Investigation of autistic traits, attachment, alexithymia and emotion recognition skills in adolescents with self-harming behavior

Non-suicidal self-injury (NSSI) refers to repetitive, direct behaviors that cause damage to one's body tissue without suicidal intent. This case-control study aimed to assess autistic traits, attachment patterns, alexithymia levels, and emotion recognition skills in adolescents exhibiting NSSI, and to examine the multidimensional relationships between these psychosocial variables and self-injurious behavior. The study included a total of 80 participants: 40 adolescents aged 12–18 years with at least one reported episode of NSSI in the past year, and 40 age- and gender-matched healthy controls. Participants completed the Autism Spectrum Quotient (AQ), the Toronto Alexithymia Scale (TAS-20), the Inventory of Parent and Peer Attachment (IPPA), the Reading the Mind in the Eyes Test (RMET), the Revised Child Anxiety and Depression Scale (RCADS), and the Inventory of Statements About Self-injury (ISAS). Sociodemographic data were collected using a structured data form developed by the researcher. The NSSI group scored significantly higher than controls on AQ, TAS-20, and IPPA, while their RMET scores were significantly lower. Among female adolescents, age of onset was earlier and the number of NSSI methods was higher. Regression analyses revealed that the number of NSSI methods was significantly predicted by autistic traits and alexithymia. Attachment scores were significantly associated with the social functions of NSSI, whereas alexithymia was related to its automatic functions. Additionally, emotion recognition was moderately correlated with both attachment and alexithymia levels. These findings suggest that NSSI should not be considered solely within the framework of comorbid psychiatric diagnoses, but also in the context of social cognition, developmental predispositions, and interpersonal functioning. The results underscore the importance of comprehensive assessment and the need for preventive interventions targeting these domains in at-risk adolescents.