Temporal dynamics of shame and guilt in adolescent NSSI: an ambulatory assessment study

Introduction: Nonsuicidal self-injury (NSSI) is a common clinical concern among adolescents, yet the roles of shame and guilt as proximal drivers of NSSI in daily life remain unclear. Using an ambulatory assessment design, we examined how these self-conscious emotions relate to momentary NSSI urges and how they fluctuate before and after NSSI acts.

Methods: We recruited 25 adolescents (M = 15.9 years, 72% female, 8% male, 20% gender-diverse) who reported shame, guilt, and NSSI urges four times per day for seven consecutive days on their smartphones. NSSI acts were logged using event-contingent prompts, followed by repeated ratings 10, 20, and 30 minutes after each act. Linear mixed-effects models were used to test concurrent and lagged associations between shame, guilt, and NSSI urges and to estimate event-related changes in these emotions.

Results: Both shame and guilt were positively associated with concurrent NSSI urges at the within- and between-person levels. Shame showed more pronounced temporal variability, with higher levels on Sundays and during the evening hours, and it increased in the minutes following NSSI. Guilt, however, showed no consistent diurnal or weekly pattern and did not change post-NSSI. ... mehrNeither emotion predicted higher urges at the next prompt one to approximately three hours later.

Discussion: In adolescents who engage in NSSI, shame and guilt co-occur with episodes of elevated urges rather than predict them over short periods. Shame appears more involved in the aftermath of NSSI, consistent with a maintenance process, whereas guilt tracked urges to a similar extent but did not change post-NSSI. Clinically, spikes in both shame and guilt may serve as actionable real-time markers, and post-episode support targeting self-criticism and anticipated judgment may be especially beneficial. Schools and health care settings can reduce barriers to help-seeking by using non-stigmatizing language around NSSI, given that shame frequently drives concealment.