Self-other representations, emotion regulation and psychological distress as pathways to non-suicidal self-injury in emerging adults

ABSTRACT

Theoretical models of non-suicidal self-injury (NSSI) have highlighted the complex interaction between underlying psychosocial vulnerabilities, but, there is limited empirical support for these conceptualizations. The aim of the study was to examine affective, cognitive and interpersonal factors predicting NSSI among emerging adults. A sample of 1,574 emerging adults aged 18–25 years, drawn from 19 colleges via multi-stage sampling completed measures of NSSI, emotion regulation, experiential avoidance, psychological distress, self-criticism, brooding-rumination, attachment style and perceived social support. The results indicated that 22.40% had engaged in one or more self-injuring behaviours in the past 12 months, with cutting skin, hitting self and severely scratching self as the most commonly endorsed methods. Exploratory structural equation modelling identified differential pathways to NSSI, with difficulties in regulating emotions emerging as the only direct predictor of NSSI. Two latent constructs reflecting relationally based affective and cognitive structures: a negative self-other representation, and attachment style of considering relationships as secondary to achievement were identified. These differentially, and indirectly impacted NSSI engagement through psychological distress and difficulties in emotion regulation. The implications for interventions to expand beyond addressing emotion regulation deficits, and include other affective, cognitive and relational vulnerabilities are discussed.

KEYWORDS:

• Non-suicidal self-injury
• emerging adults
• attachment
• emotiondysregulation
• psychological distress
• structural equation modelling

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contribution

Conceptualization and methodology (Nupur Singhal, Poornima Bhola, V. Senthil Kumar Reddi, Binukumar Bhaskarapillai); Formal analysis and investigation (Nupur Singhal, Smitha Joseph); Writing- original draft preparation (Nupur Singhal); Writing- review and editing (Poornima Bhola, V. Senthil Kumar Reddi, Smitha Joseph, Binukumar Bhaskarapillai); Funding acquisition (Nupur Singhal); Supervision (Poornima Bhola, V. Senthil Kumar Reddi)

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethical clearance for the research proposal was obtained from the ethics committee of NIMHANS [NO.NIMH/DO/IEC (BEH. Sc. DIV)/2016–2017, dated 28 November 2016].

Informed consent

Written informed consent was obtained from the participants of the study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09515070.2024.2354277

Additional information

Funding

The study was part of the doctoral work of the first author, funded by the University Grants Commission, India.

Notes on contributors

Nupur Singhal

Nupur Singhal is a psychotherapist and clinical supervisor, having completed her Ph.D. in Clinical Psychology from the National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India. Currently, she manages her private practice, along with being a visiting faculty at CHRIST (deemed to be) University, Delhi NCR campus, India. Her primary research interests include non-suicidal self-injury, youth mental health and psychotherapy processes.

Poornima Bhola

Poornima Bhola is a psychotherapist, teacher, supervisor and researcher and works as Professor, Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. She is currently the Coordinator of the psychotherapy training programme in the department. Her primary research interests include psychotherapy processes, training and development; youth mental health and suicidality; social cognition and personality dimensions. She has co-authored a book titled ‘Reflective Practice and Professional Development in Psychotherapy’ and co-edited a book ‘Ethical Issues in Counselling and Psychotherapy Practice.

V. Senthil Kumar Reddi

Dr. Venkata Senthil Kumar Reddi is a Professor at the Department of Psychiatry, National Institute of Mental Health and Neuro Sciences. In this capacity, Dr. Reddi has clinical care, supervisory, academic, research and administrative responsiblites. Additionally, Dr. Reddi is the Head of Emergency Psychiatry and Acute Care (EPAC) Services and in-charge of EPAC Post-Doctoral program. He has developed an in-house Suicide Risk Assessment and Evaluation Tool. His research interests include Suicidality, Emergency Psychiatry, Catatonia, Neuropsychiatry, Consultation Liaison Psychiatry, Training and Service development. As Technical committee member, he was involved in developing India’s first ever National Suicide Prevention Strategy, recently released by the Government of India.

Binukumar Bhaskarapillai

Binukumar Bhaskarapillai is a statistician by profession and currently working as Additional Professor, Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India. His main research areas of interest include Statistical epidemiology, Applied Multivariate Methods, Missing data analysis, Longitudinal data analysis, Meta-analysis and Survey methods.

Smitha Joseph

Smitha Joseph is a biostatistician, teacher and researcher and works as Statistician, Division of Epidemiology and Biostatistics, St. John’s Research Institute (SJRI), Bangalore, India. Currently she is teaching Statistics for undergraduate and post graduate statistics students and Biostatistics for allied health sciences courses. She is providing consultation for health researchers and students. Her primary research interests include measurement error models, mixed effect models, statistical modelling in genomic research and estimation of usual intake distribution of micro and macro nutrients.