Emotion Regulation Difficulties and Interpersonal Relationship Skills in Adolescents with Nonsuicidal Self-Injury: A Comparative Study.

Abstract

Objective: Non-suicidal self-injury (NSSI) is a clinically important behavior that often emerges during adolescence and is closely linked to emotion regulation difficulties and maladaptive interpersonal patterns. This study examined these associations in Turkish adolescents with depressive disorder and recent NSSI.

Methods: This cross-sectional comparative case-control study included 100 adolescents aged 12-18 years who had a DSM-5 diagnosis of depressive disorder and had engaged in NSSI at least once during the previous six months, and 100 healthy controls without a psychiatric diagnosis or NSSI history. Case participants were evaluated in a child and adolescent psychiatry outpatient clinic, and controls were clinically screened before inclusion. Participants completed the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Relationships Scale (IRS), and the Inventory of Statements About Self-Injury (ISAS). Normality was assessed with the Shapiro-Wilk test; because distributions were non-normal, Mann-Whitney U, Pearson's chi-square/Fisher's exact tests, Spearman's correlation analysis, and hierarchical binary logistic regression were used.

Results: The NSSI group showed significantly higher emotion regulation difficulty and toxic interpersonal relationship scores and significantly lower nurturing relationship scores than controls (all p < 0.001). ISAS autonomous functions were positively correlated with DERS total scores (r = 0.216, p = 0.031) and IRS-toxic scores (r = 0.504, p < 0.001), whereas ISAS social functions were negatively correlated with DERS total scores (r = -0.548, p < 0.001). In the final hierarchical logistic regression model, higher DERS total scores (OR = 1.062, p = 0.005) and higher IRS-toxic scores (OR = 1.227, p = 0.012) increased the odds of NSSI, whereas higher IRS-nurturing scores were protective (OR = 0.810, p < 0.001). The final model showed 94.0% classification accuracy (Nagelkerke R²=0.901).

Conclusion: These findings indicate that emotional dysregulation and maladaptive interpersonal patterns are independently associated with NSSI in adolescents. The results support multidimensional assessment and intervention strategies that address both emotion regulation and relationship functioning.