Personality Correlates of Self-Injury in Adolescent Girls: Disentangling the Effects of Lifetime Psychopathology

Abstract

Adolescent non-suicidal self-injury (aNSSI) is associated with abnormal scores on personality traits, such as high neuroticism. However, no studies to date have examined personality facets of self-injury in a cohort younger than college-age. Plus, adolescent psychopathologies, especially Depressive Disorders, are associated with a similar personality profile and are highly comorbid with aNSSI. Consequently, it remains unclear whether personality provides insights about aNSSI in youth beyond that due to underlying psychopathology. 550 community-dwelling 13- to 15-year-old never-depressed adolescent girls were interviewed for lifetime aNSSI and lifetime psychopathology. Personality traits, broad domains and specific facets, were assessed by self-report. Never-depressed adolescent girls who endorse aNSSI often met lifetime criteria for psychiatric disorders (NSSI: 20/43; 46.5% vs. non-aNSSI: 131/507; 26.1%). aNSSI and lifetime psychopathology were each independently associated with several traits (e.g., high neuroticism and conscientiousness), whereas some traits only discriminated aNSSI (e.g., high melancholia, a facet of neuroticism related to sadness and negative self-evaluation) or lifetime psychopathology independent of each other (e.g., low positive emotionality; low agreeableness). Furthermore, a multivariate model identified high melancholia, high openness to experience, and low conscientiousness as incrementally independent correlates of lifetime aNSSI over and above psychiatric illness. Proneness to melancholia, interest in new things, and poor self-control incrementally track aNSSI in never-depressed adolescent girls. Importantly, this emerges early in course (13-15 years of age) and is independent of lifetime psychiatric diagnosis. Implications for updating etiological models and clinical utility of personality assessment are discussed.

Prospective Prediction of First Onset of Nonsuicidal Self-Injury in Adolescent Girls

“…Parental substance abuse might be a risk factor via inherited genetic vulnerability to externalizing psychopathology and disinhibition more broadly, as well as due to parenting and environmental transmission of risk. 40 Although lifetime history of NSSI at baseline is closely connected to high levels of negative affect, 7,10,41 contrary to our hypotheses, NSSI first onset was not predicted by any diagnoses or personality traits characterized by negative affect pathway: adolescent or parent anxiety disorders, or depressive disorders, or greater neuroticism. Nonetheless, two of three hypothesized clinical traits underpinned by negative affect predicted future first-onset NSSI: rumination and avoidance, with the latter remaining a unique predictor in the multivariate analyses.…”

“…9 In support of this, low conscientiousness, a core personality marker of disinhibition, N correlates with adolescent NSSI over and above psychiatric illness. [10][11][12] In addition, adolescents who self-injure are more likely to report psychopathology characterized by disinhibition, including tobacco use, 13,14 alcohol use, 15 and substance use, 13 behavioral disorders, 16 and maladaptive eating behaviors. 13 There is also a relationship between parental externalizing psychopathology (specifically, attentiondeficit/hyperactivity disorder [ADHD] and substance abuse) and NSSI in offspring.…”

“…In support of this etiologic pathway, NSSI is robustly associated with greater neuroticism, which is a core personality trait reflecting negative affectivity. [10][11][12] Moreover, clinical traits indicative of negative affect, in particular rumination and self-criticism, are also associated with increased risk and frequency of NSSI. Selby et al posit that NSSI may function as a means of distraction from rumination (the cognitive process involving repetitive focus on one's thoughts and emotions).…”

“…NSSI is also associated with mental disorders characterized by negative affect, including anxiety and depressive disorders, 10,21 and borderline personality disorder. 22 Depressive symptoms in particular have been found to predict NSSI trajectory 22 and recurrence 14 in self-injuring adolescents.…”

“…Cross-sectional differences between girls with and without NSSI at baseline have been reported previously. 7,10 Furthermore, 44 girls who completed the baseline assessment and did not report NSSI dropped out of the study by the final follow-up and were not included in analyses. Attrition was not associated with any baseline characteristics, except a higher rate of behavioral disorder diagnosis and lower self-reported wellbeing.…”