Childhood Adversity and Psychophysiological Reactivity to Pain in Adolescent Nonsuicidal Self-Injury

Abstract

Background: Nonsuicidal self-injury (NSSI), the intentional, self-directed act of injuring one’s own body tissue, is a behavioral phenomenon closely linked to stress and its maladaptive regulation. NSSI is associated with childhood adversity that may underlie altered hypothalamic-pituitary-adrenal axis and autonomic nervous system response to stress in adolescents engaging in NSSI. Adolescents engaging in NSSI show decreased pain sensitivity and increased psychophysiological response to pain that may underlie the maintenance of the behavior and its stress-regulating function. Sampling and Methods: In a secondary analysis of previously published data we aimed to address the relationship between childhood adversity and altered psychophysiological pain response in an outpatient sample of n = 30 adolescents engaging in repetitive NSSI. Results: Greater childhood adversity is associated with greater cortisol secretion and increased and prolonged autonomic arousal following pain induction. Conclusions: The findings illustrate a potential neurobiological pathway linking childhood adversity to hyporesponsiveness of endogenous stress response systems that in turn show increased reactivity to the experience of pain. This hyperreactivity may counterbalance an inadequate stress response and in turn help to cope with stressful experiences. Directions for future research are discussed.

The neurophysiological embedding of child maltreatment

“…These studies varied widely in types of maltreatment and the ways in which autonomic response was indexed, but with two exceptions (Ford et al, 2010; Pollak et al, 2005) they featured samples comprising adolescents. In this respect they were similar to the two studies that reported an association between maltreatment and ANS hyper reactivity (those by Rinnewitz et al, 2018 and Shenk et al, 2010). What appears to differentiate these two studies from those that reported ANS hyporeactivity is the nature of the stressor employed.…”

“…And whereas Trickett and colleagues found that children (9–12 years) who had been physically or sexually abused exhibited especially small reactions to the TSST (Trickett et al, 2014), Linares and colleagues observed that adolescents (14–17 years) who had been sexually abused exhibited the largest cortisol response to completing the Attitudes toward Interpersonal Violence Assessment (Reese-Weber, 2008) relative to their peers and after controlling for physical abuse by their partner (Linares, Shrout, Nucci-Sack, & Diaz, 2013). A similar finding was reported by Rinnewitz et al (2018): more severe maltreatment was associated with larger increases in cortisol in response to a cold pressor task among female adolescents (12–17 years) who exhibited nonsuicidal self-injurious behaviors (Rinnewitz et al, 2018). Burgental and colleagues reported that toddlers (2 years) who had experienced frequent corporal punishment displayed larger cortisol responses to the Strange Situation (Ainsworth et al, 1978) than their peers (Bugental et al, 2003), in contrast to Sturge-Apple et al (2012), who found that toddlers who had experienced emotional neglect exhibited smaller cortisol responses to the Strange Situation.…”

“…However, two studies employing stressors other than the TSST support an account of hyper reactive ANS function. Shenk and colleagues found that female adolescents (13–23 years) who had been sexually abused were more likely than controls to display reductions of respiratory sinus arrhythmia in response to a timed cognitive task (Shenk, Noll, Putnam, & Trickett, 2010), a finding similar to that reported by Rinnewitz et al (2018), who observed a positive association between the severity of maltreatment and the magnitude of the reduction in heart rate variability in response to a cold pressor task among a sample of maltreated adolescent females (12–17 years) exhibiting nonsuicidal self-injurious behaviors (Rinnewitz et al, 2018). Oosterman and colleagues reported mixed findings, reporting that while neglected children (26–88 months) exhibited larger increases in the pre-ejection period in response to the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) compared to children who had not been neglected, they also exhibited smaller decreases in respiratory sinus arrhythmia (Oosterman, De Schipper, Fisher, Dozier, & Schuengel, 2010).…”

“…In all but one case (Ford et al, 2010), the studies that reported hyporeactivity employed a psychosocial stressor, either the TSST (in four studies) or a conflict recording or video (in two cases). However, the two studies that reported hyperreactivity used a physical (Rinnewitz et al, 2018) or cognitive challenge (Shenk et al, 2010) as the stressor. The nature of the stressor may also account for the complex pattern of results reported by Oosterman et al (2010), in which smaller decreases of respiratory sinus arrhythmia (indicative of PNS hyporeactivity) and larger increases in pre-ejection period (corresponding to SNS hyperreactivity) were observed among young children who had been neglected.…”

The Effects of Posttraumatic Stress and Trauma‐Focused Disclosure on Experimental Pain Sensitivity Among Trauma‐Exposed Women

“…Although cortisol is also known to prevent nerve and tissue damage associated with inflammation, extreme surges in cortisol, or hyperreactivity, can promote inflammation and result in increased pain sensitivity as well as the subsequent development of chronic pain syndromes (Hannibal & Bishop, 2014). Stress‐induced HPA hyperreactivity has been demonstrated among women with a history of childhood abuse (Heim et al., 2000; Rinnewitz et al., 2018) and current PTSD symptoms (Handwerger, 2009), which are both risk factors for chronic pain conditions (Moeller‐Bertram et al., 2012; Raphael & Widom, 2011). As almost half (43.2%) of the young adult women in the high PTSD symptom group reported an unwanted sexual experience as their index trauma, our findings may reflect the early stage of an altered biological process for trauma‐exposed women with PTSD.…”