Nonsuicidal self-injury (NSSI), which is typically defined as deliberate destruction of one’s own body tissue without suicidal intent and for purposes that are not socially or culturally sanctioned (1), is a growing clinical challenge in adolescence. It encompasses behaviors such as cutting or burning one’s own body tissue (2), and global prevalence estimates of NSSI among adolescents range from 16% to 17% (3, 4) with lifetime prevalence rates reaching up to 23% (5). Occurrence peaks between ages 15 and 17 and declines in young adulthood (6). NSSI during adolescence is associated not only with mental health problems but also with higher healthcare and economic burdens, reduced productivity, greater morbidity and mortality (7), and an elevated risk of later suicide attempts (8).

Because NSSI is both prevalent and consequential in adolescence, research has established a solid foundation of distal, developmental risk factors, particularly adverse childhood experiences and parental invalidation (9–13). These factors, along with their neurobiological correlates (14), are central to understanding predictors of adolescent NSSI. Yet, when individuals are asked why they engage in NSSI, the most frequently endorsed function is emotion regulation (15), especially the down-regulation of aversive affect (see the seminal work on the Four-Function Model of NSSI, 16, 17). This underscores the need to examine proximal affective states that are directly tied to the immediate intrapersonal function of NSSI. In this context, shame and guilt—distinct yet overlapping self-conscious emotions—remain insufficiently studied as proximal states in NSSI, with notable exceptions (18, 19), and their roles as antecedents and consequences have yet to be clearly specified.

Shame and guilt are self-conscious, discrete emotions elicited by evaluative contexts and oriented toward protecting the social self (20, 21). Shame typically arises from negative self-evaluation or from unwanted exposure of perceived shortcomings (18, 22). In its classic definition, shame reflects a global devaluation of the self rather than an appraisal of a specific behavior (23). Correspondingly, shame is linked to self-scrutiny, withdrawal, a sense of powerlessness, and is often associated with emotional suppression (22). A recent study in adolescents has described an association between shame-proneness and NSSI (13). By contrast, guilt is typically behavior-focused and situational (23). It is therefore more distinct from one’s self-concept or identity and can function as an adaptive emotion-regulation strategy, prompting reparative actions and behavioral change (e.g., apologizing). Although excessive or ruminative guilt can become maladaptive (24, 25), its usual trajectory and functions differ from those of shame, as guilt tends to promote constructive behavior and social cohesion rather than global self-devaluation (e.g., 26).

Beyond these classic distinctions, shame is often conceptualized as comprising both internal shame, reflecting global negative self-evaluation (e.g., feeling flawed or bad as a person), and external shame, reflecting anticipated or perceived negative evaluation by others (e.g., fear of being judged, rejected, or exposed) (27). This distinction may be particularly relevant for NSSI because the behavior is stigmatized and often concealed (28), particularly in adolescent peer contexts, where it can amplify concerns about negative evaluation. Likewise, guilt may range from action-focused, potentially reparative (“adaptive”) guilt to maladaptive forms characterized by excessive self-blame, rumination, or a perceived need for punishment (24), which may overlap with shame in some contexts.

A heightened proneness to shame and guilt has been linked to invalidating caregiving environments and adverse or traumatic childhood experiences (29, 30). These developmental contexts are also commonly associated with NSSI (31) and with a broader spectrum of psychopathology, including depression (32), borderline personality disorder (33, 34), and post-traumatic stress disorder (PTSD, 35; 36). During adolescence, a developmental period characterized by identity formation and increasing salience of peer relationships (37), coping with stressful or negative experiences may be shaped by one’s tendency to experience shame (38) or guilt (39), particularly given that adolescents generally exhibit heightened amygdala responses to social evaluation at the neurobiological level (40). NSSI may serve as a coping mechanism for regulating these self-conscious emotions, whether by managing intense internal states (the intrapersonal function of the Four-Functions model of NSSI; 16), enacting self-punishment, or signaling distress to elicit care or escape aversive social situations (i.e., interpersonal or social-signaling functions, 15). Thus, shame and guilt may constitute theoretically grounded proximal risk factors for the emergence and maintenance of NSSI across its multiple functional pathways. NSSI is also highly stigmatized (41, 42), and guilt and shame may not only precede NSSI but also follow it, adding an additional emotional burden (see, e.g., 43).

A large meta-analysis (19) found that individuals with a history of NSSI reported higher shame (moderate effect, d = 0.47) and that shame was positively associated with NSSI frequency (r = 0.24, p <.05). In the same review, guilt showed no association with NSSI; however, this conclusion was based on only two studies, both conducted with undergraduate samples (44, 45). Subsequent work has largely replicated the positive association between shame and NSSI, but not between guilt and NSSI (e.g., 46), raising the possibility that guilt may be relatively protective against NSSI when used as an emotion-regulation strategy, a pattern also noted for some externalizing outcomes such as criminal offending and substance use (47). At the same time, guilt has been linked to suicidal ideation and attempts, particularly in the context of trauma and PTSD, underscoring its complex and context-dependent role (48). Indeed, among trauma-exposed individuals, forms of guilt such as survivor guilt and moral guilt can heighten self-blame, hopelessness, and a perceived need for punishment (36, 49, 50), patterns that align more closely with suicidal cognition than with the affect-regulatory motives that typically maintain NSSI. This context-dependent nature of guilt underscores the importance of examining it as a situational state in specific contexts, such as NSSI, rather than solely as a stable trait.

Irrespective of the differential associations reported for guilt and shame, a shared limitation is that most studies are cross-sectional, retrospective, and treat these constructs as traits (i.e., guilt/shame proneness, 19). Foundational work has additionally highlighted conceptual and measurement challenges in distinguishing guilt and shame (22). By contrast, ambulatory assessment (repeated sampling on smartphones or other digital devices, see 51) may be more informative because it may capture near-real-time fluctuations in emotions and NSSI thoughts and behaviors in everyday life in an ecologically valid way and enables tests of emotional antecedents and temporal dynamics.

Research on nonsuicidal self-injury (NSSI) and related forms of self-harm has shown that elevations in negative affect are temporally linked to subsequent NSSI urges and, in some studies, to NSSI acts, while negative affect typically declines shortly after NSSI on average (see 52, for a systematic review). In a recent daily life study of 125 young adults with NSSI, the role of self-criticism was examined, and higher levels of self-criticism predicted NSSI urges and behavior within the following two hours (53). Although self-criticism is not synonymous with shame or guilt, these findings underscore that self-defeating cognitions are closely intertwined with NSSI. Another daily life study of 158 adolescents found that shame did not significantly predict subsequent NSSI at the within-person level, but that higher NSSI was associated with increases in shame in between-person analyses (54). Taken together, previous work has already advanced affect-regulation models of NSSI and may inform clinical care, for example via just-in-time digital interventions (45, 55). However, prior studies have either focused on global self-critical cognitions or on shame alone and have not examined shame and guilt side by side as distinct, time-varying states in relation to NSSI urges and acts in adolescents. It therefore remains unclear whether shame and guilt differentially track short-term fluctuations in NSSI urges and show distinct patterns in the immediate aftermath of NSSI episodes, questions that the present study aims to address.

Thus, in the current study we investigated adolescents who had recently engaged in NSSI and assessed momentary shame, guilt, NSSI urges, and NSSI acts in everyday life using ambulatory assessment, sampling four times daily for seven consecutive days and, following NSSI events, at high frequency using event-contingent prompts. We examined within- and between-day patterns of shame and guilt (research question 1). We then tested whether momentary shame and guilt were associated with the concurrent intensity of NSSI urges (research question 2) and whether shame or guilt at the previous prompt predicted NSSI urges at the next assessment (research question 3). Finally, we evaluated how shame and guilt changed when NSSI acts occurred, mapping their trajectories before and after NSSI events (research question 4).

This study was approved by the Ethics Committee of the Medical University of Vienna (1651/2019) and conducted in accordance with the Declaration of Helsinki. The present manuscript reports additional analyses of data from the cohort described in Goreis et al. (56). Details on study registration and the trial’s sample size and power rationale are provided in Goreis et al. (56) and in the German Clinical Trials Register (DRKS00025905; https://drks.de/search/en/trial/DRKS00025905). The analyses and research questions reported here are novel and have not been published previously.

The final sample consisted of 25 participants who engaged in NSSI (M_age = 15.88, 72% female, 8% male, 20% gender-diverse). On average, the sample reported engaging in NSSI 69.4 times in the past year (see Table 1 for details on NSSI methods/SITBI-R). Eight participants had a prior PTSD diagnosis (according to ICD-10), and dimensional CATS-2 scores for the full sample averaged M = 26.68 (SD = 16.32), indicating overall high PTSD symptom severity (CATS-2 DSM-5 cut-off: scores >24). Furthermore, as documented in their clinical records, 64% had a preexisting mood disorder, 48% had personality disorders, and 60% were taking psychopharmacological medication (Table 1).

The present study examined how shame and guilt relate to momentary NSSI urges and acts in adolescents using an ambulatory assessment design. Across seven days, both emotions were positively associated with concurrent NSSI urges at the within-person and between-person levels. Importantly, we found no evidence that guilt was protective and its concurrent association with urges was rather comparable to shame. However, neither shame nor guilt at the previous prompt predicted an increase in the next urge one to three hours later, indicating that these emotions co-occurred with elevated urges rather than temporally preceded them. Finally, and importantly, the high-frequency post-NSSI prompts provided a level of temporal resolution that standard time-based sampling cannot achieve and revealed a clear rise in shame after NSSI acts, whereas guilt showed no significant post-event change. This pattern, which aligns with prior cross-sectional work linking shame more robustly than guilt to self-injurious outcomes (19, 48), suggests that shame may sustain or amplify self-conscious distress following NSSI. All conclusions remained unchanged after adjusting for PTSD symptom severity. Although higher PTSD symptoms were associated with elevated baseline levels of shame and guilt, they did not modify any within-person or event-related effects.

Our first research question examined within-day and between-day dynamics of shame and guilt. Shame fluctuated throughout the week, with lower levels before the weekend and a rise on Sunday as the next school week approached. Within the day, shame was lower in the morning and higher in the evening. These patterns mirror epidemiological evidence that self-injury presentations and suicidal ideation/attempts peak on Sundays and Mondays, with higher levels in the evening and at night (66–69). The reasons for these evening elevations have been hypothesized to reflect a convergence of circadian and contextual risk processes (e.g., greater social isolation and fewer distracting activities later in the day), alongside hormonal changes across the day (e.g., in cortisol or melatonin) that may contribute to heightened evening risk (70, 71). Because most participants were secondary school students, anticipatory school stress may be a plausible explanation for the Sunday increase, we speculate that the expected academic pressure and reduced social structure may have increased negative outcomes.

In line with this, shame and guilt may also accumulate over the course of the day. Ambulatory studies likewise report evening peaks in NSSI urges and suicidal ideation (72–74), consistent with the diurnal trajectory we observed for shame and guilt. Registry evidence points in the same direction: in Ireland, adolescent self-harm/NSSI rates were lowest during school holidays and weekends across more than 150,000 presentations from 2007 to 2019, with similar patterns reported in Canada (69, 75). While school stress is unlikely to be the sole driver of NSSI urges or associated emotions, these temporal regularities suggest a practical window for detection and prevention in school and peer settings.

Regarding our second research question, moments when adolescents experienced more shame or guilt than usual coincided with stronger NSSI urges, and adolescents who generally reported higher levels of these emotions also showed higher average urges. This pattern is consistent with recent ambulatory assessment findings that heightened self-critical thoughts are associated with NSSI urges and behaviors (53), and it seems plausible that self-criticism is intertwined with other self-defeating thoughts and emotions such as shame. Crucially, these links were contemporaneous: elevations in shame or guilt did not forecast higher urges at the next prompt. This pattern, which was highly similar for both shame and guilt, suggests that these emotions function more as proximal markers of urge episodes, and may also be heightened by them, rather than as short-term drivers at the time scale we sampled. Based on our data, we cannot conclude that shame or guilt are feasible predictors of future NSSI urges or acts; however, they appear closely interrelated with urges and tend to co-occur with them. Clinically, even without a prospective effect, spikes in shame or guilt remain actionable as real-time risk markers for support (45, 55), and they should be assessed whenever possible and appropriate.

We further examined shame and guilt in the immediate episodes before and after NSSI acts (research question 4). Here, the two emotions diverged. We found a post-NSSI rise in shame, but not guilt, a pattern consistent with the view that shame is more dynamic in the context of NSSI (19). This pattern fits with a maintenance loop following self-injury rather than a pre-episode trigger, suggesting that shame may sustain the emotional and cognitive conditions that contribute to the recurrence of NSSI. An ambulatory assessment study in adolescents with NSSI likewise reported that regulatory effects, that is, reductions in negative affect following NSSI, did not occur and that NSSI was followed by increases in negative affect immediately and up to one hour afterward (76). Another daily life study in adolescents also reported increases in anger towards the self following higher levels of NSSI, and between-person (but not within-person) increases in NSSI were followed by increased feelings of shame (54). Taken together, these findings suggest that, rather than directly precipitating NSSI, shame intensifies alongside negative affect after the act and may prolong subsequent distress. In other words, in addition to experiencing distress, young people may also feel ashamed of having self-injured, and this response may vary by NSSI function. For example, NSSI motivated by self-punishment may be followed by persistent or heightened shame if the act is perceived as insufficient “atonement,” whereas NSSI serving affect regulation may be associated with lower post-event shame (16, 17). Furthermore, self-injury may also elicit anticipatory shame (e.g., fear of being discovered), thereby amplifying post-event emotional burden.

NSSI still remains one of the most stigmatized mental health concerns (77). Shame, partly driven by this stigma, may become internalized and carry its own psychosocial consequences (41, 42). The stigma surrounding NSSI also has significant negative implications for disclosure and help-seeking, as the behavior is, as mentioned, frequently concealed (see 28, for a review). We encourage clinicians to assess shame, and by extension guilt, given its role as a proximal, concurrent marker of NSSI urges. We also reiterate prior calls to use respectful, non-stigmatizing language when discussing NSSI (e.g., 78; see also 79, for concrete examples applicable to clinical care). This stance can reduce stigma and, in turn, mitigate the experience of shame among those who self-injure.

Importantly, such efforts should not be confined to clinical or school settings. Shame related to NSSI may also be shaped and reinforced within families, peer groups, and digital environments, including through critical parenting responses, peer reactions, or exposure to stigmatizing narratives online (13, 25, 43). Addressing these broader contexts may therefore be critical for reducing the emergence and maintenance of shame. At a public health level, schools can train staff in non-stigmatizing language and responses and provide clear pathways to confidential help. Stigma reduction campaigns that use person-first language and normalize help-seeking (e.g., 41) may reduce shame and, in turn, lower barriers to disclosure and care.

In conclusion, our study provides novel, ecologically valid insights into how shame and guilt unfold around NSSI in adolescents’ daily lives. Both emotions were concurrently associated with stronger urges, yet neither predicted higher urges at the next prompt (i.e., within a 1 to 3 hour interval). Overall, our findings suggest that shame is more involved in the aftermath and potential maintenance of distress than in short-term triggering of new NSSI urges, and guilt tracked urges concurrently but showed no evidence of a protective or prospective association in this design. Clinicians should routinely assess shame and guilt, treat elevations in these emotions as potential real-time risk markers, and strengthen skills plans not only for managing urges but also for the hours following an episode. This may include strategies targeting self-criticism and anticipated judgment (see 81, 82, for treatment options), with Dialectical Behavior Therapy, which emphasizes emotion regulation and self-validation, being particularly well suited in this context.