Negative affect provides a context for increased distrust in the daily lives of individuals with a history of childhood maltreatment.

Evidence on individuals affected by posttraumatic stress disorder (PTSD) following childhood maltreatment (CM) supports cognitive models suggesting that trauma engenders distrust and interpersonal threat sensitivity. We examined the associations between CM and both distrust and interpersonal threat sensitivity in daily life and investigated whether momentary negative affect (NA) provides a context that strengthens this association. Hypotheses were based on cognitive models of trauma and the feelings-as-information theory. In a 7-day ambulatory assessment study with six semirandom daily prompts (2,295 total), we measured self-reported momentary NA and assessed behavioral trust as well as interpersonal threat sensitivity via facial emotion ratings with two novel experimental paradigms in 61 participants with varying levels of CM (45,900 total trials). As hypothesized, NA was associated with increased momentary distrust, ß = .03, p = .002, and interpersonal threat sensitivity, ß = -.01, p = .021. Higher levels of CM were associated with more negative emotion ratings, independent of affective context, ß = -.07, p = .003. Momentary behavioral distrust was associated with CM at high levels of momentary NA, ß = .02, p = .027. The findings for both tasks support the feelings-as-information theory and suggest that cognitive alterations surrounding distrust and interpersonal threat, which were originally proposed for PTSD, likely also affect individuals with a history of CM.

The effect of momentary mood on appraisal of facial affect and distrust: an experimental approach using ambulatory assessment.

Previous laboratory studies have demonstrated that an observer's current mood can influence their processing of facial stimuli, for instance, the appraisal of facial affect. The aim of the present study was to explore the association between current mood and face processing in participants' daily lives, thereby making use of naturally occurring affective states. We employed Ambulatory Assessment (AA) and included two experimental tasks to test whether current mood predicts how participants evaluate (i) the valence of emotional faces and (ii) facial trustworthiness. We hypothesised a mood-congruent processing, such that individuals would rate pictures of faces more negatively and less trustworthy, the more negative their current mood was. We recruited 42 participants who completed a 7-day AA study with six random prompts per day. At each prompt, participants provided self-reports on momentary mood and completed an emotion rating task and a hypothetical distrust game. Results show that negative momentary mood was significantly associated with higher levels of distrust, but was not significantly associated with more negative emotion ratings. We discuss the incremental value and feasibility of implementing experimental tasks in AA contexts and the opportunities this opens for assessing affective and cognitive processes in natural environments.

Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD.

A neurocircuitry model of post-traumatic stress disorder (PTSD) suggests increased amygdala responses to emotional stimuli, coupled with hypoactivation of prefrontal regions associated with cognitive control. However, results are heterogenous across different subsamples of PTSD as well as different paradigms. We investigated cognitive control in a classic and emotional Stroop task in 28 female patients with complex PTSD (cPTSD), 28 female trauma-exposed healthy controls (TCs) and 28 female non-trauma-exposed healthy controls (HCs) using functional neuroimaging. Afterwards, we assessed memory function in a spontaneous free recall and recognition task. Patients with cPTSD displayed significantly greater Stroop interference with trauma-related words (as reflected in slower reaction times and increased errors) compared to the other conditions and compared to the TC and HC groups. Moreover, patients with cPTSD showed increased activation in the context of trauma-related words in brain regions associated with cognitive control (dlPFC, vmPFC, dACC) compared to both control groups, and a trend for increased activation in the insula compared to the HC group. Increased recruitment of regions contributing to cognitive control in patients with cPTSD, together with a lack of amygdala response may point to efforts to compensate for emotional distraction caused by the trauma-related words.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder.

BACKGROUND: There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD. METHODS: We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time. RESULTS: We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus. LIMITATIONS: Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition. CONCLUSION: We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder.

BACKGROUND: There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD. METHODS: We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time. RESULTS: We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus. LIMITATIONS: Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition. CONCLUSION: We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions.

Neural correlates of distraction in borderline personality disorder before and after dialectical behavior therapy.

Neural underpinnings of emotion dysregulation in borderline personality disorder (BPD) are characterized by limbic hyperactivity and disturbed prefrontal activity. It is unknown whether neural correlates of emotion regulation change after a psychotherapy which has the goal to improve emotion dysregulation in BPD, such as dialectical behavioral therapy (DBT). We investigated distraction as a main emotion regulation strategy before and after DBT in female patients with BPD. Thirty-one BPD patients were instructed to either passively view or memorize letters before being confronted with negative or neutral pictures in a distraction task during functional magnetic resonance imaging. This paradigm was applied before and after a 12-week residential DBT-based treatment program. We compared the DBT group to 15 BPD control patients, who continued their usual, non-DBT-based treatment or did not have any treatment, and 22 healthy participants. Behaviorally, BPD groups and healthy participants did not differ significantly with respect to alterations over time. On the neural level, BPD patients who received DBT-based treatment showed an activity decrease in the right inferior parietal lobe/supramarginal gyrus during distraction from negative rather than neutral stimuli when compared to both control groups. This decrease was correlated with improvement in self-reported borderline symptom severity. DBT responders exhibited decreased right perigenual anterior cingulate activity when viewing negative (rather than neutral) pictures. In conclusion, our findings reveal changes in neural activity associated with distraction during emotion processing after DBT in patients with BPD. These changes point to lower emotional susceptibility during distraction after BPD symptom improvement.

Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour.

BACKGROUND: Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress. AIMS: Investigation of neurobiological mechanisms of NSSI in borderline personality disorder. METHOD: In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed. RESULTS: We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group. CONCLUSIONS: Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension.

The latest neuroimaging findings in borderline personality disorder.

Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced deficits in emotion regulation, cognitive disturbances including dissociation, impulsivity, and interpersonal disturbances. Over the last decades, neuroimaging has become one of the most important methods to investigate neurobiological alterations possibly underlying core features of BPD. The aim of our article is to provide an overview of the latest neuroimaging research in BPD focusing on functional and structural MRI studies published since 2010. Findings of these studies are depicted and discussed referring to central domains of BPD psychopathology. On a neurochemical level, altered function in neurotransmitter systems including the serotonin, glutamate, and GABA systems was observed in patients with BPD. On a neural level, individuals with BPD showed structural and functional abnormalities in a fronto-limbic network including regions involved in emotion processing (e.g., amygdala, insula) and frontal brain regions implicated in regulatory control processes (e.g., anterior cingulate cortex, medial frontal cortex, orbitofrontal cortex, and dorsolateral prefrontal cortex). Limbic hyperreactivity and diminished recruitment of frontal brain regions may yield a link between disturbed emotion processing and other core features of BPD such as impulsivity and interpersonal disturbances. To clarify whether findings are specific to BPD, comparisons with other clinical groups are needed.

Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: a randomised controlled trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) with co-occurring severe psychopathology such as borderline personality disorder (BPD) is a frequent sequel of childhood sexual abuse (CSA). CSA-related PTSD has been effectively treated through cognitive-behavioural treatments, but it remains unclear whether success can be achieved in patients with co-occurring BPD. The aim of the present study was to determine the efficacy of a newly developed modular treatment programme (DBT-PTSD) that combines principles of dialectical behaviour therapy (DBT) and trauma-focused interventions. METHODS: Female patients (n = 74) with CSA-related PTSD were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. About half of the participants met the criteria for co-occurring BPD. Individuals with ongoing self-harm were not excluded. The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale (CAPS) and by the Posttraumatic Stress Diagnostic Scale (PDS). Hierarchical linear models were used to compare improvements across treatment groups. Assessments were carried out by blinded raters at admission, at end of treatment, and at 6 and 12 weeks post-treatment. RESULTS: Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS (33.16 vs. 2.08) and the PDS (0.70 vs. 0.14). Between-group effect sizes were large and highly significant. Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome. Safety analyses indicated no increase in dysfunctional behaviours during the trial. CONCLUSION: DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.

Experimental paradigms in personality disorder research: A review of covered RDoC constructs, methodological issues, and future directions.

Studies using experimental paradigms have been paramount in research on psychopathological processes in personality disorders (PDs). We review 99 articles that report experimental paradigms and that were published between 2017 and 2021 in 13 peer-reviewed journals. We structure the study content according to the National Institute of Mental Health Research Domain Criteria (RDoC), and report details on demographic variables, experimental design, sample size, and statistical analyses. We discuss unequal representation of the RDoC domains, representativeness of the recruited clinical groups, and a lack of sample diversity. Finally, we review issues regarding statistical power and the data analytic designs that were used. Based on the literature review, we draw implications for future experimental PD research, encouraging researchers to increase the breadth of represented RDoC constructs, the representativeness and diversity of the recruited samples, the statistical power to detect between-person effects, the reliability of estimators, the adequacy of statistical methods, and the transparency of experimental research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does self-harm have the desired effect? Comparing non-suicidal self-injury to high-urge moments in an ambulatory assessment design.

All theoretical models of non-suicidal self-injury (NSSI) posit that regulation of negative affect (NA) is a central motive for NSSI, and cross-sectional work supports this. However, previous ambulatory assessment (AA) studies that examined NSSI found mixed results. We investigated the affect regulation function of NSSI in 51 women with DSM-5 NSSI disorder in a 15-day AA study with five random daily prompts and self-initiated NSSI prompts. We extend previous work by i) comparing NSSI moments to moments of a high-urge for NSSI, ii) adding high-frequency sampling following NSSI and high-urge moments, and iii) including tension as a dependent variable. We hypothesized that NA and tension would show a steeper decrease following NSSI than following high-urge moments, if NSSI was effective in reducing NA and tension. Results showed that the significant linear NA decline following NSSI was not steeper than that following high-urge moments. For aversive tension, we found that NSSI was associated with a significant linear decrease in tension, whereas resisting an urge was not. High-urge moments were better described by an inverted U-shaped pattern, likewise leading to decreased NA and tension following the reported urge. In exploratory analyses, we provide visualized clustering of the NA and tension trajectories surrounding NSSI using k-means and relate these to participants' self-rated effectiveness of the NSSI events. Findings indicate that resisting an urge may also be effective in managing NA and tension and underline the utility of interventions such as urge-surfing.

Individuals with and without child maltreatment experiences are evaluated similarly and do not differ in facial affect display at zero- and first-acquaintance.

BACKGROUND: Individuals with a history of child maltreatment (CM) are more often disliked, rejected and victimized compared to individuals without such experiences. However, contributing factors for these negative evaluations are so far unknown. OBJECTIVE: Based on previous research on adults with borderline personality disorder (BPD), this preregistered study assessed whether negative evaluations of adults with CM experiences, in comparison to unexposed controls, are mediated by more negative and less positive facial affect display. Additionally, it was explored whether level of depression, severity of CM, social anxiety, social support, and rejection sensitivity have an influence on ratings. METHODS: Forty adults with CM experiences (CM +) and 40 non-maltreated (CM-) adults were filmed for measurement of affect display and rated in likeability, trustworthiness, and cooperativeness by 100 independent raters after zero-acquaintance (no interaction) and 17 raters after first-acquaintance (short conversation). RESULTS: The CM + and the CM- group were neither evaluated significantly different, nor showed significant differences in affect display. Contrasting previous research, higher levels of BPD symptoms predicted higher likeability ratings (p = .046), while complex post-traumatic stress disorder symptoms had no influence on ratings. CONCLUSIONS: The non-significant effects could be attributed to an insufficient number of participants, as our sample size allowed us to detect effects with medium effect sizes (f2 = .16 for evaluation; f2 = .17 for affect display) with a power of .95. Moreover, aspects such as the presence of mental disorders (e.g., BPD or post-traumatic stress disorder), might have a stronger impact than CM per se. Future research should thus further explore conditions (e.g., presence of specific mental disorders) under which individuals with CM are affected by negative evaluations as well as factors that contribute to negative evaluations and problems in social relationships.

Prosociality in personality disorders: Status quo and research agenda.

Personality disorders (PDs) are characterized by interpersonal dysfunction and deficits in prosociality are theorized to contribute to this. We review studies linking categorical PDs to prosocial and antagonistic traits and highlight studies that assessed prosocial behavior in PDs via economic games. We structure our review based on the recently proposed affordance framework of prosocial behavior, summarizing the evidence for exploitation, reciprocity, temporal conflict, and dependence under uncertainty as situational affordances that allow the expression of personality in prosocial behavior. We conclude that some of the inconsistencies in the literature may be due to studies focusing on different situational affordances and the reliance on categorical PDs. We suggest a research agenda and a set of testable hypotheses based on maladaptive personality traits included in the newly implemented dimensional PD diagnoses in ICD-11 and DSM-5.

Maladaptive personality traits as predictors of prosocial and trusting behavior in two economic games.

BACKGROUND: Dimensional models of personality disorders postulate interpersonal dysfunction as the core feature of personality pathology, and describe maladaptive personality traits that characterize the specific pattern of dysfunction that is experienced. Herein, we examined whether maladaptive traits predict prosocial and trusting behavior, both of which are highly relevant behaviors for interpersonal functioning. Specifically, we examined antagonism as a predictor of prosocial behavior in a dictator game, and suspiciousness as a predictor of trust in the faith game. MATERIALS AND METHODS: The study was preregistered and conducted online. The preregistration protocol is available at https://osf.io/er43j . Data and code are available at https://osf.io/2rvbg/ . Participants (N = 445) completed the German version of the Personality Inventory for DSM-5 to measure antagonism and suspiciousness. Additionally, they played the dictator game (more money taken away from another person indicates less prosocial behavior) and the faith game (choosing the sure choice instead of the faith choice indicates less trust). We conducted a linear regression model to test whether antagonism is associated with prosocial behavior in the dictator game and a logistic regression model to test whether suspiciousness predicts selection of the sure choice in the faith game. RESULTS: As hypothesized, higher levels of antagonism were associated with less prosocial behavior in the dictator game. The remaining hypotheses were not supported, as suspiciousness was not significantly associated with the likelihood of choosing the sure choice in the faith game. Exploratory analyses on participants' estimates of the sure choice amount suggest successful experimental manipulation in the faith game. CONCLUSIONS: The results on antagonism and prosocial behavior are consistent with those of previous studies that used categorial classification systems of personality disorders or examined non-pathological personality traits. Potential explanations for the non-significant effects of suspiciousness are discussed, including the small size and range of the sure choice payoff and that the anonymity of the game may have precluded suspicious traits from expressing. Future research with higher stakes and known interaction partners is needed to further probe the effects of suspiciousness.

Childhood Maltreatment and Borderline Personality Disorder: The Mediating Role of Difficulties with Emotion Regulation.

Exposure to childhood maltreatment (CM) increases the risk of developing borderline personality disorder (BPD). However, it remains unclear what mechanisms might mediate this link. One candidate of interest is difficulties with emotion regulation. This study aims to examine the pattern of relations among CM, difficulties with emotion regulation, and the risk of developing BPD. A total of 162 individuals diagnosed with current BPD and 162 matched healthy controls completed self-reported questionnaires assessing CM and difficulties with emotion regulation. The authors found high correlations between CM and BPD diagnosis (r = .73, p < .001). Difficulties with emotion regulation were found to mediate the link between CM and BPD diagnosis (p < .001). Results suggest that CM may play a key role in the etiology of BPD and that difficulties with emotion regulation might be a mediating component between CM and BPD.

The effects of transient receptor potential cation channel inhibition by BI 1358894 on cortico-limbic brain reactivity to negative emotional stimuli in major depressive disorder.

Abnormal emotional processing in major depressive disorder (MDD) has been associated with increased activation to negative stimuli in cortico-limbic brain regions. The authors investigated whether treatment with BI 1358894, a small-molecule inhibitor of the transient receptor potential cation channel subfamily C leads to attenuated activity in these areas in MDD patients. 73 MDD patients were randomized to receive a single oral dose of BI 1358894 (100 mg), citalopram (20 mg), or matching placebo. Brain responses to emotional faces and scenes were investigated using functional magnetic resonance imaging. Primary endpoints were BOLD signal changes in response to negative faces in cortico-limbic brain regions, i.e. bilateral amygdala (AMY), dorsolateral prefrontal cortex, anterior insula (AI), and anterior cingulate cortex. Secondary endpoints were BOLD signal changes in response to negative scenes. For each region, separate ANOVA models were computed for the comparison of treatments (BI 1358894 or citalopram) vs. placebo. The adjusted treatment differences in the % BOLD signal changes in the faces task showed that BI 1358894 induced signal reduction in bilateral AMY and left AI. In the scenes task, BI 1358894 demonstrated significant signal reduction in bilateral AMY, AI, anterior cingulate cortex and left dorsolateral prefrontal cortex. Citalopram failed to induce any significant reductions in BOLD signal in both tasks. BI 1358894-mediated inhibition of the transient receptor potential cation channel subfamily resulted in strong signal reduction in cortico-limbic brain regions, thereby supporting development of this mechanism of action for MDD patients.

Childhood maltreatment is associated with distrust and negatively biased emotion processing.

BACKGROUND: Cognitive models of post-traumatic stress disorder (PTSD) propose that trauma entails cognitive alterations of increased distrust and perceived threat from others. We tested whether these predictions also hold in individuals with varying levels of childhood maltreatment (CM), which is much more prevalent than traumatic events as required for a PTSD diagnosis. We hypothesized that higher levels of CM would entail greater distrust and perceived threat, and that distrust would be more change-resistant in participants with more CM. METHODS: The study was pre-registered; the pre-registration protocol, data, and code are available at https://osf.io/pufy2/ . We recruited 549 participants (M age = 29.2, 74.5% women) for an online study via websites related to CM, Borderline Personality Disorder, and via snowball method on social media. Participants self-reported their level of CM on the childhood trauma questionnaire (CTQ). Next, they played two rounds of a hypothetical distrust game, indicating the perceived trustworthiness of avatars by way of estimating expected monetary deductions from them (i.e. higher amounts indicating greater distrust). After the first round, we provided participants with the feedback that very little money was taken from them. We expected those with more CM to be less responsive to the positive feedback and to adapt their estimates less in the subsequent round. Following the distrust game, participants completed an emotion rating task in which they rated the emotional expressions of 60 faces on a scale from 'very negative' to 'very positive'. We included angry, fearful, and happy facial expressions, and expected individuals with higher CM levels to provide more negative ratings. We conducted linear mixed effects models with random intercepts for raters and stimuli (crossed), and modelled random slopes for all within-person predictors. RESULTS: As hypothesized, higher levels of CM were associated with higher levels of distrust and a weaker decrease in distrust following positive feedback. Further supporting our hypotheses, individuals with higher levels of CM showed more negatively shifted emotion ratings. CONCLUSIONS: Increased distrust and perceived interpersonal threat following trauma, as proposed in cognitive models of PTSD, likely also apply to individuals with CM, following a dose-response relationship. We discuss clinical implications of considering any level of CM as a potentially relevant treatment-factor, even when a trauma-related disorder is not the main diagnosis, and propose future research avenues.

Negativity on two sides: Individuals with borderline personality disorder form negative first impressions of others and are perceived negatively by them.

Impression formation is vital for social interactions and theorized to be negatively biased in borderline personality disorder (BPD). We assessed 2 sides of impression formation in BPD: BPD individuals as raters who form first impressions and as targets of others' first impressions. We further investigated BPD-Rater × Target interactions. We showed videos of 52 targets (26 BPD, 26 healthy controls [HC], 46% male) to unmedicated women with BPD (n = 32), a clinical control group with social anxiety disorder (SAD; n = 29), and a HC group (n = 37). We hypothesized (a) that BPD raters would evaluate targets more negatively than SAD and HC raters. Indeed, BPD raters evaluated targets as significantly less trustworthy, less approachable, and less similar to themselves than HC raters. Descriptively, rater groups showed a pattern of BPD < SAD < HC, but the differences between SAD and both other rater groups failed to reach statistical significance. We further expected (b) HC raters to evaluate BPD targets more negatively than HC targets, and results supported this hypothesis. Lastly, we hypothesized (c) that BPD raters would perceive BPD targets more positively than HC targets, which was not supported. We discuss how negative first impressions by and of BPD individuals could contribute to loneliness and interpersonal dysfunction and suggest potential interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study.

Nonsuicidal self-injury (NSSI) is a prevalent and impairing behavior, affecting individuals with and without additional psychopathology. To shed further light on biological processes that precede and result from NSSI acts, we built on previous cross-sectional evidence suggesting that the endogenous opioid system, and especially ß-endorphin, is involved in the psychopathology of NSSI. This is the first study assessing salivary ß-endorphin in daily life in the context of NSSI acts. Fifty-one female adults with repetitive NSSI participated over a period of 15 days in an ambulatory assessment study. Salivary ß-endorphin was assessed before and after engagement in NSSI, during high urge for NSSI, and on a non-NSSI day. Furthermore, NSSI specific variables such as pain ratings, as well as method, severity, and function of NSSI were assessed. We found that ß-endorphin levels immediately before an NSSI act were significantly lower than directly after NSSI. However, there was no difference between ß-endorphin during high urge for NSSI and post NSSI measures. We found a positive association between severity of the self-inflicted injury and ß-endorphin levels, but no significant association between ß-endorphin levels and subjectively experienced pain. The results of the present study indicate that it is possible to assess salivary ß-endorphin in daily life in the context of NSSI. Furthermore, our results provide a first indication that NSSI acts could be associated with a momentary increase of ß-endorphin, and this might reinforce NSSI engagement. More research is needed to replicate and extend our findings on peripheral ß-endorphin in daily life.

A test of the interpersonal function of non-suicidal self-injury in daily life.

Theoretical models of non-suicidal self-injury (NSSI) posit that individuals use NSSI to influence others, but this remains largely untested. We used ambulatory assessment to test the interpersonal function of NSSI in the daily lives of 51 women with DSM-5 NSSI disorder. Participants reported NSSI events, urges, motives, and positive/negative interpersonal events (IPEs) for 14 days, providing five semi-random daily assessments and event-related NSSI reports. We analyzed 3,498 data-points, including 155 NSSI events, using multilevel models. We observed a positive concurrent association between the number of negative IPEs and NSSI engagement. Additionally, perceived distress of negative IPEs was positively associated with concurrent NSSI events and urges, and predicted later events. We saw no reduction in negative or increase in positive IPEs following NSSI. In a trait-level interview, participants endorsed interpersonal motives only minimally, but indicated that others often trigger NSSI. In daily life, participants rarely endorsed the motive 'get help/attention'. The results suggest that negative IPEs trigger NSSI, but that individuals in this sample rarely used NSSI for interpersonal motives and did not experience interpersonal reinforcement of NSSI. We discuss limitations of and possible solutions for under-reporting of interpersonal motives and benefits of studying interpersonal triggers (rather than outcomes) in future studies.