Explicit and inferred motives for nonsuicidal self-injurious acts and urges in borderline and avoidant personality disorders.

Abstract

Non-suicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study employed experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI, these allowed us to infer other motives which were not explicitly endorsed. Adults (N=152, aged 18–65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally-directed rather than interpersonally-directed ones. We then used multi-level regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared to control moments (i.e., without NSSI). We examined changes in five scales of inferred motives, designed to correspond to the five classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally-oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.

Occurrence and co-occurrence of nonsuicidal self-injury and disordered eating in a daily diary study: Which behavior, when?

“…For example, studies demonstrate that both intensity (Armey et al, 2011;Berg et al, 2013;Engel et al, 2013;Haedt-Matt and Keel, 2011a;Smyth et al, 2007;Snir et al, 2015) and variability of negative affect (Anestis et al, 2012;Goldschmidt et al, 2014;Lavender et al, 2013;Vansteelandt et al, 2013) predict NSSI and DE. Moreover, studies show that NSSI and DE often occur in response to interpersonal stressors (Goldschmidt et al, 2014;Prinstein et al, 2009), and their associated negative emotions (e.g., feeling rejected or hurt; Nock et al, 2009;Snir et al, 2015), although behaviors themselves typically occur when people are alone (Nock et al, 2009). Micro-longitudinal studies have also investigated the role of food, hunger and weightrelated cues in predicting DE (Haedt-Matt and Keel, 2011b;Leahey et al, 2011;Zunker et al, 2011).…”

Ambulatory Assessment of Borderline Personality Disorder

“…Finally, several studies have examined suicidal ideation, nonsuicidal self-injury (NSSI), and suicidal behavior . Findings indicate that: (a) negative mood intensity is related to suicidal ideation [14]; (b) we do not always see evidence for a negative reinforcement process from NSSI (i.e., a reduction in negative affect after NSSI) [15], and (c) motives for NSSI and suicidal behavior may vary across individuals and across occasions [15]. …”

Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder

“…Previous EMA studies have repeatedly addressed this question but have largely focused on only one specific BPD symptom and how it related to NA, whereas a broader picture of how NA relates to all nine symptoms of the BPD syndrome has rarely been addressed (see Law et al, 2016, for an exception). Previous EMA studies have revealed positive associations between NA and interpersonal problems (Berenson, Downey, Rafaeli, Coifman, & Leventhal Paquin, 2011;Hepp et al, 2017;Hepp, Lane, Wycoff, Carpenter, & Trull, 2018), impulsivity (Tomko et al, 2015) or impulsive behaviors such as drinking (Jahng et al, 2011), and NSSI (Andrewes et al, 2017;Houben et al, 2017;Scala et al, 2018;Snir, Rafaeli, Gadassi, Berenson, & Downey, 2015). Fewer studies have addressed NA in daily life in relation to the remaining symptoms of BPD.…”