Non-Suicidal Self Injury (NSSI) and NSSI Disorder
Non-suicidal self-injury (NSSI) refers to purposely inflicting injury and/or physical pain on one’s body, without any suicidal intention or desire. NSSI has often been an overlooked problem, and its only recently that research has begun to uncover a better understanding of it. Evidence suggests that self-injury is frequently used as a way of coping with painful emotions, with the paradoxical report that somehow the physical pain relieves the emotional pain (Selby, Nock, & Kranzler, 2014). In the EmP lab we have published multiple studies linking emotional cascades to NSSI behavior, and we are currently conducting a daily experience study of NSSI using a smartphone app developed at Rutgers.
The EmP lab has also been examining the potential existence of a NSSI disorder, which is not currently a DSM diagnosis. Our evidence suggests that NSSI disorder may be distinct from borderline personality disorder, and that NSSI disorder may be fairly responsive to psychotherapy. We continue to investigate NSSI disorder and are proponents of including the disorder in a future version of the DSM.
A major focus of the EmP lab is improving the understanding of the risk factors for and causes of eating disorders such as Anorexia Nervosa and Bulimia Nervosa. Our research has examined the role of emotion dysregulation and emotional cascades in binge eating and purging, the factors that lead to suicidal behavior in anorexia, and how eating disorders interface with borderline personality disorder.
We also recently published the Positive Emotion Dysregulation Model of Anorexia (See Nothing Tastes as Good as Thin Feels, Selby et al., 2014). This model suggests that women with anorexia experience positive emotion in a maladaptive way, such that weight loss activities become highly reinforcing due to success with weight loss goals and feelings of control. This positive emotion with weight loss also motivates them to engage in further weight loss activities. In combination with negative emotion problems, many women with anorexia may experience a “perfect storm” of emotion dysregulation that can make their symptoms very severe. This model also helps to improve our understanding of the “Pro-Anorexia” website phenomenon, and why these websites can be so harmful. Ultimately, we hope that a better understanding of what leads to the development of anorexia will help us improve our current treatments.
Suicide is a leading cause of death world wide, and it is a major concern for those diagnosed with borderline personality disorder, eating disorders, and self-injurious behavior. Our lab work with a variety of collaborators across the country to develop better ways for understanding suicidal behavior in general with the Interpersonal
Theory of Suicide, and how this theory can inform suicide in the military, and suicide across various forms of psychopathology. Recent work in the lab has also extended the examination of suicidal ideation and suicidal behavior to adolescents.
The Emotional Cascade Model
At times the way people act can appear “self-sabotaging” or “self-destructive,” especially when from an outside perspective it would seem clear that their behavior is only going to make a bad situation worse. Common examples of such “dysregulated” behaviors might include binging and purging, self-injury, “self-medicating” bad moods with drugs or alcohol, or impulsive shopping. So why would people engage in these self-sabotaging of self-damaging behaviors to “feel better?” The Emotional Cascade Model (Selby & Joiner, 2009) proposes that people engage in dysregulated behaviors in response to a process called an “emotional cascade.” In an emotional cascade, people think repetitively and intensely about an event that makes them feel negative emotion, and in this process they become more and more upset. The end result is a self-amplifying positive feedback loop of intense rumination and negative emotion, which creates an emotional state which is extremely aversive, painful, and difficult to tolerate. Dysregulated behaviors, as viewed by the Emotional Cascade Model, are then used to distract from emotional cascades through intense physical sensations. These physical sensations may vary according to the behavior, but potential examples could include feelings of pain or the sight of blood in NSSI, or the tastes or textures of food or feeling of fullness in binge-eating. Due to their potency, these sensations short-circuit the emotional cascade, decrease rumination and negative emotion, and result in subsequent, immediate feelings of relief. However, dysregulated behaviors can lead to severe negative consequences over time.
Emotional Cascades and Borderline Personality Disorder
Although emotional cascades may affect many people, there is one psychological disorder in particular that may be characterized as a disorder of emotional cascades: borderline personality disorder (BPD). This is a chronic and severe disorder with symptoms including stormy interpersonal relationships, emotions that are constantly fluctuating, and frequent dysregulated behaviors including suicidal behaviors (DSM-5, 2013). Selby and Joiner (2009) have posited that BPD is a disorder where the core psychopathology results from emotional cascades, which occur more frequently and perhaps more intensely than in other disorders exhibiting behavioral dysregulation (i.e., substance use disorders, eating disorders). In this sense, BPD may be viewed the extreme continuum of emotional cascades, whereas other disorders may be closer toward the center of this spectrum. The EmP lab has conducted several studies suggesting that emotional cascades may be an important mechanism in the development of BPD, and this research is now helping inform the ways we treat BPD.