(PS8-37) Early Maladaptive Schemas and Functions of Non-Suicidal Self-Injury: Direct and Indirect Associations through Emotional Deregulation

Abstract Text: Non-suicidal self-injury (NSSI) is a significant public health concern, with higher prevalence rates among individuals with psychological disorders such as borderline personality disorder and depression. NSSI serves multiple functions, categorized as automatic versus social and positive versus negative reinforcement. It causes considerable distress and stigma among individuals who engage in it and is associated with an increased risk of suicidal behaviors. Therefore, identifying modifiable vulnerability factors is crucial for developing effective interventions. The schema therapy model proposes that early maladaptive schemas (EMS) contribute to various psychological problems. Although several studies have explored the role of EMS in NSSI, most have relied on student samples. This study aimed to assess which EMS domains are associated with different NSSI functions in a clinical sample and whether these associations are mediated by emotion dysregulation mechanisms. A cross-sectional study was conducted with a sample of 215 outpatients who frequently engaged in NSSI (72% female, Mage = 40.10, SD = 14.77; 43.7% diagnosed with personality disorders). Participants completed the Functional Assessment of Self-Mutilation scale (Lloyd et al., 1997), the Young Schema Questionnaire-3 (Young, 2006), and the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004) under the supervision of their therapist after providing informed consent. The study was approved by the institutional ethics committee (ETK-35/20-21). A path analysis model was estimated using MPLUS 8.11 with bootstrapping (N = 10,000 samples). Only the emotion dysregulation dimension of impulse control difficulty and three EMS domains were significantly associated with NSSI functions: disconnection/rejection (e.g., schemas related to a negative self-view and negative perceptions of relationships), impaired limits (e.g., entitlement and insufficient self-control), and overvigilance/inhibition (e.g., emotional inhibition and self-punishment). For the automatic functions of NSSI, the association was primarily indirect through impulse control difficulty. The three schema domains were linked to higher levels of impulse control difficulty, which in turn was associated with more NSSI for automatic functions (e.g., reducing emotional distress or feeling better). Additionally, there was a statistically significant direct association between the impaired limits domain and NSSI with social functions (e.g., avoiding social situations or seeking attention). The model showed good fit indices: χ2 (1, N = 215) = 0.06, SRMR = .003; CFI = 1.00, TLI = 1.00. The bootstrapping procedure confirmed the significance of all indirect associations. These findings enhance our understanding of how specific EMS dimensions influence different NSSI functions in clinical populations. They suggest that the role of EMS varies depending on the functions of self-injurious behaviors and highlight impulse control difficulty as a key mechanism. These results may inform the application of schema therapy in individuals who engage in NSSI.