The relationship between alexithymia, non-suicidal self-injury, and emotion regulation

Background: Previous studies link non-suicidal self-injury (NSSI) to alexithymia and emotion dysregulation. However, the role of specific NSSI functions and the role of emotional valence in alexithymia, remain unclear. Thus, the present study investigated associations between lifetime-NSSI, alexithymia, and emotion regulation strategies (expressive suppression, cognitive reappraisal), focusing on NSSI functions and emotional valence in alexithymia. Methods: A total of 328 participants (M = 29.18 years, SD = 12.73) with and without lifetime-NSSI participated in the study. They completed online questionnaires regarding alexithymia, NSSI, and preferred emotion regulation strategies. A binominal logistic regression was computed to predict NSSI group assignment. Results: Participants with lifetime-NSSI reported significantly higher levels of alexithymia, more frequent use of expressive suppression, and less frequent use of cognitive reappraisal than those without NSSI. Alexithymia correlated with a higher tendency for expressive suppression and reduced cognitive reappraisal. Both positive and negative emotional alexithymia were linked to NSSI, with alexithymia significantly associated with stronger endorsement of intrapersonal-positive NSSI functions. Key predictors of NSSI group membership included younger age, lower use of cognitive reappraisal, and greater difficulty in appraising feelings. Limitations: The cross-sectional design precluded causal inferences. Conclusions: Findings reveal that individuals with lifetime-NSSI exhibit higher levels of alexithymia, favor expressive suppression as maladaptive emotion regulation strategy, and exhibit greater difficulty in adaptive cognitive reappraisal compared to those without NSSI. These findings underscore the importance to address emotion regulation and alexithymia in NSSI interventions. This is the first study to report a link between alexithymia and the endorsement of specific (intrapersonal-positive) NSSI functions.