Contra-hedonic Functions of Self-Destructive Behaviors in Adolescents

Objective: Many self-destructive behaviors, including nonsuicidal self-injury (NSSI) and eating disorder (ED) behaviors (restrictive eating, binge eating, purging), serve an emotion regulation function. To date, it has been assumed that this is pro-hedonic in nature (e.g., to decrease negative affect). However, contra-hedonic motivations (to increase/maintain negative affect, decrease positive affect) are prevalent during adolescence and may also reinforce self-destructive behaviors. In this study, we explored the presence, frequency, and clinical characteristics of contra-hedonic functions of NSSI and ED behaviors among adolescents. Method: Participants were drawn from a larger longitudinal study and recruited online via social media. The present study included a transdiagnostic sample of 137 adolescents (75.91% White, 9.0% Hispanic, 75.18% female, mean age=15.10 years) who completed surveys assessing the frequency, severity, contra-hedonic, and pro-hedonic functions of NSSI and ED behaviors. Results: Adolescents reported engaging in NSSI, restrictive eating, binge eating, and purging for each contra-hedonic function assessed, with 81% of participants endorsing at least one contra-hedonic function of NSSI and/or ED behaviors. Contra-hedonic motivations were highest for NSSI compared to ED behaviors and consistently associated with desire to self-punish. Conclusions: This study sheds light on a largely unexplored dimension of reinforcement functions of NSSI and ED behaviors: adolescents may not only engage in these behaviors to feel better, but also to make themselves feel worse. Further characterization of both pro- and contra-hedonic functions of maladaptive behaviors in adolescents represents a promising avenue through which behavioral interventions can be more precisely designed and targeted.