Contra-Hedonic Functions of Self-Destructive Behaviors in Adolescents

Abstract

Objective: Many self-destructive behaviors, including eating disorder (ED) behaviors (restrictive eating, binge eating, and purging), and nonsuicidal self-injury (NSSI), 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 ED behaviors and NSSI 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 ED behaviors and NSSI. Results: Adolescents reported engaging in restrictive eating, binge eating, purging, and NSSI for each contra-hedonic function assessed, with 81% of participants endorsing at least one contra-hedonic function of ED behaviors and/or NSSI. Contra-hedonic motivations were highest for NSSI compared to ED behaviors and were consistently associated with a desire to self-punish. Conclusions: This study sheds light on a largely unexplored dimension of reinforcement functions of ED behaviors and NSSI: 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.