Early Maladaptive Schemas Are Associated with Self-injury Thoughts and Behavior in Adolescents

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2023 Aug 29

PMID 37644535

Authors

Pauliina Saarijarvi

Christina Salmivalli

Saija Helmi

Max Karukivi

Affiliations

Soon will be listed here.

Abstract

Background: Early maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care.

Methods: The participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants' EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs' associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff's Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression.

Results: The differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs.

Conclusions: The present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.

References

Evans E, Hawton K, Rodham K, Deeks J . The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide Life Threat Behav. 2005; 35(3):239-50. DOI: 10.1521/suli.2005.35.3.239. View

Muehlenkamp J, Claes L, Havertape L, Plener P . International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health. 2012; 6:10. PMC: 3348041. DOI: 10.1186/1753-2000-6-10. View

Van Orden K, Witte T, Cukrowicz K, Braithwaite S, Selby E, Joiner Jr T . The interpersonal theory of suicide. Psychol Rev. 2010; 117(2):575-600. PMC: 3130348. DOI: 10.1037/a0018697. View

Nock M, Banaji M . Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. J Consult Clin Psychol. 2007; 75(5):707-15. PMC: 2043087. DOI: 10.1037/0022-006X.75.5.707. View

OConnor R . The integrated motivational-volitional model of suicidal behavior. Crisis. 2011; 32(6):295-8. DOI: 10.1027/0227-5910/a000120. View

Barzilay S, Feldman D, Snir A, Apter A, Carli V, Hoven C . The interpersonal theory of suicide and adolescent suicidal behavior. J Affect Disord. 2015; 183:68-74. DOI: 10.1016/j.jad.2015.04.047. View

OConnor R, Rasmussen S, Hawton K . Distinguishing adolescents who think about self-harm from those who engage in self-harm. Br J Psychiatry. 2012; 200(4):330-5. DOI: 10.1192/bjp.bp.111.097808. View

Kiekens G, Hasking P, Nock M, Boyes M, Kirtley O, Bruffaerts R . Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors. Front Psychiatry. 2020; 11:214. PMC: 7099647. DOI: 10.3389/fpsyt.2020.00214. View

McEvoy P, Hayes S, Hasking P, Rees C . Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure. J Behav Ther Exp Psychiatry. 2017; 57:163-171. DOI: 10.1016/j.jbtep.2017.05.010. View

10.

Jiang Y, You J, Ren Y, Sun R, Liao S, Zhu J . Brief report: A preliminary comparison of self-compassion between adolescents with nonsuicidal self-injury thoughts and actions. J Adolesc. 2017; 59:124-128. DOI: 10.1016/j.adolescence.2017.05.019. View

11.

Klonsky E, Glenn C . Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS). J Psychopathol Behav Assess. 2017; 31(3):215-219. PMC: 5736316. DOI: 10.1007/s10862-008-9107-z. View

12.

Nock M, Prinstein M . A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol. 2004; 72(5):885-90. DOI: 10.1037/0022-006X.72.5.885. View

13.

Sadeh N, Londahl-Shaller E, Piatigorsky A, Fordwood S, Stuart B, McNiel D . Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms. Psychiatry Res. 2014; 216(2):217-22. DOI: 10.1016/j.psychres.2014.02.018. View

14.

Lindholm T, Bjarehed J, Lundh L . Functions of nonsuicidal self-injury among young women in residential care: a pilot study with the Swedish version of the Inventory of Statements about Self-Injury. Cogn Behav Ther. 2011; 40(3):183-9. DOI: 10.1080/16506073.2011.565791. View

15.

Zetterqvist M, Lundh L, Dahlstrom O, Svedin C . Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. J Abnorm Child Psychol. 2013; 41(5):759-73. DOI: 10.1007/s10802-013-9712-5. View

16.

Lloyd-Richardson E, Perrine N, Dierker L, Kelley M . Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007; 37(8):1183-92. PMC: 2538378. DOI: 10.1017/S003329170700027X. View

17.

Gratz K, Roemer L . The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cogn Behav Ther. 2008; 37(1):14-25. DOI: 10.1080/16506070701819524. View

18.

Dawkins J, Hasking P, Boyes M, Greene D, Passchier C . Applying a cognitive-emotional model to nonsuicidal self-injury. Stress Health. 2018; 35(1):39-48. DOI: 10.1002/smi.2837. View

19.

Voon D, Hasking P, Martin G . Change in emotion regulation strategy use and its impact on adolescent nonsuicidal self-injury: a three-year longitudinal analysis using latent growth modeling. J Abnorm Psychol. 2014; 123(3):487-98. DOI: 10.1037/a0037024. View

20.

Howe-Martin L, Murrell A, Guarnaccia C . Repetitive nonsuicidal self-injury as experiential avoidance among a community sample of adolescents. J Clin Psychol. 2012; 68(7):809-29. DOI: 10.1002/jclp.21868. View