Interpersonal Processes in Daily Life: Loneliness and Social Appraisals as Real-Time Predictors of Non-Suicidal Self-Injury Urges and Behavior

Although interpersonal factors are implicated in theoretical models of non-suicidal self-injury (NSSI), little is known about how objective social context and subjective interpersonal experiences contribute to momentary NSSI urges and behaviors in clinical populations. The present study examined between- and within-person associations among several interpersonal processes (perceived rejection, perceived social support, social context, social context appraisals, loneliness) and NSSI urges and behavior in daily life. One-hundred-twenty-five treatment-seeking adolescents and adults with recent NSSI completed a 28-day Ecological Momentary Assessment (EMA) protocol with six daily surveys (15,098 assessments). Dynamic structural equation modeling examined between- and within-person contemporaneous and temporal associations. Higher perceived rejection at baseline predicted greater average NSSI urge intensity and NSSI behavior during the 28-day EMA period, whereas baseline perceived social support was unrelated to either outcome. Momentary objective social context (i.e., being alone versus with others) was not a robust predictor of NSSI urges or behavior in daily life. In contrast, more positive momentary appraisals of social contexts predicted prospective decreases in NSSI urge intensity across 2-hour intervals, while higher-than-usual momentary loneliness predicted within-person increases in both NSSI urge intensity and the likelihood of NSSI behavior. Fully prospective mediation analyses indicated that the temporal effects of loneliness and social context appraisals on NSSI behavior operated primarily through their effect on NSSI urges. Subjective interpersonal experiences, rather than objective social context, were consistently linked to short-term NSSI risk. Interventions targeting maladaptive social appraisals and loneliness, including just-in-time adaptive interventions, may help prevent NSSI urges and behavior in daily life.