Psikohumaniora: Jurnal Penelitian Psikologi
Vol 10, No 1 (2025): 43-58. DOI: 10.21580/pjpp.v10i1.23353
ISSN 2527-7456 (online); 2502-9363 (printed)

Pathway linking executive function problems and
non-suicidal self-injury among adolescents: The mediating
role of emotion dysregulation
Aulia Rachma ,1 Donny Hendrawan

2

1

Master of Professional Psychology, Faculty of Psychology, Universitas Indonesia, Depok – Indonesia; 2 Life Span
Development Laboratorium, Faculty of Psychology, Universitas Indonesia, Depok – Indonesia
Abstract: Non-suicidal self-injury (NSSI) is a prevalent mental health issue among adolescents, with
difficulties in emotional regulation identified as a significant predictor of such behavior. A set of
neurocognitive skills known as executive function (EF) is also linked to NSSI. This study investigates
the relationship between executive function problems and NSSI behavior, explicitly examining the
mediating role of emotional dysregulation. Participants were selected using a non-probability
purposive sampling technique, with the final sample consisting of 211 Indonesian adolescents aged
between 12 and 18 (M = 14.57, SD = 1.42). The measurement instruments included the Teenage
Executive Function Inventory (TEXI), the Cognitive Flexibility Scale (CFS), the Difficulties in Emotion
Regulation Scale Short Form (DERS-SF), and the Deliberate Self-Harm Inventory (DSHI). Mediation
analysis using the PROCESS macro for SPSS (model 4), revealed that emotion dysregulation
significantly mediated the relationship between EF problems and NSSI. The indirect effect of EF
problems and NSSI through emotion dysregulation was statistically significant (B = 0.203, 95% CI
[0.0805, 0.3741]). Adolescents with lower EF are more prone to emotional difficulties, thus increasing
the risk of NSSI. The study provides implications that help elucidate the dynamics of the NSSI
phenomenon among adolescents. Furthermore, the findings highlight the need for interventions
targeting both cognitive and emotional regulation skills to reduce NSSI in adolescents and promote
overall mental health and well-being.
Keywords: adolescent; emotion dysregulation; executive function; non-suicidal self-injury

Copyright © 2025 Psikohumaniora: Jurnal Penelitian Psikologi
This is an open access article under the terms and conditions of the Creative Commons Attribution-NonCommercialShareAlike 4.0 International License.

To cite this article (APA Style):
Rachma, A., & Hendrawan, D. (2025). Pathway linking executive function problems and non-suicidal self-injury among adolescents: The
mediating role of emotion dysregulation. Psikohumaniora: Jurnal Penelitian Psikologi, 10(1), 43-58.
https://doi.org/10.21580/pjpp.v10i1.23353

__________


Corresponding Author: Donny Hendrawan (donny.hendrawan@ui.ac.id), Jl. Lkr. Kampus Raya Jl. Prof. DR. R Slamet Iman Santoso,
Pondok Cina, Kecamatan Beji, Kota Depok, Jawa Barat 16424 – Indonesia.
https://journal.walisongo.ac.id/index.php/Psikohumaniora
Submitted: 2 Oct 2024; Received in revised form: 18 May 2025; Accepted: 21 May 2025; Published regularly: May 2025

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A. Rachma, D. Hendrawan

Introduction
Adolescence is a period marked by significant
transitions across multiple domains, including
physical-biological, social, cognitive, and emotional
development. These simultaneous changes can
create a heightened sense of vulnerability, leading
adolescents to psychological distress and driving
them to adopt maladaptive coping strategies such
as non-suicidal self-injury (NSSI) (Blakemore,
2019; Liu et al., 2016). NSSI refers to the deliberate
infliction of bodily harm without suicidal intent
(Selby et al., 2012), commonly including actions
such as cutting, burning, scratching, banging,
hitting, biting, and excessive rubbing (Klonsky et
al., 2014). The Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) acknowledges NSSI as a
condition requiring further study, highlighting its
importance for clinical research and potential
future preventive actions (Mendelson, 1995).
Although NSSI is not currently classified as a
formal mental disorder, it has gained significant
attention within the psychiatric community. In
adolescents, its prevalence has raised significant
concern, having increased markedly since the 21st
century, with predictions that the trend will
continue to rise annually (Mozafari et al., 2022;
Muehlenkamp et al., 2012). Global estimates
suggest that 16% of adolescents have engaged in
NSSI behaviors (Farkas et al., 2024). Moreover, a
study involving 478 Indonesian adolescents
showed that approximately 73% of the participants had engaged in NSSI (Maharani et al., 2022).
Similarly, other research indicates that
approximately 30% of Indonesian students have
experienced NSSI (Tresno et al., 2012).
Furthermore, NSSI behaviors have been
documented in adolescent populations in low- to
middle-income countries, highlighting its global
relevance (Lim et al., 2019).
The emergence of NSSI is associated with
several factors, including executive function
problems (Hu et al., 2021; Smith et al., 2019).

44 │

executive function (EF) refers to a collection of
higher-order cognitive processes responsible for
managing thoughts, actions, and emotions to
achieve goal-oriented behavior. It encompasses
three core components: inhibitory control,
working memory, and cognitive flexibility (Best &
Miller, 2010). These cognitive skills are
fundamental for effective decision-making and
self-regulation, enabling adolescents to plan,
monitor, and modify their behavioral responses to
dynamic situations.
Adolescents who engage in NSSI behaviors
have poorer levels of inhibition, cognitive
flexibility, and working memory than typical
developing adolescents (Hu et al., 2021; Mozafari
et al., 2022). Those with low EF tend to have
reduced tolerance to challenging situations.
According to Fikke et al. (2011), the diminished
functioning of EF components impairs
adolescents’ capacity to redirect their attention
from demanding and difficult situations and to
suppress negative emotions, as well as restricting
their ability to reconstruct their thoughts to
identify alternative coping strategies, thereby
increasing their vulnerability to engaging in NSSI
behaviors (Guerreiro et al., 2015; Mozafari et al.,
2022).
Although some neuropsychological research
has found a significant link between problems in
EF and emerging NSSI behaviors in adolescents,
other studies have failed to find a meaningful
correlation. Furthermore, EF has been shown to
provide a limited explanation of the mechanisms
underlying NSSI in adolescents, possibly due to the
influence of affective control (Mürner-Lavanchy et
al., 2022; Shen et al., 2022). Allen et al. (2019)
suggest that a lack of such control may be closely
related to emotional instability or, in this instance,
the onset of emotional dysregulation in the context
of NSSI behaviors. These findings suggest that in
some cases EF problems might not always be a
single distinguishing feature of NSSI, allowing

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other psychological factors, such as emotion
dysregulation, to play a more prominent role.
Emotion dysregulation, a significant intrapersonal factor characterized by the inability to
effectively manage emotions and cognitive
processes during unpleasant events, has been
linked to the emergence of NSSI (Heffer &
Willoughby, 2018; Hooley & Franklin, 2018; Nock,
2009). It hinders individuals from achieving their
intended goals effectively (Thompson, 2019).
Notably, over 75% of diagnostic categories in the
DSM pertain to mental health issues linked to
emotion dysregulation (Sheppes et al., 2015;
Werner & Gross, 2010). Research has shown that
adolescents engaging in NSSI exhibit significantly
poorer emotion regulation skills compared to their
peers and often use NSSI to alleviate negative
feelings, including anger, sadness, and anxiety
(Glenn & Klonsky, 2013; Robinson et al., 2019). A
theoretical integration model proposed by Nock
(2012) posits that individuals may resort to NSSI
as a perceived effective strategy for emotional
regulation in response to adverse social
experiences. In addition, the lack of emotional
regulation, coupled with heightened impulsivity,
predisposes adolescents to engage in maladaptive
behaviors, including NSSI (Pfeifer & Allen, 2021).
Research also shows EF is closely linked to
regulating emotional systems, attention, and stress
levels (Lantrip et al., 2016). When individuals are
unable to manage stress effectively, their ability to
maintain focused attention is compromised, which
in turn impairs executive function and may
increase the risk of mental health problems.
Adolescents who struggle with self-regulation and
planning may have difficulty managing emotional
distress, leading to impulsive or harmful actions
such as NSSI as a way of coping with
overwhelming emotions (Wolff et al., 2019). The
close relationship between EF problems and
emotion dysregulation reflects the dynamic
interplay between cognitive and emotional

processes, significantly affecting individual
behavior (Pessoa, 2008). However, the specific
mechanisms through which EF problems
contribute to NSSI through emotion dysregulation
remain underexplored. Exploration of this gap is
particularly important, as emotion dysregulation
may provide more nuanced understanding of how
problems in executive function may lead to
maladaptive coping mechanisms such as NSSI.
Previous studies have also mostly examined
the direct relationship between EF problems and
NSSI, especially in clinical populations with
borderline personality disorder or depression
(Nilsson et al., 2021; Wang et al., 2023). The
relationship between these variables in typical
populations has not been extensively studied
(Mürner-Lavanchy et al., 2022). Understanding the
cognitive and emotional factors that contribute to
NSSI in adolescents within the typical population is
crucial, as they drive the emergence of preventive
strategies that may prevent the development of
NSSI into more serious mental health issues. The
study, therefore, aims to explore the role of EF
problems in the emergence of NSSI behaviors
among adolescents, specifically examining the
mediating effect of emotion dysregulation. The
study hypothesis is that emotion dysregulation
mediates the relationship between EF problems
and non-suicidal self-injury (NSSI) in adolescents.

Methods
Research Design
A non-experimental, quantitative correlational design was employed to examine the
relationships between the key variables, with
variations in one variable hypothesized to
consistently predict changes in another (Gravetter
& Forzano, 2018). Specifically, the study sought to
explore the relationship between EF problems,
non-suicidal self-injury (NSSI) behaviors, and
emotion dysregulation, together with the role of
emotion dysregulation as a mediator between

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A. Rachma, D. Hendrawan

such problems and NSSI. The research followed a
cross-sectional approach, with data collected
within a specific period, from May to July 2024.
Participants
The participants were selected using a nonprobability purposive sampling technique, which
involves selecting participants based on specific
criteria (Kumar, 2019). The sample consisted of
211 adolescents (boys and girls) aged 11-18 (M =
14.5, SD = 1.424), who were students at junior or
senior high schools and lived in the Jakarta, Bogor,
Depok, Tangerang, and Bekasi (Jabodetabek)
regions. Sample size was estimated using G*Power
version 3.1, with statistical parameters set at α =
.05, f² = 0.15, and power = 0.95. The minimum
sample size calculated for adequate statistical
power was 107 participants, thus confirming that
the final sample of 211 participants exceeded the
minimum required size.
Research Procedure
Data were collected face-to-face from students
attending five junior and senior high schools in the
Jabodetabek area. The schools that agreed to
participate distributed informed consent to
parents. Only students who voluntarily agreed to
participate and obtained parental consent were
included. Those who received parental permission
but chose not to participate could withdraw
without consequences. Once informed consent
was obtained from participants and their parents,
the students completed an online questionnaire
via the official Universitas Indonesia survey
platform (Tim Peneliti, 2024).
The survey was administered using
participants' devices under direct supervision
from the researchers in a classroom setting. The
research was approved by the Research Ethics
Committee of the Faculty of Psychology,
Universitas Indonesia, No. 250/FPsi.KomiteEtik/
PDP.04.00/2023.

46 │

Instruments
Executive Function
Executive function problems were assessed
using two standardized instruments: the Teenage
Executive Function Inventory (TEXI) and the
Cognitive Flexibility Scale (CFS). The TEXI,
developed by Thorell et al. (2020), consists of 20
items rated on a 5-point Likert scale (1 = ‘Very
Unsuitable’, 5 = ‘Very Suitable’) and was designed
to evaluate executive function performance in
adolescents, particularly focusing on working
memory and inhibitory control.
The CFS is a measuring instrument used to
evaluate executive function abilities related to
aspects of cognitive flexibility (Martin & Rubin,
1995). It comprises 12 self-report statements, rated
on a 6-point Likert scale (1 = ‘Strongly Disagree’, 6 =
‘Strongly Agree’). Both the TEXI and CFS were
adapted into Indonesian using a rigorous multi-step
translation process. This involved: 1) translation of
the items from English into Indonesian by two
certified translators; 2) synthesis of the translated
versions; 3) expert judgment involving five
professionals in clinical and educational psychology; 4) a readability test with six adolescents
outside the study population; and 5) backtranslation to English by two certified translators.
Based on the results of psychometric testing,
the TEXI demonstrates strong reliability, evidenced
by a Cronbach's alpha of .89, and shows good
validity, with item-total correlations ranging from
.30 to .60. On the other hand, the CFS exhibits
acceptable reliability, with a Cronbach's alpha of
.72, indicating adequate internal consistency for
psychological assessment. The Indonesian version
of the CFS also demonstrates good validity, with
item-total correlations ranging from .30 to .50.
Adolescents’ executive function problems were
measured by adding together the total scores from
the TEXI and CFS using factor score analysis
methods.

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Pathway linking executive function problems and non-suicidal self-injury among adolescents ....

Emotion Dysregulation
Emotion dysregulation was assessed using the
Difficulties in Emotion Regulation Scale - Short
Form (DERS-SF), developed by Kaufman et al.
(2016). This self-report instrument consists of 18
items rated on a 5-point Likert scale (1 = ‘Never’, 5
= ‘Always’) and was designed to measure
difficulties in emotion regulation. Like the TEXI and
CFS, the DERS-SF was adapted into Indonesian
following the same translation and validation
procedures. It demonstrates strong reliability, with
a Cronbach's alpha value of .841.
This indicates a high level of internal
consistency, making it a reliable instrument for
assessing emotional regulation difficulties within
the Indonesian context. The results of confirmatory
factor analysis (CFA) show that the model has a
good fit (CFI = .98, TLI = .97, RMSEA = .075, SRMR =
.075), indicating that the measurement tool has
good validity. Scores on the DERS-SF ranged from
18 to 90, with higher scores indicating more
significant difficulties in emotion regulation.
Non-Suicidal Self-Injury (NSSI) Behaviors
NSSI was measured using the Deliberate SelfHarm Inventory (DSHI), developed by Gratz
(2001) and adapted into Indonesian by Tresno et
al. (2012). It consists of 17 dichotomous items that
assess the occurrence of self-harming behavior,
with response options of ‘Yes’ or ‘No.’ Participants
were categorized as engaging in self-injury if they
responded ‘Yes’ to any item, while those who
answered ‘No’ to all items were classified as nonself-injuring. The Indonesian version of the DSHI
demonstrated satisfactory reliability, with a
Cronbach’s alpha of .76. It has good validity, with
total correlation values ranging from .30 to .71.
Data Analysis
The data analysis was conducted utilizing IBM
SPSS version 25. Initially, the data analysis involves
applying the Kolmogorov-Smirnov test to evaluate

the distribution of the collected data and to
determine if it conforms to a normal distribution.
Furthermore, Pearson’s correlation test is utilized
to examine the relationships between the variables,
offering a comprehensive insight into the
connections across the entire dataset. This method
enables a thorough exploration of potential
associations, enhancing the overall quality of the
analysis. To assess the hypothesis of emotion
dysregulation as mediator in the relationship
between EF problems and NSSI behavior, the SPSS
Macro PROCESS (Hayes, Model 4) was employed.
This approach facilitated the evaluation of the
direct and indirect effects of executive function on
NSSI behavior through emotion dysregulation,
specifically within the adolescent population.

Results
Demographic Data
The study sample involved 211 adolescent
participants. According to demographic data (see
Table 1), 50.7% were female, with 49.3% male.
Their ages ranged from 12 to 18 (M = 14.57, SD =
1.424). In terms of education, the majority were at
junior high school (66.8%), with the remaining
33.2% at senior high school. The majority of
participants lived in Tangerang (31.3%), followed
by Depok (21.8%), Jakarta (21.3%), Bogor (19%),
and Bekasi (6.6%). This demographic profile
suggests that the sample consisted primarily of
younger adolescents, particularly those at junior
high school, with a geographical concentration in
Tangerang, Depok, and Jakarta.
Prevalence of NSSI
The data on the frequency of NSSI show that
51.7% (n = 109) of the participants reported
engaging in such behaviors, while 48.3% (n = 102)
indicated no such history. This indicates that
slightly more than half of the participants had
engaged in NSSI, suggesting that self-injurious
behaviors were relatively prevalent within this
particular sample.

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A. Rachma, D. Hendrawan

The most frequently reported methods of
NSSI among the sample were intense scratching,
with 49.5% of participants indicating this
behavior, followed by deliberate biting of the skin
until bleeding, reported by 39.4%, and intentional
interference with wound healing, which
corresponded to 38.5% of the sample. These
findings provide insight into the prevalence and
types of self-injurious behaviors among the
adolescents in the study. For a detailed breakdown
of the number of participants reporting a history of
self-injury, please refer to Table 2, which utilizes
the Deliberate Self-Harm Inventory (DSHI) as the
measurement tool.
Statistical Results
The normality test results from the
Kolmogorov-Smirnov test yielded a significant
value of .200, which exceeds the .05 threshold. It
indicates that the data distribution for the
continuous variables, namely executive function
and emotion dysregulation, can be assumed to
follow a normal distribution. However, the NSSI
variable could not be subjected to a normality test
due to the nature of the instrument used, the DSHI,
which is based on a dichotomous scale. Since such
as scale only provides two response options, "Yes"
or "No," it is classified as a nominal scale and does
not meet the requirements for normality testing.
The findings from the Pearson correlation
analysis (Table 3) reveal a significant relationship
between the study variables. The strongest
correlation was identified to be between EF
problems and emotion dysregulation, indicating
that an increase in EF problems is associated with
higher emotion dysregulation scores (r = .37, p <
.01). Additionally, a significant correlation exists
between emotion dysregulation and NSSI, which
suggests that higher levels of emotion dysregulation correlate with an increase in NSSI

48 │

behaviors (r = .29, p < .01). Furthermore, the
correlation between EF problems and NSSI shows
a positive but weak relationship (r = .19, p = .004).
This implies that increasing EF problems may be
linked with an increased likelihood of NSSI
behaviors among adolescents.
Mediation analysis was conducted to
investigate the relationship between EF problems
(X) and NSSI behavior (Y) through emotion
dysregulation (M). The results displayed in Table 4
indicate that EF problems have a significant effect
on emotion dysregulation (B = 0.36, p < .001), with
a 95% confidence interval ranging from 0.2415 to
0.4950, confirming that higher levels of poor EF
are associated with higher levels of emotional
dysregulation.
Additionally, the results reveal a significant
positive relationship between emotional dysregulation and NSSI behavior (B = 0.55, p < .001).
The 95% CI for this relationship ranged from
0.2300 to 0.8737, indicating that increased
emotional dysregulation correlates with a higher
likelihood of engaging in NSSI.
The direct effect of EF problems on NSSI was
also assessed, but the relationship was not found
to be statistically significant (B = 0.23, p = .15), as
the CI ranged from -0.0793 to 0.5356, indicating
that poor EF does not have a direct impact on NSSI
when emotion dysregulation is accounted for (see
Table 4).
In Table 5, the indirect effect analysis
reinforced the finding that the relationships
between EF problems and NSSI through emotion
dysregulation were statistically significant (B =
0.203, 95% CI [0.0805, 0.3741]. It further supports
the hypothesis that emotional dysregulation fully
mediates the relationship between EF problems
and NSSI behaviors in adolescents.

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Table 1
Demographic Data (N = 211)
Variable
Gender
Male
Female
Age
12
13
14
15
16
17
18
Education
Junior High School
Senior High School
Domicile
Jakarta
Bogor
Depok
Tangerang
Bekasi

N

%

104
107

49.3
50.7

7
39
83
21
37
18
6

3.3
18.5
39.3
9.9
17.5
8.5
2.8

141
70

66.8
33.2

45
40
46
66
14

21.3
18.9
21.8
31.3
6.6

Table 2
Number of Adolescents based on the Type of NSSI Behavior (N = 109)
Type of NSSI Behavior
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

Cutting
Burning skin with cigarette
Burning skin with lighter or match
Inscribing words into skin
Engraving pictures onto skin surface
Intense scratching leading to bleeding
Intentional biting to damage the skin
Scraping the skin with sandpaper
Dripping acid on skin
Using bleach or oven cleaner to scrub skin
Sticking pins, needles or staples into the skin
Rubbing glass into the skin
Breaking bones
Banging head
Punching self
Disruption of wound healing process
Other forms of self-harm

Psikohumaniora: Jurnal Penelitian Psikologi — Vol 10, No 1 (2025)

f

%

38
7
16
23
12
54
43
12
3
4
37
20
5
29
38
42
26

34.9
6.4
14.7
21.1
11.0
49.5
39.4
11.0
2.7
3.6
33.9
18.3
4.5
26.6
34.9
38.5
23.8

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A. Rachma, D. Hendrawan

Table 3
Pearson Correlation Results
No.

Variable

Mean

SD

1

2

3

1
2
3

Executive Function problems
Dysregulation Emotion
Non-Suicidal Self-Injury (NSSI)

.000
.000
.5166

1.00
1.00
.500

.368**
.196**

.289**

-

95% CI
LL

UL

Note: N = 211. SD = standard deviation. ** p <.01

Table 4
Mediation Analysis Results
Effect

B

SE

Z score

p

EF to DE (a)
0.3682
.0643
5.7260
0.2415
0.4950
< .001
DE to NSSI (b)
0.5518
.1642
3.3606
0.2300
0.8737
< .001
EF to NSSI (c’)
0.2282
.1569
1.4543
-0.0793
0.5356
.1458
Note: *p < 0.05. EF = Executive Function, DE = Dysregulation Emotion, NSSI = Non-Suicidal Self-Injury

Discussion

emergence of NSSI behavior in this population
(Andover & Morris, 2014; Wolff et al., 2019).

The study investigates the mediating role of
emotion dysregulation in the relationship
between EF problems and non-suicidal self-injury
(NSSI) behavior in adolescents. The findings
demonstrate that emotion dysregulation fully
mediates the association between EF problems
and NSSI behavior, suggesting that difficulties in
emotion regulation are a crucial mechanism
through which poor EF contributes to the risk of
NSSI. The results support the theoretical model
developed based on previous research findings, in
which EF impairment is related to NSSI behavior
(Zhang et al., 2022). Executive function abilities in
adolescents, which encompass planning, decisionmaking, impulse control, and problem-solving, are
closely intertwined with their capacity for
emotional regulation (Binder et al., 2020; Lantrip
et al., 2016; Warmansyah et al., 2024). Adolescents
experiencing chronic emotional distress are often
found to exhibit deficits in EF. Moreover, previous
research has consistently indicated that emotion
dysregulation is closely associated with the

The findings underscore the heightened risk of
NSSI in adolescents with poor EF, which plays a
critical role in how individuals respond to stress
and influences both emotional and social
competence (Mozafari et al., 2022). Additionally,
previous study findings on students with NSSI
tendencies, regardless of gender, have indicated
elevated levels of executive dysfunction (Zhou et
al., 2024). Adolescents with diminished executive
function may struggle to inhibit impulsive
behaviors, including NSSI, as a maladaptive coping
strategy for managing negative emotions such as
anxiety and fear during stressful situations (Allen
& Hooley, 2015). Research also suggests that
adolescents engaging in NSSI often have significant
difficulties in controlling impulsive tendencies,
further supporting the notion that NSSI may serve
as a mechanism for coping with overwhelming
emotional states (Guerreiro et al., 2015; Mozafari
et al., 2022). A study by Fikke et al. (2011) found
that adolescents who engage in NSSI exhibit
poorer decision-making skills. It implies that

50 │

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problems in these cognitive domains may
contribute to such adolescents' difficulties in
managing their emotions and making healthier
choices when confronted with stress or emotional
challenges.
This study confirms that emotion dysregulation significantly mediates the relationship
between EF problems and NSSI. It implies that
adolescents with low executive function may not
directly engage in NSSI, but do so through their
inability to regulate their emotions effectively. This
finding aligns with previous research, which has
posited that emotion dysregulation is a central
mechanism which links cognitive function and
self-harm behaviors (Hasking et al., 2017).
Problems in EF can result in various challenges in
managing emotions, thoughts, and behaviors,
potentially contributing to suicidal ideation
and/or behaviors (Bredemeier & Miller, 2015).
Adolescents with NSSI demonstrate significantly
diminished connectivity in the medial prefrontal
cortex (mPFC) compared to healthy controls,
suggesting that alterations in this brain region are
pivotal for the effective functioning of executive
processes (Santamarina-Perez et al., 2019). These
neural modifications may underlie the challenges
faced in emotional regulation, decision-making,
problem-solving, and impulse control, reinforcing
the association between executive dysfunction
and NSSI.
NSSI serves various functions, including
alleviating negative emotions, suppressing painful
affective states, and addressing feelings of
emptiness. For some adolescents, it transforms
passive emotional pain into something tangible or
active (Robinson et al., 2019). Those who engage
in NSSI have been found to struggle with multiple
facets of emotion regulation, as indicated by
significant impairments on the Difficulties in
Emotion Regulation Scale (DERS) (Emery et al.,
2016). Additionally, Gratz and Roemer (2008)
highlighted that individuals' lack of access to

adaptive emotion regulation strategies and
difficulties in identifying and explaining their
emotions exacerbates NSSI behavior.
The results of this study indicate that just over
half of the participants reported having engaged in
NSSI, which suggests that self-injurious behaviors
are relatively common within this specific sample,
particularly among the younger adolescents. The
nearly equal split between those who engage in
NSSI and those who do not highlights the
importance of addressing NSSI within this
population, as a significant proportion of adolescents are involved in such behaviors. A
longitudinal study investigating the trajectory of
NSSI among adolescents highlighted critical
patterns in the prevalence of such behavior across
developmental stages (Esposito et al., 2023). The
findings indicate that most adolescents who
engage in NSSI begin doing so in early to midadolescence. It is also consistent with the research
of Tresno et al. (2012), who identified that in
Indonesia, the onset of NSSI typically occurs at
around the age of 14. As adolescents progress into
the late developmental phase, the study found a
notable downward trend in the prevalence of NSSI
(Esposito et al., 2023). Relevant to these previous
findings, the dual system theory posits that
socioemotional regions of the brain, such as the
amygdala, rapidly mature during adolescence. In
contrast, the prefrontal cortex, responsible for
cognitive control and self-regulation, matures
more gradually (Murray et al., 2021). Given this
developmental imbalance, adolescents are more
likely to engage in risky behaviors such as NSSI
because their cognitive control has yet to establish
itself. However, as the prefrontal cortex continues
to mature with age, the propensity to participate in
risky behaviors tends to decline (Strang et al.,
2013).
Moreover, this study was conducted among
adolescents residing in major urban areas of
Indonesia. The findings indicate that such adoles-

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A. Rachma, D. Hendrawan

cents are at risk of engaging in NSSI, which aligns
with the findings of Li et al. (2022), which suggest
that urban adolescents are more susceptible to
negative thoughts associated with NSSI. Adolescents in urban areas are more widely exposed to
NSSI information through social media than their
rural counterparts, potentially increasing their risk
of imitating NSSI behaviors (Lee et al., 2023; Wu et
al., 2024). However, this study lacks comparative
data on NSSI behaviors amongst urban and rural
adolescents in Indonesia. It highlights a potential
area for further research to explore disparities and
contributing factors across different residential
settings.
The findings have important implications for
mental health practitioners and educators.
Intervention strategies that enhance EF and
emotion regulation represent a promising
approach to reducing NSSI risk in adolescents. In
particular, psychoeducational programs that
promote the use of adaptive coping strategies can
serve as early preventive measures against the
development of maladaptive behaviors such as
NSSI. Furthermore, the study highlights the
importance of early interventions that focus on
strengthening EF through cognitive stimulation
beginning in childhood. Involving parents through
structured training can further support adolescents’ cognitive and emotional development. The
study underscores the need for a developmental,
preventive approach involving collaboration
between families, schools, and mental health
professionals.
Several limitations of the study should be
acknowledged. First, measuring NSSI behavior
using the DSHI is based on a dichotomous scale,
which may be less sensitive in capturing nuanced
differences between participants. Future research
should consider continuous measures like Likert
scales to allow for a broader spectrum of
responses and a more refined understanding of
NSSI behavior. Second, the cross-sectional design
of this study limits its ability to establish causal

52 │

relationships between executive function, emotion
dysregulation, and NSSI. Longitudinal studies are
recommended for future research to explore these
relationships' temporal dynamics.
Additionally, this study was conducted
exclusively on adolescents residing in major urban
areas of Indonesia, which may limit the
generalizability of the findings to the broader
adolescent population. Adolescents in urban
environments may experience different stressors,
social dynamics, and levels of access to mental
health resources compared to their counterparts
in rural settings. Future research should consider
including adolescents from rural areas to provide
a more comprehensive understanding of the
dynamics of NSSI behaviors among adolescents in
Indonesia.

Conclusion
The findings of the study indicate that emotion
dysregulation serves as a significant mediator in
the relationship between EF problems and NSSI
behaviors in adolescents. Specifically, those with
impaired neurocognitive abilities are more prone
to experiencing difficulties in emotional regulation,
which may in turn, increase their susceptibility to
engaging in NSSI. The mediation role of emotion
dysregulation highlights the critical mechanism by
which deficits in EF are linked to NSSI behaviors.
The study provides important insights into the
dynamics of NSSI, EF problems, and emotion
dysregulation within the context of the Indonesian
adolescent population, which remain understudied areas to the authors' knowledge. The study
findings also provide a theoretical foundation for
developing intervention strategies targeting both
EF and emotion regulation, which may represent a
promising approach to mitigating the risk of NSSI.
In addition, investigating parenting patterns and
cultural or socioeconomic factors may provide
additional valuable insights to help understand the
mechanisms of NSSI.[]

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Pathway linking executive function problems and non-suicidal self-injury among adolescents ....

Acknowledgments
The article was fully funded by the Riset UI-UTM Bilateral Strategic Alliance Matching Grant from
Universitas Indonesia (No. NKB-1183/UN2.RST/HKP.05.00/2023). The authors would like to express
their gratitude to Life Span Development Lab at the Faculty of Psychology, Universitas Indonesia, as well
as Rania Fakhirah Khairunnisa, Farras Syazwani and Owena Ardra for their invaluable support in the
conducting of the research. Their contributions were instrumental in facilitating the successful completion
of this study. Additionally, the authors extend their appreciation to Dr. Tan Joo Siang and her team from
Universiti Teknologi Malaysia (UTM) for their collaboration and insightful contributions throughout the
research proces.

Author Contribution Statement
Aulia Rachma: Conceptualization; Data Curation; Formal Analysis; Investigation; Methodology; Project
Administration; Resources; Visualization; Writing Original Draft; Writing, Review & Editing. Donny
Hendrawan: Conceptualization; Formal Analysis; Funding Acquisition; Investigation; Methodology;
Resources; Validation; Writing, Review & Editing; Supervisor.

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