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.

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.

A systematic review of daily life studies on non-suicidal self-injury based on the four-function model.

Non-suicidal self-injury (NSSI) is a prevalent, impairing, and trans-diagnostic behavior that can be comprehensively assessed in daily life studies. We conducted a systematic literature review of 35 Ambulatory Assessment and Daily Diary studies of NSSI, to achieve three aims. First, we reviewed descriptive evidence on NSSI acts. On average, studies observed 1.6 acts per participant, but evidence regarding methods, pain, and context was sparse. Second, we reviewed evidence on NSSI urges. On average, studies reported 4.3 urges per participant. Urges were also associated with increased negative affect and predicted later acts. Third, we reviewed evidence on the Four-function Model of NSSI. Eight studies partially supported negative intrapersonal reinforcement, showing increased negative affect pre NSSI, but, of these, only four studies supported decreased negative affect post NSSI. Additionally, only three studies supported positive intrapersonal reinforcement, showing decreased positive affect pre and increased positive affect post NSSI. Evidence for the interpersonal functions was limited to two studies and inconclusive. We recommend assessing the intensity, frequency, and context of acts and urges, as well as pain and urge duration in future studies. We also recommend follow-up prompts after acts and urges to better track affect trajectories, and a detailed assessment of interpersonal events.

Low positive affect display mediates the association between borderline personality disorder and negative evaluations at zero acquaintance.

BACKGROUND: Several recent studies have demonstrated that naïve raters tend to evaluate individuals with Borderline Personality Disorder (BPD) negatively at zero-acquaintance (i.e., in a 'first impression' type situation, where the rater has no knowledge of the individual and no prior interactions with them). Specifically, individuals with BPD were evaluated as less trustworthy, likeable, and cooperative than healthy participants (HCs). Based on previous impression formation studies, we hypothesized that the non-verbal cues positive affect display, negative affect display, and eye contact contribute to negative first impressions of those with BPD. METHODS: To address this question, we recruited 101 participants that rated the degree of positive affect display, negative affect display, and eye contact in 52 videos of age-and gender-matched BPD and HC participants. We hypothesized that low positive affect display, high negative affect display, and eye contact would mediate the association between group (BPD vs. HC) and ratings of trustworthiness, likeability, and cooperativeness. RESULTS: Ratings for positive affect display were significantly lower and those for negative affect display significantly higher for BPD versus HC targets, whereas eye contact did not differ significantly between groups. In multiple mediation models, positive affect display significantly mediated the association between group and trustworthiness/likeability, whereas negative affect display only mediated the association between group and likeability. None of the individual cues was a significant mediator of the association between group and cooperation. CONCLUSIONS: We emphasize therapeutic possibilities to improve positive affect display -and thus overall first impressions- to increase the chances of forming social bonds for BPD individuals.

Negative evaluation of individuals with borderline personality disorder at zero acquaintance.

Previous research suggests that individuals with Borderline Personality Disorder (BPD) tend to evaluate other people as untrustworthy or hostile, which could contribute to the marked interpersonal problems in BPD. In contrast, alterations in first impressions of potential interaction partners of those with BPD remain under-researched and poorly understood. Herein, we focused on how naïve raters evaluate BPD individuals, hypothesizing that raters would tend to evaluate them negatively. To test this hypothesis, we recruited 26 BPD and 26 healthy control participants (46% male) as targets in the 'Thin Slices' paradigm. Targets were video-taped while talking about their personal preferences (e.g. hobbies). Subsequently, these short videos ('Thin Slices') were presented to two rater samples (n = 92 and n = 44), who evaluated targets' likeability, trustworthiness, and cooperative behavior in an economic game. In both studies, raters evaluated BPD targets as less likeable and trustworthy, and in one study also as less cooperative. These findings are contrasted with results from an economic game, in which BPD targets behaved no less cooperatively than controls. We discuss limitations with regard to socioeconomic differences between the target groups and explore how negative evaluations by others may contribute to the interpersonal difficulties in BPD. We suggest that - given future replication with more strictly matched target groups- interventions aimed at improving impression management could be beneficial for BPD patients.