Clinical and psychosocial correlates of non-suicidal self-injury within a sample of children and adolescents with bipolar disorder

Abstract

Background The purpose of this study is to examine the prevalence and correlates of non-suicidal self-injury (NSSI) among children and adolescents diagnosed with bipolar disorder (BP). Methods Four hundred-thirty two youth with a diagnosis of BP and their parents, including 193 children and 239 adolescents, completed a diagnostic interview and instruments to assess youth clinical and illness history, youth comorbidity, parental mood disorder, and psychosocial functioning. Results Approximately 22% of children and 22% of adolescents reported NSSI during the course of their most recent mood episode. In a multivariate model controlling for global impairment, among children, a BPI or BPII diagnosis (versus BPNOS), psychosis, separation anxiety disorder, and greater severity of depressive symptoms were found to be associated with NSSI. Among adolescents, a mixed episode, a suicide attempt, greater severity of depressive symptoms, and poor psychosocial functioning were found to be associated with NSSI. Neither the presence of a youth comorbid disruptive behavior disorder nor a parental mood disorder was associated with NSSI. Limitations The primary limitations of this study include the use of a cross-sectional study design, lack of a control group, and limited generalizability of study results to non-clinical and ethnically diverse samples. Conclusions NSSI is not uncommon among youth with BP, particularly those who present with BPI or BPII, psychosis, a mixed episode, suicidal behavior, severe depressive symptoms, separation anxiety, and/or poor psychosocial functioning. However, the relative importance of these factors in relation to NSSI may vary with age. Treatments for BP that are developmentally sensitive, examine the function of NSSI for each youth, and teach adaptive skills to address emotional and social needs, may prove to be most successful.

Self-Harm, Affective Traits, and Psychosocial Functioning in Adults With Depressive and Bipolar Disorders

“…The relationships between self-harm history and clinical severity indicators are consistent with previous findings that individuals with self-harm history have more severe presentations of mood disorder (Esposito-Smythers et al, 2010). The current study supports the position that individuals with a mood disorder and a self-harm history have a more severe, and potentially distinct, form of mood disorder.…”

“…While lifetime rates of self-harm in youth with bipolar spectrum disorders (37%) appear to be higher than among youth with unipolar depressive disorders (13%; Esposito-Smythers et al, 2010), no study has directly compared rates of self-harm between adults with bipolar and unipolar disorders. Further, there are direct relationships between self-harm, severity of depressive symptoms and psychosocial functioning among youth with bipolar disorder (Esposito-Smythers et al, 2010), however these same relationships have received little attention in adult populations.…”

“…Further, there are direct relationships between self-harm, severity of depressive symptoms and psychosocial functioning among youth with bipolar disorder (Esposito-Smythers et al, 2010), however these same relationships have received little attention in adult populations. Whereas some research has examined the prevalence of self-harm in adults with bipolar and unipolar depressive disorders (e.g., Bryan et al, 2015; Turner et al, 2015;Vaughn et al, 2015), no studies have directly compared these disorders in terms of prevalence of self-harm or examined the specific outcomes associated with self-harm in bipolar and unipolar disorders.…”

“…First, we predicted adults with bipolar disorder (like their younger counterparts; Esposito-Smythers et al, 2010) would have a higher rate of self-harm histories compared to adults with a unipolar depressive disorder. Second, we predicted a self-harm history would be associated with poorer functioning and greater mood symptoms across disorders.…”

Bipolar disorder from childhood to adolescence: A review about diagnostic difficulties and comorbidities

“…İUB tanısı almış erişkinlerin %27.7'si 13 yaş öncesi başlangıçlı, %37.6'sı 13-18 yaş arası başlangıçlı olarak bulunmuştur (16). Bu çalışmalardan yola çıkarak İUB başlangıç belirtilerinin çocukluk döneminde görülmesi muhtemel olup tanı ergenlik ve erken erişkinlik dönemin- Erken yaş başlangıçlı İUB; uzun hecme süresi, süre-ğenlik, kısa ötimik dönemler, hızlı döngülü iki uçluluk, karma hecme, artmış intihar riski, madde kullanımı, bozulmuş işlevsellik ya da kötü hayat kalitesi ile ilişkilidir (16,55,70,71,72). Anksiyete bozukluğu ekhastalığı özellik-le yaygın anksiyete bozukluğu ve sosyal anksiyete bozukluğunun eşlik etmesi kötü prognozla ilişkilidir (67).…”