Brain-based Classification of Negative Social Bias in Adolescents With Nonsuicidal Self-injury: Findings From Simulated Online Social Interaction

Abstract

Background: Interpersonal stress and perceived rejection have been clinically observed as common triggers of nonsuicidal self-injury (NSSI), with self-injury behavior regulating both affective and social experiences. We investigated whether the subjective interpretation of social interaction in a simulated online environment might be biased in the NSSI group, and the brain mechanisms underlying the experience. Methods: Thirty female adolescent patients with NSSI and thirty female age-matched controls were investigated in this case-control study. In our novel task that simulates interaction on current social media platforms, participants indicated whether they liked or disliked pictures of other players during a functional magnetic resonance imaging (fMRI) scan. Participants also viewed positive and negative feedback directed toward them by others. The task also assessed the subjective effects of the social interaction. Finally, subjects underwent a separate facial electromyography session, which measured facial expressions processing. Outcomes: Behaviorally, the NSSI group showed a negative bias in processing social feedback from others. A multi-voxel pattern analysis (MVPA) identified brain regions that robustly classified NSSI subjects and controls. Regions in which mutual activity contributed to the classification included dorsomedial prefrontal cortex and subgenual anterior cingulate cortex, a region implicated in mood control. In the NSSI group, multi-voxel classification scores correlated with behavioral sensitivity to negative feedback from others. Results remained significant after controlling for medication, symptoms of depression, and symptoms of borderline personality disorder. Interpretation: This study identified behavioral and neural signatures of adolescents with NSSI during social interaction in a simulated social media environment. These findings highlight the importance of understanding social information processing in this clinical population and can potentially advance treatment approaches.

Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index

“…Participants with NSSI were recruited from the child and adolescent psychiatric (CAP) clinic in Linköping, Sweden, from June 2016 to March 2018, as part of a study examining neurobiological markers of NSSI in 30 clinical and 30 healthy adolescents which was carried out at the Center for Social and Affective Neuroscience, Linköping University (31). Inclusion criteria for participants were: having engaged in five or more instances of NSSI during the past 6 months, independent of psychiatric diagnosis, and being a female between 15 and 18 years of age.…”

Rejection sensitivity and adolescent non‐suicidal self‐injury: Mediation through depressive symptoms and moderation by fear of self‐compassion

“…Peters, Smart, and Baer (2015) also reported a positive association between rejection sensitivity and self‐harm in a sample of young adults, although, when dysfunctional responses to emotion were adjusted for, the association became non‐significant. Besides, in several recent neuroimaging studies where rejection was experimentally induced, it was found that adolescents with NSSI were high in rejection sensitivity and showed enhanced neural processing of social exclusion, as compared to healthy controls, depression patients, or borderline personality disorder patients (Brown et al ., 2017; Groschwitz, Plener, Groen, Bonenberger, & Abler, 2016; Perini et al ., 2019). Findings from these studies suggest that dispositional rejection sensitivity may also confer risk for NSSI in community adolescents.…”

Neurobiological Underpinnings of Social-Emotional Impairments in Adolescents with Non-Suicidal Self-Injury

“…Individuals who engage in NSSI experience greater levels of negative emotions, emotional reactivity, emotion dysregulation (Anderson & Crowther, 2012; S. E. Victor & Klonsky, 2014), and alexithymia, a difficulty in identifying and describing emotions (Lüdtke et al, 2016). Adolescents with NSSI also report that, relative to their peers, they lack social skills (Claes et al, 2010), perceive social situations as more stressful (K. L. Kim et al, 2015), are more sensitive to social rejection (Brown et al, 2017; Perini et al, 2019), and select more maladaptive solutions to social problems (Nock & Mendes, 2008). These emotional and social impairments likely interact to contribute to NSSI engagement.…”

“…However, these significant results were eliminated when depressive symptom severity was included as a covariate, leading the authors to conclude that the observed amygdala-frontal circuit disturbances underlie both NSSI and the comorbid depressive symptoms reported by these adolescents - depression is associated with similar alterations in amygdala and prefrontal activation (Arnone et al, 2012; Cullen et al, 2014; Frodl et al, 2009; Phillips et al, 2003), as well as impairments in facial emotion recognition (Demenescu et al, 2010). Studies also associate NSSI with aberrant task-specific neural activation in paradigms involving social evaluation, rejection sensitivity, and social exclusion (Brown et al, 2017; Groschwitz et al, 2016; Malejko et al, 2019; Perini et al, 2019), suggesting NSSI-specific alterations of emotion regulation pathways in social contexts. However, many of these effects were only observed in comparisons to healthy controls, and studies did not control for clinical symptoms.…”