Journal of the Korean Academy of Child and Adolescent Psychiatry

Korean Academy of Child and Adolescent Psychiatry (대한소아청소년정신의학회)
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Non-Suicidal Self-Injury and Emotional Dysregulation in Male and Female Young Adults: A Qualitative Study

  • Daphnee Thomas (Universite Paris Cite, Boulogne Billancourt) ;
  • Celine Bonnaire (Laboratoire de Psychopathologie et Processus de Sante, Universite Paris Cite)
  • Received : 2023.04.29
  • Accepted : 2023.06.21
  • Published : 2023.07.01
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Abstract

Objectives: Non-suicidal self-injury (NSSI) has been theoretically, clinically, and empirically associated with emotional dysregulation. NSSI is a means of regulating emotional states, particularly negative emotions. However, empirical studies on this topic are scarce and the literature lacks qualitative research on individuals' perceptions and comprehension of the function of self-injury. Thus, this qualitative study aimed to provide novel insights into the relationship between NSSI and emotional dysregulation in young adults. Methods: Twelve participants (mean age=22.7 years, 9 females and 3 males) from different support groups and a healthcare center participated in semi-structured interviews on NSSI-related emotional processes. Three aspects were investigated: reasons for NSSI, function of NSSI, and emotions. Each interview was voice recorded and typically lasted between 20 and 40 minutes. All responses were analyzed using thematic analysis. Results: Four major themes were identified. The results showed that NSSI had both intrapersonal and interpersonal functions, within which emotional regulation played a significant role. NSSI was also used to regulate positive emotions. The results also showed a sequence of emotions among the participants, going from feeling overwhelmed to feeling relatively calm but guilty. Conclusion: NSSI has several functions for the same individual. Thus, it would be interesting to provide integrative therapy, such as emotion-focused therapy, which focus on improving intrapersonal and interpersonal emotion regulation skills and strategies.

Keywords

References

  1. International Society for the Study of Self-Injury. What is self-injury? 2018 [Internet]. Brussels: International Society for the Study of Self-Injury [cited 2023 Apr 25]. Available from: https://www.itriples.org/what-is-nssi.
  2. Brown RC, Plener PL. Non-suicidal self-injury in adolescence. Curr Psychiatry Rep 2017;19:20.
  3. Taylor PJ, Jomar K, Dhingra K, Forrester R, Shahmalak U, Dickson JM. A meta-analysis of the prevalence of different functions of non-suicidal self-injury. J Affect Disord 2018;227:759-769. https://doi.org/10.1016/j.jad.2017.11.073
  4. Kiekens G, Hasking P, Claes L, Boyes M, Mortier P, Auerbach RP, et al. Predicting the incidence of non-suicidal self-injury in college students. Eur Psychiatry 2019;59:44-51. https://doi.org/10.1016/j.eurpsy.2019.04.002
  5. Glenn CR, Lanzillo EC, Esposito EC, Santee AC, Nock MK, Auerbach RP. Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviors in outpatient and inpatient adolescents. J Abnorm Child Psychol 2017;45:971-983. https://doi.org/10.1007/s10802-016-0214-0
  6. Victor SE, Muehlenkamp JJ, Hayes NA, Lengel GJ, Styer DM, Washburn JJ. Characterizing gender differences in nonsuicidal self-injury: evidence from a large clinical sample of adolescents and adults. Compr Psychiatry 2018;82:53-60. https://doi.org/10.1016/j.comppsych.2018.01.009
  7. Wilkinson PO, Qiu T, Jesmont C, Neufeld SAS, Kaur SP, Jones PB, et al. Age and gender effects on non-suicidal self-injury, and their interplay with psychological distress. J Affect Disord 2022;306:240-245. https://doi.org/10.1016/j.jad.2022.03.021
  8. Brossard B. Fighting with oneself to maintain the interaction order: a sociological approach to self-iInjury daily process. Symb Interac 2014;37:558-575. https://doi.org/10.1002/symb.118
  9. Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behav Res Ther 2006;44:371-394. https://doi.org/10.1016/j.brat.2005.03.005
  10. Hughes CD, King AM, Kranzler A, Fehling K, Miller A, Lindqvist J, et al. Anxious and overwhelming affects and repetitive negative thinking as ecological predictors of self-injurious thoughts and behaviors. Cognit Ther Res 2019;43:88-101. https://doi.org/10.1007/s10608-019-09996-9
  11. Nock MK. Self-injury. Annu Rev Clin Psychol 2010;6:339-363. https://doi.org/10.1146/annurev.clinpsy.121208.131258
  12. Gross JJ. Handbook of emotion regulation. New York: Guilford Press;2007.
  13. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 2004;26:41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
  14. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 2003;85:348-362. https://doi.org/10.1037/0022-3514.85.2.348
  15. Chen WL, Chun CC. Association between emotion dysregulation and distinct groups of non-suicidal self-injury in Taiwanese female adolescents. Int J Environ Res Public Health 2019;16:3361.
  16. Laporte N, Klein Tuente S, Ozolins A, Westrin A, Westling S, Wallinius M. Emotion regulation and self-harm among forensic psychiatric patients. Front Psychol 2021;12:710751.
  17. Raudales AM, Darosh AG, Contractor AA, Schatten HT, Dixon-Gordon KL, Weiss NH. Positive emotion dysregulation identifies trauma-exposed community individuals at risk for suicide and nonsuicidal self-injury. J Nerv Ment Dis 2021;209:434-442. https://doi.org/10.1097/NMD.0000000000001316
  18. Kharsati N, Bhola P. Self-injurious behavior, emotion regulation, and attachment styles among college students in India. Ind Psychiatry J 2016;25:23-28. https://doi.org/10.4103/0972-6748.196049
  19. Zelkowitz RL, Cole DA, Han GT, Tomarken AJ. The incremental utility of emotion regulation but not emotion reactivity in nonsuicidal self-injury. Suicide Life Threat Behav 2016;46:545-562. https://doi.org/10.1111/sltb.12236
  20. Gratz KL, Roemer L. The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cogn Behav Ther 2008;37:14-25. https://doi.org/10.1080/16506070701819524
  21. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101. https://doi.org/10.1191/1478088706qp063oa
  22. Lockwood J, Daley D, Townsend E, Sayal K. Impulsivity and self-harm in adolescence: a systematic review. Eur Child Adolesc Psychiatry 2017;26:387-402. https://doi.org/10.1007/s00787-016-0915-5
  23. Hasking P, Whitlock J, Voon D, Rose A. A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure. Cogn Emot 2017;31:1543-1556. https://doi.org/10.1080/02699931.2016.1241219
  24. Laye-Gindhu A, Shonert-Reichl KA. Nonsuicidal self-harm among community adolescents: understanding the "whats" and "whys" of self-harm. J Youth Adolescence 2005;34:447-457. https://doi.org/10.1007/s10964-005-7262-z
  25. Hamza CA, Willoughby T. Nonsuicidal self-injury and affect regulation: recent findings from experimental and ecological momentary assessment studies and future directions. J Clin Psychol 2015;71:561-574. https://doi.org/10.1002/jclp.22174
  26. Fox KR, O'Sullivan IM, Wang SB, Hooley JM. Self-criticism impacts emotional responses to pain. Behav Ther 2019;50:410-420. https://doi.org/10.1016/j.beth.2018.07.008
  27. Pearce H, Smoliak O, Lewis SP. Individuals' accounts and explanations of continued engagement in non-suicidal self-injury: a qualitative study. Couns Psychol Q 2022 Aug 10 [Epub]. https://doi.org/10.1080/09515070.2022.2108762.
  28. Victor SE, Klonsky ED. Daily emotion in non-suicidal self-injury. J Clin Psychol 2014;70:364-375. https://doi.org/10.1002/jclp.22037
  29. Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Curr Dir Psychol Sci 2009;18:78-83. https://doi.org/10.1111/j.1467-8721.2009.01613.x
  30. Victor SE, Glenn CR, Klonsky ED. Is non-suicidal self-injury an "addiction"? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry Res 2012;197:73-77. https://doi.org/10.1016/j.psychres.2011.12.011
  31. Himelein-Wachowiak M, Giorgi S, Kwarteng A, Schriefer D, Smitterberg C, Yadeta K, et al. Getting "clean" from nonsuicidal self-injury: experiences of addiction on the subreddit r/selfharm. J Behav Addict 2022;11:128-139. https://doi.org/10.1556/2006.2022.00005
  32. Grandclerc S, Moro MR, Lachal J. [Study of specificities as regards the self-inflicted injuries experiences (non-suicidal self-injury and suicidal behavior) of adolescent girls born to migrant parents]. Neuropsychiatrie l'Enfance l'Adolescence 2017;65:245-256. French https://doi.org/10.1016/j.neurenf.2016.11.004
  33. Fox KR, Huang X, Linthicum KP, Wang SB, Franklin JC, Ribeiro JD. Model complexity improves the prediction of nonsuicidal selfinjury. J Consult Clin Psychol 2019;87:684-692. https://doi.org/10.1037/ccp0000421
  34. Timulak L, Keogh D, McElvaney J, Schmitt S, Hession N, Timulakova K, et al. Emotion-focused therapy as a transdiagnostic treatment for depression, anxiety and related disorders: protocol for an initial feasibility randomised control trial [version 1; peer review: 3 approved]. HRB Open Res 2020;3:7.
  35. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd ed. New York: Guilford Press;2002.