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. Author manuscript; available in PMC: 2024 Jul 1.
Published in final edited form as: Arch Suicide Res. 2022 Aug 4;27(3):1002–1018. doi: 10.1080/13811118.2022.2106919

Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions

Kristen M Sorgi-Wilson 1,*, Joey C Cheung 1, Nicole K Ciesinski 1, Michael S McCloskey 1
PMCID: PMC9898468  NIHMSID: NIHMS1848190  PMID: 35924878

Abstract

Objective:

Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear.

Method:

The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI).

Results:

The EFA derived two higher-order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions.

Conclusions:

Higher-order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.

Keywords: non-suicidal self-injury, cognition, functions, repetitive negative thinking, negative self-perception

Non-suicidal self-injury (NSSI), the direct, deliberate destruction of one’s own body tissue without suicidal intent (International Society for the Study of Self-Injury, 2018), is a serious public health concern. NSSI is particularly prevalent among emerging adults, with as many as 17% to 32% of first-year college students reporting a history of NSSI (Hamza & Willoughby, 2016; Whitlock et al., 2006). A recent cross-national epidemiological study among 24 colleges found that, of first-year students reporting a lifetime history of NSSI, nearly 60% met criteria for at least one mood, anxiety, or substance use disorder (Kiekens et al., 2021). NSSI among college students is of notable concern given its association with other mental health difficulties during what can be a very academically and socially stressful period (e.g., American College Health Association, 2018; Kiekens et al., 2021), and students with high emotional reactivity may turn to NSSI as a maladaptive way to cope with such stress (Hamza et al., 2021). Moreover, the high prevalence of NSSI among emerging adults is particularly concerning given that NSSI is a known predictor of later suicidal ideation and suicide attempts (Hamza & Willoughby, 2016; Ribeiro et al., 2016).

Researchers have worked to understand the reasons that individuals engage in NSSI, identifying both intrapersonal and interpersonal psychological functions. Intrapersonal functions involve engaging in NSSI to alter one’s internal (e.g., emotional, cognitive) state (Taylor et al., 2018) and are automatically reinforcing, or reinforced within oneself (Nock & Prinstein, 2004). These include affect regulation (i.e., to change one’s emotional state), self-punishment (i.e., to express negative emotions toward oneself), anti-dissociation (i.e., to stop psychological numbness or emptiness), anti-suicide (i.e., to prevent oneself from acting on suicidal ideation), and marking distress (i.e., to create a physical sign of psychological pain; Klonsky & Glenn, 2009). Interpersonal functions involve engaging in NSSI for either positive or negative social reinforcement (Nock & Prinstein, 2004), including interpersonal influence (i.e., to communicate one’s pain to and/or seek care from others), peer-bonding (i.e., to be close to or fit in with others), revenge (i.e., to get back at others), interpersonal boundaries (i.e., to demonstrate one’s separateness from others), and autonomy (i.e., to demonstrate one’s independence; Klonsky & Glenn, 2009). Research suggests that intrapersonal functions—particularly affect regulation—are more commonly endorsed than interpersonal functions of NSSI (Taylor et al., 2018).

It is also important to understand the specific cognitive processes that are associated with, and may underlie, these psychological functions of NSSI. One such cognitive process is self-criticism—perceiving oneself as inadequate and inferior to others and/or feeling disgusted with or hatred toward oneself (Gilbert et al., 2004). Individuals with (vs. without) a history of NSSI report greater self-criticism (Ammerman & Brown, 2018; Xavier et al., 2017). Self-criticism also is positively correlated with NSSI frequency (Burke et al., 2015; Glassman et al., 2007), which is a commonly-studied index of NSSI severity—as are the number of different NSSI methods used and the duration (e.g., years) and recency of NSSI engagement (Brager-Larson et al., 2022; Turner et al., 2013; Zielinski et al., 2018). Regarding the relationship between self-criticism and psychological functions, NSSI is linked to self-critical thoughts rooted in a desire to hurt or take revenge on oneself (Gilbert et al., 2010). Thus, self-criticism has direct implications for NSSI functions, as this type of negative self-view may lead to NSSI as a means of self-punishment (Glassman et al., 2007; Hooley et al., 2010).

Other cognitive processes also relate to self-harm. The Interpersonal Psychological Theory of Suicide (Joiner, 2005; Van Orden et al., 2010) proposes that perceived burdensomeness (PB)—the perception that one’s existence is a burden to others—and thwarted belonginess (TB)—the perception that one does not belong in social groups—contribute to the desire to kill oneself and that repeated NSSI contributes to the acquired capability to act on this suicidal desire (Joiner, 2005; Joiner et al., 2012; Van Orden et al., 2010). Indeed, research supports associations between PB/TB and NSSI, finding positive correlations between NSSI history and frequency and PB and TB (Assavedo & Anestis, 2016; Chu et al., 2016). Given that PB and TB involve viewing the self negatively in relation to others, these cognitive processes may play a role in NSSI motivated by interpersonal functions (e.g., interpersonal influence, peer bonding). Thus, both theory and research support the notion that NSSI is linked to self-referential cognitive processes including self-criticism, PB, and TB, which may be further linked to certain NSSI functions.

Other (non-self-referential) negative cognitive processes have been linked to NSSI. One example is repetitive negative thinking (RNT), defined as relatively uncontrollable repetitive or perseverative thought about negative content (Ehring & Watkins, 2008). Two forms of RNT are worry—excessive thinking about feared events or future outcomes (Borkovec et al., 1998)—and rumination—past-oriented focus on the causes or effects of one’s psychological (e.g., depressed) state (Gustavson et al., 2018; Treynor et al., 2003). The Emotional Cascade Model explicitly links NSSI to RNT, asserting that rumination amplifies negative affect, creating a strong aversive state from which one may attempt to escape by engaging in harmful behaviors (e.g., NSSI, binge eating, aggression) that provide a physical distraction from escalating negative affect (Selby et al., 2008; Selby & Joiner, 2013). Thus, RNT may contribute to NSSI engagement that is motivated by an affect regulation function. Empirically, rumination and negative emotionality together have been linked to NSSI presence and frequency (Nicolai et al., 2016), and the tendency to worry correlates with the number of NSSI methods used (Ammerman et al., 2018). Moreover, in the presence of RNT, feelings of anxiety and overwhelm positively predict NSSI frequency (Hughes et al., 2019). Among individuals with high rumination, depressive symptoms are linked to NSSI engagement to regulate emotions (Hilt et al., 2008), supporting a relationship between rumination/worry and the affect regulation NSSI function.

Taken together, theory and research reveal that various cognitive processes are associated with NSSI history and/or severity, and some of these processes may be related to particular NSSI functions (e.g., self-criticism relating to the self-punishment function). To our knowledge, however, studies have not investigated patterns of associations between negative cognitive processes and the various functions of NSSI. The present study examined relationships between negative cognitive processes—rumination, worry, self-criticism, PB, and TB—and NSSI engagement and functions. Previous research indicates potential overlap between several of these cognitive processes conceptually (e.g., rumination and worry as forms of RNT; PB and TB as components of suicidal desire) and statistically (e.g., strong correlations between worry and rumination [Segerstrom et al., 2000; Yook et al., 2010] and between PB and TB [Assavedo & Anestis, 2016; Cero et al., 2015]). Thus, we first used exploratory factor analysis to identify higher-order constructs among these cognitive processes. We hypothesized that the resulting superordinate factors would be positively associated with NSSI history among the full sample and with NSSI severity among those with an NSSI history. Furthermore, given preliminary evidence and theory linking certain forms of cognition with intrapersonal (e.g., rumination with affect regulation) and interpersonal (e.g., PB/TB with peer-bonding) reasons for NSSI engagement, we hypothesized that the cognitive factors would demonstrate unique patterns of association with intrapersonal and interpersonal NSSI functions.

Method

Participants and Procedure

Participants were 1,357 undergraduates (79.44% female, 20.19% male, 0.37% transgender; Mage = 20.25, SD = 3.49) from an urban university in the Northeastern United States. They completed informed consent and self-report questionnaires through a secure website as part of a larger IRB-approved study and were compensated with course credit. Participants identified their race as White (59.40%), Asian (15.33%), Black/African American (14.15%), American Indian or Native Alaskan (0.29%), Native Hawaiian or Pacific Islander (0.07%), an “other” (4.79%) race, or more than one race (4.79%); the remainder (1.18%) preferred not to report race. Participants identified as heterosexual (84.08%), bisexual (9.58%), or homosexual (3.24%); the remainder (1.33%) preferred not to report sexual orientation. Of the participants, 473 (34.86%) reported a lifetime history of NSSI (NSSI+); Table 1 displays the demographic characteristics of this group compared to those with no NSSI history (NSSI−).

Table 1.

Demographic Variables as a Function of NSSI History Status

Variable NSSI+ (n = 473) NSSI− (n = 884) t/χ 2
Age: M(SD) 20.10(3.02) 20.33(3.71) 1.18
Gender: n(%) 18.65***
 Female 404(85.41%) 674(76.24%)
 Male 66(13.95%) 208(23.53%)
 Transgender 3(0.63%) 2(0.23%)
Race: n(%) 25.06**
 White 309(65.33%) 497(56.22%)
 Black or African American 50(10.57%) 142(16.06%)
 Asian 57(12.05%) 151(17.08%)
 Other or more than one race 48(10.15%) 87(9.84%)
  American Indian or Alaskan Native 2(0.42%) 2(0.23%)
  Native Hawaiian or Pacific Islander 0(0%) 1(0.11%)
  More than one race 29(6.13%) 36(4.07%)
  Other 17(3.59%) 48(5.43%)
 Prefer not to answer 9(1.90%) 7(0.79%)
Sexual Orientation: n(%) 77.33***
 Heterosexual 348(73.57%) 793(89.71%)
 Not Heterosexual 121(25.58%) 77(8.71%)
  Homosexual 22(4.65%) 22(2.49%)
  Bisexual 87(18.39%) 43(4.86%)
  Other 12(2.54%) 12(1.36%)
 Prefer not to answer 4(0.85%) 14(1.58%)
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Note. NSSI+ = participants with a lifetime history of non-suicidal self-injury; NSSI− = participants without a lifetime history of non-suicidal self-injury

*

p < .05

**

p < .01

***

p < .001

Measures

Demographics Questionnaire

Participants completed a brief questionnaire collecting demographic information, including age, gender, race, and sexual orientation.

Inventory of Statements About Self-Injury (ISAS)

The ISAS (Klonsky & Glenn, 2009) is a self-report measure of NSSI characteristics and functions. Participants reported the number of times they had engaged in each of 13 forms of NSSI (i.e., cutting, biting, burning, carving, pinching, pulling hair, severe scratching, banging or hitting self, interfering with wound healing [e.g., picking scabs], rubbing skin against rough surface, sticking self with needles, swallowing dangerous substances, other [write-in]). Individual frequencies were summed to derive lifetime NSSI frequency; endorsed methods were counted to derive lifetime number of NSSI methods used. Participants endorsing a history of NSSI were asked additional questions assessing NSSI characteristics (e.g., most recent engagement, age of onset) and functions. NSSI recency and age of onset were used to compute the total duration (in years) of engagement and whether participants engaged in NSSI in the past 12 months. Regarding NSSI functions, five (affect regulation, anti-dissociation, anti-suicide, marking distress, and self-punishment) load onto a higher-order intrapersonal factor, and eight (autonomy, interpersonal boundaries, interpersonal influence, peer bonding, revenge, self-care, sensation seeking, and toughness) load onto an interpersonal factor (Klonsky & Glenn, 2009). The ISAS yields scores for the aggregate intrapersonal and interpersonal and each of the 13 individual functions—all showing adequate to strong internal consistency in the present sample (α.66 to .94). Previous work supports the construct validity of the ISAS (Klonsky & Glenn, 2009).

Ruminative Response Scale-10 (RRS-10)

The RRS-10 (Treynor et al., 2003) is a 10-item self-report measure of the tendency to engage in rumination when feeling “upset (i.e., angry, sad, depressed).” The RRS-10 comprises two subscales, reflection (e.g., “Write down what you are thinking and analyze it”) and brooding (e.g., “Think about a recent situation, wishing it had gone better”), containing five items each. Both subscales showed strong internal consistency in the present sample (reflection, α = .81; brooding, α = .85) and adequate internal consistency and test-retest reliability in previous research (Treynor et al., 2003).

Sadness and Anger Rumination Inventory (SARI)

The SARI (Peled & Moretti, 2010) is a 22-item self-report measure, comprising two 11-item subscales: anger rumination (e.g., “I have difficulty getting myself to stop thinking about how angry I am”) and sadness rumination (e.g., “I keep thinking about past experiences that have made me sad”). Participants rate each item to indicate how often they engage in the tendency to ruminate when feeling sad or angry. Both subscales showed strong internal consistency in the present sample (anger rumination, α = .96; sadness rumination, α = .97) and previous research (Peled & Moretti, 2010).

Penn State Worry Questionnaire (PSWQ)

The PSWQ (Meyer et al., 1990) is a 16-item self-report measure of participants’ tendency to engage in uncontrollable worry (e.g., “My worries overwhelm me,” “Once I start worrying, I can’t stop”). The PSWQ demonstrated strong internal consistency in the present sample (α = .93) and strong internal consistency, test-retest reliability, and convergent and divergent validity in previous research (Molina & Borkovec, 1994).

Forms of Self-Criticizing/Attack & Self-Reassuring Scale (FSCRS)

The FSCRS (Gilbert et al., 2004) is a 22-item self-report measure of self-critical and self-reassuring thoughts in response to unwanted outcomes. The present study examined only the two self-critical subscales, inadequate self (e.g., “There is a part of me that feels I am not good enough”) and hated self (e.g., “I have a sense of disgust with myself”), which showed strong internal consistency (inadequate self, α = .92; hated self, α = .89) in this sample and construct validity in previous research (Gilbert et al., 2004).

Interpersonal Needs Questionnaire (INQ)

The INQ (Van Orden et al., 2012) is an 18-item self-report measure of perceived burdensomeness (PB; e.g., “These days, the people in my life would be better off if I were gone”) and thwarted belonginess (TB; “These days, I feel disconnected from other people”). Both scales demonstrated strong internal consistency in the present sample (PB, α = .92; TB, α = .89) and criterion and convergent validity in extant research (Van Orden et al., 2012).

Data Analytic Plan

Data were processed and analyzed using SPSS Version 26 (IBM Corp., 2019) and R version 3.6.1 (R Core Team, 2014), packages psych (Revelle, 2020) and lavaan (Rosseel, 2012). Preliminary analyses included bivariate correlations between cognition variables, as well as t-tests and Chi Square tests, as appropriate, comparing cognition and demographic variables between the NSSI+ and NSSI− groups.

To reduce the number of variables used and address their overlap, an exploratory factor analysis (EFA) was conducted to identify superordinate factors among the cognitive process variables. The data were first examined to confirm that assumptions of EFA were satisfied. In keeping with previous research on self-harm, the nine scale scores of interest were treated like individual items and entered into the EFA, rather than entering their component items into the analysis (Auerbach et al., 2017). Specifically, the following variables were submitted to principal axis factoring using varimax rotation: RRS-brooding, RRS-reflection, SARI-anger rumination, SARI-sadness rumination, PSWQ-total score, FSCRS-inadequate self, FSCRS-hated self, INQ-PB, and INQ-TB. A varimax (orthogonal) rotation was chosen to derive factors that were as independent as possible. To determine the number of factors to retain, we examined the scree plot, results of parallel analysis, eigenvalues (i.e., > 1), and percentage of variance accounted for by the solutions. Solutions were also explored using equamax (orthogonol) and promax (oblique) rotations, as well as confirmatory factor analysis, for further confidence in the final factor structure. Any variables that displayed complex loadings (i.e., had loadings of greater than .5 for more than one factor) were removed, and the EFA was re-run with them excluded.

We next used t-tests to assess whether scores on the resulting higher-order cognitive factors differed significantly between the NSSI+ and NSSI− groups. Among the NSSI+ group, we ran regressions to examine relationships between the cognitive factors and markers of NSSI severity: (a) lifetime NSSI frequency and number of methods (count variables assessed using negative binomial regressions1), (b) recency (presence/absence in the past 12 months; using binary logistic regression), and (c) duration (in years) of NSSI engagement (using multiple linear regression). Considering that we examined four NSSI severity outcomes, we corrected for family-wise error by adjusting the critical alpha from .05 to .0125. Among participants with NSSI, we then examined relationships between the higher-order cognitive factors and aggregate intrapersonal and interpersonal function scores (using two multiple linear regressions). If either of the models examining aggregate function scores was significant, post-hoc multiple linear regressions were used to probe relationships between the cognitive factors and the individual NSSI functions composing the respective aggregate function (intrapersonal and/or interpersonal).

Results

Preliminary Analyses

Within our sample, 473 (34.85%) participants reported a lifetime history of NSSI. As seen in Table 1, the NSSI+ and NSSI− groups did not differ significantly in age but differed in distributions of gender, race, and sexual orientation. Relative to the NSSI− group, the NSSI+ group had higher proportions of participants identifying as female (residual = 3.98, p <.001), White (residual = 3.25, p = .001), homosexual (residual = 2.14, p = .032), and bisexual (residual = 8.07, p <.001) and lower proportions of those identifying as male (residual = −4.19, p <.001), Black, (residual = −2.77, p =.006), Asian (residual = −2.45, p = .014), and heterosexual (residual = −7.74, p <.001).

Preliminary analyses examined the appropriateness of EFA for reducing the nine individual cognition variables. Skewness and kurtosis statistics indicated that the nine variables were normally distributed. Assumptions of linearity of inter-variable associations were satisfied for all variables and thus were included in the EFA. Since NSSI frequency was positively skewed and exhibited outliers, this variable was Winsorized to three standard deviations (SDs) from the mean (i.e., extreme values, three SDs above the mean, were replaced with the next highest value in the distribution; there were no extreme values three SDs below the mean; Blaine, 2018; Liao et al., 2016).

Table 2 displays bivariate correlations among and the NSSI+ and NSSI− groups’ mean scores on the nine individual cognition variables. All correlations were positive and significant (ps < .001). The NSSI+ group scored higher than the NSSI− group on each of the nine variables (ps < .001).

Table 2.

Pearson Correlations and Group Scores on Individual Cognition Variables

Correlation Mean(SD)
1 2 3 4 5 6 7 8 9 NSSI+ (n = 473) NSSI− (n = 884) t
1. RRS Brooding  0.633* 0.600* 0.714* 0.567* 0.693* 0.543* 0.516* 0.440* 13.03(3.72) 10.69(3.72) 11.08*
2. RRS Reflection 0.488* 0.599* 0.386* 0.521* 0.400* 0.322* 0.273* 13.01(3.53) 10.58(3.53) 12.09*
3. SARI Anger Rumination 0.756* 0.476* 0.562* 0.407* 0.323* 0.301* 29.37(9.27) 24.45(9.49) 9.17*
4. Sadness Rumination 0.591* 0.678* 0.526* 0.482* 0.410* 38.00(10.44) 29.23(11.27) 14.33*
5. PSWQ Total Score 0.596* 0.433* 0.400* 0.392* 59.08(13.66) 51.64(14.01) 9.40*
6. FSCRS Inadequate Self 0.736* 0.584* 0.502* 29.22(8.22) 22.35(8.33) 14.53*
7. FSCRS Hated Self 0.699* 0.548* 11.35(5.34) 7.87(3.69) 12.64*
8. INQ PB 0.713* 24.77(13.44) 17.01(8.99) 11.28*
9. INQ TB 29.11(12.17) 22.51(10.91) 9.87*
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Note. RRS = Ruminative Response Scale-10; SARI = Sadness and Anger Rumination Scale; PSWQ = Penn State Worry Questionnaire; FSCRS = Forms of Self-Criticizing/Attack & Self-Reassuring Scale; INQ = Interpersonal Needs Questionnaire; PB = Perceived Burdensomeness; TB = Thwarted Belongingness; NSSI+ = participants with a lifetime history of non-suicidal self-injury; NSSI− = participants without a lifetime history of non-suicidal self-injury

*

p < .001

Exploratory Factor Analysis

The Kaiser-Meyer-Olkin measure of sampling adequacy was .882, indicating the present data were appropriate for EFA. Only the first two factors yielded Eigenvalues greater than 1. Visual inspection of the scree plot and parallel analysis also supported this two-factor solution, which explained 63.29% of variance in the data. Thus, we determined that the two-factor solution had the most appropriate fit. Table 3 displays the factor loadings of each variable on each of the two factors. The FSCRS-inadequate self subscale loaded onto both factors at greater than .5 and was thus removed. The EFA was re-run to arrive at the final solution.2 Factor 1, labeled repetitive negative thinking (RNT), comprised RRS-brooding, RRS-reflection, SARI-anger rumination, SARI-sadness rumination, and PSWQ-total score. Factor 2, labeled negative self-perception (NSP), comprised FSCRS-hated self, INQ-PB, and INQ-TB. The two factors were positively correlated with each other, r = .58, p < .001.

Table 3.

Exploratory Factor Structure of Cognition Variables, Using Varimax Rotation

Variable Mean (SD) Factor 1 Negative Repetitive Thought Factor 2 Negative Self-Perception Communalities
RRS Brooding 11.50(3.88) 0.749 0.377 1.475
RRS Reflection 11.43(3.71) 0.643 0.197 1.186
SARI Anger Rumination 26.16(9.70) 0.759 0.164 1.223
SARI Sadness Rumination 32.29(11.75) 0.867 0.291 1.093
PSWQ Total Score 54.23(14.33) 0.561 0.324 1.599
FSCRS Hated Self 9.08(4.64) 0.398 0.651 1.656
INQ PB 19.71(11.37) 0.226 0.923 1.120
INQ TB 24.81(11.79) 0.235 0.713 1.215
Eigenvalues 2.882 2.181
% of Variance Explained 36.024% 27.264%
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Note. RRS = Ruminative Response Scale-10; SARI = Sadness and Anger Rumination Scale; PSWQ = Penn State Worry Questionnaire; FSCRS = Forms of Self-Criticizing/Attack & Self-Reassuring Scale; INQ = Interpersonal Needs Questionnaire; PB = Perceived Burdensomeness; TB = Thwarted Belongingness; Factor Loadings greater than .5 are bolded.

Relationships between Cognitive Factors and NSSI History and Severity

The NSSI+ group scored significantly higher than the NSSI− group on both RNT (t[1050.13] = 14.38, p < .001) and NSP (t[746.92] = 12.99, p < .001). Table 4 presents the results of regressions, conducted among the NSSI+ group, in which lifetime frequency and number of methods, recency (presence/absence in the past 12 months), and duration (in years) of NSSI were regressed on the two cognitive factors. NSP was positively associated with NSSI frequency, number of methods, recency, and duration. RNT was not significantly associated with any of these NSSI severity indices.

Table 4.

Regressions Predicting NSSI Severity and Functions from Higher-Order Cognitive Factors, Among those with NSSI History

Negative Binomial and Binary Logistic Regressions
Dependent Variable Predictor B SE B Wald χ2 p OR OR 95% CI
Lifetime NSSI Frequency (negative binomial)
RNT −0.007 0.024 0.094 .759 0.993 [.946, 1.041]
NSP 0.132 0.033 15.552 <.001 1.141 [1.068, 1.218]
Lifetime Number of NSSI Methods (negative binomial)
RNT 0.011 0.011 0.959 .327 1.011 [0.989, 1.033]
NSP 0.073 0.013 33.058 <.001 1.076 [1.050, 1.103]
NSSI Recency (binary logistic) RNT 0.050 0.038 1.755 .185 1.052 [0.976, 1.133]
NSP 0.186 0.047 15.994 <.001 1.205 [1.100, 1.320]
Linear Regressions
Dependent Variable Predictor B SE B t p sr
Duration of NSSI engagement (in years) RNT 0.025 0.074 0.332 .740 .017
NSP 0.335 0.087 3.846 <.001 .200
NSSI Functions
 Aggregate Interpersonal
RNT −0.005 0.015 −0.349 .728 −.018
NSP 0.030 0.017 1.723 .086 .087
 Aggregate Intrapersonal
RNT 0.086 0.024 3.571 <.001 .166
NSP 0.114 0.028 4.087 <.001 .189
 Affect Regulation
RNT 0.121 0.032 3.728 <.001 .181
NSP 0.014 0.038 0.381 .704 .018
 Anti-Suicide
RNT 0.030 0.034 0.874 .383 .042
NSP 0.189 0.040 4.696 <.001 .223
 Anti-Dissociation
RNT 0.067 0.032 2.084 .038 .098
NSP 0.155 0.038 4.120 <.001 .194
 Marking Distress
RNT 0.116 0.030 3.844 <.001 .186
NSP 0.019 0.036 0.532 .595 .026
 Self-Punishment
RNT 0.085 0.035 2.395 .017 .111
NSP 0.207 0.041 5.016 <.001 .232
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Note. NSSI = non-suicidal self-injury; NSSI frequency was Winsorized to three standard deviations from the mean to address outliers; NSSI Recency (dichotomized variable) = yes (1) vs. no (0) NSSI in the past 12 months; B = unstandardized slope; SE B = standard error of B; OR = odds ratio; CI = confidence interval; RNT = repetitive negative thinking; NSP = negative self-perception; sr = semi-partial correlation

Relationships between Cognitive Factors and NSSI Functions

Two simultaneous linear regressions were run among the NSSI+ group to examine relationships between the two cognitive factors and the aggregate interpersonal and aggregate intrapersonal functions scores. The model for aggregate interpersonal functions was not significant (F [2, 385] = 1.79, p = .17). However, in this model, there was a non-significant trend for NSP as a positive predictor (p = .086; see Table 4). We thus performed exploratory linear regressions probing relationships between NSP and the individual interpersonal functions. When considered alone, NSP was significantly associated with the interpersonal boundaries and self-care interpersonal functions, but when considered together with RNT, NSP was significantly associated with only self-care. (See Supplementary Table S3 for full results.)

As seen in Table 4, the model for aggregate intrapersonal functions was significant (F [2, 394] = 35.64, p < .001), with both RNT and NSP as positive predictors (ps < .001). We further probed the results of this model with five simultaneous linear regressions examining relationships between the two cognitive factors and each of the individual intrapersonal functions. All five regressions were significant (ps < .001; see Table 4). RNT, but not NSP, was positively associated with the affect regulation and marking distress functions. Contrarily, NSP, but not RNT, was positively associated with the anti-suicide function. Both RNT and NSP were positively associated with the anti-dissociation and self-punishment functions.3

Discussion

This study explored relationships between negative cognitive processes and NSSI engagement and functions. We identified two higher-order cognitive factors, repetitive negative thinking and negative self-perception, that were consistent with extant literature. Although designed to be orthogonal, these two factors were correlated with each other and may be conceptually interrelated (e.g., ruminating/worrying about perceived flaws, regrets, or social disconnection would reflect both repetitive negative thinking and negative self-perception), highlighting the overlap between various cognitive processes and their links with NSSI. Also of note, a self-criticism subtype involving perceiving oneself as inadequate cross-loaded onto both factors and thus was excluded from the final factor structure, whereas another subtype delineating self-hatred loaded onto negative self-perception. Thus, reflecting its constituent items (e.g., “I think I deserve my self-criticism,” “I remember and dwell on my failings”), the inadequate self subscale may relate more closely to both perseverative and self-directed negative cognitive processes, relative to the more specifically self-directed hated self (e.g., “I have a sense of disgust with myself”; Gilbert et al., 2004). Additional research is needed to replicate the complex loading of perceived self-inadequacy onto repetitive negative thinking and negative self-perception and to investigate the generalizability of this pattern to other higher-order cognitive constructs.

Participants with (NSSI+) scored higher than those without (NSSI−) a history of NSSI on repetitive negative thinking, negative self-perception, and their component cognitive variables. These results are consistent with previous work highlighting links between NSSI and both perseverative and self-referential negative thought. Analyses among the NSSI+ subsample revealed less consistent relationships between the cognitive factors and NSSI severity. Negative self-perception, but not repetitive negative thinking, was associated with several markers of NSSI severity: lifetime frequency and number of methods, past-12-month presence, and duration. Thus, although repetitive negative thinking is linked to NSSI history at a univariate level, its relationship with NSSI severity may be better accounted for by negative self-perception. This finding suggests that the tendency to think negatively about oneself, rather than more general forms of perseverative negative thought, may be particularly salient for individuals displaying more severe NSSI.

We found that repetitive negative thinking and negative self-perception were associated with aggregate intrapersonal, but not interpersonal, NSSI functions among the NSSI+ subsample. Thus, negative cognitions—internal, intrapersonal processes—may increase one’s likelihood of engaging in NSSI for automatically reinforcing reasons, whereas other factors (e.g., relationship conflicts, peer pressure) may be more important for understanding socially-reinforced functions. However, given a trend-level, non-significant association between negative self-perception and aggregate interpersonal function scores, we conducted exploratory analyses examining this cognitive factor’s relationships with the individual interpersonal functions. When considered together with repetitive negative thinking, negative self-perception was only associated with the self-care function (e.g., “creating a physical injury that is easier to care for than my emotional distress”; Klonsky & Glenn, 2009), suggesting that poor self-views may contribute to NSSI as a way to tend to one’s needs—though this exploratory result should be interpreted with caution.

Given that repetitive negative thinking and negative self-perception were significantly related to aggregate intrapersonal NSSI function scores, we explored the relationships between these cognitive factors and individual intrapersonal functions, revealing differential patterns of association. Repetitive negative thinking was uniquely associated with affect regulation and marking distress—functions reflecting the presence of unwanted emotions. This finding is consistent with the Emotional Cascade Model, which argues that rumination in response to negative affect can lead to NSSI or other maladaptive behaviors that create a physical distraction from the emotional distress (Selby & Joiner, 2013). In contrast, negative self-perception was uniquely associated with the anti-suicide function. This result may partly be explained by known links between the components of negative self-perception (self-criticism, perceived burdensomeness, thwarted belongingness) and suicidal ideation (e.g., O’Neill et. al., 2021; Van Orden et al., 2010). Thus, negative self-perception likely co-occurs with suicidal ideation, which is presumably a prerequsite to using NSSI to prevent suicidal behavior. Additional research, such as that rooted in the ideation-to-action framework (Klonsky & May, 2014), is needed to identify factors that motivate individuals to turn to NSSI rather than suicidal behavior in response to thoughts of suicide.

Despite differential relationships with some NSSI functions, repetitive negative thinking and negative self-perception were both positively associated with the anti-dissociation and self-punishment functions. The finding regarding anti-dissociation suggests that both perseverative and self-referential negative thinking might lead to a sense of numbness or emptiness from which individuals may try to escape through NSSI. This conjecture is supported by research identifying a social disconnectedness component of psychological emptiness (D’Agostino et al., 2020) and a link between rumination and dissociative experiences (Vannikov-Lugassi & Soffer-Dudek, 2018). Moreover, our results extend previous experimental findings that acceptance of (i.e., sitting with) negative emotion increased urges for both self-punishment and NSSI (Svaldi et al., 2012) and that a guilt induction led to self-administered shocks, alleviating guilty feelings (Inbar et al., 2013). The latter authors concluded that feelings of self-hatred led participants to engage in self-punishment (Inbar et al., 2013), consistent with our finding linking negative self-perception to the self-punishment NSSI function.

The results of this study should be viewed considering its limitations. Our sample consisted of (predominantly female) undergraduates. Future research should examine the generalizability of these findings to clinical and more gender-diverse samples. Moreover, self-report measures are associated with reporting biases, and their use in a cross-sectional design precludes our ability to examine the directionality of findings. To address these gaps, future research should investigate associations between repetitive negative thinking/negative self-perception and NSSI using clinical interviews, self-harm laboratory analogues, and/or experience sampling methods. For example, experience sampling could examine the frequency/content of repetitive negative thoughts or reasons that individuals consider before and after NSSI in daily life. Such longitudinal data would aid understanding of the directional (perhaps causal) nature of associations between NSSI, its functions, and maladaptive cognitive processes.

This study has important implications for the growing field of NSSI research and treatment. Most existing efforts to understand NSSI have emphasized the role of emotion regulation, whereas the impact of cognitive factors is less well understood (Hasking et al., 2017). Our results help fill this gap by elucidating unique relationships between cognitive processes and NSSI severity and functions. Given their differential associations with NSSI functions, repetitive negative thinking and negative self-perception may serve as important targets in NSSI treatment—supported by the role of strategies to address rumination/worry, self-criticism, and interpersonal relations in dialectical behavior therapy, an evidence-based treatment for self-harm (Linehan, 2014). Our findings may inspire more individualized approaches to the assessment, treatment, and prevention of NSSI.

Supplementary Material

Supp 1

Highlights.

  • Negative thinking and self-perception were higher in people who engage in NSSI.

  • Negative self-perception was associated with greater NSSI severity.

  • Negative thinking and self-perception had different relations to NSSI functions.

Acknowledgments

This work was supported by the Canadian Institute of Health Research Doctoral Foreign Study Award (201910DFD-433121-74092), and the National Institutes of Health (1R21MH126402).

Footnotes

Declaration of Interest Statement

The authors have no conflicts of interest to disclose.

1

Negative binomial regressions were selected as opposed to Poisson regressions because both NSSI frequency and number of methods demonstrated over-dispersion, as indicated by a variance that was greater than the mean and a Deviance value/df greater than 1.

2

Using an equamax (orthogonal) rotation or a promax (oblique) rotation yielded the same solution as the varimax rotation. A confirmatory factor analysis was also conducted using the same data and the eight variables that loaded onto Factor 1 or 2 (FSCRS-inadequate self scale excluded). Given that the model parameters (CFI/TLI, RMSEA, SRMR) fell within acceptable ranges (Hu & Bentler, 1999), this analysis suggested that the same two-factor solution was the best fit for the data. See Supplementary Tables S1 and S2 for results of these additional factor analyses.

3

Since gender, race, and sexual orientation differed significantly between NSSI groups, we re-ran the primary regressions between cognitive factors and NSSI (severity, functions) controlling for these demographic variables. All results remained the same except that RNT no longer significantly predicted the Anti-Dissociation function. However, given that some demographic groups had very small cell sizes, the adjusted results contained some very wide confidence intervals. Thus, we chose to use the original results, which we interpreted as more reliable than those that controlled for demographic variables.

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