Mediation of Non-suicidal Self-Injury Frequency by Aversion to NSSI Images on Implicit Association with Death and Suicide

Abstract

Non-suicidal self-injury (NSSI) is the direct, deliberate destruction of one's own body tissue in the absence of suicidal intent. It has been shown to be a strong predictor of future suicide attempts, but research is lacking in concrete explanations of that relationship. The Interpersonal Theory of Suicide (IPTS) proposes that one of the components of the path to suicide is capability for suicide, which can include fearlessness about death and pain. Engaging in NSSI may habituate a person to painful, potentially life-threatening stimuli and experiences. This could lower their aversion to self-injury related stimuli (e.g. images of self-cutting, burning, scraping), which may then increase their capability for suicide. Previous literature has shown a relationship between suicidal behaviors and decreased aversion to stimuli associated with death. One possible mechanism linking NSSI to suicidal behavior is low aversion to self-injury stimuli. In our study, we aimed to examine this relationship using a behavior assessment of suicide rather than rely on a self-report measure.