A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury.

BACKGROUND: Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers. METHOD: We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS). RESULTS: Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10). CONCLUSION: The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.

Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group.

BACKGROUND: Adolescents' nonsuicidal self-injury (NSSI) leads to distress that affects the whole family system, and siblings are reported to suffer from disrupted family communication and functioning. So far, no studies have examined the quality of relationships between adolescents with NSSI and their siblings. The aim of the present study was to examine the sibling relationship quality of adolescents with NSSI, adolescents with other mental disorders without NSSI (clinical controls, CC), and adolescents without current or past experience of mental disorders (nonclinical controls, NC). METHODS: 139 female adolescents aged 13-20 years (mean age = 16.18 years, SD = 1.62, NSSI: n = 56, CC: n = 33, NC: n = 50) and 73 siblings aged 10-28 years (mean age = 16.88 years, SD = 4.02, 60.3% female) participated. Self-report measures were used to assess psychopathology and sibling relationship quality. RESULTS: Siblings reported a wide range of negative emotional and familial consequences, such as feeling left alone with their sister's issues or a distressing family situation, as a result of their sister's NSSI. Siblings of adolescents with NSSI experienced significantly more coercion in the relationship with their sister compared to CC (d = 1.08) and NC (d = 0.67) siblings, indicating an imbalance of dominance and control in their relationship. Further, adolescents with NSSI reported significantly less warmth and empathy in the sibling relationship and higher rivalry scores between their siblings and themselves than NC adolescents, suggesting higher levels of parental favoritism among parents of adolescents with NSSI compared to NC parents (d = 0.93). Among siblings of adolescents with NSSI, high levels of warmth, conflict, and empathy were significantly associated with internalizing problems. For adolescents with NSSI a significant association was found between internalizing problems and coercion and externalizing problems and similarity. CONCLUSIONS: Given the negative impact of NSSI on siblings' emotional well-being and family life, efforts should be made to offer siblings psychoeducation and support to help them cope with the emotional and familial consequences of their sister's NSSI. Given adequate support, siblings can in turn be a source of emotional support for their sister.

Temperament and character traits in female adolescents with nonsuicidal self-injury disorder with and without comorbid borderline personality disorder.

BACKGROUND: Temperament and character traits of adolescents with nonsuicidal self-injury disorder (NSSI) might differentiate those- with and without comorbid borderline personality disorder (BPD). METHODS: Participants were 57 female adolescents with NSSI disorder without BPD (NSSI - BPD), 14 adolescents with NSSI disorder and BPD (NSSI + BPD), 32 clinical controls (CC), and 64 nonclinical controls (NC). Temperament and character traits were assessed with the Junior Temperament and Character Inventory, and impulsivity with the Barratt Impulsiveness Scale and a Go/NoGo task. RESULTS: Adolescents with NSSI disorder scored significantly higher on novelty seeking and harm avoidance and lower on persistence, self-directedness, and cooperativeness than CC. The NSSI + BPD group scored even higher than the NSSI - BPD group on novelty seeking and harm avoidance and lower on persistence and cooperativeness (d ≥ 0.72). Adolescents with NSSI reported higher levels of impulsivity than the CC and NC group. However, this difference was not found in a Go/NoGo task. CONCLUSIONS: The results provide further evidence for a distinct diagnostic entity of NSSI disorder.

Parenting behavior in families of female adolescents with nonsuicidal self-injury in comparison to a clinical and a nonclinical control group.

BACKGROUND: Nonsuicidal self-injury (NSSI) is often accompanied by dysfunctional familial relationships. Problems within the family are also frequent triggers for NSSI. METHODS: The current study investigated the parenting behavior in families of 45 female adolescents with NSSI disorder, 27 adolescents with other mental disorders (clinical controls, CCs), and 44 adolescents without mental disorders (nonclinical controls, NCs). The adolescents and their parents (92 mothers, 24 fathers) were surveyed using self-report measures. The parenting dimensions warmth and support, psychological control, and behavioral control (demands, rules, and discipline), as well as parental psychopathology and parental satisfaction were assessed. RESULTS: Adolescents with NSSI disorder reported significantly less maternal warmth and support than NCs (d = .64); this group difference was not evident in mothers' reports. No group differences emerged regarding adolescent-reported paternal parenting behavior. Mothers of adolescents with NSSI reported higher depression, anxiety, and stress scores than mothers in the NC group and less parental satisfaction than mothers in both control groups (CC and NC). CONCLUSIONS: Given the association between NSSI, low levels of adolescent-reported maternal warmth and support and low levels of mother-reported parental satisfaction, clinical interventions for adolescents with NSSI should focus on improving family communication and interaction.

[Emotion Regulation in Adolescents with Nonsuicidal Self-Injury]. / Emotionsregulation bei Jugendlichen mit Nichtsuizidalen Selbstverletzungen.

Nonsuicidal self-injury (NSSI) is a prevalent and impairing condition that was newly included in DSM-5 in the section III criteria for further research. Difficulties in emotion regulation play an important role in the development and maintenance of NSSI. This study investigated the emotion regulation in female adolescents with NSSI according to DSM-5 (n=55), clinical control adolescents with mental disorders without NSSI (n=30), and nonclinical control adolescents (n=58) using self-report questionnaires and interviews. As expected, results indicated that adolescents with NSSI have significantly more difficulties in emotion regulation compared to healthy controls. In addition, adolescents with NSSI reported also significantly more difficulties in impulse control, lack of emotional clarity, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies compared to nonclinical and clinical controls. Adolescents with NSSI felt significantly more often sadness compared to clinical controls (d=0.66) and compared to other emotions. Adolescents with NSSI indicated significantly less often happiness compared to nonclinical controls (d=1.83). Results support that adolescents with NSSI have difficulties in emotion regulation and that these difficulties are even more pronounced than in adolescents with other mental disorders. Clinical implications will be discussed.