Background & Aims
Existing research suggests that pain perception may vary in individuals engaging in non-suicidal self-injury (NSSI) (Bohus et al., 2000). Particularly concerning acute pain, NSSI has been associated with higher pain tolerance and thresholds, although findings are inconsistent (Kirtley et al., 2016). In addition to the potential relationship between NSSI and pain perception, there is a lack of investigation on how NSSI experiences may be related to interindividual differences in pain coping styles, such as cognitive processing strategies when dealing with pain. Finally, more research differentiating between past and current NSSI when studying pain perception and coping is needed. Thus, the aim of the study was to investigate the relationship between past and current NSSI and pain perception, as well as cognitive processing styles on pain, in comparison to individuals without NSSI. Further, the potential interaction of NSSI with the presence of chronic pain was taken into account.
Methods
In Study 1, 65 individuals (83% female, age: M=23.2, SD=4.2) evaluated their experience with NSSI using the Deliberate Self-Harm Inventory (DSHI, Fliege et al., 2015). Pain thresholds were assessed with a psychophysical computerized quantitative thermal sensory testing device (Medoc TSA-2). Each participant was tested for the warm/cold detection threshold and hot/cold pain threshold on the medial forearm in 3 trials. In Study 2, 365 participants (74% female, age: M=22.3, SD=3.6) completed the DSHI and Pain-related Cognitive Processing Questionnaire (PCPQ, Day et al., 2018). All participants were grouped by their NSSI experience: NG = no NSSI during lifetime, PG = NSSI in the past (at least 2 years ago), CG = current NSSI during the last year. In Study 1, 54% had experience with NSSI (N PG=19, CG=16, NG=30); in Study 2, 65% had experienced NSSI (N PG=163, CG=75, NG=172). Additionally, in Study 2 21% reported about the presence of recurrent or chronic pain.
Results
Study 1: No significant group differences were found for detection and pain thresholds. In the NSSI samples (PG, CG), thresholds were not related to the extent, frequency, or duration of NSSI behaviors.
Study 2: Significant group effects were found for Pain Diversion, Pain Focus, and Pain Openness. The CG showed significantly lower Pain Diversion compared to individuals without current NSSI (PG, NG), and higher Pain Openness. In Pain Focus the CG reached significantly higher levels than the NG. Post-hoc tests showed that these effects were mainly driven by the pain free sample, those with chronic pain did not differ in their pain-related cognitive processing regardless of their NSSI experience. Another main effect for Pain Focus indicated higher levels for chronic pain independent of NSSI.
Within the NSSI sample, more extensive and frequent NSSI behaviors, as well as a longer history of NSSI was associated with less Pain Diversion but more Pain Focus and Pain Openness.
Conclusions
The results indicate that NSSI is not directly related to pain sensitivity but is associated with systematic variations in pain coping strategies, particularly in individuals without additional chronic pain. In sum, the findings align with the Pain-Offset Relief Model (Franklin et al., 2013), where NSSI-induced pain is endured to achieve subsequent relief as the pain subsides. The quantitative and qualitative relationship of NSSI with increased acceptance and nonjudgement supports this assumption. However, maladaptive styles are more prevalent in current NSSI: individuals report absorption by pain, immersion in the pain experience, and reduced ability to suppress or distract themselves from the pain. These results provide initial insights into NSSI and cognitive pain coping in a non-psychiatric sample, suggesting NSSI is not inherently associated with maladaptive strategies. They can serve as a starting point for longitudinal causal models in pain-related NSSI research.
References
Bohus, M., Limberger, M. F., Frank, U., Sender, I., Gratwohl, T., & Stieglitz, R. D. (2001). Entwicklung der Borderline-Symptom-Liste. Psychother Psychosom Med Psychol, 51, 201– 211.
Day M. A., Ward, L. C., Thorn B. E., Lang, C. P., Newton-John, T. R. O., Ehde, D. M., & Jensen, M. P. (2018). The Pain-Related Cognitive Processes Questionnaire: development and validation. Pain medicine (Malden, Mass.), 19(2), 269–283.
Fliege, H., Kocalevent, R. D., Walter, O. B., Beck, S., Gratz, K. L., Gutierrez, P. M., & Klapp, B. F. (2015). Deliberate Self-Harm Inventory. PSYCHOMETRIKON .
Franklin, J. C., Hessel, E. T., & Prinstein, M. J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189, 362–367.
Kirtley, O. J., O’Carroll, R. E., & O’Connor, R. C. (2016). Pain and self-harm: A systematic review. Journal of affective disorders, 203, 347–363.
Presenting Author
Janina Wurtz
Poster Authors
Topics
- Pain in Special Populations: Adolescents