Reciprocal Associations Between Adolescent Girls’ Chronic Interpersonal Stress and Nonsuicidal Self-Injury: A Multi-wave Prospective Investigation

Abstract

Purpose: Nonsuicidal self-injury (NSSI) is associated with increased risk of suicide attempts. Theories of NSSI assert interpersonal stress as a common risk factor for, and perhaps consequence of, NSSI. Prior research has not examined reciprocal associations between chronic interpersonal stress and NSSI. This study used a multiwave, prospective design to address this gap in a sample of adolescent girls, a group with elevated risk for both chronic interpersonal stress and NSSI. Pubertal development was examined as a moderator of the reciprocal associations.Methods: Adolescent girls (N = 220; ages 12-16, M age = 14.69 years) at heightened risk for NSSI completed a baseline assessment and follow-up assessments over 18 months, divided into two 9-month epochs (Time 1 and 2). Pubertal development was assessed via self-and parentreport. Chronic interpersonal stress was assessed using a semistructured interview at the end of each time period. NSSI was measured using a semistructured clinical interview every 3 months within both time periods to enhance accurate reporting.Results: Path models revealed that chronic romantic stress during Time 1, but not peer or parentchild stress, predicted NSSI during Time 2 among girls with more advanced pubertal development. Moreover, NSSI during Time 1 predicted higher levels of chronic romantic and parent-child stress during Time 2.

Stressful Life Events in Different Social Contexts Are Associated With Self-Injury From Early Adolescence to Early Adulthood

“…With regard to the age-15-only association, it is possible that break-ups at that age involve a first serious romantic partner, and therefore a novel kind of stressor. The age-specific pattern is also consistent with prior work, which found that chronic romantic stress (e.g., rejection, arguments, having fewer romantic relationships than one's peers) increased the risk of self-injury among girls with advanced pubertal development (21). However, a caveat is that the items used to assess relationship breakup did not distinguish adolescents who were abandoned by a partner or friend from those who decided to break off the relationship themselves.…”

“…Adolescents also often face stressful life events as they undergo transitions in their peer networks (peer context), form intimate bonds with best friends and romantic partners (intimate relationships context), and re-negotiate their roles in relation to parents and siblings (family context) (9,20). Evidence of associations between chronic adversity relating to peer and romantic relationships and self-injury is consistent (13,19,21,22), whereas evidence of associations between family-related adversity and self-injury is mixed (21,23,24). Evidence of the unique role of acute life events in these contexts (e.g., being physically attacked by peers, the breakup of intimate relationships, or experiences of loss in the family context) is largely missing from the literature.…”

“…Romantic break-ups could be particularly stressful in cases of an adolescent's first serious relationship with an intimate romantic partner (e.g., in mid-or late adolescence). Indeed, one study found an association between romantic stress and increased risk of self-injury, but only in girls during advanced puberty (21). Finally, family-related experiences of loss are known to increase young people's risk of mental health problems (28), but familyrelated life events encountered during early adolescence may be more critical than those in later adolescence, when young people become increasingly independent from the family.…”

Brain-based Classification of Negative Social Bias in Adolescents With Nonsuicidal Self-injury: Findings From Simulated Online Social Interaction

“…The age of onset for NSSI is around 12–14 years [3] and peaks during adolescence, with rates declining in adulthood [8]. Sensitivity to interpersonal stress, high emotional distress and in some cases chronic romantic stress [9] have been suggested to play a role in the development and maintenance of NSSI, with self-injury behavior regulating both affective and social experiences [1]. The fact that interpersonal difficulties commonly precede NSSI has also been noted in the proposed DSM-5 criteria [6].…”

Self‐Stigma Toward Nonsuicidal Self‐Injury: An Examination of Implicit and Explicit Attitudes

“…lifetime prevalence of NSSI is approximately 20% in this population (Swannell, Martin, Page, Hasking, & St. John, 2014;Whitlock, Eckenrode, & Silverman, 2006), with 12month engagement rates varying widely, up to 14% (Kuentzel, Arble, Boutros, Chugani, & Barnett, 2012;Serras, Saules, Cranford, & Eisenberg, 2010;Wilcox et al, 2012). Engagement in NSSI is strongly associated with a wide range of both internalizing and externalizing psychiatric disorders (Nitkowski & Petermann, 2011). Given its high prevalence, as well as increasing evidence suggesting that NSSI is associated with both clinical and functional impairment, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) incorporated nonsuicidal self-injury disorder (NSSI-D) as a condition requiring further study (American Psychiatric Association, 2013).…”