Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Abstract

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

“…Similarly, individuals who engaged in NSSI from inpatient adolescent and adult samples reported greater impulsivity than individuals who did not engage in NSSI (i.e., motor impulsivity and non-planning as assessed on the BIS; Evren et al, 2012;Herpertz et al, 1997;McCloskey, Look, Chen, Pajoumand, & Berman, 2012). The association between impulsivity and NSSI was found with male (Evren et al, 2012) and female participants Crowell et al, 2012;Ogle & Clements, 2008), as well as among individuals with varying ethnic backgrounds, including Spanish , Italian (Di Pierro, Sarno, Perego, Gallucci, & Madeddu, 2012), American (Crowell et al, 2012;Dir et al, 2013;Ogle & Clements, 2008;St Germain & Hooley, 2012), Canadian (Cloutier et al, 2010), and German (Herpertz et al, 1997).…”

“…Qualitative review 6.1.1. NSSI vs no NSSI Individuals who engaged in NSSI self-reported greater impulsivity, as assessed by the UPPS (Whiteside & Lynam, 2001), the Barratt Impulsiveness Scale (BIS, Patton et al, 1995), the impulse control subscale of the Difficulties with Emotion Regulation Scale (DERS, Gratz & Roemer, 2004), and the Schedule for Non-Adaptive and Adaptive Personality Impulsivity Subscale (SNAP-IMP, Clark, 1993), compared to individuals who did not engage in NSSI (e.g., Arens, Gaher, & Simons, 2012;Crowell et al, 2012;Dir, Karyadi & Cyders, 2013;Glenn & Klonsky, 2010;Herpertz, Sass, & Favazza, 1997). Undergraduate students with lifetime histories of NSSI significantly differed from individuals without a history of NSSI on impulsivity measures of negative urgency (Arens et al, 2012;Black & Mildred, 2013;Dir, Karyadi, & Cyders, 2013;Ogle & Clements, 2008) and lack of premeditation (Glenn & Klonsky, 2010;Mullins-Sweatt et al, 2013;Taylor, Peterson, & Fischer, 2012).…”

“…One outlier was found (3.8 SD over the mean; Crowell et al, 2012), which was brought back into bounds (see Lipsey & Wilson, 2001). When these studies were metaanalyzed (regardless of the impulsivity measure assessed), there was a significant mean difference between the two groups (d = 0.593), indicating a medium mean effect size -see Table 1.…”

Electrodermal Activity in Adolescent Depression

“…These results led to the assumption that reduced EDA could be an important biopsychological trait in the etiology of depression. However, previous studies have evaluated EDA in adult depressed patients and studies at adolescent age are very rare (Crowell et al 2012). Therefore, in the present study we set out to determine the baseline EDA in adolescent patients suffering from MDD, prior to pharmacological treatment.…”

Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities

“…The association between NSSI and features of BPD, mainly in clinical samples, is undeniable, since NSSI is a criterion of BPD (Crowell et al, 2012;Jacobson et al, 2008;Sadeh et al, 2014). There is also an association with other personality pathologies (Klonsky et al, 2003;.…”