Does Anger Expression Mediate the Relationship Between Parental Rejection and Direct and Indirect Forms of Non-suicidal Self-injury?

Abstract

Non-suicidal self-injury (NSSI) is defined as the intentional destruction of one’s own body without an intent to die (e.g., self-cutting). On the other hand, indirect forms of self-injury refer to behaviors in which people harm themselves in an indirect way (e.g., substance use). Existing literature suggests that a negative parent–child relationship may increase vulnerability to NSSI and indirect forms of self-injury. However, little is known about the potential mediators that intervene in the aforementioned relationship. Therefore, the present work tests a path model to investigate whether the manner of anger expression—anger-in (redirect anger inwardly) or anger-out (express anger outwardly)—mediates the association between parental rejection and direct (specifically self-cutting) and indirect (specifically substance use) forms of self-injury in a cross-sectional sample of Italian adolescents. We assessed self-injury, parental acceptance/rejection, and the expression of anger using self-report questionnaires in 2464 high school students, aged 13–20 years (Mage = 15.93, SD = 1.49). Additionally, characteristics of NSSI were also assessed using semi-structured interviews. We found that parental rejection was significantly positively associated with both self-cutting and substance use. The aforementioned relationship was mediated through anger-in for self-cutting, and through anger-out for substance use. The current work demonstrated that anger expression might work as a bridge between invalidating caregiving environment (i.e., rejecting), in which an individual feels unloved and uncared for, and the occurrence of self-cutting and substance use. The salient role of anger management in the development of prevention and intervention programs for NSSI and indirect self-injury among adolescents is discussed.

Stressful life events and non-suicidal self-injury among Chinese adolescents: A moderated mediation model of depression and resilience

“…According to the experiential avoidance model of NSSI ( 22 ), negative emotions usually precede NSSI, and adolescents may engage in NSSI as a means of avoiding these emotions. Our findings are consistent with this model and with other research showing that negative emotions (such as depression, anxiety, and anger expression) are a particularly significant trigger of adolescent NSSI ( 6 , 16 , 30 , 44 , 45 , 53 ). Our results, together with those of earlier research, provide evidence of a mediated pathway in which stressful life events increase the risk of negative emotions, which in turn increases the risk of NSSI.…”

“…The findings supported our hypothesis that adolescents who experienced stressful life events are more likely to engage in NSSI. This result confirmed the findings from previous studies that showed a significant positive correlation between stressful life events and adolescent NSSI ( 16 – 18 , 44 ). This result also is consistent with what would be expected based on the general strain theory ( 15 ).…”

“…Previous research showed that stressful life events are strongly correlated with adolescents' risky behaviors ( 13 , 14 ), consistent with general strain theory ( 15 ). In line with this theory, stressful life events have been shown to be associated with adolescent NSSI in correlational studies ( 16 – 18 ) and longitudinal studies ( 19 – 21 ). For example, in a longitudinal study, Baetens et al ( 19 ) found that adolescents' stressful life events were significantly positively associated with NSSI 18 months later.…”

“…Future research should use a variety of methods (such as interviews) and information sources (such as peers) to collect data. Third, this study only tested the mediating role of depression in the relationship between stressful life events and adolescent NSSI, and future research can test the mediating roles of other emotions such as anxiety ( 6 ), anger expression ( 16 ), and shame ( 47 ). Moreover, this study only explored one moderator, namely resilience, and future research can test whether other factors such as regulatory emotional self-efficacy ( 50 ) protect against the effects of stressful life events on adolescents' depression and NSSI.…”

“…For example, in a longitudinal study, Zhu et al ( 6 ) found that anxiety symptoms mediated the relationship between cybervictimization and NSSI in a sample of 1987 adolescents in Chinese. Similarly, in a sample of 2464 Italian adolescents, Cipriano et al ( 16 ) found that anger expression mediated the relationship between parental rejection and direct and indirect forms of NSSI.…”