(PS8-30) Desire to Change and NSSI Severity: Examining the Relationship Between Motivation and Self-injury Frequency, Urges, and Thoughts

Non-suicidal self-injury (NSSI) is a significant mental health concern, characterized by deliberate harm to one’s body without suicidal intent. Research indicates that approximately 13% of young adults in the U.S. engage in NSSI at some point in their lives. However, despite its prevalence, NSSI often goes unrecognized or unaddressed, as individuals who engage in these behaviors may not perceive them as problematic. For instance, NSSI behaviors can be egosyntonic, such that individuals may not recognize the severity of impairment and, therefore, may not seek professional assessment. The normalization or minimization of self-injury can prevent help-seeking, increasing the risk of long-term distress and more severe self-harm. Given these concerns, understanding the factors that influence motivation for change is critical for developing effective interventions and reducing the burden of NSSI. Therefore, we explored how NSSI frequency, thoughts, and perceived impairment relate to the desire to change.

We ran a series of linear regressions to assess whether desire to change behavior predicted NSSI severity on a sample of 6,643 individuals with the median age of 17.89 who voluntarily took a mental health screener on a large national advocacy group’s website, and reported a lifetime history of NSSI. The questions regarding behavior change were on a scale from “strongly disagree” to “strongly agree” and could be defined as follows: “I want to decrease my self-injury”, “I want to stop my self-injury”, and “I want to stop my self-injury, but haven’t been able to”. We hypothesized that individuals with lower motivation would engage in NSSI more frequently, whereas those with higher motivation would exhibit lower frequencies of NSSI. 

Results indicated that individuals who expressed a greater desire to change their NSSI behavior engaged in self-injury on fewer days in the past month (β = -1.40, p < .001), experienced fewer urges to self-injure (β = -0.23, p < .001), and had fewer NSSI-related thoughts (β = -0.26, p < .001). Similarly, individuals who expressed a strong desire to stop self-injury—rather than just reduce it—engaged in self-injury less frequently (β = -1.48, p < .001), experienced fewer urges (β = -0.24, p < .001), and had fewer self-injurious thoughts (β = -0.27, p < .001). Finally, those who reported greater difficulty in stopping self-injury engaged in more frequent NSSI behaviors (β = 0.67, p < .001), experienced stronger urges (β = 0.12, p < .001), and had more persistent self-injury-related thoughts (β = 0.06, p < .001). Therefore, these findings suggest that lower motivation to change is associated with more frequent NSSI and stronger, more persistent urges and thoughts related to self-injury. In contrast, individuals who reported a desire to change their behavior engaged in NSSI less frequently in the past month compared to those without such desires.

This highlights the importance of motivation enhancement interventions in NSSI treatment. Given that some individuals may not perceive their NSSI as problematic, interventions that emphasize the negative impact of self-injury and foster motivation for change may be beneficial in reducing NSSI behaviors.