The functional heterogeneity of non-suicidal self-injury: insights from latent profile analysis

The functional aspects of non-suicidal self-injury (NSSI) among adolescents represent a complex phenomenon requiring deeper understanding. While research has identified various NSSI functions, including emotional regulation, attention-seeking, and social avoidance, the field lacks comprehensive analysis of how these functions cluster into distinct profiles. Understanding these functional profiles is crucial for developing targeted interventions.

A cross-sectional study of 1,783 adolescents (1,464 girls, 318 boys) aged 12-18 years was conducted across 14 psychiatric or general hospitals in nine Chinese provinces. Participants completed the Functional Assessment of Self-Mutilation (FASM), which assesses 22 distinct NSSI functions across three primary dimensions: emotional regulation, attention-seeking, and social avoidance. Additional measures included the Patient Health Questionnaire (PHQ-9) for depression and Generalized Anxiety Disorder Scale (GAD-7) for anxiety symptoms. Latent profile analysis was employed to identify distinct patterns in NSSI functions, with model selection based on fit indices including AIC, BIC, entropy, and LMRT.

Latent profile analysis revealed four distinct functional profiles: low attention-seeking-high social avoidance (LA-HS, 19.7%), high attention-seeking-high social avoidance (HA-HS, 9.5%), low attention-seeking and social avoidance (LA-LS, 57.8%), and high attention-seeking-low social avoidance (HA-LS, 13.0%). The HA-HS profile demonstrated the most severe clinical presentation, showing significantly elevated scores in NSSI frequency (M = 26.160, SD = 9.771), anxiety (GAD-7: M = 16.265, SD = 4.951), and depression (PHQ-9: M = 20.612, SD = 6.003). The LA-HS profile showed the second-highest severity (NSSI: M = 25.800, SD = 10.058; GAD-7: M = 14.775, SD = 5.376; PHQ-9: M = 19.966, SD = 5.938). Both profiles also demonstrated significantly higher rates of suicidal ideation (HA-HS: 77.6%; LA-HS: 79.2%) compared to other profiles.

Our findings reveal distinct patterns in how adolescents utilize NSSI functionally, particularly regarding attention-seeking and social avoidance dimensions. These functional profiles show meaningful associations with psychological outcomes, suggesting that understanding NSSI functions, rather than just behaviors, may be crucial for assessment and intervention. The identification of these distinct functional profiles among Chinese adolescents highlights the importance of function-specific approaches in clinical assessment and treatment planning.