Kim L. Gratz

University of Toledo · Department of Psychology

Despite the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) being a routinely used measure of discrimination , there is no current consensus regarding its fundamental psychometric properties. This study sought to: (a) test the dimensionality of the scale using a classical test theory approach, and (b), if lacking a clear multid...

Intimate partner violence (IPV) disproportionately affects women and has been linked to a range of negative psychological outcomes, including emotion dysregulation. Although IPV is often recurrent and tends to escalate in severity over time, few studies have examined the potential effects of recurrent experiences of IPV on emotion dysregulation. Th...

The Perceived Invalidation of Emotions Scale (PIES), developed to measure emotional invalidation, could aid research efforts on various internalizing disorders and minority mental health. A prerequisite for its use includes its psychometric evaluation in diverse samples; thus, the current study aimed to evaluate the psychometric properties of the P...

Background: Although health anxiety is broadly related to the overutilization of healthcare, limited research has examined this relation among individuals with substance use disorders (SUDs), or the extent to which racial/ethnic differences influence this relationship. Objectives: The purpose of the current study is to examine the moderating role o...

Background Despite the wide‐ranging negative consequences of nonsuicidal self‐injury (NSSI), there are few evidence‐based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e.,...

Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was...

Objectives Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process‐related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust corre...

Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provid...

Purpose/Objective: People with disabilities (PWD) generally exhibit an increased risk of suicidal ideation (SI) and behaviors. Underlying cognitive states, namely perceived burdensomeness, have been identified as a contributor to the increased risk of suicidal thoughts and behaviors in PWD. However, the role of body esteem in the development of SI...

This study examined the prospective relations of baseline borderline personality disorder (BPD) symptoms to later coping- and health-related outcomes during the early stages of the COVID-19 pandemic, as well as the moderating role of social media addiction in these relations. A U.S. nationwide community sample of 377 adults completed a prospective...

Despite evidence for the intergenerational transmission of borderline personality disorder (BPD) pathology from mothers to offspring, the factors underlying the relation between mother and child BPD symptoms remain unclear and little is known about the pathways through which maternal BPD symptoms may relate to BPD symptoms in their offspring. One s...

Background Borderline personality disorder (BPD) pathology is common among patients with substance use disorders (SUDs) and associated with a variety of negative outcomes, including worse SUD outcomes. One particularly relevant outcome with links to substance use problems that is likely to be elevated among SUD patients with BPD symptoms is ineffec...

Introduction: Sexual abuse during childhood is associated with risk for sexual assault as an adult, known as revictimization. Although multiple experiences of sexual assault in adulthood are also common, it is unclear how risk trajectories might continue to evolve in emerging adulthood, defined as ages 18 to 25. Clarifying risk trajectories is imp...

To identify factors that increase risk for nonadherence to recommended health protective behaviors during pandemics, this study examined the prospective relations of substance use frequency to both adherence to social distancing recommendations and social distancing intentions during the COVID-19 pandemic, as well as the role of social distancing s...

Direct and indirect body-focused self-damaging behaviors are highly prevalent and associated with negative outcomes. Despite progress in understanding the expected consequences (i.e., expectancies) that motivate individuals to engage in these behaviors, less is known about the co-occurrence of, and specific expectancies for, body-focused self-damag...

Obesity is a major public health concern, and sugar consumption is a key risk factor for obesity. Thus, there is a need to identify factors that may increase motivation to consume sugar. One such factor may be negative affect, as research has shown that negative affect increases motivation for and engagement in appetitive behaviors, including sugar...

Background: Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts). Aims: This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type. Methods: I...

Despite evidence for the interrelations of interpersonal and emotional functioning within borderline personality disorder (BPD), little research has examined the impact of socially-oriented emotion regulation strategies among individuals with BPD symptoms. This study examined the impact of one such regulation strategy, social comparison (SC; upward...

Nonsuicidal self‐injury (NSSI) is defined as the deliberate destruction of one's own body tissue without suicidal intent and for purposes not socially sanctioned. However, this definition limits the understanding and assessment of NSSI by excluding a clinically relevant form of NSSI that is both self‐driven and associated with self‐injurious intent...

Introduction: Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of l...

Background Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing...

Despite often being mandated to substance use treatment after release, many people on probation do not complete treatment. Several historical factors have been identified as relevant to substance use treatment in this population (i.e., past substance use, treatment history, and criminal history); however, less is known about the psychological chara...

Objective: Posttraumatic stress disorder (PTSD) symptoms have been associated with elevated rates of deliberate self-harm, including among women who have experienced sexual violence (SV); however, processes underlying this association have not been widely examined. Because a common function of deliberate self-harm is to reduce negative internal st...

Objective: This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status. Methods: Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interact...

Objectives: Emotional and interpersonal dysfunction appears central to nonsuicidal self-injury (NSSI), yet research examining the interplay of these factors among individuals with NSSI is limited. This study aimed to specify such associations before and after daily stressful events among individuals with (vs. without) NSSI. Methods: Young adult...

Introduction: People report multiple motives for nonsuicidal self-injury (NSSI), but few studies have examined how these motives relate to one another. This study identified person-centered classes of NSSI motives, their NSSI and psychopathological correlates, and their utility in predicting future NSSI across two samples. Methods: Participants...

Objective: This study investigated the impact of lifetime sexual violence exposure and probable posttraumatic stress disorder (PTSD) on trait and state emotional responding among a sample of 169 community women. Method: Participants completed self-report measures of experiences of lifetime sexual violence and trait emotion modulation and emotional...

Introduction: Nonsuicidal self-injury (NSSI) is associated with significant impairment and is a robust predictor of suicidal ideation, attempts, and death by suicide; however, the present lack of a brief screening instrument for NSSI coupled with consistent underidentification of NSSI in male adults has led to concerning rates of missed identifica...

Background Despite research and theory linking emotion regulation (ER) difficulties to suicidal thoughts and behaviors, limited research has examined the relations of specific ER strategies to suicide risk outcomes, and almost no research has examined interpersonal ER strategies in particular. Thus, this study sought to examine associations of spec...

Despite the clearly established link between posttraumatic stress disorder (PTSD) and emotion dysregulation, little is known about how individual symptoms of PTSD and aspects of emotion dysregulation interrelate. The network approach to mental health disorders provides a novel framework for conceptualizing the association between PTSD and emotion d...

In 2020, a novel emerging infectious disease—COVID-19—became a global pandemic and prompted unprecedented social distancing measures. We examined the associations of voluntary stay-at-home (SAH) orders during the COVID-19 pandemic with vulnerability assessments and precautionary intentions (e.g., social distancing, hand washing). A quasi-experiment...

Background The affective states most strongly associated with nonsuicidal self-injury (NSSI) remain poorly understood, particularly among veterans. This study used ecological momentary assessment (EMA) to examine relationships between affect ratings and NSSI urges and behaviors among veterans with NSSI disorder. Methods Participants (N = 40) compl...

Background: Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequ...

Objectives Extant research indicates a robust association between anxiety and nonsuicidal self-injury (NSSI). However, research identifying factors that may account for this relation is lacking. Mindfulness is one candidate construct that may account for the relation of anxiety to NSSI. The objective of the present study was to examine the indirect...

This study sought to examine the explanatory role of sleep disturbance in the associations of borderline personality disorder (BPD) symptom severity to nonsuicidal self‐injury (NSSI) and suicide risk within an at‐risk sample of patients with substance use disorders (SUDs), as well as whether emotion regulation (ER) difficulties account for signific...

There is a need to identify the subset of individuals with borderline personality disorder (BPD) symptoms at greatest risk for transitioning from suicidal ideation to a suicide attempt. Contemporary models of suicide risk propose that the capability for suicide is necessary for moving from suicidal ideation to a suicide attempt. Few studies have ex...

Given concerns of increased suicide risk among university students during the COVID-19 pandemic, this study examined rates of lifetime and past-year suicidal ideation (SI) among university students in Fall 2020 (vs. two earlier semesters), overall and across gender, racial/ethnic background, and sexual identity. Participants included 1700 universit...

Background Adherence to COVID-19 social distancing guidelines varies across individuals. Purpose This study examined the relations of pseudoscientific and just world beliefs, generalized and institutional trust, and political party affiliation to adherence to COVID-19 social distancing guidelines over three months, as well as the explanatory role...

Objective: Women who have experienced trauma report high rates of heavy episodic drinking (HED) and sleep problems. Prior work suggests that poor sleep exacerbates heavy alcohol use; however, potential mechanisms for this association are unclear. Consistent with the self-medication model, one possibility may be that women with a history of trauma a...

Background : Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these ass...

Despite evidence for an association between BPD symptoms and low/unstable self-esteem (SE), no research has examined social factors that may moderate the relation between BPD symptoms and SE difficulties. One factor that may be especially relevant is social comparison orientation (SCO). Across two studies, this research examined the main and intera...

Background: Researchers have highlighted the risk for alcohol use problems in the context of COVID-19, although the factors associated with this risk remain unclear. Objectives: This study examined the prospective relation of baseline financial strain (reported at the beginning of the pandemic) to problematic alcohol use one month later, as well as...

Despite evidence for the association between emotion regulation difficulties and posttraumatic stress disorder (PTSD), less is known about the specific emotion regulation abilities that are most relevant to PTSD severity. This study examined both item-level and subscale-level models of difficulties in emotion regulation in relation to PTSD severity...

Introduction: Theory and research suggest the need to expand research on emotion regulation (ER) within borderline personality disorder (BPD). This research examined the relations of BPD symptoms to interpersonal (venting, reassurance-seeking) and socially-oriented (social comparison) ER strategies (in addition to acceptance and avoidance), and exp...

Emotion dysregulation has been shown to be of importance in the onset and maintenance of psychiatric disorders, including substance use disorders. How difficulties in emotion regulation differ across levels of substance use, and whether these relations are influenced by co-occurring psychiatric disorders, is less clear. This study aimed to identify...

Despite the established relations between borderline personality disorder (BPD) and substance use problems in general, there is a dearth of research on the relation between BPD pathology and opioid use problems, as well as factors that may explain this relation. Therefore, this study examined the indirect relations of BPD pathology to opioid use pr...

Deliberate self-harm (DSH) is a widespread transdiagnostic health problem with increasing prevalence among adolescences, and young adults. It is therefore essential to effectively chart the epidemiology of DSH, as well as to assess the efficacy of interventions designed to modify this behavior. The aim was to translate and analyze the psychometric...

Research has largely not identified processes contributing to the relationship between physical disability and suicide risk. This cross-sectional research is aimed at examining the associations among felt stigma, perceived burdensomeness, disability severity, and perceptions about future suicidal ideation and attempts. Adults (N = 127) with physica...

Little research has examined the role of emotion regulation self-efficacy (ERSE; i.e., beliefs in one's own ability to regulate emotions) in self-injurious thoughts and behaviors (SITBs) or the factors that may underlie this relation. This study investigated whether low ERSE relates to SITBs both directly and indirectly through avoidance of negativ...

Objective Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were a...

The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective ris...

Background : Despite theories that negative reinforcement in the form of relief from negative emotions maintains nonsuicidal self-injury (NSSI), no studies have examined the extent to which specific emotional consequences of NSSI predict the maintenance of NSSI over time or explain the greater risk for NSSI found among individuals with borderline p...

Objective The social and economic consequences of COVID‐19 and related public health interventions aimed at slowing the spread of the virus have been proposed to increase suicide risk. However, no research has examined these relations. This study examined the relations of two COVID‐19 consequences (i.e., stay‐at‐home orders and job loss) to suicide...

Objective This study explored the boundaries of the proposed diagnostic criteria for nonsuicidal self‐injury disorder (NSSID) as outlined in the Conditions for Further Study section of the Diagnostic and Statistical Manual, Fifth Edition . We sought to falsify the exclusion of certain NSSI behaviors from a diagnosis of NSSID (Criterion D), arguing...

The COVID-19 pandemic has resulted in the widespread implementation of extraordinary physical distancing interventions (e.g., stay-at-home orders) to slow the spread of the virus. Although vital, these interventions may be socially and economically disruptive, contributing to adverse psychological outcomes. This study examined relations of both sta...

Objective This study examined the presence of posttraumatic stress disorder (PTSD) as a predictor of treatment response to dialectical behavior therapy (DBT) across the primary outcomes of interest within DBT (i.e., borderline personality disorder [BPD] symptoms, deliberate self‐harm, emotion regulation [ER] difficulties) and PTSD symptoms. Method...

Despite the robust relation between nonsuicidal self-injury (NSSI) and suicidal behaviors, there is considerable heterogeneity in NSSI characteristics that may have implications for the strength of the NSSI-suicide attempt relation. In particular, NSSI methods that are more severe/painful (e.g., cutting) may be more likely to increase an individual...

There is extensive variability in cocaine-related attentional bias (AB) following trauma script exposure among cocaine-dependent (CD) patients with posttraumatic stress disorder (PTSD). Therefore, research is needed to identify the specific PTSD-CD patients most likely to exhibit an AB to cocaine cues. A common polymorphism in brain-derived neurotr...

Background: Opioid abuse/dependence is associated with multiple negative outcomes relative to other forms of substance abuse/dependence, including relapse. Research identifying modifiable characteristics associated with opioid dependence and associated negative outcomes may inform the development of targeted interventions for this high-risk populat...

Despite evidence of a strong relationship between BPD and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the...

Objective Although past literature has emphasized the role of acquired capability in the relationship between nonsuicidal self‐injury (NSSI) and suicide attempts, support for the indirect relationship of NSSI to suicide attempts through acquired capability is limited. Thus, research examining other factors that may underlie this relationship is nee...

To facilitate self-evaluations and guide behavior, students often compare domain-specific academic achievements (e.g., math scores) to peers (social comparison), past achievements (temporal comparison), and other domains (e.g., verbal scores; dimensional comparison). However, no studies have examined the impact of all three comparison types (and th...

Borderline personality disorder (BPD) is characterized by emotional reactivity and interpersonal sensitivity, including greater emotional and cognitive reactivity to social rejection than controls. However, existing social rejection paradigms are not relevant to the particular social contexts that are increasingly relevant for adolescents and young...

Despite advancements in the treatment and prevention of HIV/AIDS, adherence to antiretroviral therapy (ART) remains suboptimal. Research indicates that health care provider (HCP) engagement is related to adherence, yet little is known about the specific pathways that underlie this relation. This cross-sectional study examined the relation between p...

Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of ps...

Attenuated reward responsiveness (RR) reflects alterations in responding to ordinarily rewarding experiences (Der-Avakian & Markou, 2012), and is associated with negative outcomes, such as increases in depression symptoms over time (Morgan et al., 2013), poor response to antidepressant treatment (McMakin et al., 2012), and suicidal ideation (Winer...

Non-suicidal self-injury (NSSI) has primarily been studied in the context of borderline personality disorder, with research demonstrating that NSSI is often used to obtain emotional relief. However, few studies have examined whether motivations for NSSI are comparable in other disorders associated with heightened rates of NSSI, including depressive...

Although evidence suggests that risk-taking among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) may be precipitated by trauma-related emotional distress, studies have yet to examine moderators of this effect. One moderator worth investigating is recurrent major depressive disorder (MDD), given i...

Objective Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt. Methods Participants were drawn from the US National Gu...

PURPOSE Extend existing research by (a) documenting rates of borderline personality features (BPF), NSSI, and SI among male Veterans diagnosed with PTSD and (b) examining the odds of experiencing SI based on presence of PTSD, BPF, and/or NSSI

Objective Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self‐injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic backgr...

Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulat...

Studies show that patients with substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are at high risk for engaging in risky behaviors. However, these studies do not speak to the context in which these behaviors are more likely to occur. This study examined whether SUD patients with current PTSD, compared to those without a history...

Theories of borderline personality disorder (BPD) highlight the central role of emotional dysfunction in this disorder, with a particular emphasis on emotional reactivity and emotion regulation (ER) difficulties. However, research on emotion-related difficulties in BPD has produced mixed results, often related to the particular indices of emotional...

One victimization experience can increase the risk for subsequent victimization, which is known as revictimization. The aims of this study were to build on sexual revictimization research by (a) broadening the understanding of revictimization to interpersonal (and potentially noninterpersonal) trauma generally and (b) gaining specificity in the mec...

Use of social networking sites (SNS) has dramatically increased over the past decade, with nearly 2.27 billion active monthly users (Facebook, 2018). With the increased use of SNS, rates of cyberbullying and online rejection have also increased (Smith et al., 2017). Thus, more information is needed to determine the impact of online rejection on emo...

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revea...

Background Nonsuicidal self-injury (NSSI) is common among adolescents and associated with negative outcomes. However, treatments developed specifically for NSSI and the proposed NSSI disorder (NSSID) are scarce, and access to empirically supported treatments for NSSI in many areas is limited. Online treatments carry the potential to increase the av...

U.S. veterans are at increased risk for suicide compared to their civilian counterparts and account for approximately 20% of all deaths by suicide. Posttraumatic stress disorder (PTSD) and borderline personality features (BPF) have each been associated with increased suicide risk. Additionally, emerging research suggests that nonsuicidal self-injur...

Objective: We used a daily diary to examine (1) the frequency of three types of NSSI thoughts and urges (fleeting thoughts, persistent thoughts, and intense urges), (2) the correlates of NSSI thought and urges within and across days, (3)strategies that aid in resisting NSSI thoughts and urges, and (4) the prospective association of daily NSSI though...