Cognitive Systems in NSSI and Co-Occurring Conditions

Abstract

Nonsuicidal self-injury (NSSI) is conceptualized as an emotion-avoidant behavior similar to other co-occurring maladaptive behaviors such as substance abuse, disordered eating, and obsessive-compulsive behaviors. Although all these behaviors are motivated by emotion avoidance resulting in short-term benefits, a variety of cognitive processes are vital to understanding the onset and maintenance of these behaviors. This chapter overviews current research on the cognitive processes and related neurobiological features believed to increase vulnerability to NSSI. The chapter provides an integrative summary proposing that NSSI originates from a cognitive control dysfunction, rumination, and attentional biases toward negative emotions that result in the use of NSSI or other maladaptive regulation strategies. Continued use of the behavior leads to a cyclical pattern of reward that increases positive expectancies, attentional biases, development of rule-governed behavior, and cognitive inflexibility, and reliance on NSSI for coping is exacerbated. The integrated cycle of cognitive processes discussed in this chapter complements recent transdiagnostic models of emotion-avoidant disorders and helps to expand current emotion-focused theoretical understandings of NSSI.