Learning from experience: a longitudinal investigation of the consequences, frequency, and versatility of nonsuicidal self-injury

Date

2020-07-26

Authors

Robillard, Christina Lauren

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Abstract

Nonsuicidal self-injury (NSSI) refers to direct and deliberate damage of one’s bodily tissue without the intent to die. Although NSSI abates over time for most young people, 8-32% of those with a history of NSSI exhibit a severe pattern of engagement characterized by high or increasing NSSI frequency (i.e., number of episodes) and versatility (i.e., number of methods). Unfortunately, despite these markers of NSSI severity conferring risk for psychosocial dysfunction and suicidal behaviour, the mechanisms that explain why NSSI increases in frequency or versatility are poorly understood. Behavioural models of NSSI propose that experiencing desirable emotional and social consequences following NSSI is a key mechanism that increases the intensity/strength of the behaviour. Yet, behavioural models of NSSI do not specify whether experiencing more desirable consequences relative to other people (i.e., between-person) or experiencing more desirable consequences relative to one’s own average (i.e., within-person) more strongly predicts future NSSI severity. To address this gap in theory, the present study investigated the influence of between- and within-person desirable NSSI consequences on the frequency and versatility of NSSI over four lags spaced three months apart. 210 adolescents and adults (93.81% female, Mage = 22.95 [SD = 7.17]) with a history of NSSI were recruited from NSSI communities on social networking websites and completed self-report surveys assessing the desirable consequences, frequency, and versatility of NSSI every three months for one year. At the within-person level, time-lagged hierarchical linear models revealed that experiencing more desirable emotional consequences following NSSI at TimeT, relative to one’s own average, was unrelated to NSSI frequency at TimeT+1, but predicted a rise in NSSI versatility at TimeT+1. Conversely, experiencing more desirable social consequences following NSSI at TimeT, relative to one’s own average, predicted a decrease in NSSI frequency at TimeT+1, but was unrelated to NSSI versatility at TimeT+1. At the between-person level, neither desirable emotional consequences nor desirable social consequences of NSSI predicted NSSI frequency or versatility during the study. While only partially consistent with behavioural models of NSSI, these results suggest that: (1) desirable emotional and social consequences of NSSI exert opposing influences on NSSI severity, (2) within-person increases in desirable emotional consequences of NSSI portend periods of elevated NSSI risk, and (3) empirical tests of behavioural models of NSSI should consider not only how many times but how many ways a person self-injures. By enhancing our understanding of why some individuals persistently self-injure, this study provides a springboard for refining behavioural models of NSSI, advancing longitudinal research on the contingencies that maintain self-injury, and ameliorating intervention efforts that draw on the principle of operant conditioning to reduce NSSI.

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Keywords

nonsuicidal self-injury, self-harm, operant conditioning, consequences, functions, behavioural psychology, frequency, versatility, reinforcement

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