Exploration of Nonsuicidal Self-Injury as an Addiction-Like Behaviour in Depressed Adolescents in the light of the I-PACE Model

Abstract

Nonsuicidal self-injury (NSSI) is increasingly conceptualized as an addiction-like behaviour characterized by dysregulated emotional and cognitive processes. Guided by the I-PACE model, this study investigated how person-level vulnerabilities interact with affective, mental and executive functioning to maintain NSSI in clinically depressed adolescents (N = 167, aged 12–18, M = 15.37 ± 1.75 years). Results revealed strong addiction-like patterns. Childhood trauma, depression and rumination demonstrated significant associations with NSSI frequency (r = 0.59–0.61), while resilience and self-esteem served as protective factors (r = −0.53 to −0.55). A hierarchical regression model explained 69% of variance, with trauma (OR = 1.12), depressive severity (OR = 1.11), rumination (OR = 1.11) and resilience (OR = 0.90) emerging as key predictors. Mediation analyses demonstrated how these factors operate in the addictive chain. Childhood trauma and borderline traits lead to affective dysregulation, which drives cognitive deficits that ultimately undermine resilience and increase NSSI risk (β = −0.28 and −0.24). These findings support the use of an addiction framework to conceptualize NSSI, while highlighting resilience-focused interventions as critical for breaking these maladaptive cycles.