Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Parents' lived experience of adolescents' repeated non-suicidal self-injury in China: a qualitative study

BACKGROUND AND OBJECTIVES

The prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have demonstrated the relationship between parental factors such as parenting behaviors and adolescents' NSSI. However, few studies have explored parents' responses and adolescent-parent reciprocal interaction during repeated NSSI. This study aimed to explore parents' cognition, behaviors and adolescent-parent reciprocal interaction during repeated NSSI.

METHODS

This is a phenomenological study. By purposive sampling, 24 parents of adolescents with repeated NSSI were recruited from a child and adolescent psychiatric ward in a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using thematic analysis.

FINDINGS

Three themes were identified: parents' attribution, perceptions and coping behaviors of NSSI. Chronic stress of adolescents and triggers of NSSI were associated with parental expectations. Parents initially perceived NSSI as a manifestation of puberty, a way of making needs met or a coping strategy of negative emotions, and gradually realized that it was a condition requiring psychological assistance. Parents' coping behaviors of NSSI were divided into 4 stages, namely denial, dissuasion, reflection and adaptation, and working as a team. To be more specific, parents' coping strategies at dissuasion stage included criticizing and conciliating, while those at reflection and adaptation stage included neglecting, avoiding conflicts and increasing control.

CONCLUSIONS

These findings suggest that adjusting parents' expectation and negative perceptions of NSSI is beneficial to reduce adolescent-parent conflict and adolescents' inner conflict and prevent NSSI. Furthermore, it's necessary to publicize NSSI related knowledge to promote the early detection and treatment of NSSI.

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

BACKGROUND

The 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.

METHODS

As 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.

RESULTS

Data 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.

CONCLUSION

Results 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.