Abstract
BACKGROUND: Non-suicidal self-injury (NSSI) is on the rise in adolescent populations and its addictive profile, marked by frequent repetition, severe damage, and higher suicide risk, has raised broad concern. Childhood trauma is a key influencing factor that enhances emotional sensitivity and increases susceptibility to NSSI. Rumination, characterized by persistent negative thoughts, may mediate this association by amplifying emotional distress, as suggested by the emotional cascade model. Guided by the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study employed network analysis to investigate the interactive associations among childhood trauma, rumination, and NSSI addiction in adolescents, aiming to identify core and bridge symptoms. METHODS: We enrolled 1169 adolescents with NSSI and collected data using demographic questionnaires along with the Ottawa Self-Injury Inventory, Childhood Trauma Questionnaire, and Ruminative Responses Scale. Undirected network and Bayesian network analyses were applied to examine the complex associations among symptoms and mediation analysis was performed guided by the directed acyclic graph structure. RESULTS: By integrating both directed and undirected network models, symptom rumination and emotional abuse were identified as central nodes influencing the addictive nature of self-injury. Mediation analysis supported the pathway suggested by the directed acyclic graph (DAG), showing that symptom rumination mediated the relationship between emotional abuse and NSSI addiction. Network comparison further indicated that this link between self-injury addiction and symptom rumination was stronger in the addiction group than in the non-addiction group. CONCLUSION: In Chinese adolescents, timely identification and intervention targeting rumination on emotionally abusive experiences may reduce the onset and persistence of NSSI addiction.