Affective instability and impulsivity predict nonsuicidal self-injury in the general population: a longitudinal analysis

Abstract

BackgroundImpulsivity and affective instability are related traits known to be associated with nonsuicidal self-injury, although few longitudinal studies have examined this relationship. The purpose of this study was to determine if impulsivity and affective instability predict future nonsuicidal self-injury in the general population while accounting for the overlap between these traits.MethodsLogistic regression analyses were conducted on data from 2344 participants who completed an 18-month follow-up of the 2000 British National Psychiatric Morbidity Survey. Affective instability and impulsivity were assessed at baseline with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Nonsuicidal self-injury was assessed at baseline and follow-up during semi-structured interviews.ResultsAffective instability and impulsivity predicted the onset of nonsuicidal self-injury during the follow-up period. Affective instability, but not impulsivity, predicted the continuation of nonsuicidal self-injury during the follow-up period. Affective instability accounted for part of the relationship between impulsivity and nonsuicidal self-injury.ConclusionsAffective instability and impulsivity are important predictors of nonsuicidal self-injury in the general population. It may be more useful to target affective instability over impulsivity for the treatment of nonsuicidal self-injury.

Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data

“…In summary, Peters and colleagues have determined whether MI and impulsivity can be potential predictors of future NSSH, whereas we have more comprehensively studied all types of self-harm (NSSH and SSH), and repeat self-harm (maintenance of self-harm at baseline and follow-up). From our results, we agree with Peters and colleagues that onset of future NSSH at follow-up was predicted by impulsivity at baseline (Peters et al, 2016). However, our paper can place this finding in the wider context: impulsivity does not appear to predict future SSH, or any repetition of either NSSH or SSH.…”

“…There is also a possibility that our findings in terms of SSH episodes in particular may have been underpowered to find any significant relationship that may exist with impulsivity due to the small numbers involved at follow-up. Peters and colleagues have also undertaken further work using the longitudinal element of the 2000 APMS where they examined impulsivity and MI at baseline and then NSSH at follow up after 18 months (Peters et al, 2016). In our paper, we have extended Peters and colleagues initial work to examine impulsivity and MI at baseline, and then SSH F o r P e e r R e v i e w and NSSH at baseline and follow up.…”

“…Therefore, current evidence indicates that impulsivity may be an important individualbased factor in terms of future self-harm, and that it should be analysed in the context of mood instability considering their close relationship in terms of self-harm. A recent F o r P e e r R e v i e w 4 epidemiological study using a large United Kingdom (UK) dataset has examined the effect of baseline mood instability and impulsivity on future non-suicidal self-harm (NSSH) (Peters, Baetz, Marwaha, Balbuena, & Bowen, 2016). However, there has been no epidemiological study of the inception and repetition of non-suicidal self-harm (NSSH) and suicidal self-harm (SSH) in the context of mood instability and impulsivity.…”

Suicide Ideation in Adolescents Following Inpatient Hospitalization: Examination of Intensity and Lability Over 6 Months

“…This pattern of more variable SI may reflect greater affect reactivity or lability (Bowen, Balbuena, Peters, Leuschen‐Mewis, & Baetz, ; Witte, Fitzpatrick, Warren, Schatschneider, & Schmidt, ). Evidence links affect instability to NSSI (e.g., Bresin, ; Peters, Baetz, Marwaha, Balbuena, & Bowen, ; Selby, Franklin, Carson‐Wong, & Rizvi, ) and suicidal behaviors (e.g., Fergusson, Woodward, & Horwood, ; Glenn, Bagge, & Osman, ; Yen et al., ) and suggests that suicidal and self‐harming behavior may function as attempts to regulate that distress (Armey, Crowther, & Miller, ; Zlotnick, Donaldson, Spirito, & Pearlstein, ).…”

Mood instability contributes to impulsivity, non‐suicidal self‐injury, and binge eating/purging in people with anxiety disorders

“…Mood instability likely triggers NSSI (Peters, Baetz, Marwaha, Balbuena, & Bowen, ; Selby et al ., ; Vansteelandt et al ., ) and BE/P (Anestis et al ., ; Greenberg & Harvey, ), both of which are means of regulating emotions (Alpers & Tuschen‐Caffier, ; Armey et al ., ; Claes et al ., ; Haedt‐Matt & Keel, ; Klonsky & Muehlenkamp, ; Stein et al ., ). It is possible that mood instability in people with anxiety disorders contributes to NSSI and BE/P, although this would raise the question of whether mood instability is directly associated with these behaviours, or whether these associations occur because mood instability is associated with elevated trait impulsivity (Anestis et al ., ; Few et al ., ; Maples et al ., ; Peters et al ., ), and trait impulsivity with NSSI (Berg et al ., ; Hamza et al ., ) and BE/P (Berg et al ., ; Fischer et al ., ).…”