Alexithymia and non-suicidal self-ınjury in adolescents: the roles of emotion dysregulation, impulsivity, and self-esteem

Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and is associated with significant psychosocial impairment. Although alexithymia has been linked to NSSI in previous studies, the psychological mechanisms that may explain this association remain unclear. The present study aimed to concurrently examine emotion regulation difficulties, impulsivity, and self-esteem as mediators of the association between alexithymia and NSSI in a clinical adolescent sample. The study sample consisted of 437 adolescent outpatients (79.4% girls; Mage = 15.4 years), including 147 who reported NSSI in the past year and 290 who did not. Alexithymia, emotion regulation difficulties, impulsivity and self-esteem were measured. Gender-stratified structural equation modeling (SEM) was conducted to examine whether emotion regulation difficulties, impulsivity, and self-esteem mediated the association between alexithymia and NSSI, with indirect effects evaluated using bootstrapping. The NSSI group exhibited higher levels of alexithymia, emotion regulation difficulties, impulsivity and lower self-esteem than non-NSSI peers. Alexithymia was associated with all three mediators in both genders. Mediation analyses revealed significant indirect effects for emotion regulation difficulties, impulsivity, and self-esteem in the alexithymia–NSSI association among girls. Among boys, none of the specific indirect effects reached statistical significance; however, the total indirect effect was significant. These findings highlight emotion dysregulation, impulsivity, and self-esteem as clinically relevant processes associated with alexithymia and NSSI in a clinical adolescent sample, particularly among girls. Addressing these processes in clinical assessment and intervention may contribute to more targeted approaches for reducing NSSI in adolescents. Longitudinal studies, particularly including larger male samples, are needed to clarify the directionality of these associations and to further examine gender-specific patterns. Not applicable.