Psychological correlates of nonsuicidal self-injury in women with borderline personality disorder: A cross-sectional study to inform mindfulness-based interventions

Psychological correlates of nonsuicidal self-injury in women with borderline personality disorder: A cross-sectional study to inform mindfulness-based interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychological correlates of nonsuicidal self-injury in women with borderline personality disorder: A cross-sectional study to inform mindfulness-based interventions Szilvia Kresznerits, Ágnes Zinner-Gérecz, Mónika Miklósi, Tamás Szekeres, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7301363/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jan, 2026 Read the published version in BMC Psychiatry → Version 1 posted 10 You are reading this latest preprint version Abstract Objective : Nonsuicidal self-injury (NSSI) is a significant predictor of suicide, particularly among patients with borderline personality disorder (BPD). This study examined modifiable psychological factors linked to NSSI to inform the development of a mindfulness-based intervention. Methods : In a cross-sectional design, 109 female BPD patients completed self-reported measures assessing NSSI behaviors, mindfulness skills, emotion regulation strategies, depressive symptoms, and self-compassion. Correlational analyses were performed to examine the relationships among the psychological variables, NSSI frequency, and number of NSSI methods employed. Ordinal general linear models were used to identify predictors of NSSI frequency. Results : Participants reported low levels of self-compassion, mindfulness skills, and self-esteem, alongside high depression, impulsivity, and frequent self-harming behaviour. The key risk factors for more frequent NSSI included increased impulsivity (95% CI: 1.007–1.199), higher scores on the adaptive cognitive emotional regulation strategies subscale (95% CI: 1.015–1.082) and reduced self-compassion (95% CI: 0.945–0.999). Although mindfulness skills were not directly linked to the frequency of NSSI or the number of methods used, they were moderately correlated with these risk factors. Conclusions : These findings underscore the importance of targeted interventions for NSSI in BPD patients. Mindfulness-based approaches may reduce suicide risk and improve treatment engagement by addressing deficits in impulsivity, acceptance, and self-compassion. Borderline personality disorder self-injurious behaviour mindfulness emotional regulation impulsive behaviour self-compassion suicide prevention Figures Figure 1 Figure 2 1. Introduction 1.1 Emotion regulation, impulsivity, and mindfulness skills in individuals with borderline personality disorder Borderline personality disorder (BPD) is a serious, complex, and pervasive mental illness characterised by dysfunctional patterns of instability in self-image, interpersonal relationships, affects, cognitions, and behaviours ( 1 ). Suicide deaths are particularly high in this patient population, with at least 3–6% according to follow-up studies; other studies estimate a 10% suicide rate in BPD patients, with an increased risk of younger age and male sex (Paris, 2019). BPD is also associated with severe functional impairment and a host of dysregulated behaviours that can cause harm to the individual and to the individual’s social environment, such as nonsuicidal self-injury (NSSI), substance use (23–84%), disordered eating (14–53%), and verbal or physical aggression ( 1 – 3 ). Furthermore, BPD is one of the most common personality disorders, with a point prevalence of 1.6% and a lifetime prevalence of 5.6% ( 4 , 5 ). Owing to the frequent and severe crises that characterise the disorder, patients highly utilise the healthcare system; 20% of psychiatric outpatients and 10% of inpatients have a diagnosis of BPD ( 6 ). Given the high personal and societal burden of BPD, effective yet scalable psychotherapeutic interventions are essential. However, long waiting lists due to high demand can often lead to significant deterioration of the condition and increase the risk of suicide ( 7 – 9 ). Therefore, to mitigate this risk, there is a need for short, evidence-based interventions that address the most critical factors, such as self-harm and emotion regulation difficulties. In terms of emotional mechanisms, emotion dysregulation is a core trait of BPD and is characterised by heightened emotional vulnerability, insufficient control, intense reactions, and impaired impulse management ( 10 ). These difficulties can even double the risk of nonsuicidal self-injury (NSSI) ( 11 , 12 ). The emotional cascade model ( 13 , 14 ) emphasises rumination as central to self-harming behaviours in BPD patients. This repetitive worrying intensifies negative emotions, driving individuals to use self-injury to quickly relieve overwhelming negative emotions and thoughts. In BPD, impulses lead to sudden decisions and actions, especially under stress ( 15 ). According to the mindfulness deficit theory ( 16 – 18 ), emotion and impulse control difficulties in BPD patients can be derived from reduced mindfulness skills. BPD patients tend to avoid unpleasant emotions, hindering adaptive coping development. In distressing situations, hypersensitivity and emotion suppression can lead to increased impulsivity and reliance on maladaptive coping mechanisms, such as substance use or self-harm. In contrast, the purpose of mindfulness is to be aware and accepting of experiences, help individuals distance themselves from automatic reactions and respond more flexibly to internal and external stimuli ( 16 , 17 ). 1.2. Self-harm and nonsuicidal self-injury, triggering and maintaining factors NSSI refers to deliberate, direct injuring or mutilation of one’s body tissue without suicidal intent ( 19 , 20 ) ' and for purposes not socially or culturally sanctioned” ( 21 ). NSSI affects 17%-18% of adolescents and 4%-6% of adults. Moreover, among psychiatric inpatients, NSSI rates can reach as high as 80% ( 22 – 26 ). Due to findings revealing its transdiagnostic nature, a distinct diagnostic code was added for NSSI in the DSM-5-TR ( 27 ). NSSI also serves as a predictor of future suicidal behaviour (OR = 4.27, 95% CI = 2.56–7.10) ( 28 ). Repetitive and multimethod NSSI is associated with increased suicide attempts. BPD patients are particularly vulnerable to this pattern, increasing their risk of suicide ( 29 , 30 ). In addition to psychological risks, NSSIs can result in medical complications, including infections and tissue damage ( 31 ). Biological factors also contribute significantly to the development of NSSI from a neurobiological perspective ( 32 ). Heritability is estimated at 40–60%, and gene‒environment interactions increase risk. Childhood adversity and stressors can also influence NSSI risk through various biological pathways. Fronto-limbic neural system changes are common in individuals with NSSI and affect emotion regulation and social processing. However, the role of cognitive control and the reward system in individuals with NSSI is less clear. Individuals with NSSI often show heightened sympathetic nervous system activity, altered cortisol response to stress, reduced pain sensitivity, and neural system changes during NSSI episodes ( 32 ). Psychological vulnerabilities contributing to NSSI include childhood traumatisation, attachment problems, heightened emotional reactivity, low self-esteem, low self-compassion, low anxiety tolerance, and emotion dysregulation, particularly increased rumination ( 11 , 13 , 29 , 33 – 37 ). Risk factors for NSSI include prior NSSI, cluster B personality disorders, and hopelessness, with social factors also playing a significant role, although to a lesser extent than emotional distress reduction does ( 30 , 38 – 40 ). Psychological models have also been developed to describe the triggering and maintaining factors of NSSI. The cognitive-emotional model ( 41 ) suggests that emotional reactivity, the mental representation of self-harm, self-representations, and thoughts related to NSSI (i.e., the imagined outcome and the ability to cope) contribute to NSSI as a coping strategy. The four-function model ( 26 ) outlines four reinforcement processes that maintain NSSI: automatic/social and negative/positive reinforcement. On the basis of the meta-analysis examining this theory, NSSI serves intrapersonal functions, focusing primarily on emotion regulation and reducing negative emotional states. Nevertheless, 5–21% of the tested participants did not use NSSI for emotion regulation. Therefore, treatments should assess all potential maintenance functions ( 39 ). The cognitive-emotional reactivity model ( 42 ) integrates key elements from the theories mentioned and extends them with insights from the cognitive reactivity model in recurrent depression ( 43 ). In recurrent depression, cognitive reactivity heightens vulnerability after each episode, strengthening associations between different aspects of depression. The cognitive–emotional reactivity model applies this concept to BPD, which is characterised by rapid, cyclical episodes that intensify cognitive and emotional reactivity. Maladaptive coping strategies such as self-harm reinforce connections between negative thoughts, emotions, and bodily sensations. Triggering events initiate a vortex of negative thoughts and emotions, making it increasingly difficult to identify underlying processes (Fig. 1 ). Although NSSI may provide immediate emotional relief, it can also deepen self-blame and lead to perceived loss of control. Therefore, therapy aims to teach decentralisation from automatic responses, enabling individuals to break free from this vicious cycle and develop healthier emotional management strategies ( 42 ). 1.3. Mindfulness-based practices in BPD and NSSI treatment Dialectical behaviour therapy (DBT) is a well-established and widely used treatment for BPD that is specifically designed to address core symptoms such as emotion dysregulation, impulsivity, and self-harming behaviours ( 10 , 44 ). Although the standard DBT program takes 12 months, adaptations with shorter durations (e.g., 20-week modules) have been developed to improve accessibility in healthcare settings. Improving mindfulness skills is a foundational module of DBT, enhancing patients’ awareness of internal experiences and reducing automatic, maladaptive responses. The development of mindfulness skills can directly address impulsivity ( 45 , 46 ) and promote self-injury inhibition ( 47 , 48 ). Neuroimaging studies suggest that mindfulness practices may alter neural activity in regions associated with the default mode network, emotion regulation, and impulse control and can reduce overall symptom severity in BPD patients ( 49 ). In addition to its impact on emotion regulation, mindfulness has also been associated with increased self-compassion, an important protective factor against self-harm. Greater self-compassion has been associated with reduced shame, self-criticism, and thought suppression—mechanisms that often play a role in the maintenance of NSSI ( 50 – 54 ). 1.4. Aims This study examines the relationships among mindfulness skills, NSSI, and modifiable psychological factors in individuals with BPD. The primary goal is to inform the development of targeted mindfulness-based cognitive therapy for NSSI (MBCT-NSSI) by identifying key psychological correlates of self-injurious behavior. We propose the following hypotheses: (H1) Mindfulness skills are positively correlated with adaptive emotion regulation, self-esteem, and self-compassion and negatively correlated with maladaptive emotion regulation, depression, hopelessness, impulsivity, and dissociation. (H2) NSSI severity (i.e., frequency and number of methods used) is positively correlated with maladaptive regulation, depression, hopelessness, impulsivity, and dissociation but negatively correlated with mindfulness skills, adaptive regulation, self-esteem, and self-compassion. 2. Method 2.1. Procedures and sample This study targeted adult BPD outpatients with self-reported NSSI in the past six months. The exclusion criteria included acute suicidal crisis, psychosis, bipolar manic episodes, severe substance use disorder, organic or symptomatic mental disorders, and intellectual disability. The sample size calculation ( 55 ) led to N = 58.7 at 95% confidence and a < 0.05 probability. Recruitment involved establishing an experimental mindfulness training group for BPD patients who engaged in self-harm. The intervention followed the MBCT protocol adapted for suicide prevention by Williams et al. ( 43 ). Recruitment materials were disseminated across psychiatric departments and outpatient clinics nationwide. Eligible patients who sought individual therapy at our outpatient clinic were also informed about the opportunity to participate in the study and the experimental intervention group. All the applicants underwent a standard diagnostic procedure in line with the clinic’s protocol, which was conducted by trained clinical psychologists under the supervision of the last author. National regulations determine diagnoses on the basis of the ICD-10 criteria ( 56 , 57 ). The participants completed a semistructured interview about NSSI and a self-report questionnaire (printing or online). The questionnaire contains 18 demographic questions, and the other 160 items assess mindfulness skills, emotion regulation, self-esteem, self-compassion, depression, hopelessness, impulsivity, and dissociation. A cross-sectional design was employed to examine the relationship between mindfulness and NSSI. Between 1st January 2019 and 30th June 2023, 158 applicants were screened for eligibility. All participants provided written informed consent, and the study received ethical approval. This study was a cross-sectional, observational design and does not meet the criteria for a clinical trial; therefore, no clinical trial number is applicable. The project and anonymised dataset are publicly registered at the Open Science Framework. A total of 120 outpatients (109 women [90.83%] and eleven men [9.16%]) met the inclusion criteria. To control for gender-related bias, only data from female participants were analysed. The final sample comprised 109 female BPD outpatients (M age : 27.50 years, SD = 7.85). Education levels: 9.2% (N = 10) had basic education, 55.0% (N = 60) had secondary education, and 35.8% (N = 39) had a degree in higher education. Employment status: 28.4% (N = 31) were students, 48.6% (N = 53) were employed or self-employed, and 22.9% (N = 25) were unemployed or had other passive employment statuses. Comorbidities: A total of 74.31% (N = 81) had at least one comorbid diagnosis beyond BPD, and 22.02% (N = 24) had at least two additional diagnoses (Table 1 ). Table 1 Prevalence of comorbid disorders in the BPD sample (N = 109) Comorbid diagnosis (ICD-10) % ∑% Depression Bipolar (F31.3, F31.6, F31.8) 12.84 40.37 Unipolar (F32.0, F32.1, F32.2, F32.8) 18.35 Recurrent/persistent (F33.0, F33.1, F34.8) 9.17 Neurotic, stress-related, and somatoform disorders Mixed anxiety and depressive disorder (F41.2) 21.10 40,37 Anxiety disorders (F40.0-F41.8, without F41.2) 11.01 Obsessive-compulsive disorder (F42.0-F42.2) 1.83 Posttraumatic stress disorder (F43.1) 6.42 Eating disorders (F50.0, F50.2, F50.8) 11.01 11.01 Comorbid personality disorder 11.01 11.01 Other (F19.1 in remission, F51.0, F63.8, F84.8) 4.59 4.59 The manuscript text was edited via Grammarly (Grammarly Inc., San Francisco, CA) for grammar and language clarity. All content and interpretations are the original work of the authors. 2.2. Measures The following self-administered questionnaires were included in the statistical data analysis: The general data sheet and NSSI captured demographic data, psychiatric history, suicide attempts, and details of NSSI severity (types and methods). The semistructured interview questions included “ Have you ever deliberately harmed yourself without intending to die?” “Have you done so in the past six months?” and “How many times or how often?” Participants who were unsure or unfamiliar with the terminology were provided with examples (e.g., cutting, burning). If one form of NSSI was identified, the others were queried systematically. If one type occurred, we also asked about other types based on the list shown in Fig. 2, including two additional categories (inserting objects under the skin or nails and tattooing), which did not occur in this sample. NSSI frequency was categorised as follows: 1) 1–3 times per year , 2) approximately monthly , 3) approximately weekly , or 4) daily or more frequently . Rosenberg Self-Esteem Scale (RSES) : A 10-item measure of global self-worth rated on a 4-point Likert scale ( 58 , 59 ). Five-Facet Mindfulness Questionnaire (FFMQ) : A 39-item measure of mindfulness traits across five subscales: observing , describing , acting with awareness , nonjudging inner experience , and nonreactivity ( 54 ). The adapted Hungarian questionnaire version ( 60 ) is under standardisation. Beck Depression Inventory – Shortened version (BDI-S) : A 9-item measure of depression severity ( 61 , 62 ). Beck Hopelessness Scale – Shortened version (BHS-S) : A 4-item abbreviated scale of the original Beck Hopelessness Scale measuring hopelessness ( 63 , 64 ). Barratt Impulsivity Scale-Shortened (BIS-8-S) : An 8-item self-report scale measuring impulsivity on a four-point Likert scale ( 65 , 66 ). Dissociative Experiences Scale (DES) : A 28-item self-report questionnaire measuring the frequency of dissociative experiences, with responses ranging from 0–100 ( 67 , 68 ). Cognitive Emotion-Regulation Questionnaire (CERQ) : A 36-item self-report measure to evaluate cognitive strategies in emotion regulation ( 69 ) with nine subscales ( 70 , 71 ). Self-blame , rumination , catastrophizing , and blaming others represent maladaptive strategies, whereas refocusing on planning , positive reappraisal , putting into perspective , positive refocusing , and acceptance represent adaptive strategies. Self-Compassion Scale (SCS) : A 26-item self-report instrument with three subdimensions of self-concept: self-judgment vs. self-kindness , isolation vs. common humanity , and overidentification vs. mindfulness ( 72 , 73 ). 2.3. Data analyses Data analysis was conducted with IBM SPSS Statistics 28©. Missing values were excluded from the study. A significance level (α) of 0.05 was used. Pearson’s correlation was employed to examine the relationships between continuous variables (e.g., clinical scales and number of NSSI methods). Spearman’s rank-order correlation was applied to assess associations between ordinal NSSI frequency categories and clinical variables. Ordinal general linear models (GLMs) were used to identify predictors of NSSI frequency. 3. Results 3.1. Descriptive analysis of the clinical and psychometric scales Table 2 presents the internal consistency and descriptive statistics of the administered psychometric instruments. All scales demonstrated acceptable reliability for early-stage research (Cronbach’s α > 0.70), which is consistent with the guidelines of Nunnally and Bernstein ( 74 ). However, two FFMQ subscales ( observing and nonreactivity ) and the BIS-8-S presented Cronbach’s alpha values less than 0.80, indicating suboptimal reliability for applied research settings. Based on the confirmatory factor analysis (extraction method: maximum likelihood, rotation method: varimax with Kaiser normalisation), two items from the adaptive subscale of the CERQ were excluded from the analysis. Item 20 loaded more strongly on the maladaptive scale than on the adaptive scale, whereas item 23 had similar loadings on both factors (0.387 and 0.329). The revised scale is referred to as CERQ_ad*. Table 2 Internal reliabilities and descriptive statistics of the clinical and psychometric scales Scales Cronbach’s α M SE Range Healthy standards/cut-offs RSES 0.855 10.128 0.535 0–30 > 15 ( 59 ) FFMQ_o 0.701 25.835 0.538 8–40 FFMQ_d 0.906 23.917 0.718 8–40 FFMQ_a 0.824 20.724 0.580 8–40 FFMQ_nj 0.833 20.239 0.623 8–40 FFMQ_nr 0.714 14.651 0.416 7–35 FFMQ 0.825 105.367 1.574 39–195 M = 133.80, SD = 21.58 ( 66 ) CERQ_ad 0.896 51.248 1.343 20–100 M = 64.57, SD = 10.33 ( 71 ) CERQ_ad* 0.910 CERQ_mad 0.863 50.505 1.092 16–90 M = 39.04, SD = 8.01 ( 71 ) BDI-S 0.801 22.055 0.499 9–36 < 19 ( 61 ) BHS-S 0.884 10.275 0.356 4–16 < 9 ( 64 ). BIS-8-S 0.757 20.679 0.405 8–32 M = 15.46, SD = 4.98 ( 66 ) DES 0.930 772.018 43.561 0–2800 SCS 0.898 52.576 1.444 26–130 M = 70.31, SD = 12.11 ( 73 ) Notes : N = 109. Healthy standards or cut-off points were based on nationally standardised values for the general population, where such data were available. RSES = Rosenberg Self-Esteem Scale, FFMQ = Five-Facet Mindfulness Questionnaire, FFMQ_o = FFMQ observing subscale, FFMQ_d = FFMQ describing subscale, FFMQ_a = FFMQ acting with awareness subscale, FFMQ_nj = FFMQ nonjudging to inner experience subscale, FFMQ_nr = FFMQ nonreactivity to inner experience subscale, CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, CERQ_ad* = modified CERQ adaptive subscale, excluding items 20 and 23, BDI-S = Beck Depression Inventory Shortened, BHS-S = Beck Hopelessness Inventory Shortened, BIS-8-S = Barratt Impulsivity Scale Shortened, DES = Dissociative Experience Scale, SCS = Self-Compassion Scale. The participants, on average, demonstrated low self-esteem, self-compassion, and mindfulness skills. The mean depression and hopelessness scores exceeded the values typical for the general population, and the impulsivity levels were also elevated. In terms of emotion regulation, the scores for adaptive strategies were lower than the Hungarian normative values, whereas maladaptive strategy scores were noticeably higher (Table 2 ). 3.2. Correlation of mindfulness skills with clinical and psychometric variables The total mindfulness score (FFMQ) was positively correlated with protective psychological factors—self-esteem, self-compassion, and adaptive emotion regulation strategies. In contrast, moderate negative correlations emerged between total mindfulness and depression, hopelessness, impulsivity, and dissociation. Although the correlations with specific emotion regulation strategies were weak, they aligned with the theoretical expectations (see Table 3 ). Among the FFMQ subscales, acting with awareness , nonjudging inner experience , and nonreactivity to inner experience demonstrated the strongest associations with other psychological constructs. Specifically, acting with awareness showed moderate negative correlations with impulsivity, depression, and dissociation. Nonjudging was positively correlated with self-esteem and self-compassion and negatively correlated with maladaptive emotion regulation, depression, and dissociation. Finally, nonreactivity was strongly positively correlated with self-compassion and moderately negatively correlated with depression (Table 3 ). Table 3 Pearson’s correlations between FFMQ subscales and other psychometric scales in BPD outpatients Scale SCS RSES CERQ_ ad CERQ_mad BDI-S BHS-S BIS-8-S DES FFMQ r 0.402 0.504 0.268 -0.228 -0.425 -0.339 -0.478 -0.369 p < 0.001 < 0.001 0.005 0.017 < 0.001 < 0.001 < 0.001 < 0.001 FFMQ_o r 0.090 0.092 0.179 0.105 0.055 -0.071 -0.019 0.206 p 0.360 0.342 0.062 0.278 0.568 0.466 0.848 0.032 FFMQ_d r < 0.001 0.202 0.085 0.105 -0.155 -0.191 -0.086 -0.276 p 0.999 0.035 0.381 0.275 0.107 0.046 0.376 0.004 FFMQ_a r 0.110 0.387 0.040 -0.252 -0.326 -0.194 -0.435 -0.414 p 0.260 < 0.001 0.678 0.008 0.001 0.043 < 0.001 < 0.001 FFMQ_nj r 0.464 0.425 0.133 -0.376 -0.398 -0.260 -0.162 -0.352 p < 0.001 < 0.001 0.167 < 0.001 < 0.001 0.006 0.093 < 0.001 FFMQ_nr r 0.530 0.262 0.381 -0.263 -0.359 -0.199 -0.300 -0.081 p < 0.001 0.006 < 0.001 0.006 < 0.001 0.038 0.002 0.403 Notes : N = 109, FFMQ = Five-Facet Mindfulness Questionnaire, FFMQ_o = FFMQ observing subscale, FFMQ_d = FFMQ describing subscale, FFMQ_a = FFMQ acting with awareness subscale, FFMQ_nj = FFMQ nonjudging subscale, FFMQ_nr = FFMQ nonreactivity subscale, SCS = Self-Compassion Scale, RSES = Rosenberg Self-Esteem Scale, CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, BDI-S = Beck Depression Inventory Shortened, BHS-S = Beck Hopelessness Inventory Shortened, BIS-8 = Barratt Impulsivity Scale Shortened, DES = Dissociative Experience Scale 3.3. Nonsuicidal self-injury (NSSI) Figure 2 illustrates the frequency of NSSI methods reported by participants. Self-hitting and skin-cutting were the most common types of NSSI, and 51.37% of the patients used multimethod NSSI. In terms of frequency, 13.8% of the patients engaged in NSSI 1–3 times per year , 39.4% monthly , 32.1% weekly , and 14.7% at least daily . No statistically significant correlations were found between NSSI severity, measured by the frequency or number of methods, and any of the assessed psychological variables, including mindfulness skills, dissociation, impulsivity, self-compassion, self-esteem, depressive symptoms, or emotion regulation strategies. 3.4. Predictive models of NSSI frequency To identify potential predictors of NSSI frequency, two ordinal general linear models (GLMs) were constructed. In both initial models, the outcome variable was NSSI frequency, with 1–3 events per year used as the reference category. In the first model, predictor variables included the FFMQ total score; all CERQ_mad and CERQ_ad* subscales; and scores from the BDI-S, BIS-8-S, SCS, and DES. A multicollinearity check was used before the analyses. To minimise multicollinearity, the Beck Hopelessness Scale (BHS-S) was excluded from the model because it showed an extremely strong correlation with the BDI (r = .696). There was no collinearity or multicollinearity between the remaining variables (r < .528 and VIF = 1.128–1.746 in all cases). After stepwise model refinement, three predictors were retained on the basis of statistical significance (see Table 4 ). While the model exhibited weak explanatory power, it still demonstrated a significant improvement in fit over the null model (Χ 2 ( 3 ) = 12.529, p = 0.006). Table 4 Parameter estimates in the ordinal GLM of NSSI frequency Parameter OR (Exp(B)) p 95% Wald CI BIS-8-S 1.099 0.035 1.007–1.199 CERQ_ad* 1.048 0.004 1.015–1.082 SCS 0.972 0.043 0.945–0.999 Notes : BIS-8-S = Barratt Impulsivity Scale Shortened; SCS = Self-Compassion Scale; CERQ_ad*=Cognitive Emotion Regulation Questionnaire modified adaptive subscale, without items 20 and 23. Model: Χ2( 3 ) = 12.529, p = .006 In the second model, predictor variables included age; the number of comorbid diagnoses; and dummy-coded variables for sex, history of suicide attempts (yes vs. no), and family history of suicide (yes vs. no). There was no collinearity or multicollinearity among the variables (r < .238 and VIF = 1.014–1.113 in all cases). No significant model could be established with these predictors. 4. Discussion 4.1. Interpretation of results This cross-sectional study aimed to explore the complex relationships among mindfulness, emotion regulation, and NSSI among borderline outpatients to inform a targeted, time-limited MBCT-based intervention. All participants were female outpatients enrolled in an experimental MBCT group at a nationwide specialist clinic. Over half of the sample reported engaging in multimethod NSSI, and 45.3% reported self-harming at least weekly, which is consistent with prior findings ( 29 , 30 ). In addition to BPD, most patients have comorbid mood or personality disorders. Self-reported data revealed low levels of self-esteem, self-compassion, and mindfulness skills, alongside elevated levels of depression, hopelessness, and impulsivity. These findings align with previous studies investigating risk factors associated with NSSI ( 11 , 30 , 38 , 40 ). Consistent with mindfulness deficit theory ( 16 – 18 ), mindfulness skills were notably diminished across all FFMQ subscales, with the most significant deficit observed in the nonjudging facet. Our first hypothesis (H1) was confirmed: higher levels of mindfulness were associated with higher self-esteem, self-compassion, and adaptive emotion regulation and inversely related to depression, hopelessness, impulsivity, and dissociation. These findings align with earlier research supporting the protective role of mindfulness against psychological distress ( 45 , 46 , 49 , 54 ). Our second hypothesis (H2)—that the two indicators of NSSI severity (frequency and number of methods) are significantly associated with clinical and psychometric variables—was not supported. None of the bivariate correlations between NSSI and the assessed psychological factors reached statistical significance. This lack of association suggests that, within this sample, NSSI behavior may not be linearly related to commonly assessed psychological constructs such as mindfulness deficits, dissociation, impulsivity, or emotion regulation difficulties. These null findings may reflect the complexity of NSSI in individuals with BPD, indicating that its function or severity may be influenced by other, unmeasured variables or dynamic, context-specific factors not captured in static self-report measures. 4.2. Unexpected findings Despite weak bivariate associations, an ordinal GLM revealed a statistically significant model for predicting NSSI frequency. Self-compassion emerged as a protective factor, and impulsivity increased vulnerability, which is consistent with prior findings ( 48 ). Unexpectedly, however, higher scores on the adaptive cognitive emotional strategies subscale also appeared to be a risk factor. This counterintuitive result may reflect interpretive or measurement challenges and warrants further investigation. 4.2.1. Context-sensitive implementation Prior research has highlighted that the putative adaptiveness of emotion regulation strategies depends on their type and flexible, context-sensitive implementation. Types of emotions and levels of stress can turn a putatively adaptive strategy into maladaptive coping, or they can also inhibit the practical application of an adaptive strategy known at a cognitive level ( 75 – 77 ). Moreover, clinical populations may differ fundamentally from nonclinical populations in how such strategies function ( 78 ). For example, items from the CERQ's putting into perspective subscale (e.g., “I think that other people go through much worse experiences” ) may unintentionally encourage suppression or self-invalidation in BPD, rather than resilience. 4.2.2. Polyregulation and functional sequences There is also growing evidence of polyregulation and the dynamic use of complex strategies during emotional regulation ( 79 , 80 ). In this context, NSSI might serve as an acute emotion-suppression mechanism that temporarily enables cognitive regulation strategies. Thus, the correlation may reflect a reversed pathway—adaptive strategy use may follow NSSI but not precede it. 4.2.3. Self-reflective and semantic distortions in BPD Another possible explanation involves BPD-specific cognitive‒affective biases. Individuals with BPD often have a fragmented self-concept and heightened sensitivity to evaluative language ( 81 – 83 ). They tend to exhibit negative self-referential processing biases, interpreting even neutral or positive self-statements through a distorted lens, further undermining emotional stability ( 82 , 83 ). This may cause them to interpret positively valenced self-reported items (e.g., “best,” “pleasant,” “unpleasant” ) in distorted ways, leading to paradoxically high scores on adaptive subscales that reflect identity disturbance or vulnerability, not coping skills. Impaired identity is associated with increased rumination and reduced self-control( 81 ), all of which can lead to increased emotional distress and a greater reliance on NSSI as a maladaptive coping mechanism. An alternative explanation involves the BPD population’s heightened susceptibility to evaluative language and impaired self-reflection. Individuals with BPD are often characterised by a fragmented and incoherent self-concept, which increases sensitivity to evaluative phrasing and reduces self-reflective capacity ( 81 – 83 ). They tend to exhibit negative self-referential processing biases, interpreting even neutral or positive self-statements through a distorted lens, further undermining emotional stability ( 82 , 83 ). These tendencies may help explain the unexpected appearance of adaptive emotion regulation strategies as risk factors in the model. When individuals with BPD encounter evaluative self-report items, such as those in the CERQ subscales (e.g., “pleasant,” “best,” “bad,” and “unpleasant” about self or behaviours), their elevated scores on some “adaptive” subscales may paradoxically reflect identity disturbance and heightened vulnerability rather than true coping ability. More impaired identity is associated with intensified ruminative processing, diminished self-control, and reduced identity integration ( 81 ), all of which can lead to increased emotional distress and a greater reliance on NSSI as a maladaptive coping mechanism. Future research should explore these interpretations and incorporate qualitative methods (e.g., three-step test interviews ( 84 )) to better understand how individuals interpret these items. It is essential to determine whether high scores on these adaptive subscales reflect genuine coping strategies or maladaptive responses distorted by BPD-specific cognitive-affective biases. Although mindfulness was not a direct predictor of NSSI in the GLM, the model's significant predictors (self-compassion, acceptance, impulsivity) were all closely associated with mindfulness. This finding is consistent with studies suggesting an indirect role of mindfulness through mediating psychological processes ( 48 ). Furthermore, it is also consistent with broader models of NSSI, including the four functions ( 26 ), the cognitive-emotional ( 41 ), and the cognitive-emotional reactivity ( 42 ) models. However, this finding contrasts with that of Per ( 52 ), who identified the direct effects of nonjudging and acting with awareness on NSSI engagement. 4.3. Clinical implications From a clinical standpoint, these findings highlight the importance of assessing not only the self-reported use of cognitive emotion regulation strategies but also their depth, flexibility, and functional implementation. The apparent high use of adaptive strategies may mask the limited capacity for emotionally grounded application, particularly in individuals with BPD. This underscores the need to move beyond cognitive instruction. Emotional regulation skills must be developed through experiential learning, generalised across emotional intensities and contexts, and integrated at the cognitive, affective, and bodily levels. Therapeutic approaches such as DBT, mentalization-based therapy (MBT), and MBCT already incorporate these elements and may be particularly suitable for addressing this regulatory mismatch. Finally, our results also support the relevance of loving-kindness meditation for individuals with BPD. Previous studies ( 50 – 53 ) have shown that this practice enhances self-compassion as an essential protective factor against NSSI, as identified in our results. 4.4. Strengths and limitations A primary limitation was the use of an interview-based method for assessing NSSI rather than a validated self-report measure due to the lack of such instruments in the local language at the time of data collection. Although this approach provides structured insights, including standardised tools in future research would enhance reliability and comparability. Additionally, concerns around the interpretive validity of certain CERQ subscales, particularly in the BPD population, highlight the need for mixed-methods research. The incorporation of qualitative interviews, such as the three-step test interview ( 78 ), may help contextualise patients' interpretations of adaptive vs. maladaptive coping strategies. Despite these limitations, the study has several strengths. The clinical sample reflects real-world treatment-seeking BPD patients across multiple institutions, enhancing generalizability. The relatively large clinical sample and multimethod assessment approach—including both self-report scales and clinical interviews—provided a comprehensive understanding of psychological functioning in this population. 4.5. Summary This study explored the relationships among mindfulness, NSSI, and emotion regulation in BPD patients to lay the groundwork for a time-limited, targeted MBCT-based intervention. The participants exhibited low self-compassion, mindfulness, and self-esteem, alongside high levels of impulsivity, depression, and frequent NSSI, thus highlighting a profile of elevated vulnerability. The findings identified low self-compassion, reduced acceptance, and high impulsivity as key risk factors for frequent NSSI. Although mindfulness was not a direct predictor of self-injury, its moderate associations with protective and risk factors suggest that it could indirectly influence NSSI behavior. These insights support the need for interventions that strengthen self-compassion and acceptance while addressing impulsivity and potentially maladaptive interpretations of otherwise adaptive strategies. Enhancing mindfulness—especially nonjudging and nonreactive mindfulness—may improve emotional regulation and reduce NSSI vulnerability. Overall, this study highlights the psychological mechanisms most relevant for a brief, targeted MBCT intervention. While further research is essential, especially with more refined measures and qualitative insights, prioritising psychological targets such as impulsivity and self-harm vulnerability may lead to more effective, scalable interventions for BPD, an urgent need in the face of limited healthcare resources and elevated suicide risk. Declarations Acknowledgement We thank our colleagues for their insightful feedback and our dedicated research assistants (Emese Misák, Dorottya Sal, Barbara Kulig) for their invaluable support in organising the study. We are also deeply thankful to all the participants in our pilot research, from whom we gleaned significant insights into the intricate issue of self-harm. Declaration of interests : None. Conflict of interest : None. Funding : This research was financed by the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, which is within the framework of the Neurology thematic program of Semmelweis University, TKP/2021. Human Ethics and Consent to Participate declarations: This study was approved by the Regional and Institutional Committee of Science and Research Ethics of Semmelweis University (Approval number: 240/2018). All participants provided written informed consent prior to participation. Consent to Participate declaration: All participants gave written informed consent to participate in the study. Authors’ Contribution: The manuscript text was edited for grammar and language clarity via Grammarly (Grammarly Inc., San Francisco, CA). All content and interpretations are the original work of the authors. KSz, ZGÁ and PFD conceived the study and developed the theoretical framework. KSz and ZGÁ collected the data. KSz, SzT and MM analysed the data. PFD supervised the project. All the authors discussed the results and contributed to the final manuscript. Availability of data and materials: The deidentified dataset and supporting documentation are openly available via the Open Science Framework (OSF): https://osf.io/29qn6 Clinical trial number: Not applicable (this study was a cross-sectional, observational design and does not meet the criteria for a clinical trial). The project and data are publicly registered at: https://doi.org/10.17605/OSF.IO/ZUR84 References APA. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7301363","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512010206,"identity":"0caf5103-339d-4322-b6de-0173e43a9962","order_by":0,"name":"Szilvia Kresznerits","email":"","orcid":"","institution":"Semmelweis University","correspondingAuthor":false,"prefix":"","firstName":"Szilvia","middleName":"","lastName":"Kresznerits","suffix":""},{"id":512010207,"identity":"92814ec4-7c27-482e-a17e-f1480466414a","order_by":1,"name":"Ágnes Zinner-Gérecz","email":"","orcid":"","institution":"Semmelweis University","correspondingAuthor":false,"prefix":"","firstName":"Ágnes","middleName":"","lastName":"Zinner-Gérecz","suffix":""},{"id":512010208,"identity":"62733a3f-7b70-4b1f-bcda-5ff19e9b803e","order_by":2,"name":"Mónika Miklósi","email":"","orcid":"","institution":"Eötvös Loránd University","correspondingAuthor":false,"prefix":"","firstName":"Mónika","middleName":"","lastName":"Miklósi","suffix":""},{"id":512010210,"identity":"053b498c-37bb-4c81-b82a-66039928fb62","order_by":3,"name":"Tamás Szekeres","email":"","orcid":"","institution":"National Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Tamás","middleName":"","lastName":"Szekeres","suffix":""},{"id":512010211,"identity":"bcae8533-311f-4951-85d8-f74817c8ed4b","order_by":4,"name":"Dóra Perczel-Forintos","email":"data:image/png;base64,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","orcid":"","institution":"Semmelweis University","correspondingAuthor":true,"prefix":"","firstName":"Dóra","middleName":"","lastName":"Perczel-Forintos","suffix":""}],"badges":[],"createdAt":"2025-08-05 13:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7301363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7301363/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07740-0","type":"published","date":"2026-01-16T16:29:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91104298,"identity":"97833f5b-2869-44eb-8935-baafc9f1f2c3","added_by":"auto","created_at":"2025-09-11 15:13:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe cognitive-emotional reactivity model of NSSI in BPD\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7301363/v1/ee908a4b3726d5e79ab99786.png"},{"id":91104814,"identity":"b922fed4-c003-4b50-aec7-566e9678a14d","added_by":"auto","created_at":"2025-09-11 15:21:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52164,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDescriptive statistics of the NSSI methods used.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNotes. \u003c/strong\u003en = number of patients who used the specified NSSI method. N\u003csub\u003etotal participants\u003c/sub\u003e = 109\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7301363/v1/dde569b2a5d0fe7a33f86862.png"},{"id":100614522,"identity":"8abd5e0b-c072-42d4-8a91-c6e3ff0ae83c","added_by":"auto","created_at":"2026-01-19 17:21:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1745369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7301363/v1/82c561b8-3b0f-493b-a53d-2fa040682689.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychological correlates of nonsuicidal self-injury in women with borderline personality disorder: A cross-sectional study to inform mindfulness-based interventions","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Emotion regulation, impulsivity, and mindfulness skills in individuals with borderline personality disorder\u003c/h2\u003e\u003cp\u003eBorderline personality disorder (BPD) is a serious, complex, and pervasive mental illness characterised by dysfunctional patterns of instability in self-image, interpersonal relationships, affects, cognitions, and behaviours (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Suicide deaths are particularly high in this patient population, with at least 3\u0026ndash;6% according to follow-up studies; other studies estimate a 10% suicide rate in BPD patients, with an increased risk of younger age and male sex (Paris, 2019). BPD is also associated with severe functional impairment and a host of dysregulated behaviours that can cause harm to the individual and to the individual\u0026rsquo;s social environment, such as nonsuicidal self-injury (NSSI), substance use (23\u0026ndash;84%), disordered eating (14\u0026ndash;53%), and verbal or physical aggression (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, BPD is one of the most common personality disorders, with a point prevalence of 1.6% and a lifetime prevalence of 5.6% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Owing to the frequent and severe crises that characterise the disorder, patients highly utilise the healthcare system; 20% of psychiatric outpatients and 10% of inpatients have a diagnosis of BPD (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Given the high personal and societal burden of BPD, effective yet scalable psychotherapeutic interventions are essential. However, long waiting lists due to high demand can often lead to significant deterioration of the condition and increase the risk of suicide (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Therefore, to mitigate this risk, there is a need for short, evidence-based interventions that address the most critical factors, such as self-harm and emotion regulation difficulties.\u003c/p\u003e\u003cp\u003eIn terms of emotional mechanisms, emotion dysregulation is a core trait of BPD and is characterised by heightened emotional vulnerability, insufficient control, intense reactions, and impaired impulse management (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These difficulties can even double the risk of nonsuicidal self-injury (NSSI) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The \u003cem\u003eemotional cascade model\u003c/em\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) emphasises rumination as central to self-harming behaviours in BPD patients. This repetitive worrying intensifies negative emotions, driving individuals to use self-injury to quickly relieve overwhelming negative emotions and thoughts.\u003c/p\u003e\u003cp\u003eIn BPD, impulses lead to sudden decisions and actions, especially under stress (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). According to the \u003cem\u003emindfulness deficit theory\u003c/em\u003e (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), emotion and impulse control difficulties in BPD patients can be derived from reduced mindfulness skills. BPD patients tend to avoid unpleasant emotions, hindering adaptive coping development. In distressing situations, hypersensitivity and emotion suppression can lead to increased impulsivity and reliance on maladaptive coping mechanisms, such as substance use or self-harm. In contrast, the purpose of mindfulness is to be aware and accepting of experiences, help individuals distance themselves from automatic reactions and respond more flexibly to internal and external stimuli (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.2. Self-harm and nonsuicidal self-injury, triggering and maintaining factors\u003c/h2\u003e\u003cp\u003eNSSI refers to deliberate, direct injuring or mutilation of one\u0026rsquo;s body tissue without suicidal intent (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) '\u003cem\u003eand for purposes not socially or culturally sanctioned\u0026rdquo;\u003c/em\u003e (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). NSSI affects 17%-18% of adolescents and 4%-6% of adults. Moreover, among psychiatric inpatients, NSSI rates can reach as high as 80% (\u003cspan additionalcitationids=\"CR23 CR24 CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Due to findings revealing its transdiagnostic nature, a distinct diagnostic code was added for NSSI in the DSM-5-TR (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNSSI also serves as a predictor of future suicidal behaviour (OR\u0026thinsp;=\u0026thinsp;4.27, 95% CI\u0026thinsp;=\u0026thinsp;2.56\u0026ndash;7.10) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Repetitive and multimethod NSSI is associated with increased suicide attempts. BPD patients are particularly vulnerable to this pattern, increasing their risk of suicide (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In addition to psychological risks, NSSIs can result in medical complications, including infections and tissue damage (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBiological factors also contribute significantly to the development of NSSI from a neurobiological perspective (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Heritability is estimated at 40\u0026ndash;60%, and gene‒environment interactions increase risk. Childhood adversity and stressors can also influence NSSI risk through various biological pathways. Fronto-limbic neural system changes are common in individuals with NSSI and affect emotion regulation and social processing. However, the role of cognitive control and the reward system in individuals with NSSI is less clear. Individuals with NSSI often show heightened sympathetic nervous system activity, altered cortisol response to stress, reduced pain sensitivity, and neural system changes during NSSI episodes (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychological vulnerabilities contributing to NSSI include childhood traumatisation, attachment problems, heightened emotional reactivity, low self-esteem, low self-compassion, low anxiety tolerance, and emotion dysregulation, particularly increased rumination (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Risk factors for NSSI include prior NSSI, cluster B personality disorders, and hopelessness, with social factors also playing a significant role, although to a lesser extent than emotional distress reduction does (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychological models have also been developed to describe the triggering and maintaining factors of NSSI. \u003cem\u003eThe cognitive-emotional model\u003c/em\u003e (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) suggests that emotional reactivity, the mental representation of self-harm, self-representations, and thoughts related to NSSI (i.e., the imagined outcome and the ability to cope) contribute to NSSI as a coping strategy. \u003cem\u003eThe four-function model\u003c/em\u003e (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) outlines four reinforcement processes that maintain NSSI: automatic/social and negative/positive reinforcement. On the basis of the meta-analysis examining this theory, NSSI serves intrapersonal functions, focusing primarily on emotion regulation and reducing negative emotional states. Nevertheless, 5\u0026ndash;21% of the tested participants did not use NSSI for emotion regulation. Therefore, treatments should assess all potential maintenance functions (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe \u003cem\u003ecognitive-emotional reactivity model\u003c/em\u003e (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) integrates key elements from the theories mentioned and extends them with insights from the cognitive reactivity model in recurrent depression (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In recurrent depression, cognitive reactivity heightens vulnerability after each episode, strengthening associations between different aspects of depression. The cognitive\u0026ndash;emotional reactivity model applies this concept to BPD, which is characterised by rapid, cyclical episodes that intensify cognitive and emotional reactivity.\u003c/p\u003e\u003cp\u003eMaladaptive coping strategies such as self-harm reinforce connections between negative thoughts, emotions, and bodily sensations. Triggering events initiate a vortex of negative thoughts and emotions, making it increasingly difficult to identify underlying processes (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Although NSSI may provide immediate emotional relief, it can also deepen self-blame and lead to perceived loss of control. Therefore, therapy aims to teach decentralisation from automatic responses, enabling individuals to break free from this vicious cycle and develop healthier emotional management strategies (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.3. Mindfulness-based practices in BPD and NSSI treatment\u003c/h2\u003e\u003cp\u003eDialectical behaviour therapy (DBT) is a well-established and widely used treatment for BPD that is specifically designed to address core symptoms such as emotion dysregulation, impulsivity, and self-harming behaviours (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Although the standard DBT program takes 12 months, adaptations with shorter durations (e.g., 20-week modules) have been developed to improve accessibility in healthcare settings.\u003c/p\u003e\u003cp\u003eImproving mindfulness skills is a foundational module of DBT, enhancing patients\u0026rsquo; awareness of internal experiences and reducing automatic, maladaptive responses. The development of mindfulness skills can directly address impulsivity (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and promote self-injury inhibition (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNeuroimaging studies suggest that mindfulness practices may alter neural activity in regions associated with the default mode network, emotion regulation, and impulse control and can reduce overall symptom severity in BPD patients (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to its impact on emotion regulation, mindfulness has also been associated with increased self-compassion, an important protective factor against self-harm. Greater self-compassion has been associated with reduced shame, self-criticism, and thought suppression\u0026mdash;mechanisms that often play a role in the maintenance of NSSI (\u003cspan additionalcitationids=\"CR51 CR52 CR53\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.4. Aims\u003c/h2\u003e\u003cp\u003eThis study examines the relationships among mindfulness skills, NSSI, and modifiable psychological factors in individuals with BPD. The primary goal is to inform the development of targeted mindfulness-based cognitive therapy for NSSI (MBCT-NSSI) by identifying key psychological correlates of self-injurious behavior.\u003c/p\u003e\u003cp\u003eWe propose the following hypotheses:\u003c/p\u003e\u003cp\u003e(H1) Mindfulness skills are positively correlated with adaptive emotion regulation, self-esteem, and self-compassion and negatively correlated with maladaptive emotion regulation, depression, hopelessness, impulsivity, and dissociation.\u003c/p\u003e\u003cp\u003e(H2) NSSI severity (i.e., frequency and number of methods used) is positively correlated with maladaptive regulation, depression, hopelessness, impulsivity, and dissociation but negatively correlated with mindfulness skills, adaptive regulation, self-esteem, and self-compassion.\u003c/p\u003e\u003c/div\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Procedures and sample\u003c/h2\u003e\u003cp\u003eThis study targeted adult BPD outpatients with self-reported NSSI in the past six months. The exclusion criteria included acute suicidal crisis, psychosis, bipolar manic episodes, severe substance use disorder, organic or symptomatic mental disorders, and intellectual disability. The sample size calculation (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) led to N\u0026thinsp;=\u0026thinsp;58.7 at 95% confidence and a\u0026thinsp;\u0026lt;\u0026thinsp;0.05 probability.\u003c/p\u003e\u003cp\u003eRecruitment involved establishing an experimental mindfulness training group for BPD patients who engaged in self-harm. The intervention followed the MBCT protocol adapted for suicide prevention by Williams et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Recruitment materials were disseminated across psychiatric departments and outpatient clinics nationwide. Eligible patients who sought individual therapy at our outpatient clinic were also informed about the opportunity to participate in the study and the experimental intervention group.\u003c/p\u003e\u003cp\u003eAll the applicants underwent a standard diagnostic procedure in line with the clinic\u0026rsquo;s protocol, which was conducted by trained clinical psychologists under the supervision of the last author. National regulations determine diagnoses on the basis of the ICD-10 criteria (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). The participants completed a semistructured interview about NSSI and a self-report questionnaire (printing or online). The questionnaire contains 18 demographic questions, and the other 160 items assess mindfulness skills, emotion regulation, self-esteem, self-compassion, depression, hopelessness, impulsivity, and dissociation.\u003c/p\u003e\u003cp\u003eA cross-sectional design was employed to examine the relationship between mindfulness and NSSI. Between 1st January 2019 and 30th June 2023, 158 applicants were screened for eligibility. All participants provided written informed consent, and the study received ethical approval. This study was a cross-sectional, observational design and does not meet the criteria for a clinical trial; therefore, no clinical trial number is applicable. The project and anonymised dataset are publicly registered at the Open Science Framework. A total of 120 outpatients (109 women [90.83%] and eleven men [9.16%]) met the inclusion criteria. To control for gender-related bias, only data from female participants were analysed. The final sample comprised 109 female BPD outpatients (M\u003csub\u003eage\u003c/sub\u003e: 27.50 years, SD\u0026thinsp;=\u0026thinsp;7.85).\u003c/p\u003e\u003cp\u003eEducation levels: 9.2% (N\u0026thinsp;=\u0026thinsp;10) had basic education, 55.0% (N\u0026thinsp;=\u0026thinsp;60) had secondary education, and 35.8% (N\u0026thinsp;=\u0026thinsp;39) had a degree in higher education. Employment status: 28.4% (N\u0026thinsp;=\u0026thinsp;31) were students, 48.6% (N\u0026thinsp;=\u0026thinsp;53) were employed or self-employed, and 22.9% (N\u0026thinsp;=\u0026thinsp;25) were unemployed or had other passive employment statuses. Comorbidities: A total of 74.31% (N\u0026thinsp;=\u0026thinsp;81) had at least one comorbid diagnosis beyond BPD, and 22.02% (N\u0026thinsp;=\u0026thinsp;24) had at least two additional diagnoses (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of comorbid disorders in the BPD sample (N\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComorbid diagnosis (ICD-10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026sum;%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBipolar (F31.3, F31.6, F31.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e40.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnipolar (F32.0, F32.1, F32.2, F32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecurrent/persistent (F33.0, F33.1, F34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNeurotic, stress-related, and somatoform disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMixed anxiety and depressive disorder (F41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e40,37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnxiety disorders (F40.0-F41.8, without F41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObsessive-compulsive disorder (F42.0-F42.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosttraumatic stress disorder (F43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEating disorders (F50.0, F50.2, F50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComorbid personality disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOther (F19.1 in remission, F51.0, F63.8, F84.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe manuscript text was edited via Grammarly (Grammarly Inc., San Francisco, CA) for grammar and language clarity. All content and interpretations are the original work of the authors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Measures\u003c/h2\u003e\u003cp\u003eThe following self-administered questionnaires were included in the statistical data analysis:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eThe general data sheet and NSSI\u003c/b\u003e captured demographic data, psychiatric history, suicide attempts, and details of NSSI severity (types and methods). The semistructured interview questions included \u0026ldquo;\u003cem\u003eHave you ever deliberately harmed yourself without intending to die?\u0026rdquo; \u0026ldquo;Have you done so in the past six months?\u0026rdquo;\u003c/em\u003e and \u0026ldquo;How many times or how often?\u0026rdquo; Participants who were unsure or unfamiliar with the terminology were provided with examples (e.g., cutting, burning). If one form of NSSI was identified, the others were queried systematically. If one type occurred, we also asked about other types based on the list shown in Fig.\u0026nbsp;2, including two additional categories (inserting objects under the skin or nails and tattooing), which did not occur in this sample. NSSI frequency was categorised as follows: 1) \u003cem\u003e1\u0026ndash;3 times per year\u003c/em\u003e, 2) \u003cem\u003eapproximately monthly\u003c/em\u003e, 3) \u003cem\u003eapproximately weekly\u003c/em\u003e, or 4) \u003cem\u003edaily or more frequently\u003c/em\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRosenberg Self-Esteem Scale (RSES)\u003c/b\u003e: A 10-item measure of global self-worth rated on a 4-point Likert scale (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFive-Facet Mindfulness Questionnaire (FFMQ)\u003c/b\u003e: A 39-item measure of mindfulness traits across five subscales: \u003cem\u003eobserving\u003c/em\u003e, \u003cem\u003edescribing\u003c/em\u003e, \u003cem\u003eacting with awareness\u003c/em\u003e, \u003cem\u003enonjudging inner experience\u003c/em\u003e, and \u003cem\u003enonreactivity\u003c/em\u003e (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). The adapted Hungarian questionnaire version (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) is under standardisation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBeck Depression Inventory \u0026ndash; Shortened version (BDI-S)\u003c/b\u003e: A 9-item measure of depression severity (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBeck Hopelessness Scale \u0026ndash; Shortened version (BHS-S)\u003c/b\u003e: A 4-item abbreviated scale of the original Beck Hopelessness Scale measuring hopelessness (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBarratt Impulsivity Scale-Shortened (BIS-8-S)\u003c/b\u003e: An 8-item self-report scale measuring impulsivity on a four-point Likert scale (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eDissociative Experiences Scale (DES)\u003c/b\u003e: A 28-item self-report questionnaire measuring the frequency of dissociative experiences, with responses ranging from 0\u0026ndash;100 (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCognitive Emotion-Regulation Questionnaire (CERQ)\u003c/b\u003e: A 36-item self-report measure to evaluate cognitive strategies in emotion regulation (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) with nine subscales (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). \u003cem\u003eSelf-blame\u003c/em\u003e, \u003cem\u003erumination\u003c/em\u003e, \u003cem\u003ecatastrophizing\u003c/em\u003e, and \u003cem\u003eblaming others\u003c/em\u003e represent maladaptive strategies, \u003cem\u003ewhereas refocusing on planning\u003c/em\u003e, \u003cem\u003epositive reappraisal\u003c/em\u003e, \u003cem\u003eputting into perspective\u003c/em\u003e, \u003cem\u003epositive refocusing\u003c/em\u003e, and \u003cem\u003eacceptance\u003c/em\u003e represent adaptive strategies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSelf-Compassion Scale (SCS)\u003c/b\u003e: A 26-item self-report instrument with three subdimensions of self-concept: \u003cem\u003eself-judgment\u003c/em\u003e vs. \u003cem\u003eself-kindness\u003c/em\u003e, \u003cem\u003eisolation\u003c/em\u003e vs. \u003cem\u003ecommon humanity\u003c/em\u003e, and \u003cem\u003eoveridentification\u003c/em\u003e vs. \u003cem\u003emindfulness\u003c/em\u003e (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data analyses\u003c/h2\u003e\u003cp\u003eData analysis was conducted with IBM SPSS Statistics 28\u0026copy;. Missing values were excluded from the study. A significance level (α) of 0.05 was used. Pearson\u0026rsquo;s correlation was employed to examine the relationships between continuous variables (e.g., clinical scales and number of NSSI methods). Spearman\u0026rsquo;s rank-order correlation was applied to assess associations between ordinal NSSI frequency categories and clinical variables. Ordinal general linear models (GLMs) were used to identify predictors of NSSI frequency.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Descriptive analysis of the clinical and psychometric scales\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the internal consistency and descriptive statistics of the administered psychometric instruments. All scales demonstrated acceptable reliability for early-stage research (Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;\u0026gt;\u0026thinsp;0.70), which is consistent with the guidelines of Nunnally and Bernstein (\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e). However, two FFMQ subscales (\u003cem\u003eobserving\u003c/em\u003e and \u003cem\u003enonreactivity\u003c/em\u003e) and the BIS-8-S presented Cronbach\u0026rsquo;s alpha values less than 0.80, indicating suboptimal reliability for applied research settings. Based on the confirmatory factor analysis (extraction method: maximum likelihood, rotation method: varimax with Kaiser normalisation), two items from the adaptive subscale of the CERQ were excluded from the analysis. \u003cem\u003eItem 20\u003c/em\u003e loaded more strongly on the maladaptive scale than on the adaptive scale, whereas\u0026nbsp;\u003cem\u003eitem 23\u003c/em\u003e had similar loadings on both factors (0.387 and 0.329). The revised scale is referred to as CERQ_ad*.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInternal reliabilities and descriptive statistics of the clinical and psychometric scales\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScales\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCronbach\u0026rsquo;s \u0026alpha;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealthy standards/cut-offs\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRSES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;15 (\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ_o\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ_d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ_a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ_nj\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ_nr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFMQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u0026ndash;195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;133.80, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21.58 (\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCERQ_ad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64.57, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.33 (\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCERQ_ad*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCERQ_mad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u0026ndash;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;39.04, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.01 (\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBDI-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;19 (\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBHS-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026ndash;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;9 (\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBIS-8-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15.46, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.98 (\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e772.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;2800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;70.31, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.11 (\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cstrong\u003eNotes\u003c/strong\u003e: N\u0026thinsp;=\u0026thinsp;109. Healthy standards or cut-off points were based on nationally standardised values for the general population, where such data were available. RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale, FFMQ\u0026thinsp;=\u0026thinsp;Five-Facet Mindfulness Questionnaire, FFMQ_o\u0026thinsp;=\u0026thinsp;FFMQ observing subscale, FFMQ_d\u0026thinsp;=\u0026thinsp;FFMQ describing subscale, FFMQ_a\u0026thinsp;=\u0026thinsp;FFMQ acting with awareness subscale, FFMQ_nj\u0026thinsp;=\u0026thinsp;FFMQ nonjudging to inner experience subscale, FFMQ_nr\u0026thinsp;=\u0026thinsp;FFMQ nonreactivity to inner experience subscale, CERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, CERQ_ad* = modified CERQ adaptive subscale, excluding items 20 and 23, BDI-S\u0026thinsp;=\u0026thinsp;Beck Depression Inventory Shortened, BHS-S\u0026thinsp;=\u0026thinsp;Beck Hopelessness Inventory Shortened, BIS-8-S\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, DES\u0026thinsp;=\u0026thinsp;Dissociative Experience Scale, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe participants, on average, demonstrated low self-esteem, self-compassion, and mindfulness skills. The mean depression and hopelessness scores exceeded the values typical for the general population, and the impulsivity levels were also elevated. In terms of emotion regulation, the scores for adaptive strategies were lower than the Hungarian normative values, whereas maladaptive strategy scores were noticeably higher (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Correlation of mindfulness skills with clinical and psychometric variables\u003c/h2\u003e\n \u003cp\u003eThe total mindfulness score (FFMQ) was positively correlated with protective psychological factors\u0026mdash;self-esteem, self-compassion, and adaptive emotion regulation strategies. In contrast, moderate negative correlations emerged between total mindfulness and depression, hopelessness, impulsivity, and dissociation. Although the correlations with specific emotion regulation strategies were weak, they aligned with the theoretical expectations (see Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAmong the FFMQ subscales, \u003cem\u003eacting with awareness\u003c/em\u003e, \u003cem\u003enonjudging inner experience\u003c/em\u003e, and \u003cem\u003enonreactivity to inner experience\u003c/em\u003e demonstrated the strongest associations with other psychological constructs. Specifically, \u003cem\u003eacting with awareness\u003c/em\u003e showed moderate negative correlations with impulsivity, depression, and dissociation. \u003cem\u003eNonjudging\u003c/em\u003e was positively correlated with self-esteem and self-compassion and negatively correlated with maladaptive emotion regulation, depression, and dissociation. Finally, \u003cem\u003enonreactivity\u003c/em\u003e was strongly positively correlated with self-compassion and moderately negatively correlated with depression (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePearson\u0026rsquo;s correlations between FFMQ subscales and other psychometric scales in BPD outpatients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRSES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCERQ_ ad\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCERQ_mad\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBDI-S\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBHS-S\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBIS-8-S\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDES\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.402\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.504\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.268\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.228\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.425\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.339\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.478\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.369\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ_o\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.206\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ_d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.191\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.276\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ_a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.387\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.252\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.326\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.194\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.435\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.414\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ_nj\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.464\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.425\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.376\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.398\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.260\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.352\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFFMQ_nr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.530\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.262\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.381\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.263\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.359\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.199\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003e\u003cstrong\u003eNotes\u003c/strong\u003e: N\u0026thinsp;=\u0026thinsp;109, FFMQ\u0026thinsp;=\u0026thinsp;Five-Facet Mindfulness Questionnaire, FFMQ_o\u0026thinsp;=\u0026thinsp;FFMQ observing subscale, FFMQ_d\u0026thinsp;=\u0026thinsp;FFMQ describing subscale, FFMQ_a\u0026thinsp;=\u0026thinsp;FFMQ acting with awareness subscale, FFMQ_nj\u0026thinsp;=\u0026thinsp;FFMQ nonjudging subscale, FFMQ_nr\u0026thinsp;=\u0026thinsp;FFMQ nonreactivity subscale, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale, RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale, CERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, BDI-S\u0026thinsp;=\u0026thinsp;Beck Depression Inventory Shortened, BHS-S\u0026thinsp;=\u0026thinsp;Beck Hopelessness Inventory Shortened, BIS-8\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, DES\u0026thinsp;=\u0026thinsp;Dissociative Experience Scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Nonsuicidal self-injury (NSSI)\u003c/h2\u003e\n \u003cp\u003eFigure 2 illustrates the frequency of NSSI methods reported by participants. Self-hitting and skin-cutting were the most common types of NSSI, and 51.37% of the patients used multimethod NSSI.\u003c/p\u003e\n \u003cp\u003eIn terms of frequency, 13.8% of the patients engaged in NSSI \u003cem\u003e1\u0026ndash;3 times per year\u003c/em\u003e, 39.4% \u003cem\u003emonthly\u003c/em\u003e, 32.1% \u003cem\u003eweekly\u003c/em\u003e, and 14.7% \u003cem\u003eat least daily\u003c/em\u003e.\u003c/p\u003e\n \u003cp\u003eNo statistically significant correlations were found between NSSI severity, measured by the frequency or number of methods, and any of the assessed psychological variables, including mindfulness skills, dissociation, impulsivity, self-compassion, self-esteem, depressive symptoms, or emotion regulation strategies.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4. Predictive models of NSSI frequency\u003c/h2\u003e\n \u003cp\u003eTo identify potential predictors of NSSI frequency, two ordinal general linear models (GLMs) were constructed. In both initial models, the outcome variable was NSSI frequency, with \u003cem\u003e1\u0026ndash;3 events per year\u003c/em\u003e used as the reference category. In the first model, predictor variables included the FFMQ total score; all CERQ_mad and CERQ_ad* subscales; and scores from the BDI-S, BIS-8-S, SCS, and DES. A multicollinearity check was used before the analyses. To minimise multicollinearity, the Beck Hopelessness Scale (BHS-S) was excluded from the model because it showed an extremely strong correlation with the BDI (r\u0026thinsp;=\u0026thinsp;.696). There was no collinearity or multicollinearity between the remaining variables (r\u0026thinsp;\u0026lt;\u0026thinsp;.528 and VIF\u0026thinsp;=\u0026thinsp;1.128\u0026ndash;1.746 in all cases).\u003c/p\u003e\n \u003cp\u003eAfter stepwise model refinement, three predictors were retained on the basis of statistical significance (see Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). While the model exhibited weak explanatory power, it still demonstrated a significant improvement in fit over the null model (\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;12.529, p\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eParameter estimates in the ordinal GLM of NSSI frequency\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (Exp(B))\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% Wald CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBIS-8-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.007\u0026ndash;1.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCERQ_ad*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.015\u0026ndash;1.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.945\u0026ndash;0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eNotes\u003c/strong\u003e: BIS-8-S\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened; SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale; CERQ_ad*=Cognitive Emotion Regulation Questionnaire modified adaptive subscale, without items 20 and 23. Model: \u0026Chi;2(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;12.529, p\u0026thinsp;=\u0026thinsp;.006\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eIn the second model, predictor variables included age; the number of comorbid diagnoses; and dummy-coded variables for sex, history of suicide attempts (yes vs. no), and family history of suicide (yes vs. no). There was no collinearity or multicollinearity among the variables (r\u0026thinsp;\u0026lt;\u0026thinsp;.238 and VIF\u0026thinsp;=\u0026thinsp;1.014\u0026ndash;1.113 in all cases). No significant model could be established with these predictors.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Interpretation of results\u003c/h2\u003e\u003cp\u003eThis cross-sectional study aimed to explore the complex relationships among mindfulness, emotion regulation, and NSSI among borderline outpatients to inform a targeted, time-limited MBCT-based intervention. All participants were female outpatients enrolled in an experimental MBCT group at a nationwide specialist clinic.\u003c/p\u003e\u003cp\u003eOver half of the sample reported engaging in multimethod NSSI, and 45.3% reported self-harming at least weekly, which is consistent with prior findings (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In addition to BPD, most patients have comorbid mood or personality disorders. Self-reported data revealed low levels of self-esteem, self-compassion, and mindfulness skills, alongside elevated levels of depression, hopelessness, and impulsivity. These findings align with previous studies investigating risk factors associated with NSSI (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConsistent with mindfulness deficit theory (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), mindfulness skills were notably diminished across all FFMQ subscales, with the most significant deficit observed in the \u003cem\u003enonjudging\u003c/em\u003e facet.\u003c/p\u003e\u003cp\u003eOur first hypothesis (H1) was confirmed: higher levels of mindfulness were associated with higher self-esteem, self-compassion, and adaptive emotion regulation and inversely related to depression, hopelessness, impulsivity, and dissociation. These findings align with earlier research supporting the protective role of mindfulness against psychological distress (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur second hypothesis (H2)\u0026mdash;that the two indicators of NSSI severity (frequency and number of methods) are significantly associated with clinical and psychometric variables\u0026mdash;was not supported. None of the bivariate correlations between NSSI and the assessed psychological factors reached statistical significance. This lack of association suggests that, within this sample, NSSI behavior may not be linearly related to commonly assessed psychological constructs such as mindfulness deficits, dissociation, impulsivity, or emotion regulation difficulties. These null findings may reflect the complexity of NSSI in individuals with BPD, indicating that its function or severity may be influenced by other, unmeasured variables or dynamic, context-specific factors not captured in static self-report measures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Unexpected findings\u003c/h2\u003e\u003cp\u003eDespite weak bivariate associations, an ordinal GLM revealed a statistically significant model for predicting NSSI frequency. Self-compassion emerged as a protective factor, and impulsivity increased vulnerability, which is consistent with prior findings (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Unexpectedly, however, higher scores on the adaptive cognitive emotional strategies subscale also appeared to be a risk factor. This counterintuitive result may reflect interpretive or measurement challenges and warrants further investigation.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1. Context-sensitive implementation\u003c/h2\u003e\u003cp\u003ePrior research has highlighted that the putative adaptiveness of emotion regulation strategies depends on their type and flexible, context-sensitive implementation. Types of emotions and levels of stress can turn a putatively adaptive strategy into maladaptive coping, or they can also inhibit the practical application of an adaptive strategy known at a cognitive level (\u003cspan additionalcitationids=\"CR76\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). Moreover, clinical populations may differ fundamentally from nonclinical populations in how such strategies function (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). For example, items from the CERQ's putting into perspective subscale (e.g., \u003cem\u003e\u0026ldquo;I think that other people go through much worse experiences\u0026rdquo;\u003c/em\u003e) may unintentionally encourage suppression or self-invalidation in BPD, rather than resilience.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2. Polyregulation and functional sequences\u003c/h2\u003e\u003cp\u003eThere is also growing evidence of polyregulation and the dynamic use of complex strategies during emotional regulation (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e). In this context, NSSI might serve as an acute emotion-suppression mechanism that temporarily enables cognitive regulation strategies. Thus, the correlation may reflect a reversed pathway\u0026mdash;adaptive strategy use may follow NSSI but not precede it.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e4.2.3. Self-reflective and semantic distortions in BPD\u003c/h2\u003e\u003cp\u003eAnother possible explanation involves BPD-specific cognitive‒affective biases. Individuals with BPD often have a fragmented self-concept and heightened sensitivity to evaluative language (\u003cspan additionalcitationids=\"CR82\" citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). They tend to exhibit negative self-referential processing biases, interpreting even neutral or positive self-statements through a distorted lens, further undermining emotional stability (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). This may cause them to interpret positively valenced self-reported items (e.g., \u003cem\u003e\u0026ldquo;best,\u0026rdquo; \u0026ldquo;pleasant,\u0026rdquo; \u0026ldquo;unpleasant\u0026rdquo;\u003c/em\u003e) in distorted ways, leading to paradoxically high scores on adaptive subscales that reflect identity disturbance or vulnerability, not coping skills. Impaired identity is associated with increased rumination and reduced self-control(\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), all of which can lead to increased emotional distress and a greater reliance on NSSI as a maladaptive coping mechanism.\u003c/p\u003e\u003cp\u003eAn alternative explanation involves the BPD population\u0026rsquo;s heightened susceptibility to evaluative language and impaired self-reflection. Individuals with BPD are often characterised by a fragmented and incoherent self-concept, which increases sensitivity to evaluative phrasing and reduces self-reflective capacity (\u003cspan additionalcitationids=\"CR82\" citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). They tend to exhibit negative self-referential processing biases, interpreting even neutral or positive self-statements through a distorted lens, further undermining emotional stability (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). These tendencies may help explain the unexpected appearance of adaptive emotion regulation strategies as risk factors in the model. When individuals with BPD encounter evaluative self-report items, such as those in the CERQ subscales (e.g., \u0026ldquo;pleasant,\u0026rdquo; \u0026ldquo;best,\u0026rdquo; \u0026ldquo;bad,\u0026rdquo; and \u0026ldquo;unpleasant\u0026rdquo; about self or behaviours), their elevated scores on some \u0026ldquo;adaptive\u0026rdquo; subscales may paradoxically reflect identity disturbance and heightened vulnerability rather than true coping ability. More impaired identity is associated with intensified ruminative processing, diminished self-control, and reduced identity integration (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), all of which can lead to increased emotional distress and a greater reliance on NSSI as a maladaptive coping mechanism.\u003c/p\u003e\u003cp\u003eFuture research should explore these interpretations and incorporate qualitative methods (e.g., three-step test interviews (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e)) to better understand how individuals interpret these items. It is essential to determine whether high scores on these adaptive subscales reflect genuine coping strategies or maladaptive responses distorted by BPD-specific cognitive-affective biases.\u003c/p\u003e\u003cp\u003eAlthough mindfulness was not a direct predictor of NSSI in the GLM, the model's significant predictors (self-compassion, acceptance, impulsivity) were all closely associated with mindfulness. This finding is consistent with studies suggesting an indirect role of mindfulness through mediating psychological processes (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Furthermore, it is also consistent with broader models of NSSI, including the four functions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), the cognitive-emotional (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), and the cognitive-emotional reactivity (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) models. However, this finding contrasts with that of Per (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), who identified the direct effects of \u003cem\u003enonjudging\u003c/em\u003e and \u003cem\u003eacting with awareness\u003c/em\u003e on NSSI engagement.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Clinical implications\u003c/h2\u003e\u003cp\u003eFrom a clinical standpoint, these findings highlight the importance of assessing not only the self-reported use of cognitive emotion regulation strategies but also their depth, flexibility, and functional implementation. The apparent high use of adaptive strategies may mask the limited capacity for emotionally grounded application, particularly in individuals with BPD. This underscores the need to move beyond cognitive instruction. Emotional regulation skills must be developed through experiential learning, generalised across emotional intensities and contexts, and integrated at the cognitive, affective, and bodily levels.\u003c/p\u003e\u003cp\u003eTherapeutic approaches such as DBT, mentalization-based therapy (MBT), and MBCT already incorporate these elements and may be particularly suitable for addressing this regulatory mismatch.\u003c/p\u003e\u003cp\u003eFinally, our results also support the relevance of loving-kindness meditation for individuals with BPD. Previous studies (\u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) have shown that this practice enhances self-compassion as an essential protective factor against NSSI, as identified in our results.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Strengths and limitations\u003c/h2\u003e\u003cp\u003eA primary limitation was the use of an interview-based method for assessing NSSI rather than a validated self-report measure due to the lack of such instruments in the local language at the time of data collection. Although this approach provides structured insights, including standardised tools in future research would enhance reliability and comparability.\u003c/p\u003e\u003cp\u003eAdditionally, concerns around the interpretive validity of certain CERQ subscales, particularly in the BPD population, highlight the need for mixed-methods research. The incorporation of qualitative interviews, such as the three-step test interview (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e), may help contextualise patients' interpretations of adaptive vs. maladaptive coping strategies.\u003c/p\u003e\u003cp\u003eDespite these limitations, the study has several strengths. The clinical sample reflects real-world treatment-seeking BPD patients across multiple institutions, enhancing generalizability. The relatively large clinical sample and multimethod assessment approach\u0026mdash;including both self-report scales and clinical interviews\u0026mdash;provided a comprehensive understanding of psychological functioning in this population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Summary\u003c/h2\u003e\u003cp\u003eThis study explored the relationships among mindfulness, NSSI, and emotion regulation in BPD patients to lay the groundwork for a time-limited, targeted MBCT-based intervention. The participants exhibited low self-compassion, mindfulness, and self-esteem, alongside high levels of impulsivity, depression, and frequent NSSI, thus highlighting a profile of elevated vulnerability.\u003c/p\u003e\u003cp\u003eThe findings identified low self-compassion, reduced acceptance, and high impulsivity as key risk factors for frequent NSSI. Although mindfulness was not a direct predictor of self-injury, its moderate associations with protective and risk factors suggest that it could indirectly influence NSSI behavior.\u003c/p\u003e\u003cp\u003eThese insights support the need for interventions that strengthen self-compassion and acceptance while addressing impulsivity and potentially maladaptive interpretations of otherwise adaptive strategies. Enhancing mindfulness\u0026mdash;especially \u003cem\u003enonjudging\u003c/em\u003e and nonreactive mindfulness\u0026mdash;may improve emotional regulation and reduce NSSI vulnerability.\u003c/p\u003e\u003cp\u003eOverall, this study highlights the psychological mechanisms most relevant for a brief, targeted MBCT intervention. While further research is essential, especially with more refined measures and qualitative insights, prioritising psychological targets such as impulsivity and self-harm vulnerability may lead to more effective, scalable interventions for BPD, an urgent need in the face of limited healthcare resources and elevated suicide risk.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgement\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe thank our colleagues for their insightful feedback and our dedicated research assistants (Emese Mis\u0026aacute;k, Dorottya Sal, Barbara Kulig) for their invaluable support in organising the study. We are also deeply thankful to all the participants in our pilot research, from whom we gleaned significant insights into the intricate issue of self-harm.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research was financed by the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, which is within the framework of the\u0026nbsp;Neurology thematic program of Semmelweis\u0026nbsp;University, TKP/2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Regional and Institutional Committee of Science and Research Ethics of Semmelweis University (Approval number: 240/2018). All participants provided written informed consent prior to participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u003c/strong\u003e All participants gave written informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution:\u003c/strong\u003e The manuscript text was edited for grammar and language clarity via Grammarly (Grammarly Inc., San Francisco, CA). All content and interpretations are the original work of the authors. KSz, ZG\u0026Aacute; and PFD conceived the study and developed the theoretical framework. KSz and ZG\u0026Aacute; collected the data. KSz, SzT and MM analysed the data. PFD supervised the project. All the authors discussed the results and contributed to the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The deidentified dataset and supporting documentation are openly available via the Open Science Framework (OSF): https://osf.io/29qn6\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable (this study was a cross-sectional, observational design and does not meet the criteria for a clinical trial). The project and data are publicly registered at: https://doi.org/10.17605/OSF.IO/ZUR84\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAPA. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA, US: American Psychiatric Publishing, Inc.; 2013. xliv, 947-xliv, p.\u003c/li\u003e\n\u003cli\u003eShah R, Zanarini MC. Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. 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Survey Research Methods. 2008;2:143-50.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Borderline personality disorder, self-injurious behaviour, mindfulness, emotional regulation, impulsive behaviour, self-compassion, suicide prevention","lastPublishedDoi":"10.21203/rs.3.rs-7301363/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7301363/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: Nonsuicidal self-injury (NSSI) is a significant predictor of suicide, particularly among patients with borderline personality disorder (BPD). This study examined modifiable psychological factors linked to NSSI to inform the development of a mindfulness-based intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: In a cross-sectional design, 109 female BPD patients completed self-reported measures assessing NSSI behaviors, mindfulness skills, emotion regulation strategies, depressive symptoms, and self-compassion. Correlational analyses were performed to examine the relationships among the psychological variables, NSSI frequency, and number of NSSI methods employed. Ordinal general linear models were used to identify predictors of NSSI frequency.\u003cbr\u003e\n \u003cstrong\u003eResults\u003c/strong\u003e: Participants reported low levels of self-compassion, mindfulness skills, and self-esteem, alongside high depression, impulsivity, and frequent self-harming behaviour. The key risk factors for more frequent NSSI included increased impulsivity (95% CI: 1.007–1.199), higher scores on the adaptive cognitive emotional regulation strategies subscale (95% CI: 1.015–1.082) and reduced self-compassion (95% CI: 0.945–0.999). Although mindfulness skills were not directly linked to the frequency of NSSI or the number of methods used, they were moderately correlated with these risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: These findings underscore the importance of targeted interventions for NSSI in BPD patients. Mindfulness-based approaches may reduce suicide risk and improve treatment engagement by addressing deficits in impulsivity, acceptance, and self-compassion.\u003c/p\u003e","manuscriptTitle":"Psychological correlates of nonsuicidal self-injury in women with borderline personality disorder: A cross-sectional study to inform mindfulness-based interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 15:13:38","doi":"10.21203/rs.3.rs-7301363/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-29T04:52:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T17:31:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-20T16:53:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202571904823336971111593125250446214602","date":"2025-09-20T15:15:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105279260394615565990829117323150801331","date":"2025-09-15T12:28:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66027708397339773832250591328309147562","date":"2025-09-08T14:56:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T17:03:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-08T14:15:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T14:12:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-08-05T13:48:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5833db10-9597-4cbf-95dc-b1f83cb26c02","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:47:16+00:00","versionOfRecord":{"articleIdentity":"rs-7301363","link":"https://doi.org/10.1186/s12888-025-07740-0","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2026-01-16 16:29:50","publishedOnDateReadable":"January 16th, 2026"},"versionCreatedAt":"2025-09-11 15:13:38","video":"","vorDoi":"10.1186/s12888-025-07740-0","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07740-0","workflowStages":[]},"version":"v1","identity":"rs-7301363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7301363","identity":"rs-7301363","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}