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, particularly in female adolescents, and may be linked to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and stress hormones like cortisol and DHEA-S. This study aimed to investigate associations between these hormones and motivational factors for NSSI. Methods: The study enrolled 43 female adolescents with current NSSI and various psychiatric diagnoses. Clinical assessment used the OSI questionnaire to evaluate NSSI motivations (internal/external emotion regulation, social influence, sensation seeking), urge type, and motivation to stop. Serum cortisol and DHEA-S levels were measured at 8:00 a.m. via immunofluorescence assay. Statistical analysis used Pearson correlation tests. Key Results: Significant correlations were found: cortisol levels correlated positively with distressing/upsetting urges (r=0.39, p=8.94×10⁻³) and negatively with sensation seeking (r=-0.32, p=0.04). The cortisol/DHEA-S ratio correlated negatively with external emotion regulation (r=-0.37, p=0.02) and positively with motivation to stop NSSI (r=0.40, p=0.01). Limitations: The study is limited by its small sample size, lack of male participants, absence of a matched non-self-injury control group, and potential influence of morning cortisol physiology. The sample included multiple psychiatric diagnoses that may affect hormone levels. Implications: The findings suggest a possible association between stress hormone profiles and specific motivational factors for NSSI, such as distressing urges and emotion regulation. Future longitudinal and case-control studies are needed to clarify the role of HPA axis dysregulation in NSSI and to inform potential prevention and treatment strategies targeting stress response and emotional dysregulation.