Autonomic dysregulation and nonsuicidal self-injury: findings from a cross-sectional online survey

Introduction: Dysregulation of the autonomic nervous system has been implicated in nonsuicidal self-injury (NSSI) in laboratory studies of physiological reactivity, but it remains unclear whether self-reported everyday autonomic symptom burden is associated with NSSI severity. Methods: We conducted a preregistered cross-sectional online survey of N = 1,002 German-speaking adolescents and young adults aged 14-30 years (M = 23.43; 73% women). Autonomic symptoms were assessed with the COMPASS 31; NSSI presence and frequency were measured with the SITBI-R across four reference periods (past week, month, year, lifetime). Data were analyzed using zero-inflated negative binomial models. Results: The 12-month NSSI prevalence was 22.6%. Higher COMPASS 31 scores were associated with lower odds of reporting zero NSSI episodes across all reference periods and with higher NSSI episode counts for the past month, past year, and lifetime; the past-week count association was not statistically significant. These associations held after controlling for childhood adversity, perceived stress, medication, and hormonal contraception. Discussion: These results indicate that self-reported autonomic symptom burden was robustly associated with NSSI involvement, particularly with the likelihood of any NSSI and with episode counts over longer reference periods. These findings suggest that self-reported autonomic symptom burden may represent a clinically relevant somatic correlate of NSSI severity.