Explicit and Inferred Motives for Non-suicidal Self Injurious Acts and Urges in Borderline and Avoidant Personality Disorders

• Published in: Personality disorders 2015-04, Vol.6 (3), p.267-277
• Main Authors: Snir, A., Rafaeli, E., Gadassi, R., Berenson, K., Downey, G.
• Format: Article
• Language: English
• ISSN: 1949-2715; 1949-2723
• DOI: 10.1037/per0000104

Non-suicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study employed experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI, these allowed us to infer other motives which were not explicitly endorsed. Adults (N=152, aged 18–65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally-directed rather than interpersonally-directed ones. We then used multi-level regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared to control moments (i.e., without NSSI). We examined changes in five scales of inferred motives, designed to correspond to the five classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally-oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.