Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder.

This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.

Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure.

OBJECTIVES: The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI). METHOD: Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure. RESULTS: Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury. LIMITATIONS: Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed. CONCLUSIONS: Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.

The Relationship Between Mindfulness, Depressive Symptoms, and Non-Suicidal Self-Injury Amongst Adolescents.

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.

Nonsuicidal self-injury and affect regulation: recent findings from experimental and ecological momentary assessment studies and future directions.

CONTEXT: Although research indicates that nonsuicidal self-injury (NSSI) may be used as a form of emotion regulation, studies have largely relied on the use of retrospective self-report data, which limits inferences about directionality of effects. Recently, researchers have started to employ lab-based experimental (e.g., guided imagery, acute pain) and moment sampling approaches to the study of NSSI. METHODS: In the present study, we conducted a review of this recent literature, using several electronic databases (e.g., PsychINFO, ERIC, CINAHL). RESULTS: We identified 18 studies that met our inclusion criteria. Findings indicated that the administration of pain was associated with decreases in negative affect among both self-injurers and noninjurers, although these declines were more pronounced for self-injurers in some studies. CONCLUSIONS: We discuss findings within the context of two central theories (i.e., opponent-process theory and distraction theory) and offer several recommendations for future research in this area.

Aggressiveness in different presentations of cluster headache: results from a controlled multicentric study.

BACKGROUND: The hypothalamus has been discussed as a pivotal structure for both cluster headache (CH) and aggressiveness, but little is known about the extent of self-reported aggressiveness in patients with CH. PATIENTS AND METHODS: Twenty-six patients with chronic, 25 with active episodic and 22 with episodic CH outside the active period were examined interictally with a validated questionnaire quantifying factors of aggression and compared with 24 migraine patients and 31 headache-free volunteers. RESULTS: The ANOVA was significant for the subscale 'self-aggression/depression' (F(4, 123) = 5.771, p < 0.001) with significant differences between chronic and episodic CH and healthy volunteers. No significant changes were found for other subscales and the sum scale (F(4, 123) < 1.421, p > 0.230). Especially in the clinically most affected group of patients (chronic CH and active episodic CH), high levels of "self-aggression/depression" correlate with higher prevalence of depressive symptoms and higher impairment measured on an emotional and functional level. DISCUSSION: Self-aggressive and depressive cognitions with highest scores in chronic CH seem to be reactive as they correlate with depressive symptoms and impairment. They should be considered as an important therapeutic target since they impair the patient's life significantly.

Self-injurious behaviour: limbic dysregulation and stress effects in an animal model.

BACKGROUND: Self-injurious behaviour (SIB) is prevalent in neurodevelopmental disorders, but its expression is highly variable within, and between diagnostic categories. This raises questions about the factors that contribute to aetiology and expression of SIB. Expression of SIB is generally described in relation to social reinforcement. However, variables that predispose vulnerability have not been as clearly characterised. This study reports the aetiology and expression of self-injury in an animal model of pemoline-induced SIB. It describes changes in gross neuronal activity in selected brain regions after chronic treatment with pemoline, and it describes the impact that a history of social defeat stress has on the subsequent expression of SIB during pemoline treatment. METHODS: Experiment 1--Male Long-Evans rats were injected on each of five consecutive days with pemoline or vehicle, and the expression of SIB was evaluated using a rating scale. The brains were harvested on the morning of the sixth day, and were assayed for expression of cytochrome oxidase, an index of sustained neuronal metabolic activity. Experiment 2--Male Long-Evans rats were exposed to a regimen of 12 daily sessions of social defeat stress or 12 daily sessions of handling (i.e. controls). Starting on the day after completion of the social defeat or handling regimen, each rat was given five daily injections of pemoline. The durations of self-injurious oral contact and other stereotyped behaviours were monitored, and the areas of tissue injury were quantified. RESULTS: Experiment 1--Neuronal metabolic activity was significantly lower in a variety of limbic and limbic-associated brain structures in the pemoline-treated rats, when compared with activity in the same regions of vehicle-treated controls. In addition, neuronal activity was low in the caudate-putamen, and in subfields of the hypothalamus, but did not differ between groups for a variety of other brain regions, including nucleus accumbens, substantia nigra, ventral tegmentum, thalamus, amygdala, and cortical regions. Experiment 2--All the pemoline-treated rats exhibited SIB, and whereas the social defeat regimen did not alter the total amount of self-injurious oral contact or other stereotyped behaviours, it significantly increased the severity of tissue injury. CONCLUSIONS: A broad sampling of regional metabolic activity indicates that the pemoline regimen produces enduring changes that are localised to specific limbic, hypothalamic and striatal structures. The potential role of limbic function in aetiology of SIB is further supported by the finding that pemoline-induced self-injury is exacerbated by prior exposure to social defeat stress. Overall, the results suggest brain targets that should be investigated further, and increase our understanding of the putative role that stress plays in the pathophysiology of SIB.

Sensory abnormalities in autism. A brief report.

Sensory abnormalities were assessed in a population-based group of 208 20-54-month-old children, diagnosed with autism spectrum disorder (ASD) and referred to a specialized habilitation centre for early intervention. The children were subgrouped based upon degree of autistic symptoms and cognitive level by a research team at the centre. Parents were interviewed systematically about any abnormal sensory reactions in the child. In the whole group, pain and hearing were the most commonly affected modalities. Children in the most typical autism subgroup (nuclear autism with no learning disability) had the highest number of affected modalities. The children who were classified in an "autistic features" subgroup had the lowest number of affected modalities. There were no group differences in number of affected sensory modalities between groups of different cognitive levels or level of expressive speech. The findings provide support for the notion that sensory abnormality is very common in young children with autism. This symptom has been proposed for inclusion among the diagnostic criteria for ASD in the upcoming DSM-V.

The functions of nonsuicidal self-injury: support for cognitive-affective regulation and opponent processes from a novel psychophysiological paradigm.

Although research on the reasons for engaging in nonsuicidal self-injury (NSSI) has increased dramatically in the last few years, there are still many aspects of this pernicious behavior that are not well understood. The purpose of this study was to address these gaps in the literature, with a particular focus on investigating whether NSSI (a) regulates affective valence in addition to affective arousal and (b) serves a cognitive regulation function in addition to an affect regulation function. To elucidate these issues, the present study utilized a sample of 112 participants (33 controls, 39 no pain controls, 16 NSSI individuals, and 24 controls matching the affect dysregulation levels of the NSSI group), employed psychophysiological measures of affective valence (startle-alone reactivity) and quality of information processing (prepulse inhibition), and used experimental methods involving an NSSI-proxy to model the NSSI process. Results largely were consistent with predictions, supporting the hypotheses that NSSI serves to regulate cognitive processing and affective valence. On this latter point, however, the control groups also showed a decrease in negative affective valence after the NSSI-proxy. This unexpected finding is consistent with the hypothesis that opponent processes may contribute to the development of self-injurious behaviors (Joiner, 2005). Overall, the present study represents an important extension of previous laboratory NSSI studies and provides a fertile foundation for future studies aimed at understanding why people engage in NSSI.

Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study.

OBJECTIVE: Self-injurious behavior (SIB) is one of the most distinctive features of borderline personality disorder (BPD) and related to impulsivity and emotional dysregulation. METHOD: Female patients with BPD (n = 11) and healthy controls (n = 10) underwent functional magnetic resonance imaging while listening to a standardized script describing an act of self-injury. Experimental sections of the script were contrasted to the neutral baseline section and group-specific brain activities were compared. RESULTS: While imagining the reactions to a situation triggering SIB, patients with BPD showed significantly less activation in the orbitofrontal cortex compared with controls. Furthermore, only patients with BPD showed increased activity in the dorsolateral prefrontal cortex during this section and a decrease in the mid-cingulate while imagining the self-injurious act itself. CONCLUSION: This pattern of activation preliminary suggests an association with diminished emotion regulation, impulse control as well as with response selection and reappraisal during the imagination of SIB.

Tourette's syndrome and deep brain stimulation.

In this prospective double blind randomised "N of 1" study, a patient with a severe form of Tourette's syndrome was treated with bilateral high frequency stimulation of the centromedian-parafascicular complex (Ce-Pf) of the thalamus, the internal part of the globus pallidus (GPi), or both. Stimulation of either target improved tic severity by 70%, markedly ameliorated coprolalia, and eliminated self injuries. Severe forms of Tourette's syndrome may benefit from stimulation of neuronal circuits within the basal ganglia, thus confirming the role of the dysfunction of limbic striato-pallido-thalamo-cortical systems in this disorder.

Physiological correlates of self-injurious behavior in captive, socially-reared rhesus monkeys.

This study examined the relationship between self-injurious behavior (SIB) in rhesus monkeys and several biological variables, including monoamine metabolites in cerebrospinal fluid (CSF) and circulating levels of ACTH, cortisol, and testosterone. Cisternal CSF and blood plasma samples were obtained from 23 individually housed male rhesus macaques, 14 of which had a veterinary record of self-inflicted wounding. CSF samples were analyzed for 5-hydroxyindole-3-acetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) using isocratic high-performance liquid chromatography with electrochemical detection (HPLC-EC). Plasma samples were analyzed for ACTH, cortisol, and testosterone using commercially available radioimmunoassays (RIAs). Rates of self-directed biting were determined by systematic observation of all monkeys. Monkeys with SIB did not differ from controls in their basal monoamine or gonadal activity. However, the SIB group showed consistently lower mean plasma cortisol levels than the control group. Plasma cortisol was negatively correlated with rates of self-directed biting. These results suggest a persistent dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in monkeys with SIB. It is not yet clear whether this phenomenon of low cortisol represents chronically reduced adrenocortical secretion under basal conditions or a difference in response to the mild stress of capture and chemical restraint. The implications of these findings will be discussed with respect to SIB in humans as well as post-traumatic stress disorder (PTSD), a condition characterized by pituitary-adrenocortical hypoactivity.

The self-mutilative nature of severe onychophagia: a comparison with self-cutting.

OBJECTIVE: To investigate the psychophysiological pattern associated with severe and mild onychophagia, and to compare this pattern with that demonstrated by previous research on self-cutting. METHOD: Comparisons between the psychophysiological responses accompanying 3 behaviours were made using a guided imagery methodology. Imagery of nail-related, skin-cutting, and neutral events were presented in 4 stages. RESULTS: Experiment I distinguished participants exhibiting severe and mild onychophagia by the severity and frequency of nail-biting and by the pattern of psychophysiological response across the stages. Experiment II indicated that the change in psychophysiological arousal accompanying severe onychophagia was not as dramatic as that demonstrated for skin-cutting. The behaviour seems to be less effective in reducing tension. CONCLUSION: Severe onychophagia appears to manage the level of tension experienced by an individual, instead of dramatically reducing it in times of crisis. Such a process is consistent with that demonstrated in individuals with obsessive-compulsive disorder.

Cortical damage enhances pemoline-induced self-injurious behavior in prepubertal rats.

Self-injurious behavior (SIB) is a devastating characteristic of several developmental disorders including a number of mental retardation syndromes. The functional neuroanatomy and neuropharmacology of SIB is not well understood. Self-biting behavior (SBB) can be induced in rats by a high dose, systemic injection of pemoline (250 mg/kg, SC). This animal model allows for the investigation of anatomical and pharmacological aspects of SIB. Cortical pathology is a common occurrence in human disorders with SIB, and may be a fundamental pathological factor in producing the behavior. The present experiment was designed to investigate the effects of cortical damage on pemoline-induced SBB in prepubertal rats. Bilateral cortical aspirations were performed in 3-5-week-old rats. One week postsurgery, a pemoline challenge was administered. Behavioral comparisons were completed between the lesion group and an anesthetized-only control group. Results indicated that cortical damage significantly enhanced pemoline-induced SBB, along with some of the other pemoline-induced stereotypical behaviors. These results support the hypothesis that cortical damage influences the expression of stimulant-induced self-injury, and potential mechanisms for this influence are suggested.

Dynamics of self-injurious behaviors.

Self-injurious behavior was examined in a case study of head-banging by an 8-year-old girl with profound mental retardation and an autistic disorder. Trajectories of the arm movements and impact forces of the head blows were determined from a dynamic analysis of videotapes. Results revealed a high degree of cycle-to-cycle consistency in the qualitative dynamics of the limb motions, with one hand motions being faster than those with two hands (inphase and antiphase) and the motions with the helmet about 25% faster than those without the helmet. The impact force of SIBs as a percentage of body weights are near the low end of forces generated in boxing blows and karate hits.