The Self, Emotions, and Self-Injury: Links Between Self-Oriented Cognition and Emotion Processes in Non-Suicidal Self-Injury

Abstract

Non-suicidal self-injury (NSSI)—the intentional destruction of one’s own body tissue without suicidal intent (e.g., self-cutting, self-hitting; Hooley et al., 2020)—is widely prevalent, occurs across different psychiatric disorders, and elevates risk for suicide. Decades of research indicate that self-oriented cognition (e.g., attentional focus on the self; our beliefs about ourselves) and emotion processes (e.g., how we experience and regulate emotions) are key risk and maintenance factors for NSSI. For example, a fluctuating and predominantly negative self-concept is strongly associated with NSSI onset and maintenance, as are difficulties understanding, tolerating, and regulating negative emotions. Although self-oriented cognition and emotion processes are dually implicated in NSSI, these facets are typically studied separately in NSSI research. We therefore know remarkably little about how self-concept impairments are linked to emotion impairments within people struggling with NSSI. This gap in knowledge is concerning given that our beliefs about ourselves are associated with our emotions, and risk factors for psychopathology tend to interact. Across three studies, this dissertation examines relationships between self-oriented cognition and emotion processes within people who engage in NSSI. In study 1 (N = 134; ages 18+), we developed a lab-based behavioral task to examine how adults who engage in NSSI (n=40) regulate negative affect when experiencing negative self-focus, compared with adults who engage in indirect forms of self-injury (e.g., difficulties with substance use, disordered eating; n=46) and adults with no self-injurious behaviors (n=48). People who engage in NSSI and indirect forms of self-injury alike were more likely than those without self-injury to select behavioral strategies (e.g., a word activity, physical pain) relative to cognitive strategies (e.g., reappraisal, rumination) to regulate their emotions. Findings suggest that people who engage in NSSI are more likely to choose behavioral regulation strategies when experiencing negative self-focus, even when cognitive strategies are available and made salient. Study 2 (N = 286) examines how emerging adults (ages 18-25) who engage in NSSI regulate negative emotions that require self-evaluation (shame and guilt) versus negative emotions that do not (sadness and anger). Participants with and without NSSI (n = 150 and n=136, respectively) completed an online behavioral task that induced specific negative emotions through autobiographical memories. Following autobiographical memory recall, participants selected one of three cognitive emotion regulation strategies: rumination (thinking further about the memory), distraction (thinking about something unrelated to the memory) and counteract (recalling a positive autobiographical memory that elicits pride). People who engage in NSSI were more likely than those without NSSI to ruminate when experiencing sadness or anger, and to distract or counteract when experiencing guilt. These findings suggest that discrete negative emotions may be linked to NSSI via different emotion regulation pathways. In Study 3 (N = 187) we explored associations among multiple components of self-concept and emotion that have each been associated with NSSI. At two time points across a three-month span, emerging adults (ages 18-25) with and without a history of NSSI (wave 1: n=87 and n = 100, respectively; wave 2: n = 44 and n = 42) completed questionnaires assessing dimensions of self-concept (e.g., self-criticism, self-alienation) and emotion (e.g., difficulties identifying emotions, emotion regulation tendencies). Regularized network analyses were used to compare relationships within and between groups across time. Results indicated that self-alienation and difficulties identifying emotions were among the most strongly connected variables to other variables in the network for people with and without a history of NSSI alike, both at wave 1 and wave 2. Accordingly, feeling disconnected from oneself and being unable to identify one’s emotions may lead to additional self- and emotion-related difficulties for people with and without NSSI. Taken together, these studies indicate that examining self-oriented cognition and emotion processes concurrently could deepen our understanding of NSSI. Results further highlight the importance of considering self and emotion processes jointly in NSSI treatment.