(PS9-C74) Investigating the Relationship Between Self-esteem and NSSI: The Mediational Role of Body Regard

Engagement in nonsuicidal self-injury (NSSI), or the intentional destruction of body tissue without suicidal intent, has been consistently related to low self-esteem (Forrester et al., 2017); however, more research is needed to understand the mechanisms through which this relationship occurs. One possibility is that poor self-esteem leads to lower body regard, which is a multifaceted construct including one’s perceptions of, feelings toward, and connection with their body (Muehlenkamp, 2012). The present study sought to explore whether body regard would mediate the relationship between self-esteem and both a history of NSSI and the severity of NSSI behaviors in those with such a history. Participants included 2206 undergraduates (71.7% female, Mage = 21.07) who completed online assessments of self-esteem (Rosenberg Self-Esteem Scale, 1979), body regard (Body Regard Scale; Muehlenkamp, 2019), and NSSI history, frequency, recency, and versatility (Inventory of Statements About Self-Injury; Klonsky, 2009). Approximately 21% of the sample (n = 468) reported a history of NSSI. Two mediation models were tested via bootstrapping using Model 4 of the PROCESS macro (Hayes, 2022) with NSSI history and NSSI severity as the outcome variables. In the first model, the total model of self-esteem leading to a history of NSSI through body regard was significant, F(1, 2118) = 1473.81, p < .001, explaining 41% of the variance. The indirect effect of self-esteem on NSSI history through body regard was significant, (indirect effect = -.257, SE = .048, 95% CI: -.354, -.165) and the direct effect of self-esteem on NSSI history also remained significant, (direct effect = -.312, SE = .068, 95% CI: -.446, -.178). In the second model, a composite variable of overall NSSI severity was created by summing NSSI frequency, NSSI recency, and NSSI versatility, or the number of methods used to self-injure. The total model of self-esteem leading to NSSI severity through body regard was significant, F(1, 447) = 69.26, p < .001, explaining 13.4% of the variance. The indirect effect of self-esteem on NSSI severity through body regard was significant, (standardized indirect effect = -.100, SE = .114, 95% CI: -.531, -.084). The direct effect of self-esteem on NSSI severity also remained significant, (standardized direct effect = -.266, SE = .173, 95% CI: -1.145, -.467). Taken together, these results indicate that low self-esteem may lead to less positive feelings toward and less desire to care for one’s body which is then associated with increased risk for not only NSSI engagement, but also increased severity of these behaviors. This is consistent with previous research indicating that low body regard may be a risk factor for more frequent engagement in NSSI (Muehlenkamp et. al, 2013). Future research should test the relationships between these constructs using experimental and longitudinal methods to determine causality, especially given the bidirectional relationships between self-concept and NSSI (Spitzen et al., 2020). Future research should also investigate whether adding interventions that address body regard specifically to treatments for low self-esteem would be helpful in treating or preventing engagement in NSSI.