Abstract: Nonsuicidal self-injury (NSSI) is defined as the deliberate, direct, and socially unacceptable destruction of one’s own body tissue without a conscious suicidal intent. This behavior has become a major public health problem among adolescents. The initial occurrence of NSSI and its subsequent peak periods often coincide with the identity crisis stage of adolescents. Identity confusion represents a sense of feeling “mixed up, ” that is, being unable to enact and maintain lasting commitments to life alternatives and lacking a clear sense of purpose and direction. Considerable evidence has linked identity confusion to NSSI. According to the identity-NSSI interplay model, NSSI may serve as a means of developing a sense of identity (i.e., “I am a self-injurer”), which goes against the common values and attitudes in society. The destabilization of a self-injurer may lead individuals to a further increased sense of identity diffusion. Based on this theory, the present study tested the bidirectional association between identity confusion and adolescents’ NSSI as well as the mediating role of alienation and the moderating role of gender in this association.
A sample of 1258 Chinese middle school students (50.1% girls; M_age at Wave 1 = 13.81 years) completed self-report questionnaires regarding identity confusion, alienation, and NSSI at three time points (called T1, T2, and T3), with 6-month intervals. The random intercept cross-lagged panel model (RI-CLPM) was employed to separate between- and within-person effects, and to test the mediation role of alienation in the reciprocal relations between identity confusion and adolescent NSSI. Moreover, the multi-group RI-CLPM was used to test the gender differences in the associations among identity confusion, alienation, and NSSI.
Results showed that identity confusion and NSSI were mutually reinforcing at the within-person level when controlling for between-person effects. Specifically, initial NSSI significantly and positively predicted T2 identity confusion, which in turn significantly positively predicted T3 NSSI. T2 NSSI also positively predicted T3 identity confusion. More importantly, T2 alienation longitudinally mediated the association between T1 NSSI and T3 identity confusion. These associations among identity confusion, alienation, and NSSI did not differ between genders.
This study found that alienation played a unidirectional mediating role in the association between NSSI and identity confusion, and this pattern is consistent across genders. This finding indicates that identity in Chinese culture has a “relational” quality, and identity confusion among Chinese adolescents does not necessarily lead to maladaptive behaviors (e.g., NSSI). Furthermore, this study highlights the importance of developing a healthy identity in the prevention and intervention of NSSI. Specifically, schools are encouraged to organize more activities or courses related to personal development, which provide adolescents with ample time and opportunities for self-exploration. This approach, thereby, may help them achieve a greater sense of continuity and integrity in their identities.

Key words: identity confusion, non-suicidal self-injury, alienation, random intercept cross-lagged panel model, adolescence