Profiles of Cognitive Appraisal of Non-Suicidal Self-Injury Scars and Their Clinical Correlates in Adults with a History of Self-Injury: A Cross-Sectional Study

Abstract

Scars are the most durable consequence of non-suicidal self-injury (NSSI), but how patients appraise them, and how appraisal dimensions combine within individuals, remains unclear. In this cross-sectional study, 234 adults with a history of NSSI and at least one scar, recruited consecutively in Ryazan and Moscow, Russia, completed the Russian NSSI Scar Cognition Scale (Hopelessness, Shame, Inner Strength) and measures of suicidal ideation, social anxiety, rumination, body-image dysphoria and NSSI functions. Profiles were derived by cluster analysis and tested for stability. Three stable profiles emerged: low-salience (55.1%), negative-dominant (28.2%) and strength-dominant (16.7%). The negative-dominant profile showed the highest suicidal ideation, social anxiety, rumination, body-image dysphoria and self-punishment; the strength-dominant profile showed suicidal ideation and social anxiety similar to the low-salience profile, intermediate rumination and body-image dysphoria, and the strongest endorsement of NSSI functions. These differences persisted after covariate adjustment. Scar appraisal explained a further 7.9% of variance in suicidal ideation beyond demographics, self-injury status and general distress; scar visibility explained none. In behavioural remission, the negative-dominant profile reported higher suicidal ideation than the other profiles. Scar appraisal distinguishes subgroups with different clinical correlates. Longitudinal studies are needed to establish whether these profiles predict outcomes or can guide treatment.