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Longitudinal development of pain sensitivity in adolescent non-suicidal self-injury

https://doi.org/10.1016/j.jpsychires.2017.02.001Get rights and content

Highlights

  • Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity (PS).

  • Cross-sectional studies suggest a normalization of PS in individuals with remission of NSSI.

  • This is the first study addressing longitudinal changes in PS in patients with NSSI.

  • Results provide evidence for an inverse relationship between clinical improvements and changes in PS.

  • NSSI may be terminated once pain tolerance gets too high.

Abstract

Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity (PS). Existing theories posit that altered PS is a risk factor for NSSI. Cross-sectional data suggest that PS normalizes in those terminating self-injury. However, previously no study addressed the longitudinal course of PS in patients engaging in NSSI. We addressed changes in PS and clinical symptomatology in adolescents with NSSI (n = 18) and matched controls (n = 19) over one year. Despite significant clinical improvements, PS did not change in the NSSI group but decreased in controls. Greater NSSI reduction was associated with increased pain tolerance. Findings are discussed in the light of current theories on PS in NSSI.

Introduction

Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity (PS) (Koenig et al., 2016). The pain analgesia hypothesis describes alterations of PS as risk factor for the engagement in NSSI, hypothesizing that individuals who are less sensitive to pain are more likely to actually engage in NSSI (Nock, 2010). According to Nock, “it is unclear if […] pain analgesia is a dispositional factor […], emerges via habituation […], or is a by-product of the release of endogenous opiates that results from repeated NSSI” (Nock, 2009). Previously, few cross-sectional studies addressed PS in individuals with a life-time history and subsequent remission of self-injury. Bekrater-Bodmann et al. found normalized heat pain thresholds comparable to controls in patients with remitted borderline personality disorder (BPD), but still elevated cold pain thresholds (Bekrater-Bodmann et al., 2015). Similar, an earlier study by Ludäscher et al. suggested normalization of PS in BPD patients who terminated NSSI (Ludäscher et al., 2009). However, no study addressed changes in PS in patients with NSSI in a longitudinal design. Here we aimed to investigate the course of PS over the time of one year in adolescents with NSSI compared to a healthy control group. Based on existing evidence from cross-sectional studies, it was hypothesized that clinical improvements in adolescents with NSSI would be associated with a normalization of PS.

Section snippets

Material and methods

The present study is a one-year follow-up on participants of an experimental laboratory case-control study comparing adolescents with DSM-5 (section-3) diagnosis of NSSI to a group of participants without NSSI or any other psychiatric disorder. The study protocol was approved by the Ethical Committee of the Medical Faculty, Heidelberg University, Germany (ID S-471/2013), and registered at the German Clinical Trials Register (Study ID: DRKS00007807). The protocol and results from the first

Results

Sociodemographic and clinical characteristics of the study sample by group and time of assessment are provided in Table 1. With respect to clinical improvement, the current level of functioning showed a significant main effect of GROUP (χ2(1) = 166.13, p < 0.001) and TIME (χ2(1) = 5.42, p = 0.019), as well as a significant TIME*GROUP interaction (χ2(1) = 11.04, p = 0.001), indicating a different change over time in the level of functioning for patients with NSSI and controls. For patients the

Discussion

The present study is the first longitudinal study investigating changes in PS in patients engaging in NSSI. Based on existing cross-sectional data, it was hypothesized that clinical improvements after one year would be associated with a ‘normalization’ of PS. Drawing on the present results we cannot confirm such hypothesis. We found PS unchanged in patients with NSSI over the time-course of one year while matched controls showed increases in PS (i.e., lower pain threshold and tolerance at

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