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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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Avoidant Personality Disorder
Borderline Personality Disorder
Borderline Personality Questionnaire
Depression, Anxiety, and Stress Scale
Difficulties in Emotion Regulation Scale
Diagnostic and Statistical Manual for Mental Disorders
Ecological Momentary Assessment
Experiences Questionnaire (constitutes a measure of decentering)
Generalized Linear Model with Mixed Effects
Healthy Control Group
Non- Suicidal Self-Injury
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The authors are grateful to all participants who made this study possible.
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.
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.
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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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
- Non-suicidal self-injury
- Borderline personality disorder
- Emotion dysregulation
- Ecological momentary assessment