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

Abstract

BackgroundThe management of emergency presentations at child and adolescent psychiatric outpatient clinics, by children and adolescents with self-injurious thoughts and behaviors, represents very responsible tasks but also offers the opportunity for immediate interventions. The stability and degree of emotional reactivity (ER) is a significant psychopathological symptom for development and maintenance of self-injurious behavior, differentiating between those who have continued to injure themselves and those who have not. In general, the relationship between ER and self-injurious behavior has been shown to be bidirectional. However, the stability of ER over time, as well as important predictors for ER itself have not been investigated so far. Therefore, this present study aimed at investigating the stability of ER over time and the relationship between non-suicidal self-injury (NSSI) and ER. Reinforcement functions and several variables of psychological functioning were considered as possible influencing factors.MethodsAs part of a longitudinal study, 97 adolescents aged 11–18 years who presented due to self-injurious thoughts or behaviors underwent standardized emergency management. This included a specified detailed psychiatric assessment at baseline (including the Emotion Reactivity Scale, ERS, and the Self-Injurious Thoughts and Behaviors Interview, SITBI) and treatment recommendations. These were followed by a catamnestic examination with two follow-up appointments. Changes over time in ER, NSSI, reinforcement functions of NSSI and general indicators of psychological functioning (General Severity Index, GSI) were examined and significant correlations were followed up by a linear-mixed effect model predicting the ERS score over time.ResultsData analysis revealed a statistically significant decrease in ERS scores and GSI over time. However, reinforcement functions for and the symptomatology of NSSI did not change. Furthermore, no predictive relationship from ER to NSSI could be identified. A linear-mixed effect model predicting the ERS identified the GSI, automatic positive reinforcement (as a reinforcement function for NSSI) and age as the only significant predictors.ConclusionResults demonstrate the importance of NSSI reinforcement functions for heightened emotional reactivity and emphasize their role as a point for therapeutic intervention by providing alternatives to NSSI and thereby possibly reducing emotional reactivity.

Mechanisms and intervention strategies of emotional dysregulation in individuals with nonsuicidal self-injury

“…Abnormalities of emotional perception and regulation in nonsuicidal self-injury ED is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (eg, sadness, anger, or fear) to generate an appropriate emotional response, cope with mood instability and emotional overactivity, and return to the emotional baseline 26 . Previously published studies showed that NSSI was associated with difficulty in emotional perception, emotional overactivity, and emotion regulation [27][28][29][30][31] . For example, individuals engaged in NSSI struggled with perceiving their emotions and expressing them to others through interpersonal communication.…”

“…Emotion recognition, a critical component of social communication skills, may lead to an altered emotion perception and explanation, causing interpersonal problems in adolescents with NSSI. In terms of emotional reactivity, research results showed that the emotional responsiveness of the NSSI group was significantly higher than that of the healthy control group, which was considered one indicator to distinguish between NSSI and non-NSSI populations 9,30 . ED and maladaptive behaviors were predictors of NSSI behaviors 31 .…”

Construct validity of the German version of the Emotion Reactivity Scale

“…It has been associated with suicidal attempts [ 8 , 9 ] and contributes to physical harm that may require medical intervention. Given the potential for emotional reactivity to change over time [ 10 ], recognizing individuals with heightened emotional reactivity early in clinical practice could help prevent the development and maintenance of dysfunctional coping strategies like non-suicidal self-injury [ 11 ].…”