High-school students and self-injurious thoughts and behaviours: clues of emotion dysregulation

Abstract

Background Suicide attempts and self-harm in adolescence are a major public health concern: they are among the main causes of disability-adjusted life-years worldwide, with severe long-term health consequences in terms of mental illness and psychiatric hospitalisation and a significantly increased risk of suicide. Several studies recently focused on the hypothesis that adolescents may be particularly vulnerable to emotional dysregulation and on the relation between problems with emotion regulation and suicidal and self-harming behaviours. Italian epidemiological data about prevalence of these behaviours at the community level are lacking. Our study aimed to estimate the prevalence of self-injurious thoughts and behaviours (SITBs) in a representative sample of community adolescents, and to examine the association between SITBs and the emotional and behavioural profiles. Methods Anonymous self-report questionnaires were completed by 1507 students aged 11–18 years from 24 high schools in the North-eastern Italian region of Friuli Venezia Giulia. Information was collected on SITBs, on the socio-environmental context, and on the psychological profile (‘Achenbach’s YSR questionnaire 11–18, Multidimensional Test of Self-harm and Multi-Attitude Suicide Tendency Scale). Results Overall, 11.1% of adolescents reported self-harming behaviours without suicide ideation or attempts, 6.4% declared having thought to suicide without acting a suicide attempt or self-harm, 1.4% declared having attempted suicide and really thought to take away their life. Access to health services following a suicide thought, a self-harming behaviour or suicide attempt was infrequent, particularly for suicide ideation. At the YSR, all the SITBs groups reported high scores in almost all scales, with the most evident differences in the self-harming groups in which adolescents reported significantly higher scores in all scales, both internalising and externalising. An emotion dysregulation profile was found in almost all the groups. Conclusions This study provides us with an estimate of the prevalence of SITBs in the adolescent population and confirms the importance of further investigating the association between SITBs and emotion dysregulation. The naturalistic setting of community studies appears to be useful for studies in this field, and it allows to approach the onerous and often neglected issue of adolescent suicidality.

Paradoxes in Borderline Emotional Dysregulation in Adolescence: Influence of Parenting, Stressful Life Events, and Attachment

“…Borderline personality disorder (BPD) can be observed in up to 50% of adolescent inpatients ( 1 ) and is associated with significant social dysfunction and high levels of suicide and comorbidities, which justifies the importance of preventing this disorder ( 2 ). In adults as well as adolescents, emotional dysregulation has been clearly imputed in the onset of the behavioral disorders impacting the severity of borderline disorder, such as suicidal, self-harm, and self-destructive impulsive behaviors ( 3 , 4 ). Furthermore, the borderline symptoms most directly indicative of this emotional dysregulation, such as anger outbursts and emotional instability (alternating excitement, sadness, and hopelessness), are both the most common symptoms of borderline disorder at this age and those with the greatest predictive value for the illness ( 1 ).…”

Reward processing in young people with self-harm behaviour

“…Past research also suggests that individuals engage in SH to relieve negative affect (NA) 6 . Greater NA often preceeds SH enactment 26,27 In line with this, NA has been reported in individuals with SH compared with healthy controls in cross-sectional and longitudinal behavioural studies 28–30 . In young people with SH, BOLD activity in reward-related regions correlates with self-reported deficits in emotion regulation 31 , and is modulated by stimuli’s valence 32 .…”

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm

“…There are also six DSM-oriented scales (DOS) relating to: Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity Problems, Oppositional Defiant Problems, and Conduct Problems. Based on the scores they obtained on the syndrome scales for anxiety/depression, attention problems, and aggressive behavior, individuals' emotional-behavioral regulation was classified as: no dysregulation for T scores < 180; a moderately deficient emotion self-regulation for T scores from 180 to 210; or a full-blown dysregulation profile for T scores ≥ 210 [37][38][39][40][41].…”