Longitudinal Prediction of Adolescent Nonsuicidal Self-Injury: Examination of a Cognitive Vulnerability-Stress Model

Abstract

Virtually no longitudinal research has examined psychological characteristics or events that may lead to adolescent nonsuicidal self-injury (NSSI). This study tested a cognitive vulnerability-stress model as a predictor of NSSI trajectories. Clinically-referred adolescents (n =143; 72% girls) completed measures of NSSI, depression, attributional style, and interpersonal stressors during baseline hospitalization. Levels of NSSI were reassessed 3, 6, 9, 15, and 18 months later. Latent growth curve analyses suggested that a cognitive vulnerability-stress interaction significantly predicted increases in NSSI between 9 and 18 months post-baseline. This association remained significant while considering the longitudinal association between depressive symptoms and NSSI; results were not significantly mediated by depressive symptoms at 9 months.

Characterizing Interpersonal Difficulties Among Young Adults Who Engage in Nonsuicidal Self-Injury Using a Daily Diary

“…A second unexpected finding was the absence of between-group differences in the strength of the association between negative interpersonal interactions and subsequent negative affect, either later that day or the following day. These findings are inconsistent with the cognitive vulnerability-stress model of NSSI (Guerry & Prinstein, 2010), which posits more intense emotional reactivity to interpersonal stressors among individuals with NSSI. One possible explanation for this unexpected finding is that the assessment schedule utilized in this study was not sufficiently sensitive to detect differences in emotional reactivity to interpersonal stressors, either because these emotional responses are more brief (e.g., lasting an hour or less) or more enduring (e.g., lasting several days) than would be characterized by three retrospective reports per day.…”

“…Notably, however, these differences in daily peer interactions were accounted for by group differences in baseline levels of social anxiety and the use of support seeking to cope with distress. These findings are consistent with the cognitive vulnerability-stress model of NSSI (Guerry & Prinstein, 2010), which suggests that cognitive and behavioral processes associated with anxiety interfere with effective interpersonal behaviors in people with NSSI. Moreover, these findings highlight several potential mechanisms through which individuals with NSSI may experience worse quality peer relationships (Claes et al, 2010;Hilt et al, 2008;Hoff & Muehlenkamp, 2009), including the experience of less frequent and less satisfying peer interactions, behavioral and cognitive difficulties associated with social anxiety (e.g., fears of negative evaluation and associated behavioral avoidance), and the tendency to rely on intrapersonal (vs. interpersonal) coping strategies during times of distress.…”

“…Consistent with the developmental and social signaling models, the relationship between childhood maltreatment and NSSI has been found to be mediated by cognitive processes such as self-criticism (Glassman, Weierich, Hooley, Deliberto, & Nock, 2007), which, in turn, may increase interpersonal reactivity (Guerry & Prinstein, 2010). Finally, consistent with the cognitive vulnerabilitystress model, a negative attributional style has been found to strengthen the association between negative life events (including interpersonal stressors) and NSSI in a prospective study of adolescents (Guerry & Prinstein, 2010). Together, past research in this area suggests that individuals with (vs. without) NSSI may have deficits in the ability to: (a) initiate or maintain relationships with desired groups or individuals, (b) communicate personal and emotional information to others, (c) experience or interpret interactions with others as supportive, (d) regulate distress following unpleasant interpersonal interactions, and (e) effectively seek support or reassurance from others during times of stress.…”

“…Consistent with all three theories, individuals with (vs. without) NSSI rate themselves as less competent at meeting interpersonal goals (Baetens, Claes, Muehlenkamp, Grietens, & Onghena, 2012) and less likely to seek social support to cope with distress (Andover, Pepper, & Gibb, 2007). Consistent with the developmental and social signaling models, the relationship between childhood maltreatment and NSSI has been found to be mediated by cognitive processes such as self-criticism (Glassman, Weierich, Hooley, Deliberto, & Nock, 2007), which, in turn, may increase interpersonal reactivity (Guerry & Prinstein, 2010). Finally, consistent with the cognitive vulnerabilitystress model, a negative attributional style has been found to strengthen the association between negative life events (including interpersonal stressors) and NSSI in a prospective study of adolescents (Guerry & Prinstein, 2010).…”

“…According to the social signaling hypothesis (Nock, 2008), NSSI is enacted when less intense and less costly behaviors, such as verbal communications of distress, have not been effective in achieving communicative goals due to poor signal quality or clarity or insufficiently responsive environments. Alternatively, the cognitive vulnerability-stress model (Guerry & Prinstein, 2010) suggests that people who engage in NSSI tend to make more negative attributions when they encounter interpersonal stressors, resulting in more affective arousal and greater reliance on maladaptive behaviors to cope with the resultant distress. Finally, Yates' (2004) developmental model suggests that traumatic experiences in childhood, especially maltreatment, lead to impairments in motivational, emotional, and relational skills, which, in turn, contribute to the use of NSSI (vs. more adaptive strategies) to meet emotional and interpersonal needs.…”