The relationship between emotional reactivity and adolescent non-suicidal self-injury: the mediating role of distress tolerance and gender differences

Background Non-suicidal self-injury (NSSI) is a growing concern among adolescents, yet the emotional mechanisms underlying this behavior remain insufficiently understood. Emotional reactivity—including sensitivity, intensity, and persistence—may be associated with NSSI through its relationship with adolescents’ capacity to tolerate emotional distress, and this indirect association may differ by gender. Methods A total of 3,640 adolescents (M age = 18.27, SD = 1.45; 52.34% were male) completed measures of emotional reactivity, distress tolerance, and NSSI behaviors. Structural equation modeling was used to examine the mediating role of distress tolerance in the link between emotional reactivity and NSSI, and multi-group analyses were conducted to explore gender-related patterns. Results Emotional reactivity was significantly and positively associated with NSSI. Distress tolerance mediated the association between emotional reactivity and NSSI: higher emotional reactivity was associated with lower distress tolerance, which in turn was associated with higher levels of NSSI. Gender-stratified analyses showed that the indirect effects were significant among females but not males. Further examination of the dimensions of emotional reactivity revealed that gender differences were significant for emotional intensity but not for emotional sensitivity or emotional persistence. Conclusions These findings suggest that distress tolerance is a key psychological factor underlying the association between emotional reactivity and NSSI, with this association being particularly salient among female participants. Prevention and intervention programs should focus on strengthening distress-tolerance skills and providing gender-sensitive support to reduce NSSI risk among adolescents.