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.