Article

Differentiating adolescent self-injury from adolescent depression: Possible implications for borderline personality development

Department of Psychology, University of Utah, Salt Lake City, UT, USA.
Journal of Abnormal Child Psychology (Impact Factor: 3.48). 01/2012; 40(1):45-57. DOI: 10.1007/s10802-011-9578-3
Source: PubMed

ABSTRACT

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.

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Available from: Sheila E Crowell
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    • "As reported in Table 1, the self-injuring and control groups did not differ on age or IQ. However, consistent with previous research (e.g., Crowell et al., 2005, 2012), self-injuring participants scored higher on all self-report measures of internalizing and externalizing psychopathology. Although not reported, parent-report measures demonstrated similar between-groups differences. "
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    ABSTRACT: Abstract Rates of self-inflicted injury (SII) among adolescents have risen in recent years, yet much remains to be learned about the pathophysiology of such conduct. Behaviorally, self-injuring adolescents report high levels of both impulsivity and depression. Aberrant neural responding to incentives, particularly in striatal and prefrontal regions, is observed among both impulsive and depressed adolescents, and may mark common vulnerability to symptoms of anhedonia, irritability, and low positive affectivity. To date, however, no studies have examined associations between central nervous system (CNS) reward responding and self-injury. In the current study, self-injuring (n=19) and control (n=19) adolescent females, ages 13-19 years, participated in a monetary incentive delay task in which rewards were obtained on some trials and losses were incurred on others. Consistent with previous findings from impulsive and depressed samples, self-injuring adolescents exhibited less activation in both striatal and OFC regions during anticipation of reward than controls. Self-injuring adolescents also exhibited reduced bilateral amygdala activation during reward anticipation. Although few studies to date have examined amygdala activity during reward tasks, such findings are common among adults with mood disorders and borderline personality disorder. Implications for neural models of impulsivity, depression, heterotypic comorbidity, and development of both self-injury and borderline personality traits are discussed.
    Full-text · Article · Jan 2016 · Development and Psychopathology
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    • "As expected given our recruitment strategy, self-injuring participants scored higher on both the SIQ, F(1,55)=23.7, p<0.001, and the LSASI, F(1,55)=28.8, p<0.001. Further details about the sample are reported elsewhere (Crowell et al. 2012, 2013). For purposes of this study, all participants were pooled into a single group for further analysis given no differences in levels of depression, internalizing psychopathology, or post-DST cortisol levels. "
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    ABSTRACT: Although the dexamethasone suppression test (DST) has limited use as a marker of depression given inadequate sensitivity and specificity, it marks prospective risk for suicide among adults. However, few studies have examined associations between the DST, suicidal ideation, and self-inflicted injury (SII) among adolescents, even though SII is the single best predictor of eventual suicide. We evaluated the DST as a correlate of suicidal ideation and retrospective reports of self-inflicted injury (SII) among adolescent girls, ages 13-17, with histories of depression (n=28) or depression/self-harm (n=29). Lower post-DST cortisol was associated with suicidal ideation and SII, over-and-above parent-reports and combined parent-/self-reports of internalizing and externalizing behavior. These findings are consistent with recent acquired capacity models of stress-related psychopathology in which hypothalamic-pituitary adrenal (HPA) axis function is altered through epigenetic/allostatic mechanisms among vulnerable individuals who incur adversity early in life.
    Full-text · Article · Jan 2015 · Journal of Abnormal Child Psychology
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    • "As expected given our recruitment strategy, self-injuring participants scored higher on both the SIQ, F(1,55)=23.7, p<0.001, and the LSASI, F(1,55)=28.8, p<0.001. Further details about the sample are reported elsewhere (Crowell et al. 2012, 2013). For purposes of this study, all participants were pooled into a single group for further analysis given no differences in levels of depression, internalizing psychopathology, or post-DST cortisol levels. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the dexamethasone suppression test (DST) has limited use as a biomarker of depression given inadequate sensitivity and specificity, it marks prospective risk for suicide among adults. However, few studies have examined associations between the DST, suicidal ideation, and self-inflicted injury (SII) among adolescents, even though SII is the single best predictor of eventual suicide. We evaluated the DST as a correlate of suicidal ideation and retrospective reports of self-inflicted injury (SII) among adolescent girls, ages 13-17, with histories of depression (n = 28) or depression and self-harm (n = 29). Lower post-DST cortisol was associated with suicidal ideation and SII, over-and-above parent-reports and combined parent-/self-reports of internalizing and externalizing behavior. These findings are consistent with recent acquired capacity models of stress-related psychopathology in which hypothalamic-pituitary adrenal (HPA) axis function is altered through epigenetic/allostatic mechanisms among vulnerable individuals who incur adversity early in life.
    Full-text · Article · Sep 2014 · Journal of Abnormal Child Psychology
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