An initial investigation of the association between DSM–5 posttraumatic stress disorder symptoms and nonsuicidal self-injury functions.

Abstract

Objective: Despite the well-established link between posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), little is known about factors that may lead to self-injury among trauma-exposed individuals. Moreover, no research to date has examined these relations in the context of the newly revised Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) PTSD criteria. Thus, the purpose of the current study was to explore the associations between DSM-5 PTSD symptom clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and self-injury functions using a small sample of college students. Method: Participants (N ϭ 81) were recruited for a lifetime history of NSSI and trauma exposure. Results: Findings revealed a statistically significant path from PTSD avoidance symptoms to NSSI social functions and from PTSD negative alterations in cognitions and mood symptoms to NSSI intrapersonal functions, even after controlling for relevant covariates. Conclusions: Results of the current study highlight the importance of assessing for NSSI among trauma-exposed individuals. Considering that NSSI is a risk factor for suicidal behavior and potentially a clinically distinct diagnosis, future research should continue to explore these associations using larger, more diverse clinical samples. Clinical Impact StatementThis study examined the link between posttraumatic stress disorder (PTSD) symptom clusters and reasons for engaging in nonsuicidal self-injury (NSSI), referred to as a NSSI function. Results indicated that PTSD symptom clusters are differentially related to NSSI functions. Specifically, PTSD negative alterations in cognitions and mood symptoms were associated with engaging in NSSI for intrapersonal (i.e., emotion regulation) functions, whereas PTSD avoidance symptoms were related to NSSI for social functions (i.e., communication, avoidance). These results suggest that PTSD symptom clusters may differentially maintain NSSI behaviors, and highlight the importance of assessing for NSSI among those who experience PTSD symptoms.

Self-harm in Young People: Investigating the Role of Resilience and Posttraumatic Stress Related to the COVID-19 Pandemic

“…The present study showed that COVID-19 related posttraumatic stress levels increased one-fold the risk of engaging in self-harm with and without suicidal intent in young adults. This finding is consistent with existing evidence indicating that posttraumatic stress is a predictor of self-harm (Dixon-Gordon et al, 2014 ; Ennis et al, 2020 ). However, posttraumatic stress levels specifically related to the pandemic was not a consistent predictor across the two different types of self-harm (with and without suicidal intent) in emerging adults.…”

“…Exposure to traumatic events and posttraumatic stress disorder (PTSD) symptoms have been associated with self-harm in emerging adults (Ennis et al, 2020 ). It has been suggested that self-harm may operate as a maladaptive coping strategy in the light of trauma exposure, while trauma symptoms mediate the relationship between trauma exposure and self-harm (Smith et al, 2014 ).…”

Psychosocial Factors Associated With Increased Adolescent Non-suicidal Self-Injury During the COVID-19 Pandemic

“…On the basis of a literature review, we developed an unconstrained classification matrix, which focused on the relevant factors of NSSI. The identified categories, including "Experienced trauma, " "Body-focused bullying, " "Social isolation from peers, " "Hurt by information on social media, " and "Parent-child relationships, " were all retrieved from previously published studies (22)(23)(24)(25)(26)(27)(28).…”

Intrapersonal functions of nonsuicidal self-injury statistically mediate the effect of posttraumatic stress disorder symptoms on fearlessness about death.

“…As NSSI functions to decrease negative affect and increase positive affect (Armey et al, 2011;Franklin et al, 2013), greater use of NSSI for intrapersonal regulation may therefore emerge to manage symptoms of reexperiencing (Horowitz & Stermac, 2018) and alterations in cognitions and mood (Ennis et al, 2020). Interpersonal trauma has also been associated with interpersonal functions of NSSI (Horowitz & Stermac, 2018), as has trauma-related avoidance (Ennis et al, 2020). While individual facets of trauma-related sequelae PTSD, NSSI, AND FEARLESSNESS ABOUT DEATH may differentially predict separate functions of NSSI, it is worth noting that in the present study global PTSD symptoms were indirectly associated with FAD only through the intrapersonal functions of NSSI.…”

“…The second is geared toward interpersonal (i.e., social) functions such as influencing others or avoiding social engagement. In the context of the posttraumatic stress response, there is evidence to suggest that individuals use NSSI to cope with trauma-related dissociation (Horowitz & Stermac, 2018), interpersonal conflict (Horowitz & Stermac, 2018), avoidance (Ennis et al, 2020), and symptoms of negative mood (Ennis et al, 2020; Forbes et al, 2019). That is, individuals report using NSSI for the purpose of modulating trauma-related sequelae tied to emotional distress and interpersonal difficulties.…”