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. 2025 Jul 15;25(1):704.
doi: 10.1186/s12888-025-07129-z.

Network analysis of the relationship between self-injury addiction, attachment, and anxiety in adolescents with non-suicidal self-injury

Lin Zhao #  1 , Shijian Wang #  2 , Jingya Li  1 , Linghua Kong  3 , Doudou Zheng  4 , Ying Yang  5
Affiliations

Network analysis of the relationship between self-injury addiction, attachment, and anxiety in adolescents with non-suicidal self-injury

Lin Zhao et al. BMC Psychiatry. .

Abstract

Background: Non-suicidal self-injury (NSSI) has become increasingly prevalent, with its impact growing more severe among adolescents. Addictive NSSI typically manifests through higher frequencies, more severe injuries, and a broader range of affected body areas, potentially leading to trauma, disability, or even suicide. This study aims to explore the complex network relationships among adolescent attachment, anxiety, and NSSI addiction, offering new insights into the mechanisms underlying NSSI addiction in adolescents.

Methods: A total of 1169 adolescent patients with NSSI were enrolled. Demographic questionnaires, the Ottawa Self-Injury Inventory, the Inventory of Parent and Peer Attachment, and the Multidimensional Anxiety Scale for Children were administered for assessment. The complex network relationships among symptoms were analyzed using undirected network analysis and directed Bayesian network analysis, followed by causal inference.

Results: The core symptom nodes in the network model included four dimensions of anxiety symptoms: MASC2 (harm avoidance), MASC3 (social anxiety), MASC4 (separation anxiety), and MASC1 (physical symptoms), as well as Peer3 (peer alienation) related to attachment relationships. Undirected network analysis indicated that the key bridging nodes for NSSI addiction were Peer3 (peer alienation) and MASC1 (physical symptoms). Directed acyclic graph (DAG) analysis further confirmed this relationship, demonstrating that these two key bridging nodes directly influence NSSI addiction. Additionally, DAG analysis revealed that MASC3 (social anxiety) indirectly influences NSSI addiction by affecting Peer3 (peer alienation) and MASC1 (physical symptoms).

Conclusion: Physical anxiety symptoms and peer alienation directly influence NSSI addiction among adolescents. Additionally, social anxiety indirectly influences NSSI addiction by affecting physical anxiety and peer alienation.

Keywords: Adolescents; Anxiety; Attachment; NSSI addiction; Network analysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was executed in compliance with the Declaration of Helsinki and received approval from the Ethics Committee of Shandong University (approval number: 2024-R-156). Informed consent to participate in this study was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Symptom networks of adolescent self-injury addiction, anxiety and attachment. Note: In the figure, green nodes represent self-injury addiction symptoms; blue nodes represent anxiety symptoms, and orange nodes represent attachment symptoms. The blue line represents positive correlations; the red line represents negative correlations. The edge thickness of the line represents the strength of the association between symptom nodes
Fig. 2
Fig. 2
Standardized EI and BEI for each node in the network
Fig. 3
Fig. 3
Centrality and bridge centrality stability tests
Fig. 4
Fig. 4
Bayesian network estimated using the hill-climbing algorithm displayed as a Directed Acyclic Graph (DAG). Symptoms are presented as nodes, and the edge thickness represents the frequency of the edge in the Bootstrap sample. The greater the thickness, the more stably the edge is learned in different subsamples, that is, it has stronger statistical reliability. Note: Abbreviation: A: self-injury addiction. MASC1: physical symptoms; MASC2: harm avoidance; MASC3: social anxiety; MASC4: separation anxiety. Father1: father trust; Father2: father communication; Father3: father alienation; Mother1: mother trust; Mother2: mother communication; Mother3: mother alienation. Peer1: peer trust; Peer2: peer communication; Peer3: peer alienation
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