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J Abnorm Child Psychol
DOI 10.1007/s10802-014-9901-x
A Longitudinal Moderated Mediation Model of Nonsuicidal
Self-injury among Adolescents
Jianing You & Min-Pei Lin & Freedom Leung
# Springer Science+Business Media New York 2014
Abstract This study tested a longitudinal moderated media-
tion model of the engagement in non suicidal self-injury
(NSSI) based on Nocks (2009) integrated theoretical model
of the development of NSSI. We assessed general predispos-
ing factors (i.e. borderline personality disorder features), pre-
cipitating factors (i.e. negative emotions), and NSSI-specific
vulnerability factors (i.e. behavioral impulsivity and self-
criticism) among 3,600 Chinese secondary school adolescents
(56.6 % females, aged between 12 and 18 years). Assessments
were conducted for three times, 6 months apart. Results sup-
ported the longitudinal mediation model, such that negative
emotions mediated the relation of borderline personality dis-
order features to NSSI. The moderating effects of behavioral
impulsivity and self-criticism were both significant, indicating
that adolescents with higher levels of both variables were
more likely to engage in NSSI. Moreover, behavioral
This research was funded in part by National Natural Science Foundation
of China (Grant No. 31300874) and South China Normal University
Young Teacher Research Cultivation Grant (2012KJ013) awarded to
Dr. Jianing You. This study was also supported by Key Laboratory of
Mental Health and Cognitive Science of Guangdong Province and Re-
search Center for Crisis Intervention and Psychological Service of
Guangdong Province, South China Normal University. The funders had
no role in study design, data collection and analysis, decision to publish,
or preparation of the manuscript.
J. You (*)
Center for Studies of Psychological Application & School of
Psychology, South China Normal University, Guangzhou, China
e-mail: youjianing@gmail.com
M.<P. Lin
Department of Educational Psychology and Counseling, National
Taiwan Normal University, Taipei City, Taiwan, Republic of China
F. Leung
Department of Psychology, The Chinese University of Hong Kong,
Hong Kong, China
impulsivity made additional contribution to the prediction of
future NSSI above and beyond the effects of other risk factors.
Findings of this study may help to elucidate the diverse roles
of different types of risk factors in the engagement in NSSI,
and may also shed new light on our understanding about the
nature of this behavior.
Keywords Nonsuicidal self-injury . Borderline personality
disorder . Negative emotions . Behavioral impulsivity .
Self-criticism . Moderated mediation
Nonsuicidal self-injury (NSSI) is the deliberate, direct, social-
ly unacceptable destruction or alteration of body tissue that
occurs in the absence of conscious suicidal intent (Nock and
Favazza 2009). Common NSSI acts include cutting/carving
skin, self-hitting, banging the head or other parts of the body
against the wall, burning skin and severely scratching
(Jacobson and Gould 2007). This behavior usually begins
between 12 and 14 years of age and is prevalent among
adolescents (Jacobson and Gould 2007). In a review of studies
with community adolescent samples across the globe, a mean
lifetime prevalence rate of 17.9 %, a mean 12-month preva-
lence of 19.0 %, and a mean 6-month prevalence of 15.1 %
were reported (Muehlenkamp et al. 2012). The relatively high
prevalence rate of NSSI has elicited much attention to this
behavior. In fact, a new NSSI disorder has been included in the
fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5; American Psychiatric Association 2013)
as a condition requiring further study. The aim of the present
study was to address one of the major questions which are in
great need of further study: why adolescents engage in NSSI.
To answer this question, Nock (2009) has proposed an
integrated theoretical model of the development of NSSI.
According to this model, NSSI is caused by the interplay of
multiple risk factors, including distal risk factors, general

predisposing factors for maladaptive behaviors, precipitating
factors, and NSSI-specific vulnerability factors. Distal risk
factors include genetic predisposition for high emotional/
cognitive reactivity, childhood abuse/maltreatment, and famil-
ial hostility/criticism. General predisposing factors comprise
both intrapersonal and interpersonal factors, such as high
aversive emotion and poor communication skills. These fac-
tors correspond to two of the core features of borderline
personality disorder (BPD), i.e. high emotional reactivity
and unstable relationship (Leung and Leung 2009). In fact,
NSSI is one of the diagnostic criteria of BPD in DSM-IV-TR
(Association 2000).
In Nocks (2009) theoretical model, precipitating factors
for NSSI are examined through functional analysis, which
focuses on the immediate events that precede and follow
NSSI. Four functions of NSSI have been identified (Nock
and Prinstein 2004). They are intrapersonal positive reinforce-
ment function (e.g., to feel something), intrapersonal negative
reinforcement function (e.g., to relieve depression), interper-
sonal positive reinforcement function (e.g., to get attention),
and interpersonal negative reinforcement function (e.g., to
avoid punishment). Previous studies demonstrated that NSSI
primarily serves the intrapersonal negative reinforcement
function, or the emotion regulation function (see Klonsky
2007; Messer and Fremouw 2008; for reviews). Thus, nega-
tive emotions may be one of the precipitating factors for NSSI.
However, there are many non-injuring or less destructive
ways to regulate negative emotions. Why certain people spe-
cifically select NSSI rather than other coping behaviors? To
answer this question, Nock (2009) proposed several hypoth-
eses, including the social learning hypothesis, self-punishment
hypothesis, social signaling hypothesis, pragmatic hypothesis,
pain analgesia hypothesis and implicit identification hypothe-
sis. This study focused on testing the self-punishment and the
pragmatic hypothesis. According to the self-punishment hy-
pothesis, individuals specifically select NSSI as a coping
strategy because they simultaneously possess a sense of self-
criticism or self-hatred along with negative emotions, and by
injuring the body, they could punish the self. The pragmatic
hypothesis, on the other hand, proposes that people may
choose to engage in NSSI over other self-regulating strategies
because it is a rapid, effective, and easily implemented method
of regulating ones affective/cognitive and social experiences.
Thus, individuals who are more impulsive and less tolerant of
distress are more likely to conduct NSSI.
Previous studies have provided some initial support for
different types of risk factors in Nocks (2009) theoretical
model. Regarding the distal risk factors, Zoroglu et al.
(2003) found that adolescents who had suffered childhood
abuse or neglect had 2.7-fold higher NSSI behaviors than their
counterparts with no history of abuse or neglect. Baral et al.
(1998) also revealed the strong association between sexual
abuse and NSSI. For the general predisposing factors, many
J Abnorm Child Psychol
studies have shown the link between BPD and NSSI (e.g.,
Chapman et al. 2005; Nock et al. 2006; Shearer 1994), as well
as the close relations of various BPD features, e.g., high
emotional reactivity, unstable relationship and unstable sense
of self, to NSSI (e.g., Hilt et al. 2008a; Nock et al. 2008; You
et al. 2012a; You et al. 2012b). With regard to the precipitating
factors of negative emotions, a considerable number of studies
have documented the correlation between depression, anxiety,
anger, hostility and NSSI (e.g., Hilt et al. 2008b; Laye-Gindhu
and Schonert-Reichl 2005; Muehlenkamp and Gutierrez
2004, 2007; Ross and Heath 2002).
Finally, both of the NSSI-specific vulnerability factors,
behavioral impulsivity and self-criticism, stemming from the
pragmatic and self-punishment hypotheses respectively have
been relatively well studied. First, evidence supporting the
association between poor impulse control and NSSI came
from two lines of research. On the one hand, past research
showed that self-injurers scored significantly higher on vari-
ous self-report measures of impulsivity than non-injurers
(Claes et al. 2001; Herpertz et al. 1997; Janis and Nock
2009). On the other hand, NSSI has been found to link with
many other impulsive behaviors, including frequent antisocial
behaviors, alcohol consumption, smoking, and drug use (De
Leo and Heller 2004; Hawton et al. 2006; Hilt, Nock et al.
2008; Patton et al. 1997). Non-significant relationship be-
tween NSSI and behavioral tasks of impulsivity (e.g., go/no
go task) was also revealed in laboratory studies (e.g., Glenn
and Klonsky 2010; Janis and Nock 2009). This inconsistency
may be due to that the laboratory behavioral tasks could not
capture self-injurers heightened impulsivity under emotional
distress in real life situations. Second, some studies also
found that those who engaged in NSSI reported significantly
higher levels of self-criticism than do non-injurers (Glassman
et al. 2007), and self-punishment was among the primary
reasons self-injurers gave for engaging in NSSI (Nock and
Prinstein 2004).
Although previous research provided preliminary support
for Nocks (2009) theoretical model of NSSI, they were lim-
ited in several areas. First, most of past studies examined the
bivariate associations between various risk factors and NSSI.
They seldom included different types of risk factors and NSSI
in a single model and assessed their relationships simulta-
neously. Thus, the distinct roles played by these diverse types
of risk factors in the engagement in NSSI are largely unexam-
ined. Second, most of previous research examining the rela-
tions of various risk factors and NSSI was cross-sectional. The
temporal associations thus could not be ascertained, which
may undermine the significance of these results. Third, if
behavioral impulsivity and self-criticism are specific vulnera-
bility factors for NSSI, they should make additional contribu-
tions to the prediction of NSSI above and beyond those of the
general and precipitating factors. Extant literatures, neverthe-
less, have not tested this hypothesis. Fourth, many previous
J Abnorm Child Psychol
studies on NSSI were conducted with clinical samples. With
the prevalence of NSSI in community adolescents
(Muehlenkamp et al. 2012), more attention should be paid to
NSSI among non-clinical youths.
To partly fill in the knowledge gaps, the present study
examined the roles of multiple types of risk factors in the
engagement in NSSI among a large sample of Chinese com-
munity adolescents assessed over three waves, 6 months apart.
We focused on the contributions of general predisposing
factors (i.e. BPD features), precipitating factors (i.e. negative
emotions), and NSSI-specific vulnerability factors (i.e. behav-
ioral impulsivity and self-criticism) to the engagement in
NSSI. Towards this end, we tested a longitudinal moderated
mediation model, in which negative emotions served as a
mediator of the relation between BPD features and NSSI,
and behavioral impulsivity and self-criticism exerted moder-
ating effects on the mediation model. We also tested whether
behavioral impulsivity and self-criticism provided additional
predictive utility above and beyond those of the general pre-
disposing factors and the precipitating factors in examining
future NSSI. Based on Nocks (2009) theoretical model, we
hypothesized that adolescents with high levels of behavioral
impulsivity and self-criticism would be more likely to engage
in NSSI than their counterparts with low levels of both vari-
ables. Both of the NSSI-specific vulnerability factors were
also hypothesized to make additional contributions to the
prediction of NSSI.
Method
Participants
Participants came from eight secondary schools in Hong
Kong and were surveyed semiannually for three times. All
students from the participating schools were invited to partic-
ipate in the study, yet participation was on a voluntary basis.
Because of the cooperation of school authorities and their
strong encouragement, overall student participation rates were
close to 99 % in all schools. At the baseline assessment (Wave
1), 5,423 students (2,857 females) participated. They aged
between 12 and 18 years (M=14.63 years, SD=1.25) and
studied in Grades 710. All of them are Chinese.
We re-assessed the Wave 1 sample after a 6-month and a
12-month interval, respectively. At the Wave 2 assessment,
6,911 adolescents (52.6 % females) participated and 3,999
(55.4 % females) of them were retained from the Wave 1
sample. At the Wave 3 assessment, 6,831 adolescents
(52.6 % females) were included and 3,600 (56.6 % females)
of them were successfully followed for all three waves. The
participant retention rates were 73.7 and 66.4 % for the first
two waves and all three waves, respectively. Attrition was
mainly due to students transferring to other schools or absent
from school on the day of assessment. Comparisons among
participants who participated in Wave 1 testing only, those
who participated in Wave 1 and Wave 2 testing, and those who
participated in all three testing revealed no significant differ-
ences on all studied variables. Descriptive analyses of NSSI at
different waves were based on samples of the corresponding
waves. Other analyses were based on the three-wave
followed-up sample.
Procedure
We obtained written informed consent from participants par-
ents before the testing. During each assessment wave, the
same batch of questionnaires was group administered in class-
rooms of 3542 students under the supervision of school
personnel. At the beginning of each assessment, teachers were
required to make it clear to students that participation was
voluntary and students could stop anytime whenever they feel
uncomfortable. A unique ID number for each student was
created for data-matching purpose. Participants were assured
strict confidentiality of the collected data and that only re-
search personnel have access to the questionnaires. All testing
materials and procedures were approved by the university
Institutional Review Board.
Measures
Nonsuicidal Self-Injury (NSSI) Seven NSSI behaviors, i.e.,
self-cutting, burning, biting to injury, punching to bruise,
severely scratching skin to injury, inserting sharp objects to
the nail or skin, and banging the head or other parts of the
body against the wall that leads to bruise, were assessed in
this study. Participants were asked In the past 6 months,
have you engaged in the following behaviors to deliberately
harm yourself but without suicidal intent? All the seven
NSSI behavior items were rated on a 4-point scale, ranging
from 1 never, 2 once or twice, 3 three to five times to 4
six times or more.
Emotional Reactivity (ER) The 21-item Emotion Reactivity
Scale was used to measure emotional reactivity as character-
ized by emotional sensitivity, intensity and persistence (Nock
et al. 2008). Sample items included I tend to get very emo-
tional very easily, When I experience emotions, I feel them
very strongly/intensely, and When I am angry/upset, it takes
me much longer than most people to calm down. Factor
analysis revealed a unidimensional structure. The ERS
showed good convergent and divergent validity via relations
to behavioral inhibition/activation, and criterion-related valid-
ity as measured by associations with specific types of psycho-
pathology and self-injurious thoughts and behaviors (Nock
et al. 2008). Responses were made on a 5-point Likert scale,
ranging from 1 not at all like me to 5 completely like me.

This scale had Cronbachs alphas of 0.96, 0.97 and 0.97 for
the Wave 1, 2, and 3 data in this study, respectively.
Unstable Relationship (UR) A 7-item scale extracted and
modified from the Interpersonal Relationship Section of the
Revised Diagnostic Interview for Borderlines (DIB-R;
Zanarini et al. 1989) was used to assess unstable relationship
in this study. We extracted all three items in the Abandonment/
Engulfment/Annihilation Concerns subsection, all three items
in the Unstable Close Relationship subsection, and one item in
the Recurrent Problems in Close Relationships subsection.
Among all items in the Interpersonal Relationship Section,
we believe these items best characterize unstable relationship
in adolescents. Adjustments were made to the language ex-
pression to make sure that these items could be understood by
Chinese adolescents. This scale has good concurrent validity
and has been validated and used in previous studies with
Chinese community adolescents (Leung and Leung 2009;
You et al. 2012a, 2012b). Sample items of this scale included
I either love or hate other people in an extreme way and
My relationships with other people are very unstable.
Responses were made on a 4-point scale (1=strongly disagree
and 4=strongly agree). This scale had Cronbachs alpha
values of 0.85, 0.84 and 0.86 for the Wave 1, 2, and 3 data
in this study, respectively.
Unstable Self-Image (USIM) We extracted four items from
the Rosenbergs 5-item Stability of Self Scale (Alsaka and
Olweus 1986) to assess the construct of unstable self-image.
The items included My self-evaluations are entirely different
everyday, Compared to most people, my self-evaluation
changes very quickly, Some days I have a very good opin-
ion about myself, other days I have a very poor opinion about
myself, and Sometimes I feel good 1 minute and then the
next minute I feel terrible. The item I feel nothing, or almost
nothing, can change the opinion I currently hold of myself.
was not included in this study because the meaning of this
item was quite different from those of the others. Ratings were
made on a 4-point scale (1=strongly disagree and 4=strongly
agree). This scale had Cronbachs alpha values of 0.90, 0.90
and 0.91 for the Wave 1, 2, and 3 data, respectively.
Negative Emotions (NE) The Chinese version of the short
Depression Anxiety Stress Scale (DASS21; Taouk et al.
2001) was used to assess three common negative emotions:
depression (DASS-D), anxiety (DASS-A) and tension/stress
(DASS-S). The DASS-21 has good convergent and
discrimant validity (Antony et al. 1998). Sample items of
DASS-21 included I feel that life was meaningless, I find
myself getting agitated, and I find it difficult to relax.
Responses were made on a 4-point scale (0=do not apply to
me at all and 3=apply to me very much or most of the time).
Internal consistency for all three subscales of DASS-21 was
J Abnorm Child Psychol
good in this study (for the Wave 1 data, the Cronbachs alpha
values were 0.86, 0.80 and 0.83 for DASS-D, DASS-A and
DASS-S, respectively; for the Wave 2 data, the Cronbachs
alpha values were 0.87, 0.82 and 0.85, respectively; and for
the Wave 3 data, the Cronbachs alpha values were 0.86, 0.81
and 0.86, respectively).
Behavioral Impulsivity (BI) Behavioral impulsivity was
assessed by ten impulsive behaviors. These items were de-
rived from the Impulse Action Patterns Section of the DIB-R
(Zanarini et al. 1989). From this section, we extracted both
items in the Substance Abuse subsection (i.e. alcohol abuse
and drug abuse), one item in the Sexual Deviance subsection
(i.e. promiscuity), and seven items in the Other Impulsive
Behaviors subsection (i.e. binge eating, spending sprees, ver-
bal outbursts, physical fights, physical threats, physical as-
saults, and property damage). Items measuring paraphilias,
gambling sprees, reckless driving and antisocial actions were
not selected because these behaviors are very rare among
Chinese adolescents. Participants rated the frequency of en-
gaging in these behaviors during the past 6 months using a 4-
point scale, ranging from 1 never, 2 once or twice, 3
three to five times to 4 six times or more. This scale had
Cronbachs alphas of 0.69 for the Wave 1 data, 0.69 for the
Wave 2 data, and 0.73 for the Wave 3 data in this study.
Self-Criticism (SC) The 9-item Self-Criticism Subscale of the
Depressive Experiences Questionnaire (DEQ; Blatt et al.
1976) was used to measure participants self-critical thinking
style. This scale has sufficient internal consistency and satis-
factory inter-correlations with the other two subscales, i.e.,
Dependency and Efficacy, of the DEQ (Zuroff et al. 1990).
Sample items of the SCS include I often find that I dont live
up to my own standards or ideals and There is a consider-
able difference between how I am now and how I would like
to be. Responses were made on a 7-point scale (1=not at all
like me and 7=like me very much). This scale had Cronbachs
alpha values of 0.82, 0.86 and 0.87 for the Wave 1, 2, and 3
data, respectively.
Data Analysis
The longitudinal moderated mediation model was tested fol-
lowing a series of steps. First, we tested the longitudinal
factorial invariance of BPD features as indicated by ER, UR,
and USIM, and NE as indicated by DASS-D, DASS-A, and
DASS-S. Establishment of the longitudinal factorial invari-
ance ensures that the fundamental meanings of the latent
constructs of BPD features and NE do not change over time.
Factorial invariance is traditionally established by fitting a
sequence of models: a) the unconstrained model with the
covariances among the residuals of corresponding indicators
across measurement occasions being freely estimated; b) the
J Abnorm Child Psychol
loading invariance or weak factorial invariance model with the
loadings of corresponding indicators being equated across
time; c) the intercept invariance or strong factorial invariance
model with the intercepts of corresponding indicators being
equated across time; and d) the residual invariance or strict
factorial invariance model with the residual variances of cor-
responding indicators being equated across time. In this study,
we only tested the weak factorial invariance model as this is
the minimum requirement for examining covariance relations
(Little et al. 2007).
Next, we tested the full hypothesized longitudinal media-
tion model of NSSI with the whole sample. Model fit for the
longitudinal factorial invariance and the mediation models
was assessed using a number of indexes. Because of the large
sample size, the chi-square (2) statistic is likely to overesti-
mate the lack of fit and will always suggest a lack of fit
(Bollen 1989). Therefore, multiple complementary fit indices
were used to evaluate individual model fit (Hu and Bentler
1999), specifically the non-normed fit index (NNFI), compar-
ative fit index (CFI), and the root mean square error of
approximation (RMSEA) and its 90 % confidence interval
(CI). Acceptable model fit was defined by the following
criteria: RMSEA <0.08, NNFI >0.90, CFI >0.90. Good model
fit was defined by the following criteria: RMSEA <0.05,
NNFI >0.95, CFI >0.95.
Finally, we tested the moderating effects of BI and SC
separately on the longitudinal mediation model. To test the
moderating effect of BI, we used the residual centering
approach proposed by Little et al. (2006). This approach
includes two steps. In the first step, BI and the indicators of
the first-order latent variables (i.e. ER, UR, and USIM of
BPD features, and DASS-D, DASS-A, and DASS-S of
NE) were multiplied and the resulting product is then
regressed on BI and all first-order effect indicators. The
residuals of these regression analyses were saved in the
data set. In the second step, the residuals were used as
indicators of the product variable in the latent interaction
model. Significant coefficients of the paths from the prod-
uct latent variable to the outcome variable indicate signif-
icant moderating effect of BI. The moderating effect of SC
was tested using the same procedure. A detailed practical
illustration of the residual centering approach can be found
in Steinmetza et al. (2011).
To examine whether BI and SC made additional contribu-
tions to the prediction of NSSI above and beyond those of
BPD features and NE, we conducted a hierarchical multiple
regression analysis. The dependent variable was Wave 3 NSSI
total frequency. Independent variables included Wave 1 NSSI
frequency at Step 1, Wave 1 BPD features (i.e. ER, UR, and
USIM) and NE (i.e. DASS-D, DASS-A, and DASS-S) at Step
2, and Wave 1 BI and SC at Step 3.
Descriptive and regression analyses were conducted using
SPSS 20.0. The longitudinal moderated mediation models
were tested using EQS 6.1 (Bentler 2005). Missing data were
handled using the Full Information Maximum Likelihood
method.
Results
Prevalence of NSSI
Among the Wave 1, Wave 2 and Wave 3 samples, 10.3 %
(n=559 out of 5,423), 12.7 % (n=869 out of 6,911) and 9.2 %
(n=621 out of 6,831) of the participants endorsed one or more
of the seven NSSI behaviors in the preceding 6 months,
respectively. For all three waves, females (13.9 %, n=397
for Wave 1; 15.1 %, n=546 for Wave 2; 10.8 %, n=382 for
Wave 3) were significantly more likely than males (6.3 %, n=
162 for Wave 1; 10.0 %, n=323 for Wave 2; 7.5 %, n=239 for
Wave 3) to conduct NSSI [for Wave 1, 2 (1, N=5,423)=
84.04, p < 0.001; for Wave 2, 2 (1, N = 6,859) = 40.82,
p<0.001; for Wave 3, 2 (1, N=6,749)=22.23, p<0.001].
Among participants engaging in NSSI, cutting was the most
prevalent method (5.2, 5.7, and 4.6 % in Wave 1, 2, and 3
respectively), followed by biting (4.8, 5.5, and 4.4 % in Wave
1, 2, and 3 respectively), scratching (4.7, 4.6 and 4.0 % in
Wave 1, 2, and 3 respectively), banging the head or other parts
of the body against the wall (3.2, 3.6, and 3.0 % in Wave 1, 2,
and 3 respectively), punching (2.5, 2.8, and 2.4 % in Wave 1,
2, and 3 respectively), and inserting sharp objects to the nail or
skin (2.1, 1.7, and 1.5 % in Wave 1, 2, and 3 respectively).
Burning (0.8, 0.7, and 0.8 % in Wave 1, 2, and 3 respectively)
was the least prevalent method of NSSI.1
The Longitudinal Factorial Invariance Models
BPD Features We first fitted the unconstrained model of the
latent construct of BPD features. The data violated the as-
sumption of multivariate normality, Mardias coefficient=
24.69, p<0.01. Thus, analyses were rescaled by Satorra
Bentler modification (Satorra et al. 1991). The unconstrained
model achieved a satisfactory fit, 2SB (15, N=3336)=26.12,
p<0.05, CFI=0.999, NFI=0.998, NNFI=0.998, RMSEA=
0.015 (90 % CI: 0.0040.024). Next, we tested the loading
invariance model. This model also showed a satisfactory fit to
the data, 2SB (19, N=3336)=37.82, p<0.01, CFI=0.999,
NFI = 0.998, NNFI = 0.998, RMSEA = 0.017 (90 % CI:
0.0090.025). Thus, the weak factorial invariance was
established for BPD features across the three waves of assess-
ment. Standardized factor loadings and factor correlations are
presented in Fig. 1.
1
Detailed information regarding the percentages of participants engaging
in each NSSI behaviors with different frequencies could be obtained from
the correspondence author upon request.
 J Abnorm Child Psychol

UR1 DASS-D1
.77 .85
ER1 DASS-A1
.82 Wave 1 NE1 .88
Wave 1 BPD1
.91
.87 DASS-S1
USIM1

.61
.62
DASS-D2
UR2 .86
.76 .52 DASS-A2
.56 Wave 2 NE2 .89
ER2
Wave 2 BPD2 .82 .92
DASS-S2
.85
USIM2
.63
.65
DASS-D3
UR3 .87
.78 DASS-A3
Wave 3 NE3 .90
ER3 .89
Wave 3 BPD3 .83 DASS-S3
.87
USIM3 Fig. 2 Standardized factor loadings and factor correlations for the weak
factorial invariance model for negative emotions. N=5,423. NE negative
Fig. 1 Standardized factor loadings and factor correlations for the weak emotions; DASS-D the depression subscale for the Depression Anxiety
factorial invariance model for BPD features. N=5,423. BPD borderline Stress Scale; DASS-A the anxiety subscale for the depression anxiety
personality disorder features; UR unstable relationship; ER emotional stress scale; DASS-S the stress (tension) subscale for the depression
reactivity; USIM unstable self-image. All factor loadings and factor anxiety stress scale. All factor loadings and factor correlations are signif-
correlations are significant at 0.001 level icant at 0.001 level

NE Data for the indicators of NE also violated the assumption

of multivariate normality, Mardias coefficient = 60.82, regulation strategy. The whole model accounted for 48.3,
p<0.01. Satorra Bentler modification method was thus used 40.4 and 36.0 % of the total variance in Wave 3 BPD features,
again. The unconstrained model for the latent construct of NE NE, and NSSI, respectively. Standardized path coefficients for
demonstrated an excellent fit, 2SB (15, N=3288)=14.71, the full longitudinal mediation model are presented in Fig. 3.
p>0.05, CFI=1.000, NFI=0.999, NNFI=1.000, RMSEA=
0.000 (90 % CI: 0.0000.016). The loading invariance model The Moderated Mediation Models
also showed a good fit to the data, 2SB (15, N=3288)=55.02,
p<0.001, CFI=0.997, NFI=0.996, NNFI=0.995, RMSEA= BI as a Moderator We tested the moderating effect of BI on
0.024 (90 % CI: 0.0170.032). Therefore, the weak factorial the longitudinal mediation model using the residual centering
invariance was also established for negative emotions across approach as described in the data analysis section. The
the three waves of assessment. Standardized factor loadings resulting model had a good fit to the data, 2SB (231, N=
and factor correlations for this model are presented in Fig. 2. 2994)=1162.20, p<0.001, CFI=0.955, NFI=0.944, NNFI=
0.943, RMSEA=0.036 (90 % CI: 0.0340.038). The product
The Full Longitudinal Mediation Model latent variable BI Wave 1 BPD was significant in predicting
Wave 2 NE (B=0.28, SE=0.11, p<0.01), BI Wave 1 NE
After establishing factorial invariance for both the latent con-
structs of BPD features and NE, we proceeded to test the full Wave 1 Wave 2 Wave 3
hypothesized longitudinal mediation model of NSSI with the
whole sample. Satorra Bentler modification method was used BPD1 .67 BPD2 .70 BPD3
again for adjusting multivariate non-normality (Mardias co- .67 .26 .26
efficient=398.43, p<0.01). This full mediation model dem-
.30 NE1 .43 NE2 .50 NE3
onstrated an acceptable fit to the data, 2SB (169, N=3001)=
.33 .13 .06
1599.89, p<0.001, CFI=0.935, NFI=0.928, NNFI=0.919,
RMSEA=0.053 (90 % CI: 0.0510.055). This suggests that NSSI1 .44 NSSI2 .59 NSSI3
BPD features characterized by emotional reactivity, unstable
Fig. 3 Standardized path coefficients for the full longitudinal mediation
relationship and unstable sense of self-image may lead to model for NSSI. N=5,423. BPD borderline personality disorder features;
negative emotions, i.e., depression, anxiety and tension, which NE negative emotions; NSSI non suicidal self-injury. All coefficients are
may then lead to the performance of NSSI as an emotion significant at 0.01 level
J Abnorm Child Psychol

was significant in predicting Wave 2 NSSI (B=0.14, SE= Table 1 Summary of the hierarchical multiple regression analysis
predicting wave 3 NSSI frequency by wave 1 bpd features, negative
0.04, p<0.001), BI Wave 2 NE was significant in predicting
emotions, behavioral impulsivity and self-criticism after controlling for
Wave 3 NSSI (B=0.37, SE=0.17, p<0.01), BI Wave 1 NSSI wave 1 nssi frequency (N=3,167)
was significant in predicting Wave 2 NSSI (B=0.06, SE=
0.01, p<0.001), and BI Wave 2 NSSI was significant in Predictor B SE t R2
predicting Wave 3 NSSI (B=0.09, SE=0.01, p<0.001). These Step 1 0.243
results suggested that BI significantly moderated the longitu- Wave 1 NSSI 0.47 0.02 0.49 21.71*
dinal mediation model, such that a higher level of BI made
Step 2 0.005
adolescents more vulnerable to NE and subsequent NSSI.
Wave 1 UR 0.02 0.01 0.06 1.78
Wave 1 ER 0.00 0.00 0.02 0.47
SC as a Moderator The same residual centering approach was
Wave 1 USIM -0.00 0.01 -0.01 0.24
used in testing the moderating effect of SC. The resulting
Wave 1 DASS-D 0.00 0.01 0.01 0.31
model had a good fit to the data, 2SB (231, N=2990)=
Wave 1 DASS-A 0.01 0.01 0.04 0.98
1099.82, p<0.001, CFI=0.947, NFI=0.934, NNFI=0.933,
Wave 1 DASS-S -0.01 0.01 -0.05 1.01
RMSEA=0.051 (90 % CI: 0.0480.054). The product latent
Step 3 0.014
variable SCWave 2 BPD was significant in predicting Wave *
Wave 1 BI 0.02 0.01 0.14 4.70
3 NE (B=0.44, SE=0.13, p<0.01), SCWave 1 NE was
Wave 1 SC 0.00 0.00 0.04 1.20
significant in predicting Wave 2 NSSI (B=0.15, SE=0.04,
Total R2 =.258
p<0.001), SC Wave 2 NE was significant in predicting
Wave 3 NSSI (B=0.50, SE=0.15, p<0.001), SCWave 1 UR, unstable relationship; ER, emotional reactivity; USIM, unstable self-
NSSI was significant in predicting Wave 2 NSSI (B=0.15, image. DASS-D, the depression subscale for the depression anxiety stress
SE=0.03, p<0.001), and SCWave 2 NSSI was significant in scale; DASS-A, the anxiety subscale for the depression anxiety stress
scale; DASS-S, the stress (tension) subscale for the depression anxiety
predicting Wave 3 NSSI (B=0.23, SE=0.02, p<0.001). These
stress scale
results also suggested that SC exerted a significant moderating *
p<0.001
effect on the longitudinal mediation model.

Examining the Additional Predictive Utility of Behavioral
Impulsivity and Self-Criticism for NSSI
As described in the data analysis section, we conducted a
hierarchical multiple regression analysis to examine the addi-
tional predictive utility of BI and SC for NSSI. Results are
summarized in Table 1. The full model with all Wave 1
predictors were significant in predicting Wave 3 NSSI fre-
quency, F(9, 1,457)=57.53, p<0.001. Step 1 with Wave 1
NSSI frequency was significant, F(1, 1,465) = 471.34,
p<0.001. After controlling for Wave 1 NSSI frequency, all
Wave 1 BPD features and NE variables were non-significant
at Step 2, F(6, 1,459)=1.66, p>0.05. Step 3 with Wave 1 BI
and SC were significant, F(2, 1,457)=13.50, p<0.001.
However, only BI acted as a significant individual predictor
at Step 3.
Discussion
Using a longitudinal design, this study examined the roles of
general predisposing factors, precipitating factors, and NSSI-
specific vulnerability factors in the engagement in NSSI.
Findings suggest that negative emotions mediate the relation
of BPD features to NSSI, and behavioral impulsivity and self-
criticism moderated the mediating relationship. Although with
a small effect size, behavioral impulsivity also made an addi-
tional contribution to future engagement in NSSI above and
beyond those of BPD features, negative emotions, and previ-
ous NSSI. This study advances our knowledge about the
nature of NSSI as an impulsive emotion regulation strategy.
Below, we discuss the main findings of the present study.
First, we found in this study that possessing a high level of
BPD features, i.e. emotional reactivity, unstable relationship
and unstable self-image significantly increased the likelihood
of engaging in NSSI as an emotion regulation strategy over
time. BPD features, according to Nock (2009), are regarded as
general predisposing factors for NSSI. These factors are those
that influence both the type and the amount of resources that
the individual can elicit to cope with stress and/or distress. The
significant paths from BPD features to negative emotions are
in line with previous research revealing the associations be-
tween BPD and depression, anxiety, and tension (e.g., Gratz
et al. 2008; Levy et al. 2007; Stiglmayr et al. 2008). Apart
from its induction of negative emotions, BPD features may
also link with NSSI through the compromise of ones coping
ability. For example, since increased emotional reactivity con-
tributes to intense and prolonged negative emotional experi-
ence, adolescents with high emotional reactivity usually could
not tolerate the extreme emotional distress and prefer emotion-
focused coping strategies (e.g., binge eating and NSSI) to
problem-focused ones, because the former ones could quickly
distract them from aversive experience. Additionally, having

unstable relationship and unstable self-image restricts ones
opportunity to learn effective interpersonal and self-regulation
skills, which may subsequently increase the likelihood that
adolescents use extreme and maladaptive coping behaviors.
These possibilities may be examined in future studies.
Another significant contribution of the present study is that
we tested the role of two NSSI-specific vulnerability factors:
behavioral impulsivity and self-criticism deriving from the
pragmatic and the self-punishment hypotheses in Nocks
(2009) model respectively, in the engagement in NSSI. Both
of the variables significantly moderated the longitudinal me-
diation model originating from BPD features to negative
emotions and to NSSI. Adolescents with a high level of
behavioral impulsivity were more likely to engage in NSSI
than those with a low level of behavioral impulsivity.
Furthermore, behavioral impulsivity made an additional con-
tribution to the prediction of future NSSI above and beyond
the effects of previous NSSI, BPD features, and negative
emotions. This result echoes previous findings showing that
youths who self-injured scored significantly higher than non-
injurers on self-reported measures of impulsivity (Claes et al.
2001; Glenn and Klonsky 2010; Herpertz et al. 1997; Janis
and Nock 2009). This maybe because NSSI is easily execut-
able and can be performed effortlessly in virtually any context
as compared to other coping behaviors (Nock 2009).
Moreover, since NSSI might cause severe physical pain and
even permanent scar, adolescents with low impulsivity may
prefer other less destructive behaviors in dealing with distress.
Result regarding the moderating effect of self-criticism is
also in line with previous research showing that low self-
esteem and a sense of self-hatred are related to NSSI in
adolescents (Glassman et al. 2007; Lundh et al. 2007), and
self-hatred and anger towards the self are common
thoughts/feelings precipitating NSSI (Nock et al. 2009). In
the face of emotional distress and/or stressful events, adoles-
cents who have developed a more self-critical cognitive style
may be more likely to engage in NSSI for self-punishment.
This study also examined the additional predictive utility of
behavioral impulsivity and self-criticism to future NSSI above
and beyond the effects of previous NSSI, BPD features and
negative emotions. Only behavioral impulsivity emerged as a
significant predictor, although the effect size may be small.
This finding highlights the impulsive nature of NSSI and may
inform the clinical conceptualization of this behavior. Many
previous researchers have put much emphasis on the
impulsivity facet of NSSI. For example, Lacey and Evans
(1986) argued that NSSI, together with substance abuse, binge
eating, etc., are all behaviors of impulse dyscontrol. They
suggested individuals repetitively engaging in these behaviors
form a unitary multi-impulsive personality group.
Muehlenkamp (2005) also argued for a separate deliberate
self-injury syndrome, and one of the proposed diagnostic
criteria of this syndrome pertains to the inability to resist the
J Abnorm Child Psychol
impulse to hurt oneself. However, some previous studies
failed to find a significant association between impulsivity
and NSSI among young adults (e.g., Chapman et al. 2009;
Glenn and Klonsky 2011). These null findings are consistent
with the small effect size of the prospective association be-
tween impulsivity and NSSI in the present study. Despite
these non-significant findings in some of the past studies
and the small effect size in this study, we believe that impul-
sivity should still be considered as an important risk factor for
NSSI, at least among community adolescents. This may be
due to four possible reasons. First, the null findings in previ-
ous studies were revealed among young adults and the nature
of NSSI may differ across adolescents and adults. Second, the
significant prospective relation of impulsivity to NSSI in this
study was emerged above and beyond other NSSI risk factors.
If we consider only the bivariate association between impul-
sivity and future NSSI, the effect would be larger. Third, NSSI
may have significant consequences (e.g., NSSI may be asso-
ciated with future suicide attempts; Guan et al. 2012) and thus
even risk factors for NSSI with a small effect size should be
taken seriously. Fourth, the impact of impulsivity on NSSI
may have a cumulative effect. This effect may be more obvi-
ous over an extensive period. Spanning only a 1-year interval,
the present study may not be able to reveal a large effect size.
Given these considerations, we encourage future studies ex-
amining risk factors for NSSI to still regard impulsivity as a
potential candidate. Moreover, interventions of NSSI may
target not only teaching adaptive emotion regulation skills,
but also increasing self-injurers distress tolerance and im-
pulse control abilities.
Strengths and Limitations
The present study has several strengths. First and foremost, we
examined the roles of different types of risk factors in adoles-
cents engagement in NSSI. This advances our understanding
on why adolescents engage in NSSI. In particular, we revealed
the unique and additional contribution of behavioral impul-
sivity to NSSI above and beyond other risk factors. This may
shed light on the impulsive nature of NSSI among adoles-
cents. Other strengths include the longitudinal design, the
large sample size, and the relatively low attrition rate.
Despite these strengths, results of this study should also be
interpreted with some limitations in mind. First, despite the
large sample size, all participants in this study were Chinese
high school students. It is unclear to what extent one can
generalize our findings to adolescents in other countries or
cultures, to populations of older ages, or to clinical samples.
However, the consistency between our findings and those
obtained from western samples reviewed above may give
some confidence to the generalizability of our results.
Second, all measures used in this study were self-report ques-
tionnaires. Shared method variance may thus influence the
J Abnorm Child Psychol
results of the associations among variables. Third, this study
collected data for three times, with a 6-month interval between
each time. Nevertheless, to study the effects of precipitating
factors on NSSI, future studies may benefit from using eco-
logical momentary assessment (EMA) method, asking partic-
ipants to report the antecedents, consequences, and affects
associated with each NSSI episode immediately after the
episode. Together with the information about the general
vulnerability factors, such as adolescents BPD features, and
the NSSI-specific vulnerability factors, such as their levels of
behavioral impulsivity and self-criticism, the EMA method
may result in more thorough understanding on how the gen-
eral vulnerability factors influence adolescents reactivity to
stress, as well as how these factors work together to influence
adolescents final decision of engaging in NSSI.
Acknowledgments This research was funded in part by National Nat-
ural Science Foundation of China (Grant No. 31300874) and South China
Normal University Young Teacher Research Cultivation Grant
(2012KJ013) awarded to Dr. Jianing You. This study was also supported
by Key Laboratory of Mental Health and Cognitive Science of Guang-
dong Province and Research Center for Crisis Intervention and Psycho-
logical Service of Guangdong Province, South China Normal University.
The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Conflict of Interest The authors declare that they have no conflict of
interest.
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