Predicting Non-Suicidal Self-Injury in Young Adults with and without Borderline Personality Disorder: a Multilevel Approach Combining Ecological Momentary Assessment and Self-Report Measures

Psychiatric Quarterly (2021)Cite this article

Abstract

Non-suicidal self-injury (NSSI) is an increasingly prevalent phenomenon associated with many detrimental outcomes, ranging from poor academic performance to suicide attempts. Research on self-harming behaviors has identified emotion dysregulation, negative affect, and borderline pathology as strong risk factors of NSSI, whereas the potential protective effects of metacognitive skills such as decentering have not yet been explored. The current study combined ecological momentary assessment (EMA) and self-report measures to explore potential risk and protective factors of NSSI in a clinical group of Borderline Personality Disorder (BPD) patients with NSSI (N = 22), a subclinical group of college students with NSSI (N = 19), and a non-clinical healthy control group (N = 23). Participants completed self-report measures of borderline pathology, emotion dysregulation, decentering ability, and negative emotional symptoms, and they used the Sinjur App (EMA instrument) at least three times a day for 15 days to capture negative affect and NSSI in daily life. A multilevel mixed-effect regression analysis with both self-report and EMA measures was conducted to identify predictors of NSSI. The multilevel analysis showed that only momentary frustration directly predicted NSSI. Momentary guilt and anger only predicted NSSI when interacting with more stable traits of borderline pathology and negative emotional symptoms. Most importantly, greater decentering capacity protected against self-injury and attenuated the association between momentary sadness and NSSI. Findings contribute novel knowledge about NSSI, documenting the protective effects of decentering and highlighting the benefit of interventions that target metacognitive emotion regulation skills.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

APD:

Avoidant Personality Disorder

BPD:

Borderline Personality Disorder

BPQ:

Borderline Personality Questionnaire

DASS-21:

Depression, Anxiety, and Stress Scale

DERS:

Difficulties in Emotion Regulation Scale

DSM:

Diagnostic and Statistical Manual for Mental Disorders

EMA:

Ecological Momentary Assessment

EQ:

Experiences Questionnaire (constitutes a measure of decentering)

GLMM:

Generalized Linear Model with Mixed Effects

HC:

Healthy Control Group

NSSI:

Non- Suicidal Self-Injury

STD:

Student Group

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Acknowledgments

The authors are grateful to all participants who made this study possible.

Authors´ Contributions

DV designed the study and developed the Sinjur App. JCP, JS and DV recruited patients and evaluated them. LB and DV recruited controls and students and evaluated them. IA, DV, LB, and CS analysed the data, and IA, DV, LB, CS, and SN interpreted the data. All authors contributed to writing the manuscript and all of them read and approved the final manuscript.

Funding

This research was supported by a Spanish government grant to DV (I + D + i fellowship, PSI2016–79980-P). LB, SN and DV were supported by the Catalan government with a PERIS fellowship, reference number SLT006/17/00159. IA and CS are supported by Chilean government by a Becas-Chile fellowship program by the National Agency for Research and Development (ANID), reference numbers 2015–72160105 and 2018–72190624, respectively.

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Affiliations

  1. Psychiatry and Mental Health Department, Hospital Universitari d’Igualada, Consorci Sanitari de l’Anoia & Fundació Sanitària d’Igualada, Igualada, Barcelona, Spain

    Laia Briones-Buixassa, Carlos Schmidt, Stella Nicolaou & Daniel Vega

  2. Mental Health and Social Innovation Research Group and Centre for Health and Social Care Research, Universitat de Vic – Universitat Central de Catalunya, Vic, Spain

    Laia Briones-Buixassa

  3. Cognition and Brain Plasticity Unit [Bellvitge Biomedical Research Institute- IDIBELL], University of Barcelona, Barcelona, Spain

    Ítalo Alí

  4. Brain, Cognition and Behavior PhD Program, University of Barcelona, Barcelona, Spain

    Carlos Schmidt & Stella Nicolaou

  5. Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain

    Juan Carlos Pascual & Joaquim Soler

  6. Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain

    Juan Carlos Pascual & Joaquim Soler

  7. Department of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Barcelona, Spain

    Juan Carlos Pascual, Joaquim Soler & Daniel Vega

Authors
  1. Laia Briones-Buixassa
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  2. Ítalo Alí
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  3. Carlos Schmidt
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  4. Stella Nicolaou
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  5. Juan Carlos Pascual
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  6. Joaquim Soler
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  7. Daniel Vega
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Corresponding author

Correspondence to Daniel Vega.

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Ethics Approval and Consent to Participate

The study was approved by the ethics committee of the Hospital Universitari de Bellvitge, Barcelona (protocol no. PR360/16).

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Not applicable.

Competing Interests

Authors declare that they have no competing interests.

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Briones-Buixassa, L., Alí, Í., Schmidt, C. et al. Predicting Non-Suicidal Self-Injury in Young Adults with and without Borderline Personality Disorder: a Multilevel Approach Combining Ecological Momentary Assessment and Self-Report Measures. Psychiatr Q (2021). https://doi.org/10.1007/s11126-020-09875-7

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Keywords

  • Non-suicidal self-injury
  • Self-harm
  • Borderline personality disorder
  • Emotion dysregulation
  • Ecological momentary assessment
  • Youth
  • Decentering