Abstract
BACKGROUND: Adolescence is a period marked by emotional volatility, interpersonal vulnerability, and underdeveloped cognitive control, making youths especially susceptible to non-suicidal self-injury. Distinct forms of NSSI may differ in psychological function and clinical relevance. This study is the first to employ network analysis with dual network models to examine the complex interplay among emotion regulation, interpersonal sensitivity, cognitive insight, and 18 specific NSSI behaviors in adolescents. The primary goal was to identify key psychological nodes and central NSSI behaviors within the network structure to inform more targeted prevention and intervention strategies. METHODS: A total of 5572 adolescents (ages 12-18; 53.9% male) from three urban secondary schools in Nanning, Guangxi Zhuang Autonomous Region, China, participated in self-report surveys conducted between September and November 2023. Standardized and previously validated instruments were used to assess NSSI behaviors, emotion regulation, interpersonal sensitivity, and cognitive insight. Network analysis using mixed graphical models and LASSO regularization was conducted to identify central and bridging nodes across binary-level and symptom-level NSSI networks. RESULTS: Network analysis revealed robust interconnections between emotion regulation, interpersonal sensitivity, cognitive insight, and various NSSI behaviors. In the binary-level network, the fragile inner-self (strength = 1.5) dimension of interpersonal sensitivity exhibited the highest strength, while cognitive reappraisal(bridge strength = 0.88) and expressive suppression(bridge strength = 0.73) showed the strongest bridge strength. Self-reflection was directly associated with NSSI behaviors, and self-certainty was linked to both emotion regulation and interpersonal sensitivity. In the symptom-level network, the most central NSSI behaviors included deliberately scraping the skin to cause bleeding, tying objects around the body, punching hard surfaces, banging the head, and cutting the skin. Fragile inner-self (bridge strength = 0.79) emerged as the strongest bridge node in this network. CONCLUSIONS: This study suggests that emotion regulation, interpersonal sensitivity and cognitive insight are closely associated with adolescent NSSI behaviors, highlighting their potential relevance for intervention strategies.