Do Cortisol and Dehydroepiandrosterone Influence Motivational Factors for Non-Suicidal Self-Injury in Female Adolescents?

{"Background": "Non-suicidal self-injury (NSSI) is a significant public health issue affecting up to 28% of community-based adolescents and up to 80% of inpatient populations, with higher prevalence in females. NSSI typically emerges during puberty and is associated with emotional dysregulation, but not suicidal intent. The hypothalamic-pituitary-adrenal (HPA) axis, particularly cortisol and dehydroepiandrosterone sulfate (DHEA-S), plays a critical role in stress response. Cortisol supports acute stress responses via catabolic effects, while DHEA-S has anti-glucocorticoid properties. Previous research on stress hormones and suicidal behavior has yielded conflicting results, and data on NSSI specifically remain limited. Given that NSSI is more common in post-adrenarche females and is linked to impaired stress regulation, the authors hypothesized that different cortisol-DHEA-S response patterns might correlate with motivational factors for NSSI.", "Methods": "The study enrolled 43 female adolescents (mean age 15.23 years, SD \u00b1 1.74) with current NSSI (DSM-5 criteria) and various psychiatric diagnoses, recruited from the University Hospital of Bari, Italy, between January 2018 and April 2022. Exclusion criteria included medical conditions precluding active collaboration and intellectual disability. Psychiatric diagnoses were made by experienced clinicians using DSM-5 criteria. Participants completed the Ottawa Self-Injury Inventory (OSI), a 27-item self-administered questionnaire assessing cognitive, affective, behavioral, motivational, and environmental aspects of NSSI. Key OSI items analyzed were: item 9 (type of urge: distressing/upsetting, comforting, intrusive/invasive; scored 0\u20134), item 14 (motivational functions: Internal Emotion Regulation [IER, score 0\u201324], Social Influence [SI, score 0\u201328], External Emotion Regulation [EER, score 0\u201312], Sensation Seeking [SS, score 0\u201316]), and item 22 (motivation to stop NSSI; scored 0\u20134). Serum cortisol and DHEA-S levels were measured at 8:00 a.m. via immunofluorescence assay. The cortisol/DHEA-S ratio was calculated from raw values. Pearson correlation tests were used to assess relationships between hormone levels and OSI scores, with significance set at p < 0.05.", "Key Results": "The sample included patients with depressive disorders, anxiety disorders, personality disorders, and other diagnoses. Mean cortisol level was not explicitly reported in the results section; reference ranges were 48\u2013195 \u03bcg/L for cortisol and 24\u2013368 \u03bcg/dL for DHEA-S. Significant correlations included: (1) cortisol level with distressing/upsetting urge (item 9): r = 0.39, p = 8.94 \u00d7 10\u207b\u00b3; (2) cortisol level with sensation seeking (item 14, SS): r = \u22120.32, p = 0.04; (3) cortisol/DHEA-S ratio with external emotion regulation (item 14, EER): r = \u22120.37, p = 0.02; (4) cortisol/DHEA-S ratio with motivation to stop NSSI (item 22): r = 0.40, p = 0.01. No significant correlations were found between hormones and other urge types (comforting, intrusive/invasive) or other motivational functions (IER, SI).", "Clinical Implications": "The direct correlation between cortisol and distressing/upsetting urges suggests that heightened HPA axis activity may contribute to the negative affective states that precede NSSI episodes. The inverse correlation between cortisol and sensation seeking may reflect downregulation of the HPA axis in response to chronic stress, potentially increasing vulnerability to mental health problems. The correlation between cortisol/DHEA-S ratio and external emotion regulation suggests that the balance of these hormones influences how adolescents use NSSI to manage interpersonal stressors. The positive correlation between cortisol/DHEA-S ratio and motivation to stop NSSI indicates that individuals experiencing greater hormonal stress dysregulation may also feel more compelled to cease self-injury, possibly due to the distress it causes. These findings support the integration of stress management and emotion regulation strategies into NSSI prevention and treatment programs, particularly for female adolescents. The authors recommend longitudinal studies to distinguish predisposing biological factors from consequences of self-harm, and suggest expanding research to include male patients and additional HPA axis hormones."}