Neural correlates of reward valuation in individuals with nonsuicidal self-injury under uncertainty.

BACKGROUND: Attitudes toward risk and ambiguity significantly influence how individuals assess and value rewards. This fMRI study examines the reward valuation process under conditions of uncertainty and investigates the associated neural mechanisms in individuals who engage in nonsuicidal self-injury (NSSI) as a coping mechanism for psychological pain. METHODS: The study involved 44 unmedicated individuals who reported five or more NSSI episodes in the past year, along with 42 age-, sex-, handedness-, IQ-, and socioeconomic status-matched controls. During the fMRI scans, all participants were presented with decision-making scenarios involving uncertainty, both in terms of risk (known probabilities) and ambiguity (unknown probabilities). RESULTS: In the NSSI group, aversive attitudes toward ambiguity were correlated with increased emotion reactivity and greater method versatility. Whole-brain analysis revealed notable group-by-condition interactions in the right middle cingulate cortex and left hippocampus. Specifically, the NSSI group showed decreased neural activation under ambiguity v. risk compared to the control group. Moreover, reduced hippocampal activation under ambiguity in the NSSI group was associated with increased emotion regulation problems. CONCLUSIONS: This study presents the first evidence of reduced brain activity in specific regions during value-based decision-making under conditions of ambiguity in individuals with NSSI. These findings have important clinical implications, particularly concerning emotion dysregulation in this population. This study indicates the need for interventions that support and guide individuals with NSSI to promote adaptive decision-making in the face of ambiguous uncertainty.

Psychosocial factors affect the occurrence of nonsuicidal self-injury in adolescents with major depressive disorder through chain mediation.

In the adolescent group, about half of adolescents with major depressive disorder (MDD) have NSSI. Psychosocial factors are associated with the development of NSSI. Clarifying the relationship between psychosocial factors and NSSI in adolescents with MDD can help us achieve early prevent. Demographic data, Hamilton Depression Scale-24 (HAMA24), childhood trauma questionnaire, emotional intelligence scale and interpersonal reactivity index were collected from 187 adolescents with MDD. Use ANOVA, Chi-square test, Binary Logistic Regression, Pearson correlation analysis, Mediation effect analysis and the Structural Equation Model for data analysis. The results of ANOVA showed that there was significant difference between the two groups in HAMD24 total score, impulsiveness, emotional intelligence, and empathy (p < 0.05). In the regression analysis, women, depression degree, motor impulsiveness (MI), personal distress (PD) and appraisal of other's emotions empathy were the risk factors for MDD adolescents to produce NSSI behavior. Among the indicators that were significantly related to MDD and NSSI, MI and PD mediate the relationship between MDD and NSSI. The structural equation model showed that MDD, PD and MI had a direct impact on NSSI, but PD and MI had multiple intermediary effected in the relationship between MDD and NSSI. Emotional intelligence, emotional neglect and cognitive impulsiveness indirectly affected the occurrence of NSSI behavior. Impulsiveness, personal distress, emotional neglect, and emotional intelligence are important risk factors that affect NSSI behavior in adolescents with MDD, and they affect the occurrence of NSSI in adolescents with MDD through chain mediation.

Pathway from childhood trauma to nonsuicidal self-injury in adolescents with major depressive disorder: the chain-mediated role of psychological resilience and depressive severity.

This study aimed to explore the pathway from childhood trauma to nonsuicidal self-injury (NSSI) in adolescents with major depressive disorder (MDD) and to examine the chain-mediating role of psychological resilience and depressive symptoms in this pathway. A total of 391 adolescents with MDD were recruited in the present study. The Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Chinese version of the Symptoms Check List-90 (SCL-90), the Chinese version of the Conner-Davidson Resilience Scale (CD-RISC), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC) were used to evaluate childhood trauma, depressive symptoms, psychological resilience and NSSI, respectively. Our results showed that 60.87% of adolescents with MDD had NSSI in the past month. Childhood trauma frequency was negatively correlated with psychological resilience but positively correlated with depressive symptoms and NSSI severity in adolescents with MDD. The stepwise logistic regression analysis identified that age, childhood trauma and depressive symptoms could independently predict the occurrence of NSSI, and the three-step hierarchical regression showed that childhood trauma, psychological resilience and depressive symptoms were all significantly associated with NSSI frequency in adolescents with MDD. Furthermore, the chain-mediation analysis revealed that psychological resilience and depression serially mediated the relationship between childhood trauma and NSSI in adolescents with MDD. Interventions targeted at improving resilience and depression may mitigate the impact of childhood trauma severity on NSSI risk in adolescents with MDD.

Brain-gut axis mechanism of subthreshold nonsuicidal self-injury addictive features in adolescents.

Nonsuicidal self-injury (NSSI) is associated with an increased risk of suicide. As the diagnostic criteria outlined in DSM-5 and other related clinical studies, a patient must have engaged in self-injurious behavior at least 5 times within the past year. However, patients with fewer than 5 self-injury behaviors should not be ignored. Our study included 46 adolescents aged 10-19 years with subthreshold NSSI (sNSSI), along with a control group of 50 healthy adolescents matched for age and other factors. We collected resting-state functional magnetic resonance imaging data and stool samples. The Ottawa Self-Injury Inventory and Deliberate Self-Harm Inventory were used to evaluate self-harm behaviors and addictive features. Local brain activity was assessed using fractional amplitude of low-frequency fluctuations (fALFF), and brain regions with abnormal fALFF were selected as seeds for whole-brain functional connectivity analysis. Stool samples were identified using 16S rDNA amplicon sequencing, and the LDA Effect Size method was used to explore significant differences between grouped samples. Mediation analysis was performed to investigate the brain-gut axis mechanisms of addictive features in sNSSI. We found that compared with healthy controls, sNSSI patients have abnormal fALFF in left thalamus and posterior cingulate cortex, dysconnectivities of left thalamus, and decreased Prevotellaceae. Our results suggested that addictive features of sNSSI may have a brain-gut mechanism. Furtherly, patients with 1-4 NSSI behaviors in the past year should have separate name for identification, such as "subthreshold NSSI".

Depression and posttraumatic stress disorder in adolescents with nonsuicidal self-injury: comparisons of the psychological correlates and suicidal presentations across diagnostic subgroups.

BACKGROUND: Nonsuicidal self-injury (NSSI) combined with suicide ideation increases the risk of suicidal behaviors. Depression and posttraumatic stress disorder (PTSD) are comorbidities of NSSI compounding this relationship. The present study compared diagnostic subgroups of NSSI based on current depression and PTSD on psychological correlates (i.e., vulnerabilities and impairment) and suicidal presentations (i.e., suicidal cognitions and behaviors) in a psychiatric sample of adolescents. METHODS: Eighty-seven adolescents meeting DSM-5 criteria for NSSI and 104 age-range-matched nonclinical controls (NC) participated. Participants completed self-report measures on psychological vulnerabilities and impairment (e.g., emotion regulation difficulties, negative cognitions). Adolescents with NSSI also completed clinical interviews on psychiatric diagnoses and a recent self-injurious behavior (SIB). Scores on the psychological correlates of NSSI were compared between adolescents with NSSI and NC, and across three diagnostic subgroups of NSSI (A: NSSI+/depression-/PTSD-, n = 14; B: NSSI+/depression+/PTSD-, n = 57; C: NSSI+/depression+/PTSD+, n = 14). Differences between NSSI diagnostic subgroups were tested on the motives for SIB and accompanying suicidal presentations (e.g., desire, intent, motive, lethality). RESULTS: Common comorbidities of NSSI included depression, panic disorder, generalized anxiety disorder, and PTSD. The NSSI subgroup classification was significantly associated with panic disorder, which was controlled for in the subsequent group comparisons. Overall, adolescents who engage in NSSI with vs. without depression reported more psychological vulnerabilities and impairment and a greater degree of suicidal thoughts/desire in SIB (i.e., groups B, C >A), which remained significant after controlling for panic disorder. An increased odds of the suicidal motive for SIB was found in adolescents with all three conditions (i.e., group C: NSSI+/depression+/PTSD+) compared to those with NSSI but neither depression nor PTSD (i.e., group A: NSSI+/depression-/PTSD-); however, this was not significant after controlling for panic disorder. CONCLUSIONS: Psychological underpinnings of adolescent NSSI in clinical contexts may be largely associated with concurrent depression. Suicidal motives in adolescents who engage in NSSI in the presence of depression and PTSD may be confounded by the co-occurrence of panic disorder. This study warrants the importance of attending to the comorbid depression with NSSI in adolescents as it is related to an increase in suicidal desire accompanying SIB.

Measurement and stratification of nonsuicidal self-injury in adolescents.

BACKGROUND: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI. METHODS: The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures. RESULTS: A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures. CONCLUSIONS: When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.

Borderline personality traits mediate the relationship between negative life events and nonsuicidal self-injury in a clinical sample with youth depression.

BACKGROUND: Borderline personality traits play a significant role in nonsuicidal self-injury (NSSI), particularly in depressed youths. NSSI is also highly correlated with negative life events. This research aimed to explore the connections between negative life events, borderline personality traits, and NSSI. METHODS: The study included 338 depressed youth aged 13 to 25 years. Self-reported measures and clinical interviews were utilized to evaluate the depressive symptoms, borderline personality traits, negative life events, and NSSI behaviours of these participants. Identifying variables linked to NSSI was the aim of our analysis, and we also conducted a mediation analysis to look into the influence of borderline traits on the connection between negative life events and NSSI. RESULTS: Of the 338 depressed youth, approximately 59.47% (201/338) displayed NSSI, which was associated with greater clinical severity. Borderline traits had an independent influence on NSSI and it partially explained the connection between negative life events and NSSI, even when accounting for depression symptoms. Depressed youth who were more vulnerable to NSSI behaviours often experienced negative life events such as interpersonal relationships, academic pressure, being punished, and loss. CONCLUSIONS: Our research suggests that depressed youth who experience more negative life events are more likely to experience NSSI, and negative life events indirectly influence nonsuicidal self-injury through borderline personality traits. Implementing interventions focused on mitigating borderline symptoms could be a promising therapeutic approach for addressing NSSI in young people.

The mediating effects of school bullying victimization in the relationship between childhood trauma and NSSI among adolescents with mood disorders.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a serious problem in the adolescent population worldwide. Childhood trauma and bullying have been identified as risk factors for NSSI. We explored the relationships among Childhood trauma, Bullying victimization and the severity of NSSI behaviours, and test the effect of Bullying victimization in mediating the association between Childhood trauma and the NSSI behaviours. METHODS: A total of 123 adolescents were recruited. They were diagnosed with depression or depressive episodes of bipolar disorder and had experienced NSSI in the last year. They were assessed using the Chinese version of the Childhood Trauma Questionnaire (CTQ-C), the Revised Olweus Bullying Victimization Questionnaire (OBVQ-R), and the Adolescent Self-Harm Questionnaire (ASHQ). RESULTS: Females presented a significantly greater prevalence of sexual abuse and relationship bullying than boys. Individuals in the younger age group (10-14 years) presented a greater incidence of emotional neglect, verbal bullying, relationship bullying, and total bullying, and their NSSI score was also higher than that of those in the older age group (15-19 years). Only children show a greater prevalence of sexual abuse than nononly children. Single-parent families scored higher on emotional abuse, emotional neglect, physical neglect and physical bullying than two-parent families. There was a significant positive correlation between each dimension of childhood trauma and all the dimensions of bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. The mediating effects of bullying victimization on emotional abuse, physical abuse, emotional neglect and physical neglect were 14%, 21%, 20%, 13% and 20%, respectively. CONCLUSION: There was a significant positive correlation between childhood trauma and bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. Bullying victimization played the partial mediating effects between Childhood trauma and NSSI.

Impacts of difficulties with emotion regulation on the longitudinal relationship between peer victimization and changes in adolescent nonsuicidal self-injury.

INTRODUCTION: Research has found that peer victimization is associated with adolescent nonsuicidal self-injury (NSSI) behavior; however, most of these studies ignored the association between these constructs at the within-person level. Additionally, the association between peer victimization and NSSI may vary among adolescents with different personal characteristics. With a longitudinal design, this study investigated whether and how emotion regulation (ER) difficulties moderate the relationship between peer victimization and changes in NSSI, with particular attention given to the unique moderating role of different dimensions of ER difficulties. METHODS: The study sample comprised 3,561 adolescents aged between 10 and 17 years old (Mage = 13.22, SD = 0.85; 56.9% males). Self-report assessments were administered in December 2021 and June 2022 in Shanxi province, China. RESULTS: The latent change score model showed that the adolescent NSSI increased during our assessments, with peer victimization as a significant predictor. ER difficulties moderated the association between peer victimization and NSSI changes, but interestingly, in an unexpected pattern. Specifically, peer victimization significantly predicted NSSI changes among adolescents with low ER difficulties but not for those with high ER difficulties. Moreover, among the multiple dimensions of ER difficulties, only nonacceptance of emotional responses and limited access to emotion regulation strategies interacted with peer victimization to predict NSSI changes and showed interaction patterns similar to those at the overall level of ER difficulties. CONCLUSIONS: The current study revealed the moderating role of ER difficulties in the relationship between peer victimization and changes in NSSI. These findings provide intervention implications for adolescents who engage in NSSI.

Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness.

BACKGROUND: This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway. METHODS: A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale. RESULTS: (1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents. CONCLUSIONS: Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.

Pattern of non-suicidal self-injury in Chinese male prisoners: A latent class analysis.

OBJECTIVES: Nonsuicidal self-injury (NSSI) occurs more frequently in the prisoner population than in the general population. Monitoring and management of this behavior is challenging because NSSI may present in diverse ways. People often use more than one method of NSSI, and there are many possible combinations of these behaviors. We used latent class analysis (LCA) to identify subgroups of male inmates based on methods and frequency of NSSI. METHODS: A total of 1042 male prisoners in China (Mage = 38.45, SD = 10.67) completed measures of hopelessness, sensation seeking, identity integration, and suicidal ideation, and NSSI was assessed in a structured interview. RESULTS: Results of the LCA supported a three-class model: high-NSSI (1.8%), moderate-NSSI (8.0%), and no-or-negligible NSSI (90.2%). Multinomial logistic regression analyses showed that prisoners in the high-NSSI and moderate-NSSI classes were significantly more likely than those in the no-or-negligible NSSI class to show high hopelessness, high sensation seeking, and low identity. Furthermore, suicidal ideation was significantly higher in the high-NSSI and moderate-NSSI classes than in the no-or-negligible NSSI class. CONCLUSIONS: Classifying groups of prisoners based on features of NSSI is potentially useful for understanding risk factors and for developing tailored prevention and treatment strategies.

A self-determination theory perspective on the relationship between emotion regulation styles, mindfulness facets, and well-being in adults with self-injury.

BACKGROUND: The relevance of emotion regulation (ER) difficulties to nonsuicidal self-injury (NSSI; the deliberate destruction of one's bodily tissue without suicidal intent) has been repeatedly documented. Recently, specific mindfulness facets (i.e., awareness, nonjudging, describing) have been proposed as mechanisms that explain this relationship. The present study sought to extend this line of inquiry by exploring the mediating role of mindfulness facets in the relation between self-determination theory-based ER styles (i.e., integrative ER, suppressive ER, emotion dysregulation) and indices of positive and negative well-being (i.e., subjective vitality, NSSI difficulties), while controlling for gender, in adults with recent NSSI engagement. METHODS: US adults with a history of more than one occurrence of NSSI within the last year (n = 222) completed online measures of ER styles, mindfulness facets, subjective vitality, and NSSI difficulties. RESULTS: A mediation model indicated that the effects of ER styles on positive and negative well-being were explained by specific mindfulness facets (i.e., awareness, nonjudging, nonreactivity, describing). CONCLUSIONS: The present study provides preliminary evidence that facets of dispositional mindfulness may be mechanisms through which ER styles impact positive and negative indices of well-being in adults with lived experience of NSSI.

Patterns and Transitions of Nonsuicidal Self-Injury Outcome Expectancies and Their Associations with Nonsuicidal Self-Injury among Adolescents.

Nonsuicidal self-injury (NSSI) outcome expectancies (i.e., the expectations that certain outcomes will follow NSSI) have been confirmed to predict NSSI engagement. However, it remains unclear whether adolescents hold different patterns of NSSI outcome expectancies and therefore vary in their risks of NSSI engagement. Moreover, little is known about whether patterns transition over time, influencing the development of NSSI. Additionally, possible gender differences in the patterns and their transitions need to be explored. This study aims to address these research gaps. A total of 679 adolescents (55.8% females; Mage = 15.19, SDage = 1.40) completed questionnaires and were surveyed semiannually for three times. Using latent profile analysis, regular latent transition analysis, and random intercept latent transition analysis, this study identified four patterns of NSSI outcome expectancies: High Affect Regulation and Moderate Negative Expectancies, Low Negative Expectancies, High Negative Expectancies, and High Communication and Negative Expectancies. The first two patterns showed high risks of NSSI, whereas the latter two patterns showed low risks of NSSI. Low Negative Expectancies was an unstable pattern. It had higher probabilities of transitioning to another high-risk pattern than transitioning to the low-risk patterns. The other three patterns had high stability. Gender had no significant effects on the four patterns or their transitions. The findings highlight the combined effects of NSSI outcome expectancies and underscore that NSSI outcome expectancies may change over time. Prevention and interventions targeting multiple factors corresponding to these expectancies should be developed.

A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood.

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.

Adolescent Nonsuicidal Self-Injury and Suicidality: A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort.

Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI.

Longitudinal Associations Between Negative Body Image, Self-Disgust, and Nonsuicidal Self-Injury Among Chinese Adolescents: Disentangling Between- and Within-Person Effects.

Nonsuicidal self-injury (NSSI) and negative body image are both highly prevalent among adolescents, and there are theoretically proposed reciprocal associations between them. However, previous research has not differentiated between stable personal traits and time-varying state levels when examining these associations, and the underlying mechanisms remain unclear. To address these gaps, this study investigated the longitudinal associations between negative body image, self-disgust, and NSSI among Chinese adolescents, disentangling the between- and within-person effects by employing random intercept cross-lagged panel models (RI-CLPMs). A total of 515 Chinese adolescents (50.7% boys; baseline Mage = 12.34 years, SD = 0.47) participated in a four-wave longitudinal study with 6-month intervals. The results indicated that, at the between-person level, higher levels of self-disgust were associated with more NSSI and more concerns about general appearance, facial appearance, shortness, and fatness, but were not associated with concerns about thinness. At the within-person level, general appearance concern and NSSI positively predicted each other over time through self-disgust. Concerns about facial appearance, shortness, and fatness all positively predicted self-disgust, which in turn positively predicted NSSI over time, but not vice versa. These findings highlight the stable and trait-like associations between self-disgust, NSSI, and most negative body image dimensions. Self-disgust is worth considering as a target for intervention, as it plays a mediating role in the long-term associations between negative body image and NSSI.

Unwanted Pursuit Behavior Victimization as a Predictor of Engagement in Nonsuicidal Self-Injury.

While prior research has studied associations between child abuse and nonsuicidal self-injury (NSSI), there is limited research assessing unwanted pursuit behavior (UPB) victimization and NSSI. In addition, few studies have assessed the self-reported functions of NSSI among survivors of violence. Among a sample of 18-25-year-old young adults (N = 333), both UPB victimization and child abuse were significantly associated with NSSI frequency. In regression models, UPB victimization was associated with increased use of affect regulation, antidissociation/feeling-generation, self-punishment, and antisuicide functions, while child abuse was associated only with antidissociation/feeling-generation and self-punishment. Affect regulation mediated the association between UPB victimization and NSSI frequency, but not the association between child victimization and NSSI frequency. Implications for research and clinical practice will be discussed.

Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self-injury.

Family influence is a crucial factor in the onset and maintenance of eating disorders. Nonsuicidal self-injury (NSSI) and restrictive eating disorders (REDs) co-occur in a significant percentage of subjects but family functioning of these families remains underexplored. This study examines the family functioning perceptions of 80 families with adolescents experiencing RED, comparing those with and without NSSI, alongside a control group, utilising the FACES-IV assessment. The study also aims to compare the triadic (adolescent-mother-father) perception of family functioning in the three groups. The results reveal distinct family dynamics in adolescents with both RED and NSSI, marked by problematic functioning perceptions from all family members and low parental agreement. A further understanding of the family functioning of adolescents with RED with NSSI can help clinicians in defining the treatment setting.

Nonsuicidal Self-Injury and Suicidal Beliefs in Adolescent Inpatient.

Background and Objectives: Although nonsuicidal self-injury (NSSI), by definition, excludes suicidal intent, numerous studies show associations between NSSI and suicidal phenomena in clinical and outpatient adolescent samples. Given the growing interest in the relationship between NSSI and suicidal phenomena, the present study aimed to investigate the relationship between NSSI and suicidal beliefs in adolescent psychiatric inpatients. Materials and Methods: The study sample included 50 adolescent inpatients at a specialized facility, with a mean age of 15.44 ± 1.39, who fulfilled DSM-5 criteria for NSSI. For study purposes, we use the Ottawa Self-Injury Inventory (OSI) and Brief Suicide Cognitions Scale (B-SCS). Statistical data processing was performed in the R software 4.3.0 (R Core Team, Vienna, Austria). Results: Of all NSSI functions, the Internal ER function score was the highest (18.72 ± 7.08), followed by External ER (8.10 ± 3.11), Social Influence (5.88 ± 5.37), and Sensation Seeking (3.44 ± 2.98). The mean Craving (C) score was 14.06 ± 7.51. The mean value of the B-SCS score was 19.54 ± 5.24. It was found that the B-SCS score is significantly related to Internal ER (r = 0.441, p < 0.001) and Craving (r = 0.297, p = 0.036). The multivariable model shows that internal ER function and participants' age are significantly related to the B-SCS score. Conclusion: Despite the limitations of the study, it is emphasized that cognitions occurring across the fluid suicidal belief system alone do not fully capture the complexity of suicide, but assessing the suicidal belief system in NSSI inpatient adolescents could nevertheless provide helpful information for identifying individuals who may have an elevated vulnerability to experiencing suicidal ideas and behaviors over time.

Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury.

BACKGROUND: Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories. METHODS: The sample consists of n = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires. RESULTS: At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established. CONCLUSIONS: While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.