Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence

Abstract

Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.

The Relation between Neuroticism and Non-Suicidal Self-Injury Behavior among College Students: Multiple Mediating Effects of Emotion Regulation and Depression

“…Therefore, if negative emotions cannot be alleviated for a long time, highly neurotic individuals may avoid or alleviate unpleasant and disgusting emotional experiences to a certain extent by resorting to NSSI behavior. This strengthens the correlation between negative emotions and NSSI behavior, resulting in individuals’ dependency on NSSI behavior when processing negative emotions [ 34 ]. In addition, we found that cognitive reappraisal was not significantly linked to depression or NSSI behavior in the presence of other variables, especially expressive suppression.…”

Childhood Trauma as a Risk Factor for High Risk Behaviors in Adolescents with Borderline Personality Disorder

“…Previous studies in this area have also reported the alarming occurrence of a link between early childhood traumas and BPD ( 39 ). These studies suggested that there is a complicated interaction between childhood trauma, BPD and epigenetic mechanisms that negatively affect brain development and lead to different manifestations of BPD, including high risk behaviors ( 14 , 40 ). In this work, all correlations between each of the forms of trauma, the total number of childhood traumas, and the scores of various forms of high risk behaviors in the sample of adolescents with BPD reached the level of at least weak correlational relationships.…”

Social Anxiety Profiles and Psychopathological Symptom Differences in Spanish Adolescents

“…In relation to the anxiety variable, there are large effect sizes between pro les 1 and 3 (d = - 2020) observed that adolescents with a self-destructive pro le scored very high in SA. Given these results, it is important to examine whether SA should be regarded as a thought disorder of higher-order, mainly in exibility, which may contribute to the development of more severe disorders (Herpers et al, 2021). In addition, targeted interventions are suggested to enhance interpersonal functioning for a deeper understanding of SA.…”

“…In a broader context, experiencing SA in early development may be a key factor leading to subsequent internalizing disorders in adolescence and often anticipates the diagnosis of social anxiety disorder (SAD) (Herpers et al, 2021). SAD is mostly diagnosed during late childhood and adolescence (Wong & Rappe, 2015).…”