Emotion dysregulation and non-suicidal self-injury: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists. METHODS: The present study presents a comprehensive meta-analytic review of the literature on the association between NSSI and emotion dysregulation. A total of 48 publications, including 49 independent samples, were included in this analysis. RESULTS: Overall, a significant association was found between emotion dysregulation and NSSI (pooled OR = 3.03 [95% CI = 2.56-3.59]). This association was reduced but remained significant (OR = 2.40 [95% CI = 2.01-2.86]) after adjustment for publication bias. Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior. Lack of emotional awareness/clarity and cognitive aspects of dysregulation yielded weaker, yet significant, positive associations with NSSI. CONCLUSIONS: Findings support the notion that greater emotion dysregulation is associated with higher risk for NSSI among individuals across settings, regardless of age or sex. Furthermore, findings reveal facets of dysregulation that may have unique implications for NSSI. This meta-analysis highlights the importance of better understanding emotion dysregulation as a treatment target for preventing NSSI.
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Typical behavioral manifestations of emotion dysregulation, such as self-harm, suicidal ideation, eating disorder behaviors, or substance abuse, are associated with increased morbidity and mortality.
“Additionally, typical behavioral manifestations of emotion dysregulation, such as self-harm, suicidal ideation, eating disorder behaviors, or substance (ab)use, are associated with increased morbidity and mortality (4–7).”
From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [7]
The Introduction describes non-suicidal self-injury as a possible response to emotion dysregulation and reports its association with suicidal behavior, including suicide attempts. The Abstract reports a significant association between emotion dysregulation and self-injury. The paper does not establish the broader claim that suicidal ideation, eating-disorder behaviors, and substance use are all behavioral manifestations associated with increased morbidity and mortality. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSeveral studies on clinical and non-clinical samples revealed a significant positive association between ED and self-harm, as well as a significant positive association between ED and suicidal ideation and attempts.
“Several studies on clinical and non-clinical samples revealed a significant positive association between ED and self-harm (Wolff, 2019), as well as a significant positive association between ED and suicidal ideation and attempts (Turton et al., 2021).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Wolff, 2019
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Boyne, H., & Hamza, C. A. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115925 · Cited by 15 · see citing works
Madjar, N., Daka, D., Zalsman, G., & Shoval, G. (2021) · School Psychology International · doi:10.1177/0143034321998741 · Cited by 15 · see citing works
Bock, M. M., Graf, T., Woeber, V., Kothgassner, O. D., Buerger, A., & Plener, P. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.617941 · Cited by 14 · see citing works
Weatherford, J. V., Ruork, A. K., Yin, Q., Lopez, A. C., & Rizvi, S. L. (2024) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.13045 · Cited by 24 · see citing works
- Authors
- Wolff, J. C., Thompson, E., Thomas, S. A., Nesi, J., Bettis, A. H., Ransford, B., Scopelliti, K., Frazier, E. A., & Liu, R. T.
- Affiliations
- Brown University (US)
- Corresponding author
- Wolff, Jennifer C.
- ORCID
- Venue
- European Psychiatry
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-06
- Volume
- 59
- Pages
- 25-36
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- PMC
- PMC6538442
- OpenAlex
- W2938332705
- Cited by
- 512
- References
- 102
- Citations by year
- 2026: 102 · 2025: 116 · 2024: 78 · 2023: 89 · 2022: 70 · 2021: 40 · 2020: 15 · 2019: 2
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH019927, T32MH078788)
- American Foundation for Suicide Prevention (PDF-010517)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- emotional dysregulation, non-suicidal self-injury, impulsivity, emotional awareness, emotion regulation strategies, goal-directed behavior
- MeSH terms
- Self-Control, Affective Symptoms, Emotions, Female, Humans, Male, Risk Factors, Self-Injurious Behavior, Suicidal Ideation
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