NSSI characteristics. Results: Using latent profile analysis, we identified six unique profiles reflecting differences in thoughts/urges to self‐injure, self‐efficacy, social support, optimism, coping, underlying adversities, perceptions of scarring, disclosure, resilience and self‐compassion. Multivariate analyses of variance confirmed these profiles differed according to NSSI characteristics such as frequency of NSSI, a self‐assessment of recovery, the desire to self‐injure or avoid self‐injury and the number of people disclosed to. Limitations: A homogenous sample and cross‐sectional design limit generalisability of our findings across populations and across time. Conclusions: Our findings reinforce that recovery can take many different forms, with different factors being relevant to different individuals. Adopting a person‐centred approach that centres an individual's lived experience and emphasises what is important to them in the recovery process offers opportunities for more empathic responses to self‐injury and better outcomes for individuals who self‐injure. [ABSTRACT FROM AUTHOR]

Abstract Non-suicidal self-injury (NSSI) among adolescents continues to be a significant public health concern worldwide. A recent systematic review and meta-analysis found that the global prevalence of NSSI in adolescents aged 12–18 years was 17.2%, with higher rates reported among females (19.7%) than males (14.8%). This behavior has been linked to several negative outcomes, such as depression, anxiety, substance abuse, and suicidal ideation. The present study aimed to classify adolescents based on intrapersonal and interpersonal factors associated with NSSI proposed in Nock’s (2009) integrated model of NSSI, to identify distinct clusters targeting specific risk factors. This encompassed negative cognition, emotional vulnerability, poor coping skill, peer-victimization, family adaptability, and perceived stress. A total of 881 adolescents aged 11–16 years in South Korea completed self-reported questionnaires on automatic thoughts, depression, emotional regulation, peer victimization, family adaptability and perceived stress. Latent profile analysis (LPA) revealed three distinct classes: “the severe group”, “the moderate group”, “the mild group”. Class 3 (“severe group”: N = 127) exhibited greater severity related to NSSI, including negative cognition, emotional vulnerability, poor coping skills, peer victimization, and perceived stress, with weaker levels of factors that can prevent NSSI compared to class 1 (“mild group”: N = 416) and class 2 (“moderated group”: N = 338). The present study emphasizes the importance of considering both intrapersonal (e.g., negative automatic thoughts & emotional dysregulation) and interpersonal factors (i.e., peer victimization) when understanding NSSI - among adolescents. These findings can be utilized to develop interventions aimed at reducing the prevalence and severity of NSSI among adolescents.

Nonsuicidal self-injury (NSSI) is a growing phenomenon, yet there is still a limited understanding of the behavior, intent behind the behavior and what individuals themselves say about their behavior. This study collected pro-NSSI public blog posts from Reddit and analyzed the content linguistically using Linguistic Inquiry and Word Count software, to examine the use of NSSI specific words, linguistic and psychological linguistic properties. The results inform current mental health practices by dispelling myths and providing insight into the inner world of people who engage in NSSI. The linguistic properties found in the analysis reflected the predicted results; authors of pro-NSSI posts used first-person singular pronouns extensively, indicating high levels of mental health distress and isolation. This study demonstrates how understanding the language of self-harm can help inform mental health treatment using family therapy. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) among adolescents continues to be a significant public health concern worldwide. A recent systematic review and meta-analysis found that the global prevalence of NSSI in adolescents aged 12–18 years was 17.2%, with higher rates reported among females (19.7%) than males (14.8%). This behavior has been linked to several negative outcomes, such as depression, anxiety, substance abuse, and suicidal ideation. The present study aimed to classify adolescents based on intrapersonal and interpersonal factors associated with NSSI proposed in Nock's (2009) integrated model of NSSI, to identify distinct clusters targeting specific risk factors. This encompassed negative cognition, emotional vulnerability, poor coping skill, peer-victimization, family adaptability, and perceived stress. A total of 881 adolescents aged 11–16 years in South Korea completed self-reported questionnaires on automatic thoughts, depression, emotional regulation, peer victimization, family adaptability and perceived stress. Latent profile analysis (LPA) revealed three distinct classes: "the severe group", "the moderate group", "the mild group". Class 3 ("severe group": N = 127) exhibited greater severity related to NSSI, including negative cognition, emotional vulnerability, poor coping skills, peer victimization, and perceived stress, with weaker levels of factors that can prevent NSSI compared to class 1 ("mild group": N = 416) and class 2 ("moderated group": N = 338). The present study emphasizes the importance of considering both intrapersonal (e.g., negative automatic thoughts & emotional dysregulation) and interpersonal factors (i.e., peer victimization) when understanding NSSI - among adolescents. These findings can be utilized to develop interventions aimed at reducing the prevalence and severity of NSSI among adolescents. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a behaviour many counselling psychologists encounter in practice, and the way clinician's respond can have an important impact on the individual's experience of recovery. The person-centred NSSI recovery framework incorporates the voices of lived experience in understanding the multi-faceted nature of recovery. Objectives: This paper outlines important considerations for how the recovery framework can guide clinicians with respect to both therapeutic stance and intervention targets in order to support clients in navigating their experience of NSSI and recovery. Implications: Clinicians should adopt a strengths-based approach and foster self-efficacy and self-compassion with persons with lived experience. This paper provides specific recommendations for counselling psychologists and their clients, including encouraging clinicians to avoid making assumptions about the causes, meanings, and outcomes of self-injury, and to be cognizant of the non-linear nature of the recovery process. [ABSTRACT FROM AUTHOR]

Objective Experiential avoidance, an individual’s unwillingness to experience uncomfortable internal feelings/emotions, has been found to be associated with history of self-injury. This association is mainly found in studies that use global measures of experiential avoidance. However, experiential avoidance is purported to be a multidimensional construct. This study aims to test both unidimensional and multidimensional measures of experiential avoidance and their associations with self-injury.Method University students (n = 632, M = 25.01, SD = 7.13, 78.8% female, 70.9% with lived experience of self-injury) completed well-validated self-report measures of self-injury, experiential avoidance (The Brief and the Multidimensional Experiential Avoidance Questionnaire).Results As expected, all sub-scales of multidimensional measure of experiential avoidance were highly correlated with the global score for experiential avoidance. The global measure of experiential avoidance differentiated individuals with no history, with past history, and recent history of self-injury. When assessed using the multidimensional measure, only the sub-factors behavioural avoidance and repression and denial differentiated those with no history of self-injury from those with recent history and those with recent history from those with past history of self-injury.Conclusion Findings raise the possibility that associations between experiential avoidance and self-injury may be down to two specific aspects of experiential avoidance, namely 1) behavioural avoidance and 2) repression/denial. If true, this will have important theoretical, clinical, and measurement implications for research into self-injury.

Nonsuicidal self‐injury (NSSI) is theorized to be caused by negative associations with the self, including low self‐esteem, but the mechanisms explaining why low self‐esteem is related to more severe NSSI are unclear. The current study aimed to address this limitation by evaluating a mediation model, proposing that low self‐esteem would relate to more severe NSSI through increasing self‐punishment motivations. Data came from 468 undergraduate students with a history of NSSI who completed an online survey measuring NSSI characteristics and functions, self‐esteem, and self‐punishment motivations for NSSI. Mediation was tested using a structural equation model using bootstrapped 95% percentile‐corrected confidence intervals in which NSSI severity was modeled as a latent variable composed of NSSI frequency, recency, and versatility of methods. The total model was significant and the indirect effect of self‐esteem on NSSI severity through self‐punishment motives was significant. Self‐esteem also retained significant direct effects on NSSI severity, indicating partial mediation. These results provide support for the benefits and barriers model of NSSI, suggesting that negative self‐views increase risk for more severe NSSI through self‐punishment motivations. Clinical interventions that emphasize self‐compassion and focus on modifying self‐punishment motivations may help reduce NSSI behavior. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury is a concerning and prevalent behavior, particularly among adolescents and university students. Most theoretical models focus on the role avoidance plays in self-injury but, there is no consensus on what is being avoided. The aim of this study was to gain insight from individuals with lived experience of self-injury to better understand the role of avoidance in NSSI. Thirtyfive interviews were conducted with individuals with lived experience of NSSI (18 – 44 years) and analyzed using reflexive thematic analysis. Three themes were developed to address our aim: active not passive; a short term distraction; externalizing inner turmoil. Our analysis suggests that avoidance is not a term that resonates with individuals with lived experience of NSSI. The theoretical and methodological implications of these findings are that we need to use language that resonates with individuals with lived experience and improve the way avoidance is conceptualized.

Non-suicidal self-injury (NSSI) is the deliberate damage caused to one’s own body tissue, without the intent to die. Voluntary disclosure of one’s NSSI can catalyze help-seeking and provision of support, although what informs the decision to disclose NSSI is not yet well understood. There is currently no existing framework specific to the process of NSSI disclosure, and the aim of this study was to assess the fit between factors involved in the decision to disclose NSSI and two broader frameworks of disclosure: the Disclosure Decision-Making and Disclosure Processes models. A directed content analysis was used to code interview transcripts from 15 participants, all of whom were university students aged between 18 and 25 (M = 20.33, SD = 1.88), with 11 identifying as female. All participants had lived experience of NSSI which they had previously disclosed to at least one other person. All codes within the coding matrix, which were informed by the disclosure models, were identified as being present in the data. Of the 229 units of data, 95.63% were captured in the existing frameworks with only 10 instances being unique to NSSI disclosure. Though factors that inform the decision to disclose NSSI largely align with the aforementioned models of disclosure, there are aspects of disclosure decision-making that may be specific to NSSI.

Previous studies demonstrated that boredom leads to increased self-administration of painful electric stimulation, a proxy for non-suicidal self-injury (NSSI). However, in these experimental studies, participants had no behavioral alternatives besides electric stimulation to break the monotony. A first aim in the current experimental study was to examine whether boredom still leads to self-administering aversive stimuli when positive behavioral alternatives are present. This boredom effect was furthermore compared to an anger induction. The second aim was to examine whether history of NSSI and negative urgency (i.e., the tendency to engage in impulsive action in response to negative emotions) positively moderate the link between boredom and self-administered aversive stimuli. In a between-subjects design using college students (N = 129), participants were randomly assigned to one of three emotion induction writing tasks (i.e., boredom, anger, neutral), during which frequency of self-administered positive (chirping birds) and aversive (screaming pig) sounds was measured. The latter was used as a proxy for NSSI behavior. Results showed that boredom led to increased selection of aversive sounds compared to the neutral and anger conditions, despite the presence of a positive alternative (i.e., positive sounds). No difference in frequency of selecting the aversive sounds was observed between the anger and neutral condition. Neither history of NSSI nor negative urgency moderated the effect of condition on self-administered aversive stimuli. The current results tentatively support a causal and specific link between boredom and NSSI, and warrant further examination of the role of boredom in maladaptive behaviors such as NSSI. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantify the prevalence of non‐suicidal self‐injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so‐called prevalence, meta‐analysis. Method: Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot. Results: 79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta‐analyses on self‐injury in EDs to date. Overall prevalence of non‐suicidal self‐injury was 34.59% (95%CI = 30.49–38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96–30.03%), 41.98% (95%CI = 32.35–51.91%), 36.97% (95%CI = 30.69–43.46%), 21.21% (95%CI = 14.93–28.12%) and 37.65% (95%CI = 28.59–47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies. Discussion: Non‐suicidal self‐injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self‐injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self‐injury in people with ED, irrespective of specific diagnoses. The method of determining self‐injury varied across studies and may limit this study. Public Significance: This study highlights the prevalence of self‐injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self‐injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self‐injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self‐injury. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) is a serious public health concern that typically onsets during early adolescence. Adolescents (N = 980, ages 12–19 years) admitted for acute, residential psychiatric treatment completed baseline clinical interviews assessing mental disorders and questionnaires measuring demographics, early life adversity, and symptom severity. Prevalence rates of NSSI for lifetime (thoughts: 78%; behaviors: 72%), past year (thoughts: 74%; behaviors: 65%), and past month (thoughts: 68%; behaviors: 51%) were high. Although effect sizes were modest, the presence of a lifetime depressive disorder, sexual abuse, and comorbidity (i.e., three or more current disorders) were significant correlates of experiencing NSSI thoughts and behaviors. Furthermore, lifetime depressive disorder, current anxiety disorder, and comorbidity were associated with a greater odds of persistent NSSI thoughts and/or behaviors. Longitudinal studies are needed to determine whether targeting these factors reduces the persistence of NSSI thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) merupakan perilaku melukai diri sendiri secara sengaja tanpa ada niatan untuk bunuh diri. Terdapat berbagai macam faktor yang menjadi penyebab seseorang melakukan perilaku NSSI, salah satunya adalah disregulasi emosi. Namun, publikasi penelitian mengenai topik serupa di Indonesia masih sangat terbatas sehingga tujuan dari penelitian ini adalah mengetahui peran disregulasi emosi terhadap kecenderungan melakukan perilaku NSSI pada remaja. Partisipan (N=159) merupakan remaja berusia 14-24 tahun (laki-laki= 15, perempuan= 130, tidak menjawab= 14) yang pernah atau sedang melakukan perilaku NSSI. Data didapatkan dengan menyebarkan instrumen Inventory of Statement about Self-Injury (ISAS) dan Difficulties in Emotion Regulation Scale (DERS) yang sudah dimodifikasi. Hasil analisis menggunakan regresi linier sederhana menunjukkan bahwa disregulasi emosi berperan terhadap kecenderungan remaja melakukan perilaku NSSI dengan sumbangan efektif sebesar 26,1% (p

Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provide preliminary data on the validity of a new self-report measure, the NSSI by Proxy Questionnaire (NSSIBPQ). Two nationwide community samples of young adults (one general community sample and one with a history of traditional NSSI and suicidality) completed online studies. NSSI by proxy was reported by 18% of the general community sample and 45% of the self-injuring sample. Findings support the clinical relevance of NSSI by proxy and its potential to meet criteria for an NSSI disorder diagnosis. Results also provide preliminary support for the internal consistency and convergent, discriminant, and concurrent validity of the NSSIBPQ. [ABSTRACT FROM AUTHOR]

Military service members and veterans (SMVs) are at risk for self-directed violence, including nonsuicidal self-injury (NSSI). While NSSI is an important construct worthy of independent study, it is understudied among SMVs and, when included in research, typically examined in the context of suicide risk. Consequently, lifetime prevalence rate estimates of NSSI among SMVs vary. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis estimated the average lifetime NSSI prevalence among SMVs and explored demographic and methodological factors that may account for observed variability. Based on a search of Ovid MEDLINE, Embase, PsycINFO, and Web of Science, 47 samples from 42 articles across five countries met inclusion criteria. Results revealed an average NSSI lifetime prevalence rate of 15.76% among SMVs. Significantly higher prevalence rates were observed among clinical (28.14%) versus community (11.28%) samples and studies using interviews to assess NSSI (23.56%) versus self-report (13.44%) or chart review (7.84%). Lifetime prevalence increased as publication year increased and decreased as sample size increased. In contrast to prior literature, prevalence rates were comparable between active-duty SMVs, and studies collecting data anonymously versus those that did not. Lifetime prevalence was not moderated by age, gender, race, country, primary research focus, quality of NSSI operationalization, or whether NSSI methods were assessed. Findings suggest NSSI is a pervasive problem among military personnel, particularly within clinical settings, highlighting the need for systematic assessment of this important but understudied clinical phenomenon among SMVs. Further research is necessary to elucidate additional risk factors for NSSI among SMVs, including trauma exposure. [ABSTRACT FROM AUTHOR]

AbstractObjectivesParticipantsMethodsResultsConclusionNon-suicidal self-injury (NSSI) risk in young adults is impacted by both affective and cognitive responses to stress. While previous research shows affective reactivity (AR) increases risk for NSSI, less research has examined the role of cognitive reactivity (CR). The current study examined how individual differences in CR to stress relate to NSSI.The sample included 192 college students (M = 19.84 years, SD = 2.51, 82% women).Participants completed a baseline questionnaire followed by a laboratory visit involving measures before and after stress induction.Analyses indicated that individuals who engage in NSSI reported more affective and cognitive reactivity to stress. Additionally, higher levels of affective and cognitive reactivity uniquely predicted NSSI. A combined model yielded mixed results. Higher levels of AR led to lower levels of CR, while higher levels of CR predicted more NSSI.In sum, results demonstrated significant but unique effects of affective and cognitive reactivity to stress on NSSI. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is an intentional self-injury behavior that doesn’t have any suicidal intent. Various factors could cause a person to engage in NSSI behavior, one of them being emotional dysregulation. However, the research publication on a similar topic in Indonesia is still limited. Therefore this study is aimed to determine the role of emotional dysregulation on NSSI behavior tendencies in adolescents. Participants (N=159) were adolescents aged 14-24 years (male= 15, female = 130, did not answer = 14) who had or were currently engaging in NSSI behavior. The data was obtained by distributing the Inventory of Statements about Self-Injury (ISAS) and the modified version of Difficulties in Emotion Regulation Scale (DERS). Analysis used in this study was simple linear regression. The result showed that emotional dysregulation played a role in the tendency of adolescents to carry out NSSI behavior, with an effective contribution of 26.1% (p<0.05). [ABSTRACT FROM AUTHOR]

We tested whether difficulties in emotion regulation mediated the association between family functioning and non-suicidal self-injury (NSSI), and whether associations between family functioning, emotion regulation, and NSSI were moderated by social support. University students (N = 846, 75.8% female, 35.5% with a history of NSSI, Mage = 20.76) completed an online questionnaire including well-validated measures of family functioning, emotion regulation, social support, and NSSI. Poor family functioning was positively associated with history of NSSI, but not past 12-month frequency of NSSI. Difficulties in emotion regulation were positively associated with both history of NSSI and frequency of NSSI in the past 12 months. Social support from friends moderated the relationship between difficulties in emotion regulation and history of NSSI; the association was stronger at higher levels of support. Poor family functioning had an indirect effect on both history of NSSI and frequency of NSSI via difficulties in emotion regulation; however, for frequency the indirect effect was only observed when social support from friends and significant others were low. Poor family functioning, difficulties in emotion regulation, and social support work together to predict NSSI engagement among university students. Findings inform potential integration of current theories and design of targeted interventions. Highlights: We investigated family functioning, difficulties in emotion regulation, social support, and NSSI among university students. Poor family functioning and emotion regulation difficulties were positively associated with NSSI. Emotion regulation difficulties mediated relationships between poor family functioning and history and frequency of NSSI. This mediated effect was only present for NSSI frequency when social support from friends and significant others were low. Early intervention may target family functioning; intervention for university students may target emotion regulation. [ABSTRACT FROM AUTHOR]

• Self-injury is a common symptom of multiple psychiatric and developmental disorders. • Social factors have been described, but the neurobiology is not well understood. • Convergent findings from human and animal studies implicate common risk factors. • Animal models may advance understanding of diverse populations of self-injurers. Self-injurious behavior is a debilitating characteristic that is highly prevalent in autism and other neurodevelopmental disorders. In these populations, self-injury has typically been interpreted in relation to behavioral reinforcement and/or sensory stimulation. However, self-injury is also commonly exhibited by people with a variety of neuropsychiatric disorders, where it is typically described in relation to emotional regulation and the presence or absence of suicidal ideation. Interestingly, self-injury has also been documented in many non-human animal species, especially when exposed to early environmental deprivation, isolation, and distress. Despite the propensity of animals to self-injure under adverse conditions, animal models of self-injury have not been the focus of much research, and translation of the data from these models has largely been limited to autism and neurodevelopmental disorders. This review summarizes evidence that common biological and environmental mechanisms may contribute to vulnerability for self-injury in neurodevelopmental disorders, psychiatric disorders, and distressed animals, and that investigations using animal models may be highly beneficial when considering self-injury as a behavioral phenotype that exists across diagnostic categories. Investigations using animal models have revealed that individual differences in stress responses and anxiety-related behavior contribute to vulnerability for self-injury. Animal models have implicated dysregulation of monoaminergic, glutamatergic, and other neurotransmitter systems in expression of self-injury, and these models have suggested neural targets for pharmacotherapy that have potential relevance for diverse clinical populations. [ABSTRACT FROM AUTHOR]

PurposeNonsuicidal self-injury (NSSI) is associated with increased risk of suicide attempts. Theories of NSSI assert interpersonal stress as a common risk factor for, and perhaps consequence of, NSSI. Prior research has not examined reciprocal associations between chronic interpersonal stress and NSSI. This study used a multiwave, prospective design to address this gap in a sample of adolescent girls, a group with elevated risk for both chronic interpersonal stress and NSSI. Pubertal development was examined as a moderator of the reciprocal associations.MethodsAdolescent girls (N = 220; ages 12-16, M age = 14.69 years) at heightened risk for NSSI completed a baseline assessment and follow-up assessments over 18 months, divided into two 9-month epochs (Time 1 and 2). Pubertal development was assessed via self- and parent-report. Chronic interpersonal stress was assessed using a semistructured interview at the end of each time period. NSSI was measured using a semistructured clinical interview every 3 months within both time periods to enhance accurate reporting.ResultsPath models revealed that chronic romantic stress during Time 1, but not peer or parent-child stress, predicted NSSI during Time 2 among girls with more advanced pubertal development. Moreover, NSSI during Time 1 predicted higher levels of chronic romantic and parent-child stress during Time 2.ConclusionsResults revealed a reciprocal relationship between chronic romantic stress and engagement in NSSI. Further, this association may be best understood in the context of pubertal development.

Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) is a prevalent maladaptive body-focused behavior among youth and young adults. Yoga is associated with improved mindfulness, body image, and self-compassion; all of which are associated with decreased NSSI. This study evaluated the relationship between yoga and NSSI frequency, and if the relationship would be mediated by mindfulness, self-compassion, and/or body appreciation. Participants were recruited from a random sample of university students via email and included those with some yoga experience (N = 384; M age = 19.98, SD = 2.20). Participants completed an anonymous online survey assessing their levels of yoga participation, NSSI, mindfulness, self-compassion, and body appreciation. Bias corrected serial mediation regression models indicated the relationship between yoga participation and NSSI frequency was significantly mediated by self-compassion followed by body appreciation. Body appreciation was also a significant single mediator of yoga's relationship with NSSI. Mindfulness was not a significant mediator in any of the analyzes. Yoga practice is associated with reduced NSSI behaviors through its positive relationships with body appreciation and self-compassion. Body appreciation appears to be an important mechanism underlying the link between yoga participation and NSSI behavior suggesting that interventions promoting positive body image, such as yoga, could be innovative strategies for clinicians to consider. • Yoga participation is associated with lower lifetime NSSI frequency. • Self-compassion and body appreciation mediated yoga's association with NSSI. • Body appreciation may be a key factor to understanding yoga's relationship to lower NSSI. • Yoga may be a viable clinical tool given its negative association with NSSI frequency. [ABSTRACT FROM AUTHOR]

Abstract Background Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking. Methods The main objective of the present study is to evaluate a newly developed universal prevention program (“DUDE – Du und deine Emotionen / You and your emotions”), based on a skills-based approach in schools, in 3200 young adolescents (age 11–14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called “Stress-free through the school day” as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change. Discussion DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation. Trial registration German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945

Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI. To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI. 1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties. Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI. These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI. Outcome expectancies can differentiate people based on NSSI history. Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history. Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history. [ABSTRACT FROM AUTHOR]

Nonsuicidal self‐injury (NSSI) is defined as the deliberate destruction of one's own body tissue without suicidal intent and for purposes not socially sanctioned. However, this definition limits the understanding and assessment of NSSI by excluding a clinically relevant form of NSSI that is both self‐driven and associated with self‐injurious intentions: NSSI by proxy. Specifically, we propose that NSSI by proxy be defined as the intentional destruction of one's own body tissue through the elicitation of another being's (e.g., human, animal) actions, wherein the agency of the person being injured is a critical facet of the behavior. We review the literature supporting the clinical relevance of this behavior, as well as its similarities to traditional NSSI. Next, we propose four behaviors that may be conceptualized as NSSI by proxy, and identify two other behaviors that warrant further investigation. Finally, we identify future directions for research in this area and implications for the assessment and treatment of NSSI. [ABSTRACT FROM AUTHOR]

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

Abstract: Language is a powerful form of communication that not only conveys ideas and knowledge but also can assign meaning and value to the world around us. As such, language has the power to shape our attitudes toward individuals, behaviors, and ideas, by labeling them (indirectly or not) as "good" or "bad." In this way, language can be used to propagate stigma and other unhelpful attitudes toward individuals who already experience stigma. One behavior that may be particularly prone to the impact of unhelpful language is nonsuicidal self-injury (NSSI). In this article, we draw on Staniland's NSSI stigma framework to demonstrate how an individual with lived experience of NSSI may be exposed to stigmatizing messaging through 30 different channels, and propose that the accumulation of these messages may be particularly damaging. We conclude by offering practical tips for clinicians and researchers wishing to empathically work with individuals who self-injure. [ABSTRACT FROM AUTHOR]

Background: Rumination is a cognitive process that has been implicated in the onset and maintenance of a variety of psychological difficulties. The purpose of this review and meta‐analysis was to examine the nature and strength of the relationship between rumination and non‐suicidal self‐injury (NSSI). Methods: The protocol for this review was pre‐registered (CRD42019148186). A literature search of electronic databases PsycINFO, CINAHL, MEDLINE, and Web of Science was performed from the earliest date available to March 2020. Thirty‐nine eligible papers were identified. An additional seven papers were identified from a search conducted in September 2021, resulting in a total of 46 papers. Separate meta‐analyses were undertaken for NSSI frequency and NSSI history, with studies grouped by rumination type (depressive, transdiagnostic, anger, brooding, reflection, catastrophising, overall). Moderator analyses were also conducted along with a narrative synthesis of adjusted associations and longitudinal studies. Results: Rumination had a positive small association with NSSI frequency and a positive moderate association with NSSI history. The adjusted associations yielded mixed findings and most longitudinal research found rumination to be associated with prospective NSSI. Limitations: Most included studies had a moderate risk of bias and used a student sample. A limitation of this review was that only English language papers were included. Conclusions: Findings indicate that rumination is associated with NSSI, but more so the likelihood of engaging in NSSI overall than the frequency. Rumination‐focused techniques for NSSI may therefore be of benefit. Further research is needed to understand this association, particularly with longitudinal studies that focus on state rumination rather than stable trait rumination. Practitioner points: Rumination was found to have a small to moderate association with NSSI.Some individuals who engage in NSSI may benefit from psychological techniques that target rumination.Most of the studies included had a moderate risk of bias. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking. Methods: The main objective of the present study is to evaluate a newly developed universal prevention program ("DUDE – Du und deine Emotionen / You and your emotions"), based on a skills-based approach in schools, in 3200 young adolescents (age 11–14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called "Stress-free through the school day" as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change. Discussion: DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation. Trial registration: German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945 [ABSTRACT FROM AUTHOR]

There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature. To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI. Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems. These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed. There are several reasons to think that NSSI and alcohol use are linked. No reviews or meta-analyses have been conducted. We found a significant and small effect linking greater NSSI with greater alcohol use. [ABSTRACT FROM AUTHOR]

Objective: The Emotional Cascade Model posits that nonsuicidal self‐injury (NSSI) functions to distract from cascades of intense negative emotion and rumination. We investigated the moderating role of rumination in the relationships between reactivity, intensity, and perseveration of emotion and NSSI. Method: University students (N = 992) completed self‐report measures of self‐injury, emotional reactivity, intensity and perseveration, and rumination. Results: Together, the dimensions of negative emotion were associated with NSSI, but none contributed unique variance. For positive emotion, reactivity was negatively associated with history of self‐injury and perseveration was negatively associated with frequency of the behaviour. Rumination was associated with NSSI, but did not moderate associations between the dimensions of negative emotion and self‐injury. Rumination moderated the relationship between perseveration of positive emotion and history of NSSI, such that it was only significant at high levels of rumination. Conclusion: Findings highlight the importance of dimensions of positive emotion in understanding self‐injury. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is associated with considerable deficits in managing negative self-directed internal experiences. The present study explores the neurophysiological correlates of self-referential processing in individuals with NSSI. A total of 26 individuals with NSSI (≥5 episodes of NSSI behavior in the past year, without suicide attempts) and 35 age-, sex-, education-, and intelligence quotient (IQ)-matched controls participated in this study. Participants underwent fMRI scanning as they performed a personal relevance rating task, which required them to evaluate the personal relevance of emotional words. As predicted, we found that individuals engaging in NSSI tended to rate negative adjectives as more relevant and positive adjectives as less relevant. An analysis of functional neuroimaging data showed that the NSSI group had increased activity relative to the control group in the inferior parietal lobe, inferior temporal gyrus, calcarine, insula, and thalamus in response to positive adjectives. The NSSI group also demonstrated greater activation in the calcarine and reduced activation in the inferior frontal gyrus in response to negative self-referential stimuli compared with the control group. In addition, increased right inferior parietal lobe activity during positive self-referential processing was correlated with reduced suicidal ideation in the NSSI group. Our study provides neural evidence for self-referential processing bias in individuals with NSSI and highlights the need for further research to clarify the pathophysiological features that are specific to NSSI.

Background: Understanding the processes underlying non‐suicidal self‐injury (NSSI) is important given the negative consequences of this behaviour. Qualitative research has the potential to provide an in‐depth exploration of this. There has been limited research regarding the interpersonal processes associated with NSSI; therefore, a meta‐synthesis was conducted to investigate this. Methods: A search of PsycINFO, MEDLINE, Web of Science, and CINAHL electronic databases from date of inception to November 2020 was conducted. In total, 30 papers were included in the final review. A meta‐ethnographic approach was utilized to synthesize the data. Results: Two overarching themes were found. Within 'Powerful relational dynamics', NSSI was cited as a response to participants becoming stuck in aversive or disempowering relational positions with others. Within the 'Taking matters into their own hands' subtheme, NSSI was reported as a way for participants to get interpersonal and emotional needs met. Limitations: Several included papers did not comment on the researcher–participant relationship, which may have affected qualitative results. A small number of potentially eligible papers were unavailable for synthesizing. Conclusion: Findings provide a more nuanced investigation of the interpersonal processes underlying NSSI. Consistent with relevant theories, NSSI appears to be a way of mitigating difficult interpersonal experiences or getting interpersonal needs met. NSSI may be engaged in as a substitute to other, less damaging ways to cope. An argument is made for a more empathetic understanding of NSSI and the use of relational interventions. Practitioner points: Self‐injury may occur in response to interpersonal stressorsSelf‐injury can be a means to get interpersonal needs metSelf‐injury may replace other means of coping that become blocked or thwartedEmotional distress can be closely linked with interpersonal factors for this groupRelational therapies may be beneficial where interpersonal processes are linked to NSSI [ABSTRACT FROM AUTHOR]

According to Social Cognitive Theory, the anticipated consequences of a behaviour (outcome expectancies), influence the likelihood of engaging in a behaviour. Results from self-report studies suggest that people who have self-injured expect self-injury will regulate emotions while people who have never self-injured expect self-injury to result in pain. In this study we trialled three experimental tasks measuring implicit self-injury related outcome expectancies. 150 Australian university students aged 18–45 (M = 21.45, SD = 3.84) completed the experimental tasks (Sentence Completion Task, Implicit Association Tests, Covariation Bias Task) within a laboratory setting. Results revealed that implicit associations with affect regulation, pain, and communication differentiated people according to self-injury history in the sentence completion task. The strength of implicit associations with affect regulation also predicted the recency of self-injury. People who had self-injured, but not in the past 12 months appeared to have a bias towards associating images of self-injury and neutral words when compared to people who had recently self-injured. Implicit associations, as measured by the Implicit Association Tests did not significantly differentiate participants by self-injury history. Results suggest that the sentence completion task could further research and theoretical understanding of the role of implicit outcome expectancies in facilitating self-injury. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) is defined as intentional self-inflicted damage to the surface of the body without suicidal intent. Research shows that approximately 15% of adolescents engage in NSSI behaviors, necessitating school counselors with the knowledge and skills to respond systemically and systematically. Five functions of NSSI have been identified, including: (a) affect regulation (anxiety, anger, frustration, depression); (b) change cognitions (distraction from problems, stopping suicidal thoughts); (c) self-punishment; (d) stop dissociation; and (e) interpersonal (secure care and attention, fit in with peers) (Peterson et al., 2008). As educational leaders and mental health professionals, school counselors are in a unique position to educate school personnel, accept referrals, provide responsive services, and provide referrals to address non-suicidal self-injury of students (American School Counselor Association, 2017). This article will describe how school counselors can respond to NSSI, briefly reviewing recent literature in training and education, NSSI protocols, and interventions used in school settings. [ABSTRACT FROM AUTHOR]

Many dysregulated behaviours, used to cope with intense or unwanted emotion, can be learned in an interpersonal context. Nonsuicidal self-injury (NSSI) is potentially one such behaviour. In this study we explored whether knowing a parent self-injured was related to NSSI among young adults, and whether such an association was associated with thoughts and beliefs about NSSI. Specifically we tested the roles of anticipated outcomes of NSSI, and belief in the ability to resist urges to self-injure, in this relationship. A sample of 669 university students, aged between 17 and 30 years (M = 20.77, SD = 2.31), completed self-report measures of the constructs of interest. Of the sample 43 (6.4%) were aware of a parent self-injuring; this was associated with a threefold increase in history of NSSI reported by participants. This relationship was mediated by expectations that NSSI would relieve negative affect, and weaker expectations of resulting physical pain. The relationship between pain expectancies and NSSI was moderated by self-efficacy to resist NSSI. The results suggest that knowledge of parental NSSI may be a risk factor for NSSI among their children, and that cognitions about NSSI could be a potential mechanism explaining this relationship. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is a complex behavior that serves many functions and may be motivated by several factors. Although previously limited to the context of personality disorders, consideration of how general personality traits might be related to NSSI warrants examination. Our aims were to investigate whether clusters based upon the Big Five personality traits exist among people who have engaged in NSSI, and explore systematic differences with regard to gender, age, key indicators of NSSI severity, functions of NSSI, emotional avoidance, alexithymia, psychological distress, and emotion regulation strategies. A sample of 236 university students (83% female, M age = 21.59, SD = 5.43) who had engaged in NSSI completed an anonymous online questionnaire. Cluster analysis yielded three subgroups who were characterized by tendencies for resilience, dysregulation, and disagreeableness. Resilient and dyregulated profiles fell within opposite ends of a continuum with regard to severity of NSSI, psychological distress and alexithymia, and adaptive vs less adaptive emotion regulation strategies. Dysregulated characteristics were also associated with affect regulation and self-punishment functions of NSSI. Disagreeable characteristics were associated with high alexithymia and psychological distress. Implications of these findings for theory and tailored treatment approaches to NSSI are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Nonsuicidal self-injury (NSSI) is a behavior that can be perplexing to many people. Usually engaged as a means of regulating intense or unwanted emotions, it seems to counter the human instinct to avoid pain and harm to the self. The language people use to talk about NSSI, and individuals who engage in the behavior, can contribute to the significant stigma that is associated with NSSI. In this data-driven commentary, we report on the language clinicians and researchers typically use when talking about NSSI, and the language they consider appropriate to use. We observed some disparity in the language people use and what they deemed appropriate. Notably, researchers and clinicians report underusing terms that people with lived experience find most appropriate (someone with a history of self-injury; someone with lived experience of self-injury). We call on all researchers and clinicians to be mindful of the language they use to discuss NSSI and adopt person-centered and respectful language at all times. [ABSTRACT FROM AUTHOR]

Growing interest has been paid to the concept of non‐suicidal self‐injury (NSSI) recovery. In research, and sometimes clinical practice, the focus has been on NSSI cessation, with recovery operationalised with reference to the time since someone last self‐injured. Yet, perspectives from people with lived experience of NSSI indicate that recovery is much more complex. Drawing on recent empirical work, and the voices of people with lived experience of NSSI, we outline a new framework for conceptualizing NSSI recovery. We argue that recovery is nonlinear and multifaceted, comprising: Realistic Expectations and Setbacks; Normalizing Thoughts and Urges; Fostering Self‐efficacy; Identifying Strengths; Finding Alternatives; Addressing Underlying Adversities; Addressing and Accepting Scarring; Navigating Disclosures; and Self‐acceptance. In presenting research and clinical implications of this new framework, we propose that this framing offers a more complete understanding of NSSI recovery—one conducive to optimizing wellbeing and promoting resilience among individuals with lived experience. [ABSTRACT FROM AUTHOR]

Objective: Nonsuicidal self-injury (NSSI) is often cited as a key risk factor for future suicidal behavior. Capability for suicide has been repeatedly cited as an important mechanism that can account for this association. Despite this, direct tests of this hypothesis have been rare and methodologically constrained. In the present study, we conducted a direct test of this hypothesis while addressing several constraints of prior literature. Method: In a large sample of suicidal and self-injuring adults (n = 1,020), we tested whether changes in fearlessness about death (FAD), a core facet of the capability for suicide, accounted for the relationship between NSSI and future suicide attempts at 28-day and 2-year follow-up. FAD was assessed using the gold-standard self-report form (ACSS-FAD), an implicit test of suicide-related affect (affect misattribution paradigm-Suicide), and explicit affective ratings of suicide-relevant images. Mediation with bootstrapping was implemented to test our main hypotheses. Results: As anticipated, lifetime NSSI frequency was significantly associated with suicide attempt frequency at follow-up; however, FAD failed to consistently mediate this association. Results were largely consistent across all three measures of FAD. Post hoc power analyses indicated sufficient power to detect small effects. Conclusions: Taken together, these results fail to support the hypothesis that capability for suicide explains the link between NSSI and future suicidal behavior. We discuss the implications of our results for research and theory, situating our findings in the context of recent advances in the understanding of suicide risk more broadly. Public Health Significance Statement: The capability for suicide may not sufficiently explain the important longitudinal relationship between nonsuicidal self-injury and suicide attempts. [ABSTRACT FROM AUTHOR]