Impulsivity and self-harm in adolescence: a systematic review

Abstract

Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11–25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews identified 4496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity-related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision making may offer most benefit in supporting those who self-harm.

The Development of First‐Episode Direct Self‐Injurious Behavior and Association with Difficulties in Emotional Regulation in Adolescence

“…It was surprising that we did not find impulsivity associated with prior to engagement with D‐SIB. Evidence has suggested difficulties with impulsivity are associated with self‐harm behavior in community school‐aged adolescent samples (Hawton et al., ; O'Connor et al., ) and, specifically, the initiation of self‐harm, which may act as a bridge between intention and enactment (Lockwood et al., ). Our findings may suggest that impulsivity is more pronounced at the moment of enactment.…”

“…It should also be considered that dimensional analysis of the difficulties in emotional regulation scale, while indicative of potential associations, is limited as comprehensive measures of individual components of emotional regulation. For example, the dimension, impulse control difficulties, refers specifically to a loss of control and therefore only considers one distinct unidimensional component of impulsivity (Lockwood et al., ).…”

“…Conversely, the acquisition of adaptive emotional regulation strategies is associated with self‐harm cessation (Whitlock, Prussien, & Pietrusza, ). Recent meta‐analyses support coping‐based theories of self‐harm and suggest it to be transdiagnostic across a range of emotional disorders (Bentley et al., ) with increased risk for adolescent self‐harm in those with anxiety, depression (Fliege, Jeon‐Ran, Grimm, & Klapp, ; Laye‐Gindhu & Schonert‐Reichl, ), impulsivity (Lockwood, Daley, Ellen, & Sayal, ; O'Connor, Rasmussen, & Hawton, ), and aggression (Madge et al., ; Skegg, ). Adolescence has been characterized as a period of impaired cognitive functioning in emotionally charged environments (Casey & Caudle, ) and decreased emotional coping (Zimmerman & Iwanski, ) within which young people use a range of coping strategies to modify emotional affect (Riediger & Klipker, ).…”

Nonsuicidal self-injury among adolescents with disorders of emotion and behavior: Clinical characteristics and association with suicidality

“…Kada je reč o eksternalizujućim simptomima, kod pacijenata sa samopovređivanjem u našem uzorku češće su bile prisutne heteroagresivne manifestacije i učestalije korišćenje alkohola. Ovo je u skladu sa postojećim podacima o tome da oni koji se samopovređuju mogu biti skloniji i drugim oblicima impulsivnih ponašanja i da brzo i bez mnogo promišljanja donose odluku kako da se oslobode negativnih osećanja (26,27).…”

Early life stress predicts negative urgency through brooding, depending on 5-HTTLPR genotype: A pilot study with 6-month follow-up examining suicide ideation

“…Heterogeneity in measurement of impulsivity has led researchers to focus on identifying precise components of impulsivity that differentially predict psychopathology, with a recent meta-analysis suggesting negative urgency as the dimension of impulsivity with the strongest association to various types of psychopathology, including suicidal behavior (Berg et al, 2015). It is associated with endorsement of painful and provocative experiences among college students and clinical outpatients (Bender et al, 2011), with non-suicidal self-injury among adolescents and young adults (Glenn and Klonsky, 2010; Lockwood et al, 2017), and with suicide ideation in cross-sectional research with clinical and non-clinical samples (Johnson et al, 2017; Klonsky and May, 2010). However, no previous research of which we are aware has examined the association between negative urgency and early life stress in the context of risk for suicide ideation and/or behavior.…”