Psychological Clusters, Prospective Mental Imagery, and Treatment Implications in Adolescents and Young Adults Engaging in Non-Suicidal Self-Injury (NSSI)

Background Non-suicidal self-injury (NSSI) is a prevalent and clinically significant behavior among adolescents and young adults, typically emerging in early adolescence and closely associated with emotional dysregulation and psychological distress. Theoretical frameworks such as the Integrated Motivational–Volitional (IMV) model emphasize the contribution of these psychological factors to the development of NSSI. However, few empirical studies have investigated how these variables may interact to form distinct, clinically meaningful subgroups. The present study employed a person-centered cluster analysis to identify psychological profiles based on levels of anxiety, depression, and self-efficacy. Furthermore, the study examined how these clusters relate to intrusive prospective mental imagery, NSSI behavior, age of NSSI onset, and prior therapeutic experiences. Methods Five hundred sixty-nine adolescents completed the online survey in Germany. NSSI (SITBI), emotion regulation (ERQ), emotional distress (BDI-II, STAI-T), self-efficacy (WIRKALL_r) and intrusive prospective mental imagery (IFES-S) were assessed. Afterwards, the ascertained data was clustered via TwoStep cluster analysis, followed by multivariate general linear models and chi-square tests to examine group differences in intrusive prospective mental imagery, emotion regulation, and NSSI. Results Two distinct psychological profiles emerged: Cluster 1, characterized by high emotional distress and low self-efficacy, and Cluster 2, marked by lower distress and higher self-efficacy. Individuals in Cluster 1 reported significantly higher NSSI engagement, including both lifetime and recent self-injury, more vivid and intrusive prospective mental imagery related to NSSI, and higher use of cognitive suppression. Early onset of NSSI and previous psychotherapy were more prevalent in Cluster 1 and were associated with more severe clinical features like NSSI lifetime, particularly when combined with imagery-related variables. Conclusions This study provides novel evidence that person-centered psychological profiles are differentially associated with NSSI behavior, prospective intrusive images of self-harm, and emotion dysregulation. In line with the IMV model, self-efficacy may act as a protective factor, moderating the pathway from psychological distress to self-injurious urges. Mental imagery, especially prospective intrusive imagery, emerged as a potentially under-recognized mechanism within this process. Targeted interventions aiming to enhance self-efficacy and modify intrusive prospective mental imagery may represent promising short-term approaches for early and personalized treatment of adolescents engaging in NSSI.