The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university

Despite the theoretical emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), few studies have examined this relationship. The present study sought to examine the role of emotion dysregulation in DSH by extending the findings of Gratz (2006) regarding the environmental (i.e. childhood maltreatment) and individual (i.e. emotional inexpressivity and affect intensity/reactivity) factors associated with DSH among 249 female undergraduates. Specifically, the present study examined whether emotion dysregulation (a) is associated with DSH above and beyond these other risk factors and (b) mediates the relationship between these risk factors and DSH. Findings indicate that overall emotion dysregulation distinguished women with frequent DSH from those without a history of DSH, adding reliably to the prediction of DSH status above and beyond maltreatment, inexpressivity, and affect intensity/reactivity. Moreover, among self-harming women, emotion dysregulation accounted for a significant amount of additional variance in DSH frequency and mediated the relationship between emotional inexpressivity and DSH frequency. Results also suggest the particular relevance of two specific dimensions of emotion dysregulation to DSH: limited access to effective emotion regulation strategies and a lack of emotional clarity, each of which reliably improved the prediction of DSH status and accounted for unique variance in DSH frequency among self-harming women above and beyond the other risk factors in the models. Results suggest the potential utility of teaching self-harming women more adaptive ways of responding to their emotions, including nonavoidant strategies for modulating emotional arousal and the ability to identify, label, and differentiate among emotional states.     

Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm

This study examined the point prevalence of Borderline Personality Disorder (BPD) and its clinical correlates in patients with recent deliberate self-harm (DSH) in Hong Kong. A representative consecutive sample (n = 160) of patients with DSH referred to Prince of Wales Hospital from April 1, 2007 to March 31, 2008 was recruited. Their BPD status was determined according to the BPD subscale of the Chinese version of Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). The point prevalence of BPD was calculated. Subjects with and without BPD were compared in terms of demographic and clinical characteristics. Thirty out of 160 (18.8%) DSH patients were found to suffer from BPD. DSH patients with BPD were more likely to be female (p = .020), more often reported history of childhood physical (p = 0.043) and sexual abuse (p < 0.001), history of past DSH (p = 0.010), being younger at first DSH (p = 0.039), and more likely to suffer from current alcohol and substance use disorder (p = 0.043) and eating disorder (p = 0.040) than those without BPD. Being female, having history of childhood sexual abuse and current alcohol and substance use disorder were found to be independent predictors of BPD status by binary logistic regression.     

Repetition of deliberate self-harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition

Repetition of deliberate self-harm (DSH) is common. Some patients repeat multiple times. We have investigated the characteristics of repeaters, and mortality in three groups of DSH patients by repetition status. Data collected by the Oxford Monitoring System for Attempted Suicide were used to examine the pattern of repetition of DSH patients presenting to a general hospital between 1990 and 1997. Each patient was tracked through the monitoring system with regard to repetition. Patients traceable through National Death Registers were followed up until 2000 with respect to mortality. A total of 4,167 patients were studied of which 1,022 (24.5%) repeated at least once during follow-up. Using multinomial regression, past history of DSH was the variable most strongly associated with frequent (4+) and less frequent (1-3) repetitions. Risk of suicide was significantly increased in females with frequent repetition (7.7% dying by suicide), compared with both those with 1-3 repetitions (2.3%) and those not repeating (1.0%). The analyses were repeated for the 2,167 patients with no past history of DSH at their first presentation. Using multinomial regression, personality disorder was the only variable that was associated with 4+ repetitions compared with no repetitions, although a number of variables distinguished between patients with 1-3 repetitions and no repeat episodes. For clinicians assessing DSH patients, past history of DSH is the best predictor of infrequent and frequent repetition. In patients with no past history of DSH the presence of personality disorder increases the risk of frequent repetition of DSH.     

Predicting Deliberate Self‐Harm in Adolescents: A Six Month Prospective Study

Few studies have investigated the extent to which psychosocial/psychological factors are associated with the prediction of deliberate self‐harm (DSH) among adolescents. In this study, 737 pupils aged 15–16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents (n = 31) reported an act of DSH between Time 1 and Time 2. In multivariate analyses, worries about sexual orientation, history of sexual abuse, family DSH, anxiety, and self‐esteem were associated with repeat DSH during the course of the study, but history of sexual abuse was the only factor predictive of first‐time DSH. The findings suggest that school‐based programs focused on how young people cope with psychosocial stressors may offer promise.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.     

Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention.

The authors suggest that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice.     

Multiple protective and risk factors for drug use and abuse: cross-sectional and prospective findings.

A conceptual elaboration was developed that incorporates many risk and protective factors, and both direct and moderating (buffering) influences on drug involvement were tested. From prospective data, 14 factors related to drug use were selected and assigned empirically to either a multiple protective index (PFI) or a risk factor index (RFI). Analyses examined the relationships of the RFI, PFI, and their interaction on measures of cigarette, alcohol, cannabis, cocaine, and hard drug use cross-sectionally in late adolescence and later in young adulthood. These same variables were used to predict alcohol, cannabis, and cocaine abuse 8 years later. Vulnerability as measured by the RFI, PFI, and their interaction was highly associated with drug use in adolescence, moderately associated with certain types of drug use in young adulthood, and strongly associated with heightened drug problems in adulthood.     

Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients

This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.     

The antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment

The association between psychotic symptoms and violence is unclear, due in part to methodological features of investigations that have examined this question, and in part to the fact that the association likely differs by disorder and treatment conditions. Using data from The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons, we examined 128 men with schizophrenia or schizoaffective disorder discharged from general and forensic psychiatric hospitals in Canada, Finland, Germany, and Sweden. The association between symptoms and aggressive behavior was studied during two 6 month periods when the patients lived in the community. Severe positive and negative symptoms of psychosis, depression, and anxiety were measured at the beginning of each of the 6 month periods. In addition, at the beginning of the second 6 month period changes in symptoms in the previous period were indexed. Aggressive behavior was measured in each 6 month period by reports from patients and from collaterals. During the first 6 months post-discharge, after controlling for the presence of antisocial personality disorder or PCL score and past diagnoses of alcohol/drug abuse/dependence, the presence of a severe positive symptom significantly increased the risk of aggressive behavior. During the second 6 month period, after controlling for antisocial personality disorder or PCL score and self-reported alcohol/drug use, the presence of a severe positive symptom, a TCO symptom, and an increase in TCO symptoms significantly increased the risk of aggressive behavior. Neither depot medications nor obligatory community treatment reduced the risk of aggressive behavior after controlling for the presence of a severe positive symptom and/or TCO symptoms. These findings suggest that, among men with schizophrenia being treated in the community, the presence of severe psychotic symptoms and the development of TCO symptoms are antecedents of aggressive behavior.     

Eye-tracking dysfunction and birth-month weather in schizophrenia.

The prevalence of eye-tracking dysfunction (ETD) is significantly elevated in individuals with a diagnosis of schizophrenia and in their nonschizophrenic relatives, suggesting that ETD marks a familial (most likely genetic) risk factor for schizophrenia. Birth in a season with intemperate weather is also a widely reported risk factor for schizophrenia and is particularly marked for the subgroup with no family history of the disorder. This study examined how these two risk factors covaried in 78 patients with a Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) diagnosis of schizophrenia. Eye tracking and birth-month weather were independently assessed. As hypothesized, patients without ETD were significantly more likely to be born in months with intemperate weather (both hot and cold) than either patients with ETD or people in the general population. Etiologic factors associated with severe weather near birth may be important sources of nonfamilial schizophrenia.     

Deliberate Self‐Harm in Adolescents Aged 12–18: A Cross‐Sectional Survey of 18,104 Students

Little is known about accurate prevalence and associated factors of deliberate self‐harm (DSH) among adolescents in Asian countries. In this study, the prevalence and associated factors of DSH among adolescents in Japan were examined. Data were derived from a cross‐sectional survey using an anonymous self‐report questionnaire and enrolling 8,620 adolescents aged 12–15 and 9,484 aged 15–18. DSH in the previous 12 months was reported by 3.3% (95% CI, 2.9–3.7) of junior and 4.3% (3.9%–4.7%) of senior high school respondents. The prevalence was more than four times as high among girls as among boys for both age groups. DSH was further strongly associated with having suicidal thoughts, having depression/anxiety symptoms, and having used recreational drugs. These associated factors were similar for both sexes and for both older and younger teenagers. A substantial minority of adolescents present with DSH, even among those aged 12–15. The prevalence of DSH in Japan was in the lower ranges of those reported for Western countries. The identified associated factors were not dissimilar from those reported in the West.     

Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.     

Distinguishing Between Subgroups of Adolescents Who Self‐Harm

The differences in factors associated with subgroups of adolescents in the continuum of deliberate self‐harm (DSH) phenomena were investigated. In an anonymous self‐report survey of 6,020 adolescents aged 15 and 16 years, 3.2% of adolescents (5.3% females, 1.3% males) reported DSH with intent to die, 2.8% (4.3% females; 1.5% males) reported DSH without intent to die, and 15% (22.4% females; 8.5% males) reported thoughts of DSH without acts. Regression analysis indicated considerable overlap in vulnerability factors along the spectrum of DSH thoughts and acts. A uniquely distinct relationship was found between DSH of a friend and DSH without intent to die on one hand and DSH of a family member with DSH with intent to die on the other. Results indicate that familial and nonfamilial social influences on DSH behavior may be important in designing prevention programs and that educational programs for the promotion of psychological well‐being may be helpful for adolescents at any point along the spectrum of DSH that was examined.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.     

Mental Disorders, Religion and Spirituality 1990 to 2010: A Systematic Evidence-Based Review

Religion/spirituality has been increasingly examined in medical research during the past two decades. Despite the increasing number of published studies, a systematic evidence-based review of the available data in the field of psychiatry has not been done during the last 20 years. The literature was searched using PubMed (1990–2010). We examined original research on religion, religiosity, spirituality, and related terms published in the top 25 % of psychiatry and neurology journals according to the ISI journals citation index 2010. Most studies focused on religion or religiosity and only 7 % involved interventions. Among the 43 publications that met these criteria, thirty-one (72.1 %) found a relationship between level of religious/spiritual involvement and less mental disorder (positive), eight (18.6 %) found mixed results (positive and negative), and two (4.7 %) reported more mental disorder (negative). All studies on dementia, suicide, and stress-related disorders found a positive association, as well as 79 and 67 % of the papers on depression and substance abuse, respectively. In contrast, findings from the few studies in schizophrenia were mixed, and in bipolar disorder, indicated no association or a negative one. There is good evidence that religious involvement is correlated with better mental health in the areas of depression, substance abuse, and suicide; some evidence in stress-related disorders and dementia; insufficient evidence in bipolar disorder and schizophrenia, and no data in many other mental disorders.     

Externalizing Symptomatology Among Adoptive Youth: Prevalence and Preadoption Risk Factors

The extent of symptomatology related to attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) was examined in a statewide sample of adopted youth, aged 4–18 years (n = 808). The use of normed questionnaires in a nonclinical sample decreased biases associated with past research on adopted children. According to parental report, a striking number of the youth qualified as manifesting significant symptom levels of externalizing behavior problems: 21% met symptom cutoffs for ADHD (with or without ODD) and 20% met criteria for ODD (with or without ADHD), for a combined total of 29% of the sample. A number of parent-reported, preadoptive risk factors distinguished these groups from one another and from the nonexternalizing youth. The clearest associated factors included histories of preadoption abuse/neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption. We discuss implications regarding both etiology and current controversies surrounding the disproportionate levels of behavioral difficulties in adopted youth.     

Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review

Evidence from 85 studies was examined to identify risk factors most strongly related to intimate partner physical abuse perpetration and victimization. The studies produced 308 distinct effect sizes. These effect sizes were then used to calculate composite effect sizes for 16 perpetration and 9 victimization risk factors. Large effect sizes were found between perpetration of physical abuse and five risk factors (emotional abuse, forced sex, illicit drug use, attitudes condoning marital violence, and marital satisfaction). Moderate effect sizes were calculated between perpetration of physical abuse and six risk factors (traditional sex-role ideology, anger/hostility, history of partner abuse, alcohol use, depression, and career/life stress). A large effect size was calculated between physical violence victimization and the victim using violence toward her partner. Moderate effect sizes were calculated between female physical violence victimization and depression and fear of future abuse.     

Risk factors for male-to-female partner sexual abuse

We review the risk and protective factors for male-to-female sexual abuse. Although partner sexual abuse is a low base rate behavior, which can attenuate correlation coefficients, several relations had moderate effect sizes. Younger (under 30) and older (over 50) women, compared to those between 30 and 50 years old, were more likely to report being victims of partner sexual abuse, as were unemployed women and women from low-income households. Prior unwanted sexual experiences (from a wide variety of perpetrators) and the severity of male-to-female partner physical aggression were associated with male-to-female partner sexual abuse. It is difficult to form conclusions from only six empirical studies. More empirical studies are needed to ascertain the populations most at risk for partner sexual abuse.     

Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type

The authors examined psychosocial correlates of drug and alcohol abuse in 462 hospitalized adolescents, and the extent to which these associations may be affected by gender or by substance type. Participants completed a battery of psychometrically-sound, self-report measures of psychological functioning, environmental stress, drug abuse, and alcohol abuse. Four multiple regression analyses were conducted to determine the joint and independent predictors of drug abuse and alcohol abuse, for males and for females. Multiple regression analysis revealed that seven variables--age, depression, impulsivity, low self-esteem, delinquent predisposition, low peer insecurity, and history of child abuse--jointly predicted both drug and alcohol abuse, for both males and females. However, several differences were found with respect to which variables made independent contributions to the predictive models--with only delinquent predisposition making a significant independent contribution for all four conditions. We found distinct patterns of psychosocial predictor variables for drug and alcohol abuse, as well as distinct patterns for males and females. These results may reflect differing risk factors for drug abuse and alcohol abuse in adolescent psychiatric patients--and differing risk factors for males and females. Such differences have potential implications for prevention and treatment.     

Suicide Clusters: A Review of Risk Factors and Mechanisms

Suicide clusters, although uncommon, cause great concern in the communities in which they occur. We searched the world literature on suicide clusters and describe the risk factors and proposed psychological mechanisms underlying the spatio‐temporal clustering of suicides (point clusters). Potential risk factors include male gender, being an adolescent or young adult, drug or alcohol abuse, and past history of self‐harm. However, the majority of studies lack methodological rigor. Many different psychological mechanisms are described, including contagion, imitation, suggestion, learning, and assortative relating, but supporting empirical evidence is generally lacking. More scientifically rigorous studies are needed to improve understanding of suicide clusters.