Family Communication,Cognitive Distortion,and Emotion Regulation as Predictors of Self-Harm Behaviors in Young Adult of Pakistan: A Serial Mediation Analysis
Restricted accessResearch articleFirst published online 2025
Family Communication,Cognitive Distortion,and Emotion Regulation as Predictors of Self-Harm Behaviors in Young Adult of Pakistan: A Serial Mediation Analysis
The present study explored the serial mediation approach of cognitive distortion and emotional dysregulation in association between poor family communication and self-harm behaviors (SHBs) in young adults. For this purpose, 263 participants (112 [43%] men and 151 [57%] women) age ranging from 15 to 25 years (M = 18.16, SD = 2.11) students of 1st to 6th year recruited from public and private institutes (colleges and universities) of Lahore, an urbanized city of Pakistan with the help of multistage stratified sampling technique. Family Communication, a subscale of FACES IV, cognitive distortion scale, difficulty in emotion regulation and SHB scale for young adults were used to measure family communication, cognitive distortion, emotion dysregulation and SHBs respectively. Results concluded that the cognitive distortions and emotional dysregulation partially mediate the association between family communication and SHBs. Further findings are discussed with respect to cultural implication and challenges to young adults along with some recommendations for upcoming studies.
AkhlaqA.MalikN. I.KhanN. A. (2013). Family communication and family system as the predictors of family satisfaction in adolescents. Science Journal of Psychology, 2013, Article ID sjpsych-258. https://www.sjpub.org/sjpsych/abstract/sjpsych-258.html–64
AndoverM. S.MorrisB. W. (2014). Expanding and clarifying the role of emotion regulation in nonsuicidal self-injury. The Canadian Journal of Psychiatry, 59(11), 569–575. https://doi.org/10.1177/070674371405901102
4.
ArmeyM. F.CrowtherJ. H.MillerI. W. (2011). Changes in ecological momentary assessment reported affect associated with episodes of non-suicidal self-injury. Behavior Therapy, 42(4), 579–588. https://doi.org/10.1016/j.beth.2011.01.002
5.
BaigN. U. A.RehmanR. R.MobeenN. (2014). A parent-teacher view of teens behaviors in nuclear and joint family systems in Pakistan. Qualitative Report, 19(34), 1–12. https://doi.org/10.46743/2160-3715/2014.1021
6.
BaileyD.WrightN.KempL. (2017). Self-harm in young people: A challenge for general practice. British Journal of General Practice, 67(665), 542–543. https://doi.org/10.3399/bjgp17X693545
BrownM. Z.ComtoisK. A.LinehanM. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111(1), 198–202. https://doi.org/10.1037/0021-843X.111.1.198
11.
ChaC. B.WilsonK. M.TezanosK. M.DiVastoK. A.TolchinG. K. (2019). Cognition and self-injurious thoughts and behaviors: A systematic review of longitudinal studies. Clinical Psychology Review, 69, 97–111. https://doi.org/10.1016/j.cpr.2018.07.002
12.
ChapmanA. L.GratzK. L.BrownM. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394. https://doi.org/10.1016/j.brat.2005.03.005
13.
DuriezP.GoueslardK.TreasureJ.QuantinC.JollantF. (2023). Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study. International Journal of Eating Disorders, 56(8), 1534–1543. https://doi.org/10.1002/eat.23974
14.
FortuneS.CottrellD.FifeS. (2016). Family factors associated with adolescent self-harm: A narrative review. Journal of Family Therapy, 38(2), 226–256. https://doi.org/10.1111/1467-6427.12119
15.
FranklinJ. C.PuziaM. E.LeeK. M.LeeG. E.HannaE. K.SpringV. L.PrinsteinM. J. (2013). The nature of pain offset relief in nonsuicidal self-injury: A laboratory study. Clinical Psychological Science, 1(2), 110–119. https://doi.org/10.1177/2167702612474440
16.
GhaziF. R.GanW. Y.TungS. E. H.ChenI. H.PoonW. C.SiawY. L.RuckwongpatrK.ChenJ. S.HuangS. W.GriffithsM. D.LinC. Y. (2024). Problematic gaming in Malaysian university students: Translation and psychometric evaluation of the Malay language versions of gaming disorder test and gaming disorder scale for young adults. Evaluation & the Health Professions, 47(1), 93–104. https://doi.org/10.1177/01632787231185845
17.
GratzK. L.RoemerL. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
18.
GrossJ. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
GrossJ. J.SheppesG.UrryH. L. (2011). Cognition and emotion lecture at the 2010 SPSP emotion preconference: Emotion generation and emotion regulation: A distinction we should make (carefully). Cognition & Emotion, 25(5), 765–781. https://doi.org/10.1080/02699931.2011.555753
21.
HallD.McNallieJ. (2016). The mediating role of sibling maintenance behavior expectations and perceptions in the relationship between family communication patterns and relationship satisfaction. Journal of Family Communication, 16(2), 386–402. https://doi.org/10.1080/15267431.2016.1215316
22.
HankinB. L.AbelaJ. R. (2011). Nonsuicidal self-injury in adolescence: Prospective rates and risk factors in a 2½ year longitudinal study. Psychiatry Research, 186(1), 65–70.
23.
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press.
24.
HesseC.PauleyP. M.Frye-CoxN. E. (2015). Alexithymia and marital quality: The mediating role of relationship maintenance behaviors. Western Journal of Communication, 79(1), 45–72. https://doi.org/10.1080/10570314.2014.943418
25.
HooleyJ. M.FoxK. R.BoccagnoC. (2020). Nonsuicidal self-injury: Diagnostic challenges and current perspectives. Neuropsychiatric Disease and Treatment, 16, 101–112. https://doi.org/10.2147/NDT.S198806
26.
HusainM. O.UmerM.TaylorP.ChaudhryN.KiranT.AnsariS.HusainN. (2019). Demographic and psychosocial characteristics of self-harm: The Pakistan perspective. Psychiatry Research, 279, 201–206. https://doi.org/10.1016/j.psychres.2019.02.070
27.
IshratS.NazS. (2020). Prevalence of cognitive distortions among adolescents in Punjab, Pakistan. Pakistan Journal of Humanities & Social Sciences Research, 3(1), 195–205. https://doi.org/10.37605/pjhssr.3.1.15
28.
JaworskaN.MacQueenG. (2015). Adolescence as a unique developmental period. Journal of Psychiatry & Neuroscience: JPN, 40(5), 291–293. https://doi.org/10.1503/jpn.150268
29.
KavlaB.UysalB. (2024). Psychological interventions for self-harm behaviour and suicide attempts in borderline personality disorder: A systematic review. Psikiyatride Güncel Yaklaşımlar, 16(1), 88–101. https://doi.org/10.18863/pgy.1289978
30.
KempD.MackertM.LiS.TableB.YangJ.KirtzS.Hughes WagnerJ. (2024). Talking about prescription opioid misuse: The effect of family communication patterns and messages advocating direct and indirect communication. Health Communication, 39(1), 83–95. https://doi.org/10.1080/10410236.2022.2159136
31.
KhaliqK.SaleemS. (2016). Parenting styles, interpersonal difficulties and cognitive distortions in university students. [Unpublished Manuscript].
KiranT.ChaudhryN.BeeP.TofiqueS.FarooqueS.QureshiA.Chew-GrahamC. A. (2021). Clinicians’ perspectives on self-harm in Pakistan: A qualitative study. Frontiers in Psychiatry, 12, Article 607549. https://doi.org/10.3389/fpsyt.2021.607549
34.
KirkcaldyB.Richardson-VejlgaardR.SiefenG. (2009). Birth order: Self-injurious and suicidal behaviour among adolescents. Psychology, Health & Medicine, 14(1), 9–16. https://doi.org/10.1080/13548500801983058
35.
KlonskyE. D. (2007a). Non-suicidal self-injury: An introduction. Journal of Clinical Psychology, 63(11), 1039–1043. https://doi.org/10.1002/jclp.20412
36.
KlonskyE. D. (2007b). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002
37.
KlonskyE. D. (2009). The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation. Psychiatry Research, 166(2–3), 260–268. https://doi.org/10.1016/j.psychres.2008.04.006
38.
KoernerA. F.SchrodtP. (2014). An introduction to the special issue on family communication patterns theory. Journal of Family Communication, 14(1), 1–15.
39.
LeN.BelayY. B.LeL. K. D.PirkisJ.MihalopoulosC. (2023). Health-related quality of life in children, adolescents and young adults with self-harm or suicidality: A systematic review. Australian & New Zealand Journal of Psychiatry, 7(57), 952–965. https://doi.org/10.1177/00048674231165477
40.
LimK. S.WongC. H.McIntyreR. S.WangJ.ZhangZ.TranB. X.TanW.HoS. C.HoR. C. (2019). Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: A meta-analysis. International Journal of Environmental Research and Public Health, 16(22), Article e4581. https://doi.org/10.3390/ijerph16224581
41.
LinehanM. M. (1993). Skills training manual for treating borderline personality disorder. Guilford press.
42.
McEvoyD.BranniganR.CookeL.ButlerE.WalshC.ArensmanE.ClarkeM. (2023). Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews. Journal of Psychiatric Research, 168, 353–380. https://doi.org/10.1016/j.jpsychires.2023.10.017
43.
McEvoyD.BranniganR.WalshC.ArensmanE.ClarkeM. (2023). Identifying high-risk subgroups for self-harm in young people. European Journal of Public Health, 33(Suppl_2), ckad160.197. https://doi.org/10.1093/eurpub/ckad160.197
44.
McEvoyD.BranniganR.WalshC.ArensmanE.ClarkeM. (2024). Identifying high-risk subgroups for self-harm in adolescents and young adults: A longitudinal latent class analysis of risk factors. Journal of Affective Disorders, 351, 40–48. https://doi.org/10.1016/j.jad.2024.01.230
45.
McMahonE. M.HemmingL.RobinsonJ.GriffinE. (2023). Suicide and self harm in young people. Frontiers in Psychiatry, 13, Article 1120396. https://doi.org/10.3389/fpsyt.2022.1120396
46.
MéndezM. L.PadrónI.FumeroA.MarreroR. J. (2024). Effects of internet and smartphone addiction on cognitive control in adolescents and young adults: A systematic review of fMRI studies. Neuroscience & Biobehavioral Reviews, 159. Article 105572. https://doi.org/10.1016/j.neubiorev.2024.105572
47.
MenninD. S.HolawayR. M.FrescoD. M.MooreM. T.HeimbergR. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302. https://doi.org/10.1016/j.beth.2007.01.002
48.
MittermeierS.SeidelA.ScheinerC.KleindienstN.RomanosM.BuergerA. (2024). Emotional dysregulation and its pathways to suicidality in a community-based sample of adolescents. Child and Adolescent Psychiatry and Mental Health, 18(1), Article 15. https://doi.org/10.1186/s13034-023-00699-4
49.
NaeemM. (2024). Role of parenting, life stressors and self-harm behaviors in eating problems in young adults [Unpublished doctoral thesis]. University of Management and Technology, Lahore.
50.
NockM. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18, 78–83. https://doi.org/10.1111/j.1467-8721.2009.01613.x
OlsonD. (2011). FACES IV and the circumplex model: Validation study. Journal of Marital and Family Therapy, 37(1), 64–80. https://doi.org/10.1111/j.1752-0606.2009.00175.x
53.
OlsonD. H.DeFrainJ. (2000). Marriage and the family: Diversity and strengths. Mayfield.
54.
ÖzdemirİKuruE. (2023). Investigation of cognitive distortions in panic disorder, generalized anxiety disorder and social anxiety disorder. Journal of Clinical Medicine, 12(19), Article 6351. https://doi.org/10.3390/jcm12196351
55.
PerezJ.VentaA.GarnaatS.SharpC. (2012). The difficulties in emotion regulation scale: Factor structure and association with nonsuicidal self-injury in adolescent inpatients. Journal of Psychopathology and Behavioral Assessment, 34(3), 393–404. https://doi.org/10.1007/s10862-012-9292-7
56.
PetersonR.GreenS. (2009). Families first: Keys to successful family functioning communication. Virginia State University.
57.
PrinsteinM. J.HeilbronN.GuerryJ. D.FranklinJ. C.RancourtD.SimonV.SpiritoA. (2010). Peer influence and nonsuicidal self injury: Longitudinal results in community and clinically-referred adolescent samples. Journal of Abnormal Child Psychology, 38, 669–682.
58.
QianJ.WongQ.BurnettA.McGillivrayL.HanJ.LarsenM.TorokM. (2023). Risk of repeat self-harm and suicide death following an episode of hospital self-harm presentation among adolescents and young adults. Journal of Affective Disorders, 321, 191–200. https://doi.org/10.1016/j.jad.2022.10.032
59.
RamzanN.MalikF.FatimaI. (2023). Father involvement and psychological adjustment in Pakistani adolescents: Family environment as a mediator. Marriage & Family Review, 59(8), 504–522. https://doi.org/10.1080/01494929.2023.2199731
60.
RehnaT.HanifR.AqeelM. (2020). Moderating role of gender on the relationship between cognitive errors and anxiety among adolescents. Foundation University Journal of Psychology, 4(1), 86–102. https://doi.org/10.33897/fujp.v4i1.68
61.
RenY.CuiS.CuiT.TangC.SongJ.JacksonT.HeJ. (2024). Relations of body dissatisfaction with self-injurious thoughts and behaviours in clinical and non-clinical samples: A meta-analysis of studies published between 1995 and 2022. Health Psychology Review, 18(3), 599–618. https://doi.org/10.1080/17437199.2024.2310140
62.
Ritchie, L. D., & Fitzpatrick, M. A. (1990). Family communication patterns: Measuring intrapersonal perceptions of interpersonal relationships. Communication Research, 17(4), 523–544. https://doi.org/10.1177/009365090017004007
63.
SadathA.KavalidouK.McMahonE.MaloneK.McLoughlinA. (2024). Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review. PLoS one, 19(2), Article e0292691. https://doi.org/10.1371/journal.pone.0292691
64.
SaleemS.AsgharA.MahmoodZ. (2020). Perceived parental rearing practices, interpersonal relationships and psychological problems in college students. Bahria Journal of Professional Psychology, 19(2), 1–16.
65.
SaleemS.ZahraS. T.SubhanS.MahmoodZ. (2021). Family communication, prosocial behavior and emotional/behavioral problems in a sample of Pakistani adolescents. The Family Journal: Counseling and Therapy for Couples and Families, 29(4), 404–410. https://doi.org/10.1177/10664807211023929
66.
SarfarazN.RasheedM.NoorS. A.RehmanK. (2019). Cognitive distortions, suicidal ideation and quality of life (QoL) in obsessive compulsive disorder (OCD) in Lahore, Pakistan. Discourse, 5(1), 159–166.
67.
SawyerS. M.AzzopardiP. S.WickremarathneD.PattonG. C. (2018). The age of adolescence. The Lancet Child & Adolescent Health, 2(3), 223–228. https://doi.org/10.1016/S2352-4642(18)30022-1
68.
SelbyE. A.JoinerT. E.Jr. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13(3), 219–229. https://doi.org/10.1037/a0015687
69.
ShekhaniS. S.PerveenS.HashmiD. E. S.AkbarK.BachaniS.KhanM. M. (2018). Suicide and deliberate self-harm in Pakistan: A scoping review. BMC psychiatry, 18, Article 44. https://doi.org/10.1186/s12888-017-1586-6
70.
TayyabaM.ZahraS. M.NaeemF.SohailM. (2024). Family system and gender as predictors of religious coping in Pakistani patients with hepatitis C. Journal of Religion and Health, 63(3), 2466–2481. https://doi.org/10.1007/s10943-023-01970-w
71.
TwengeJ. M. (2020). Increases in depression, self-harm, and suicide among US adolescents after 2012 and links to technology use: Possible mechanisms. Psychiatric Research and Clinical Practice.
72.
van SchieC.GallagherR.Krause-UtzA. (2024). Exploring the complex relationship between childhood trauma and self-harm. Journal of Aggression, Maltreatment & Trauma, 33(3), 321–339. https://doi.org/10.1080/10926771.2023.2189976
73.
VictorS. E.MuehlenkampJ. J.HayesN. A.LengelG. J.StyerD. M.WashburnJ. J. (2018). Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults. Comprehensive Psychiatry, 82, 53–60. https://doi.org/10.1016/j.comppsych.2018.01.009
74.
WesterK. L.KingK. (2018). Family communication patterns and the mediating role of communication competence and alexithymia in relation to nonsuicidal self-injury. Journal of Mental Health Counseling, 40(3), 226–239. https://doi.org/10.17744/mehc.40.3.04
WolffJ. C.ThompsonE.ThomasS. A.NesiJ.BettisA. H.RansfordB.ScopellitiK.FrazierE. A.LiuR. T. (2019). Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. European Psychiatry, 59, 25–36. https://doi.org/10.1016/j.eurpsy.2019.03.004
Yazici-CelebiG.YilmazM.KaracoskunM. E.SahinA. I. (2024). Examination of the mediating role of attachment dimensions in the link between suicide probability and cognitive distortions about relationships in university students. Journal of Education in Science Environment and Health, 10(1), 60–68. https://doi.org/10.55549/jeseh.1419349
79.
ZafarH.DebowskaA.BoduszekD. (2021). Emotion regulation difficulties and psychopathology among Pakistani adolescents. Clinical Child Psychology and Psychiatry, 26(1), 121–139. https://doi.org/10.1177/1359104520969765
80.
ZahraS. T.SaleemS. (2022). Family cohesion and emotional–behavioral problems in Pakistani young children: A moderating role of interpersonal skills. The Family Journal, Article 10664807221139504. https://doi.org/10.1177/10664807221139504
81.
ZetterqvistM. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health, 9(1), 31–43. https://doi.org/10.1186/s13034-015-0062-7
