Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Abstract

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Frequency and types of emotional dysregulation in referrals to child and adolescent mental health services

“…Nascent mental problems in younger children may be characterized by diffuse symptoms, which may not crystallize as specific diagnoses until later in adolescence, causing this age group to primarily be described with more general ED terms, which did not yet point to a specific disorder. Self‐harm was more common in adolescents than in children in line with existing literature 33,36–38 and a recent study found that ED in particular contributed to self‐harm in adolescents 39 . Self‐harm is typically used as a way of coping with difficult thoughts or feelings 33,37 and may be a deliberate strategy of regulating emotions.…”

“…Self-harm was more common in adolescents than in children in line with existing literature 33,[36][37][38] and a recent study found that ED in particular contributed to self-harm in adolescents. 39 Self-harm is typically used as a way of coping with difficult thoughts or feelings 33,37 and may be a deliberate strategy of regulating emotions. Risk factors for self-harm include adverse childhood environment and experiences, maladaptive parenting, and childhood maltreatment, 38 which may lead to stress reactions or adjustment disorders, possibly explaining that these were the most frequent diagnoses in children with self-harm.…”

Self-Mutilation Among Adolescents: A Systematic Review With Meta-Analysis

“…For socioeconomic factors, the influence of the following factors was observed: being an only child; 14,26,31,34 low economic situation; 6,18,36,49,52,83,88 low education; 15,63 and having an employment relationship. 29 As for family factors, the following stand out: low parental education; 15,25,36 conflicts with parents or between siblings; 13,21,31,34,39,45,48,52,56,64,79,82,87,92 witnessing domestic violence; 12,32,39 separated parents; 13,18,32,39,60,64 absence/excessive presence of parents; 14,17,28,35,39,86 self-inflicted violence in the family; 18,53,84,…”

Emotional Reactivity in Adolescents With Non-suicidal Self-injury and Its Predictors: A Longitudinal Study

“…In a previous publication a significant positive correlation between patients' ERS sensitivity score and the occurrence of NSSI within the last year was found and a correlation between the ERS and different types of reinforcement as a motivating factor for NSSI was detected (25). In order to explain the emergence and maintenance of NSSI, Hasking et al have introduced the Cognitive-Emotional Model of NSSI.…”