Introduction
Nonsuicidal self-injury (NSSI) is of growing clinical concern due to
high prevalence rates across numerous age ranges (e.g., Gillies et al.,
2018; Swannell et al., 2014) and evidence that NSSI engagement may be
increasing (e.g., Duffy et al., 2019; Wester et al., 2018). Given the
negative outcomes associated with NSSI, including psychological and
social difficulties (e.g., Plener et al., 2015), as well as suicidal
behaviors (Franklin et al., 2017), there is a need to better understand
the contextual factors that contribute to behavior engagement. While
theoretical (e.g., Nock, 2009) and empirical (i.e., Hepp et al., 2020)
research highlights that the majority of individuals engage in NSSI to
cope with negative affect, little is known regarding the events or
circumstances that may produce negative emotion states among those who
engage in NSSI.
It has been found that individuals who engage in NSSI experience more
interpersonal difficulties than their peers (Adrian et al., 2011;
Tatnell et al., 2014). Consequently, a cognitive vulnerability-stress
model of NSSI may be a useful lens to view the relationship between
interpersonal difficulties and NSSI. From this framework we can posit
that individuals who engage in NSSI may be more likely to experience
high arousal during interpersonal difficulties, thus increasing their
need for a (maladaptive) coping mechanism (i.e., NSSI; Guerry &
Prinstein, 2009). Supporting this, individuals with a history of NSSI
report more subjective distress after an interpersonal stressor (Kim et
al., 2015) and interpersonal conflict has been shown to precede the
occurrence of NSSI urges (Nock et al., 2009; Victor et al., 2018) and
NSSI engagement (Turner et al., 2016). Furthermore, negative affect
states specific to interpersonal stress, such as feeling rejected and
angry towards others, have been shown to rise in the hours preceding
NSSI acts and decrease afterwards (Snir et al., 2015), as well as
predict NSSI engagement (Nock et al., 2009).
Despite mounting evidence highlighting the impact of interpersonal
stress on NSSI, limited recent research has focused on identifying which
aspects, or characteristics, of interpersonal stress may confer risk for
NSSI. Prior research has demonstrated that specific relationships may be
more salient in understanding risk for NSSI: those engaging in NSSI were
found to have less daily contact with family members or friends as
compared to romantic partners (Turner et al., 2016). It is likely that
this extends to the effects of stress within these relationships. Beyond
the relationship itself, it may be that interpersonally-relevant
negative affect states are also important in risk for NSSI. Subjective
reports of rejection, but not criticism, were found to uniquely predict
later NSSI urges (Victor et al., 2019). Together, these findings provide
initial support for the notion that consideration of nuanced aspects of
interpersonal stress may improve NSSI risk prediction and prevention.”
Research in this area has potentially been limited by traditional
assessment methodologies. While studies examining interpersonal stress
and NSSI have utilized numerous study designs (i.e., cross-sectional,
experimental, intensive longitudinal; Adrian et al., 2011; Kim et al.,
2015; Snir et al., 2015; Tattnel et al., 2014; Turner, et al., 2016;
Victor et al., 2018), they have heavily relied upon validated, but often
static or trait-like, Likert-type self-report items to assess
interpersonal contexts and stress. These approaches may be failing to
capture important aspects of interpersonal relationships that haven’t
been a focus of past research, but may be important in conferring NSSI
risk (i.e., relationship characteristics; cognitive-affective or
behavioral responses to behavioral stress). One way to advance our
understanding of the particular aspects of interpersonal stress that may
be salient for those engaging in NSSI is by examining participant-driven
dialogue. This approach affords the application of text-based analyses,
which have the flexibility to highlight the information deemed important
by those with lived experience. Such analysis has demonstrated initial
promise within the suicide literature (e.g., Jacobucci et al., 2021) and
thus has a natural extension to understanding NSSI risk.
The current study aimed to leverage participant-driven interview data,
in which participants discussed a recent interpersonal stressor, as a
way to enhance the field’s knowledge of interpersonal difficulties in
relation to NSSI. As there are known differences in interpersonal
relationships across developmental stages (Wrzus et al., 2013),
interviews from two different samples were utilized: undergraduate
students and adults recruited from the community. The first aim of this
study was to examine the nuanced aspects of interpersonal stress
identified through participant-driven interviews across samples. We
hypothesized that through the extraction of latent topics from the
interview dialogue, a range of topics (i.e., stressor content,
interpersonal target, and cognitive-affective response) would be
modeled. Second, we aimed to investigate whether these topics wereuniquely related to NSSI history. Given the strong association
between NSSI and emotion regulation (i.e., Andover & Morris, 2014), and
the heightened distress following an interpersonal stressor experienced
by those with a NSSI history (Kim et al., 2015), we considered the
impact of emotion dysregulation in these models. We hypothesized, based
on prior research (i.e., Victor et al., 2019; Turner, Wakefield et al.,
2016), that specific affective states and interpersonal targets
(identified via the first aim) would be associated with the presence of
NSSI history; we also expected that the specifics of these associations
would differ based on sample. Finally, as our third aim, we examined how
valence of participant dialogue impacted the above associations;
however, no specific predictions were made.