State-level brain dynamics reveal neural correlates of negative-mode rigidity in non-suicidal self-injury

Non-suicidal self-injury (NSSI) is marked by persistent bias toward negatively valenced or salient internal experiences and difficulty disengaging from them once activated, yet the neural dynamics that support this clinical rigidity remain poorly understood. Intrinsic brain activity normally cycles among recurrent large-scale states, and alterations in how these states are occupied or transitioned may provide a neural analogue of negatively biased internal modes. Using resting-state fMRI from 160 patients with NSSI and 50 psychiatric controls, we applied Hidden Markov Modeling to characterize latent brain states and their temporal properties. NSSI was associated with disproportionate engagement of a recurrent ventral attention-related state, reduced differentiation between states, and greater variability within states. Greater dominance of this state was linked to more severe emotion-regulation difficulties at baseline and showed prognostic relevance for subsequent improvement in NSSI behaviors over three months. These findings indicate that NSSI involves a biased tendency to settle into salience- and attention-related brain states, highlighting attentional deficits as a clinically relevant feature of this condition. When considered alongside prior evidence showing heightened variability in connectivity strength and network topology, the results point to convergent disruptions in neural flexibility across multiple organizational levels in NSSI and underscore large-scale neural dynamics as a potentially informative target for future mechanistic and translational research.