Predictors of continuation and cessation of non-suicidal self-injury in adolescents
2022, 30 (7):
Non-suicidal self-injury is a socially unacceptable behavior whereby an individual deliberately harms themselves without suicide ideation; it is an important risk factor for future suicide ideation, suicidal behavior and long-term psychological disorders. As a high risk group, non-suicidal self-injury behavior in adolescents poses a serious risk to their physical and mental health, and has a significant social “contagion” effect. Understanding the factors that predict the continuation or cessation of non-suicidal self-injury behavior in adolescents is helpful to provide new perspectives for early prevention and intervention.
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This study combed through relevant literature from China and abroad using longitudinal tracking and retrospective studies, and employed Nock’s integrative theoretical model to classify the factors that are predictive of the continuation or cessation of non-suicidal self-injurious behavior in adolescents into three categories: physiological mechanisms, personal traits and social factors. In terms of physiological mechanisms, a neurobiological basis for the continuation or cessation of non-suicidal self-injurious behavior in adolescents was identified. For example, when β-endorphin levels and the resting-state functional connectivity (RSFC) between the amygdala and frontal lobes were abnormal in adolescents, these individuals might become dependent on non-suicidal self-injurious behavior as a means of restoring homeostasis in the body, and thus, they perpetuate the behavior.
In terms of personal traits, adolescents with deficits in emotion regulation were more likely to develop and maintain non-suicidal self-injurious behavior, while those who were good at accepting their emotional responses, and able to use adaptive emotion regulation strategies, were more likely to stop this behavior in the future; adolescents with borderline personality disorder, impulsive personality traits, low levels of self-esteem, and high levels of self-criticism and self-punishment tended to persist in non-suicidal self-injury behavior over a longer period of time, whereas adolescents with high levels of self-esteem, positive beliefs about adversity, and low levels of self-punishment were more likely to stop the behavior. The non-suicidal self-injury function on which the adolescent relied also influenced the course of the behavior, with adolescents who relied on non-suicidal self-injury for intrapersonal functions (e.g., anti-dissociation, self-punishment, and affect regulation, etc.) being highly likely to maintain the behavior over time. However, those who relied on non-suicidal self-injury for interpersonal functions (e.g., peer-bonding, interpersonal influence, autonomy, revenge, etc.) were more likely to stop the behavior after a period of time. In addition, adolescents’ prior experience of non-suicidal self-injurious behavior might also be one of the strongest predictors of future persistence with this behavior, with adolescents with more severe levels of non-suicidal self-injurious behavior being at greater risk of continuing the behavior and, conversely, being more likely to stop.
In terms of social factors, risk factors such as peer bullying and poor family relationships might weaken an individual's ability to cope with distress, which in turn might trigger or exacerbate non-suicidal self-injurious behavior in adolescents. Conversely, effective social support, such as peer support, family support, psychological counselling and therapy, could provide protective resources for the development of non-suicidal self-injurious behavior and might help adolescents to stop this behavior.
At present, most of the relevant studies at home and abroad focus on the prevalence, research methods, relevant influencing factors and functions of non-suicidal self-injurious behavior, and relatively little theoretical and practical exploration of the persistence or cessation of non-suicidal self-injurious behavior has been carried out. Future research should pay more attention to the diversification of research methods and measurement techniques for non-suicidal self-injurious behavior, and the expansion of research areas (e.g., personality, cognitive orientation, etc.), as well as to the differences in age groups and cultural backgrounds, in order to further identify risk and protective factors that are significant predictors of the development of non-suicidal self-injurious behavior, and to further explore the interaction between these factors.