Anger precedes and predicts nonsuicidal self-injury in veterans: Findings from an ecological momentary assessment study.

Veterans have high rates of suicide, and nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicide risk; however, there is presently little known about antecedents of NSSI that might inform intervention efforts. Accumulating research suggests that anger and hostility play an important role in NSSI, but whether these emotions precede and predict NSSI is currently unknown. The aim of the current study was to examine the temporal relationships between anger/hostility and NSSI urges and behavior among veterans diagnosed with NSSI disorder. Our hypothesis was that angry/hostile affect would predict subsequent NSSI urge and engagement, but not vice versa. Forty veterans with NSSI disorder completed a 28-day ecological momentary assessment study with three daily prompts to report on their affect and NSSI urges and engagement. Multilevel cross-lagged path modeling was used to determine the direction of effects between angry/hostile affect and NSSI urges and engagement over time. Consistent with our hypothesis, results indicated that the lagged effects of angry/hostile affect on subsequent NSSI urge and engagement were significant, whereas the lagged effects of NSSI urge and engagement on angry/hostile affect were not significant. Findings highlight the importance of assessing and treating anger among veterans who engage in NSSI.

Prospective Prediction of First Onset of Nonsuicidal Self-Injury in Adolescent Girls.

OBJECTIVE: Adolescent nonsuicidal self-injury (NSSI) is a significant risk factor for suicidal behavior and an important clinical marker of psychopathology. NSSI is especially common in adolescent girls. A number of psychosocial correlates of adolescent NSSI have been identified, including problems characterized by disinhibition and negative affectivity. However, it is unknown whether these characteristics prospectively predict first-onset NSSI, limiting our understanding of its etiology and prevention. The current study addresses this gap in the literature. METHOD: Participants in the Adolescent Development of Emotion and Personality Traits (ADEPT) project at Stony Brook University who had not experienced NSSI at baseline (462 girls, mean age = 14.39 years, SD = 0.62 years) completed baseline measures of hypothesized risk factors related to problems with disinhibition and negative affectivity, including adolescent psychopathology, personality and clinical traits, and parental psychopathology. First onset of NSSI was monitored at 9-month intervals by in-person and telephone interviews over the next 36 months. RESULTS: There were 42 first onsets of NSSI (9.1%) in the 3 years since baseline. First-onset NSSI was independently predicted by adolescents' low conscientiousness, high avoidance, and parental substance abuse at baseline. The composite risk index predicting first-onset NSSI demonstrated good accuracy for identifying girls who will start self-injuring (area under the curve = 0.78, sensitivity = 0.85, specificity = 0.57). CONCLUSION: These results highlight the role of disinhibition and avoidance in the development of NSSI. The risk index predicting NSSI onset may help to guide the design and application of novel interventions to prevent this condition in adolescent girls.

The role of parental psychopathology and personality in adolescent non-suicidal self-injury.

Adolescent non-suicidal self-injury (NSSI), a significant risk factor for suicidal behavior, is strongly associated with adolescent psychopathology and personality traits, particularly those characterized by poor self-regulation. Some parental psychopathology and personality traits have also been identified as risk factors for adolescent NSSI, but specific parental characteristics and mechanisms involved in this association have not been systematically examined. The current study comprehensively investigated the contribution of parental psychopathology and personality to adolescent NSSI using data from the baseline wave of the Adolescent Development of Emotion and Personality Traits (ADEPT) study of 550 adolescent girls (mean age = 14.39 years, SD = 0.63) and their biological parents. We first investigated whether parental lifetime psychiatric diagnoses, and personality and clinical (rumination, self-criticism, emotional reliance) traits were associated with adolescent NSSI. We also tested whether adolescent history of psychiatric illness, personality, and clinical traits mediated the associations between parental characteristics and adolescent NSSI. Parental substance use disorder, adult-ADHD symptoms, self-criticism, and lower agreeableness and conscientiousness were associated with offspring's NSSI. These associations were mediated through adolescent characteristics. In contrast, parental mood and anxiety disorders and neuroticism were unrelated to adolescent NSSI. The results suggest that parental traits and disorders characterized by self-regulatory difficulties and lack of support constitute risk factors for self-injury in adolescent girls, acting via adolescent traits. This demonstrates that parental influences play a significant role in the etiology of adolescent NSSI.