1
|
Boyne H, Hamza CA. Pain tolerance as a 'barrier' to nonsuicidal self-injury: A longitudinal study. Psychiatry Res 2024; 336:115925. [PMID: 38678744 DOI: 10.1016/j.psychres.2024.115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Theoretical perspectives underscore that low pain tolerance may be a relevant 'barrier' to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.
Collapse
Affiliation(s)
- Holly Boyne
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada.
| | - Chloe A Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada
| |
Collapse
|
2
|
Boyne H, Hamza CA. Pain analgesia or desensitization? A longitudinal lab-based study on the link between pain and nonsuicidal self-injury. Psychiatry Res 2022; 318:114943. [PMID: 36384068 DOI: 10.1016/j.psychres.2022.114943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
Mounting evidence suggests that individuals who engage in nonsuicidal self-injury (NSSI) have lower pain sensitivity (e.g., pain thresholds and tolerances) than individuals without a history of NSSI. However, research has been largely cross-sectional, so it is unclear whether low pain sensitivity may increase risk for NSSI, or whether NSSI diminishes pain sensitivity over time. In the present study, the relations among NSSI frequency, versatility (number of NSSI methods), pain threshold, and pain tolerance were examined using a longitudinal research design. Participants included 156 undergraduate students at a large university (87% female; Mage = 19.79) with a recent history of NSSI. Participants reported on their NSSI engagement and completed a cold pressor task in a baseline session, as well as at one year follow-up. Eight regression models were run to examine the nature of the association between the two pain measures (i.e., pain threshold and tolerance) and the two NSSI measures (i.e., frequency and versatility). Pain tolerance and pain threshold predicted NSSI versatility over time, but NSSI frequency and versatility did not predict pain threshold or tolerance over time. Results suggest that low pain sensitivity may be a risk factor for severe NSSI engagement.
Collapse
Affiliation(s)
- Holly Boyne
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada.
| | - Chloe A Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Flach E, Koenig J, van der Venne P, Parzer P, Resch F, Kaess M. Hypothalamic-pituitary-thyroid axis function in female adolescent nonsuicidal self-injury and its association with comorbid borderline personality disorder and depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110345. [PMID: 33964324 DOI: 10.1016/j.pnpbp.2021.110345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/11/2021] [Accepted: 05/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Behavioral disturbances in adolescence are potentially linked to aberrant functioning of the thyroid gland. Accordingly, alterations of the hypothalamic-pituitary-thyroid (HPT) axis might impact psychopathological development. Yet corresponding research in adolescents with nonsuicidal self-injury (NSSI) and comorbid mental disorders is scarce. METHODS The present study examined HPT axis functioning in adolescents with NSSI compared to healthy controls (HC) using blood-based assays of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and the ratio of these hormones (fT3/fT4 ratio). Cortisol was additionally examined to contrast HPT axis functioning with a well-established biomarker of stress responsivity. Moreover, associations between clinical characteristics, HPT axis and HPA axis functioning were investigated. Female adolescents meeting NSSI criteria according to DSM-5 criteria (n = 117) were compared to adolescent HC (n = 41). Standardized serum-based endocrinological assays and interview- and questionnaire-based psychiatric assessments were used. Smoking status was included as covariate for all analyses. RESULTS NSSI patients displayed altered HPT axis functioning as fT3/fT4 ratio values were blunted in comparison to HC. Negative correlations were further present between fT3, fT3/fT4 ratio and severity of BPD symptoms, depression scores and symptomatic distress. TSH correlated negatively with severity of BPD symptoms and symptomatic distress exclusively. Cortisol values differed neither significantly between experimental groups nor correlated significantly with clinical characteristics. CONCLUSIONS Longitudinal examinations, assessing links between psychopathology and endocrinological alterations, are warranted to address potential clinical implications of thyroid markers in child and adolescent psychiatry.
Collapse
Affiliation(s)
- Elisa Flach
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Julian Koenig
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Psychiatric Department (UPD), University of Bern, Bern, Switzerland
| | - Patrice van der Venne
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Peter Parzer
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Psychiatric Department (UPD), University of Bern, Bern, Switzerland.
| |
Collapse
|
4
|
Abstract
ABSTRACT Adolescents and emerging adults who engage in nonsuicidal self-injury (NSSI) often participate in online activity regarding their self-injury. Of particular importance are the potential benefits and risks associated with online NSSI activity, including how individuals describe their NSSI experiences. One way that individuals describe these experiences is by discussing NSSI as an addiction. Accordingly, we used thematic analysis to explore why individuals may use addiction references to describe their NSSI experiences. To do this, we examined 71 posts from a popular NSSI social network. Four themes emerged: difficulty inherent in stopping, authentication, warn others, and communicate the plight of the behavior. Findings highlight a number of avenues for research as well as implications for clinicians working with clients who self-injure perceive NSSI as an addiction. Mental health professionals can leverage their understanding of clients' perceptions of NSSI to better serve this population.
Collapse
|
5
|
Mitchell RHB, Hower H, Birmaher B, Strober M, Merranko J, Rooks B, Goldstein TR, Hunt JI, Dickstein DP, Diler RS, Ryan ND, Gill MK, Axelson D, Keller MB, Yen S, Goldstein BI. Sex Differences in the Longitudinal Course and Outcome of Bipolar Disorder in Youth. J Clin Psychiatry 2020; 81:19m13159. [PMID: 33113597 PMCID: PMC8597235 DOI: 10.4088/jcp.19m13159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite substantial literature on sex differences in adults with bipolar disorder (BD), little is known about this topic in youth; this study examines sex differences in mood symptomatology and psychiatric comorbidity in prospectively followed youth with BD. METHODS A subsample of the Course and Outcome of Bipolar Youth study (N = 370; female n = 199, male n = 171) enrolled October 2000-July 2006 (age at intake = 7-17.11 years) who met DSM-IV criteria for bipolar I disorder (BD-I; n = 221), bipolar II disorder (BD-II; n = 26), or operationalized BD not otherwise specified (BD-NOS; n = 123) with ≥ 4 years follow-up was included. Analyses examined sex differences at intake and, prospectively, in mood symptomatology and psychiatric comorbidity for a mean ± SD follow-up of 10.5 ± 1.72 years. RESULTS Females were older than males at intake (mean ± SD age = 13.33 ± 3.32 vs 12.04 ± 3.16 years; P = .0002) and at age at mood onset (9.33 ± 4.22 vs 7.53 ± 3.74 years; P < .0001). After adjustment for confounders, males spent more time with syndromal ADHD (Padjusted = .001) and females spent more time with syndromal anxiety (Padjusted = .02). There were trends toward males spending more time with substance use disorder and females having more non-suicidal self-injurious behavior (Padjusted = .07 and .09, respectively). There were no sex differences on outcome variables, including rate of or time to recovery and recurrence. CONCLUSIONS Contrasting with adult literature, this study identified minimal sex differences in the course of youth with BD. Longer-term studies are needed to clarify if youth-onset BD remains a "sex neutral" subtype of BD or diverges according to sex in adulthood.
Collapse
Affiliation(s)
- Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, EG-47, 2075 Bayview Ave, Toronto, ON M4N 3M5.
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry, School of Medicine, University of California at San Diego, San Diego, California, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Rooks
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Bradley Hospital, East Providence, Rhode Island, USA
| | - Daniel P Dickstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Bradley Hospital, East Providence, Rhode Island, USA
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Neal D Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
6
|
MacLean WE, Damian AF, Hoch J, Tervo RT, Symons FJ. Comparative analysis of self-injurious behaviour topographies in young children with and without developmental delay. J Intellect Disabil Res 2020; 64:673-680. [PMID: 32643272 PMCID: PMC8212423 DOI: 10.1111/jir.12758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND The present study presents post hoc analyses of specific topographies of self-injurious behaviour (SIB) exhibited by young children with developmental delay (DD) and children with typical development (TD). We conducted these analyses to better understand similarities and differences between the groups from a developmental perspective. No previous study has compared the prevalence, severity and co-occurrence of specific topographies of SIB in young children. METHOD The participants were parents of two groups of children one with DD (n = 49, mean age = 37.5 months) and one with TD (n = 49, mean age = 36.6 months). Individual items of the SIB subscale from the Repetitive Behaviour Scale-Revised were used in the analyses. RESULTS Seven of the eight Repetitive Behaviour Scale-Revised SIB categories were reported for both groups. Children in the DD group were significantly more likely to engage in Hits Self against Surface or Object, Hits Self with Body Part, Inserts Finger or Object, Skin Picking and Bites Self. Parental ratings of severity were also significantly greater for the DD group for these five topographies. The DD group engaged in a significantly greater number of SIB topographies than the children in the TD group. Children in the TD group were more likely to exhibit a single SIB topography while the DD group were more likely to engage in two or more topographies. Topographies involving self-hitting were not only more frequent among the children in the DD group but also more likely to be rated as moderate or severe in nature. CONCLUSIONS Compared with the TD group, the topographies of SIB exhibited by the DD group were more prevalent, more severe and co-occurred with greater frequency. Inclusion of a group of children with TD provided an important comparative context for the occurrence of SIB in children with DD.
Collapse
|
7
|
Abstract
It is not uncommon for patients with obsessive-compulsive disorder (OCD) to present with symptoms that suggest possible risk. This can include apparent risk, which reflects the content of obsessional fears, and genuine risk arising as the unintended consequence of compulsive behaviors. In both situations, risk can cause confusion in relation to diagnosis and treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. Guidance is offered to support clinical decision making and treatment planning.
Collapse
Affiliation(s)
- Angela Lewis
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Caroline Stokes
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital and the Institute of Child Health, University College London, London, UK
| | | | - Georgina Krebs
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
8
|
Lin B, Kaliush PR, Conradt E, Terrell S, Neff D, Allen AK, Smid MC, Monk C, Crowell SE. Intergenerational transmission of emotion dysregulation: Part I. Psychopathology, self-injury, and parasympathetic responsivity among pregnant women. Dev Psychopathol 2019; 31:817-831. [PMID: 31064587 PMCID: PMC6790982 DOI: 10.1017/s0954579419000336] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.
Collapse
Affiliation(s)
- Betty Lin
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Parisa R. Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Dylan Neff
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Ashley K. Allen
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Marcela C. Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Sheila E. Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Srinivasan R, Wolstencroft J, Erwood M, Raymond FL, van den Bree M, Hall J, Skuse D. Mental health and behavioural problems in children with XXYY: a comparison with intellectual disabilities. J Intellect Disabil Res 2019; 63:477-488. [PMID: 30993819 DOI: 10.1111/jir.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The phenotype of children with XXYY has predominantly been defined by comparison to other sex chromosome aneuploidies trisomies affecting male children; however, the intellectual ability of children with XXYY is lower than children with other sex chromosome aneuploidies trisomies. It is not known to what extent the phenotype identified to date is specific to XXYY, rather than a reflection of lower IQ. This study evaluates the mental health and behaviour of children with XXYY, in comparison to children with intellectual disabilities of heterogeneous genetic origin. METHODS Fifteen children with XXYY and 30 controls matched for age (4-14 years), sex and intellectual ability were ascertained from the IMAGINE ID study. IMAGINE ID participants have intellectual disabilities due to genetic anomalies confirmed by National Health Service Regional Genetic Centre laboratories. The mental health and behaviour of participants was examined with the Development and Well-being Assessment and the Strengths and Difficulties Questionnaire. RESULTS Children with XXYY experienced significantly more frequent and intense temper outbursts than the control group. CONCLUSION Our results suggest that temper outbursts may be specifically associated with the XXYY phenotype. These problems have a significant impact on the daily lives of boys with XXYY and their families. It is crucial to ensure that families are well supported to manage these difficulties.
Collapse
Affiliation(s)
- R Srinivasan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - M Erwood
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F L Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Biomedical Campus, Cambridge, UK
| | - M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - J Hall
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
| |
Collapse
|
10
|
Demers LA, Schreiner MW, Hunt RH, Mueller BA, Klimes-Dougan B, Thomas KM, Cullen KR. Alexithymia is associated with neural reactivity to masked emotional faces in adolescents who self-harm. J Affect Disord 2019; 249:253-261. [PMID: 30780118 PMCID: PMC6724702 DOI: 10.1016/j.jad.2019.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a major, trans-diagnostic mental health problem among adolescents. Alexithymia has been identified as a developmental risk factor for NSSI. Research on how alexithymia relates to the neurobiology of automatic emotion processing is only beginning to emerge. This study evaluates the relationship between alexithymic features and neural responses to automatic processing of emotional content in adolescents with NSSI. METHODS 25 female adolescents (ages 13-21) with a history of repeated engagement in NSSI completed the Toronto Alexithymia Scale and the Difficulties with Emotion Regulation Scale and underwent functional magnetic resonance imaging (fMRI) during a task in which participants were exposed to masked emotions. RESULTS One facet of alexithymia, limited internal emotion awareness or externally-oriented thinking (EOT), was related to differential reactivity to masked emotional faces in clusters in the right supramarginal gyrus and right inferior frontal gyrus. Follow-up assessment of regional reactivity revealed that greater EOT is associated with lower activation to masked happy faces but higher activation to masked fearful faces. Other facets of alexithymia did not show relationships with reactivity to masked emotional faces. LIMITATIONS This is a cross-sectional and small sample that only includes females, which may attenuate generalizability of findings. CONCLUSIONS We report neural correlates of multiple facets of alexithymia in adolescents with NSSI. Among adolescents who self-harm, those with higher levels of EOT may be less alert to subtle positively-valenced emotion cues. For this subset of adolescents with NSSI, interventions designed to enhance mental representation of emotional responses and attention to positive emotions may be appropriate.
Collapse
Affiliation(s)
- Lauren A Demers
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA.
| | | | - Ruskin H Hunt
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN 55455, USA
| | - Kathleen M Thomas
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| |
Collapse
|
11
|
Klimes-Dougan B, Begnel E, Almy B, Thai M, Schreiner MW, Cullen KR. Hypothalamic-pituitary-adrenal axis dysregulation in depressed adolescents with non-suicidal self-injury. Psychoneuroendocrinology 2019; 102:216-224. [PMID: 30590339 DOI: 10.1016/j.psyneuen.2018.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is characterized by causing harm to one's own body without the intent of suicide. While major depressive disorder (MDD) has been associated with elevated cortisol (at least in some subgroups), prior studies in NSSI have suggested that NSSI is associated with blunted reactivity to stress of the hypothalamic-pituitary-adrenal (HPA) axis, possibly consistent with an allostatic load model. The present study used a multi-level approach to examine salivary cortisol in the context of a social stressor in 162 adolescents (ages 12 to 19 years old) with MDD with a history of repeated engagement in NSSI (MDD/NSSI) versus MDD without repeated NSSI (MDD), and healthy controls (HC). Observed (expressed) and self-reported (experienced) ratings of stress were also obtained during the social stress paradigm. The results showed that MDD/NSSI exhibited lower salivary cortisol levels and differed in cortisol trajectories in the context of a social stressor compared to HC and MDD. Observed stress, but not self-reported stress, during the social stress paradigm was greater for the MDD/NSSI than HC. Follow-up analyses suggested the possibility that this pattern of lower cortisol for those who engage in NSSI was present in females and males, and was more pronounced in those with repeated NSSI (but not subthreshold NSSI) and those with a history of NSSI and suicide attempts. Overall, these findings add to the prior literature and begin to show a consistent pattern for how stress is processed in atypical ways for those who engage in repeated NSSI. Importantly, these results suggest that some of the heterogeneity across adolescent depression may be better represented by these underlying biological processes, perhaps even representing subgroups that will benefit from different types of intervention. Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Depressed Adolescents with Non-Suicidal Self-Injury.
Collapse
Affiliation(s)
- Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Erin Begnel
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Brandon Almy
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Twin Cities, United States.
| | - Michelle Thai
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | | | - Kathryn R Cullen
- Psychiatry Department, School of Medicine, University of Minnesota, Twin Cities, United States.
| |
Collapse
|
12
|
Ricketts EJ, Rozenman M, Snorrason Í, Pérez JB, Peng MG, Kim J, Piacentini J. Confirmatory factor analysis of the SLEEP-50 Questionnaire in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder. Psychiatry Res 2019; 273:197-205. [PMID: 30654305 PMCID: PMC6561822 DOI: 10.1016/j.psychres.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/17/2018] [Accepted: 01/05/2019] [Indexed: 11/29/2022]
Abstract
The study objective was to perform a confirmatory factor analysis of the SLEEP-50 Questionnaire (SLEEP-50) in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder and compare sleep complaints in adults with Trichotillomania, Excoriation Disorder and non-affected controls. Participants were 234 adults with Trichotillomania, 170 with Excoriation Disorder, and 146 non-affected controls. Participants rated sleep using the SLEEP-50 and Pittsburgh Sleep Quality Index (PSQI). Confirmatory factor analysis was used to assess fit of the originally-proposed SLEEP-50 factors within Trichotillomania and Excoriation Disorder. Findings revealed acceptable to good fit of the original factors. Internal consistency was excellent in Trichotillomania and good in Excoriation Disorder for the total score and poor to good for subscales. Convergent validity was strong for the total and weak to strong for subscales in both groups. Findings suggest greater sleep complaints in Trichotillomania and Excoriation Disorder than in the general population. Trichotillomania and Excoriation Disorder groups reported greater rates of sleep apnea, narcolepsy, restless leg syndrome/periodic limb movement disorder, circadian rhythms sleep disorder, and sleep-related affective disorder relative to controls. There were no significant differences for insomnia, sleep state misperception, sleepwalking, nightmares, or hypersomnia. Results underscore the importance of clinical assessment of sleep disorders in Trichotillomania and Excoriation Disorder.
Collapse
Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA.
| | - Michelle Rozenman
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA; Department of Psychology, University of Denver, Denver, CO, USA
| | - Ívar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Jocelyn B Pérez
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Micalla G Peng
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Jessica Kim
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Poon JA, Thompson JC, Forbes EE, Chaplin TM. Adolescents' Reward-related Neural Activation: Links to Thoughts of Nonsuicidal Self-Injury. Suicide Life Threat Behav 2019; 49:76-89. [PMID: 29349794 PMCID: PMC7184534 DOI: 10.1111/sltb.12418] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
Abstract
Adolescence is a critical developmental period marked by an increase in risk behaviors, including nonsuicidal self-injury (NSSI). Heightened reward-related brain activation and relatively limited recruitment of prefrontal regions contribute to the initiation of risky behaviors in adolescence. However, neural reward processing has not been examined among adolescents who are at risk for future engagement for NSSI specifically, but who have yet to actually engage in this behavior. In the current fMRI study (N = 71), we hypothesized that altered reward processing would be associated with adolescents' thoughts of NSSI. Results showed that NSSI youth exhibited heightened activation in the bilateral putamen in response to a monetary reward. This pattern of findings suggests that heightened neural sensitivity to reward is associated with thoughts of NSSI in early adolescence. Implications for prevention are discussed.
Collapse
Affiliation(s)
- Jennifer A Poon
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - James C Thompson
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tara M Chaplin
- Department of Psychology, George Mason University, Fairfax, VA, USA
| |
Collapse
|
14
|
Luby JL, Whalen D, Tillman R, Barch DM. Clinical and Psychosocial Characteristics of Young Children With Suicidal Ideation, Behaviors, and Nonsuicidal Self-Injurious Behaviors. J Am Acad Child Adolesc Psychiatry 2019; 58:117-127. [PMID: 30577927 PMCID: PMC6550290 DOI: 10.1016/j.jaac.2018.06.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Based on previous findings that suicidal ideation (SI) and behavior (SB) arose in depressed preschoolers and showed stability into school age, we sought to investigate whether unique clinical and psychosocial correlates of SI/SB and nonsuicidal self-injurious behaviors (NSSI) could be identified in young children recuited into a depression treatment study and healthy controls. METHOD Data from 288 children 3.0 to 6.11 years of age who were recruited for participation in a psychotherapy treatment study of depression and 26 healthy control subjects (total N = 314) were used. At baseline, subjects received a comprehensive assessment of psychopathology and suicidal ideation/suicidal behavior. Multinominal logistic regressions were conducted comparing those with no SI/SB/NSSI to those with SI/SB or NSSI. Those with SI/SB who also had NSSI were placed in the SI/SB group. RESULTS In this sample of young children, the rates of NSSI, SI, and SB were 21.3%, 19.1%, and 3.5% respectively. Children with SI/SB or NSSI experienced a greater frequency of violent life events than children with no SI/SB/NSSI. Children with SI/SB had significantly more preoccupation with death compared to subjects with NSSI and subjects with no SI/SB/NSSI. Children with SI/SB had more vegetative signs of depression and greater depression severity, and those with NSSI were more irritable with higher depression severity than those with no SI/SB/NSSI. CONCLUSION Distinct characteristics of SI/SB and NSSI in early childhood were identified, informing high risk subgroups. Findings suggest that clinicians should be aware of the potential for SI/SB and/or NSSI in young children and should directly address these symptoms in clinical interviews. CLINICAL TRIAL REGISTRATION INFORMATION A Randomized Controlled Trial of PCIT-ED for Preschool Depression. https://clinicaltrials.gov/; NCT02076425.
Collapse
|
15
|
Ramsey J, Martin EC, Purcell OM, Lee KM, MacLean AG. Self-injurious behaviours in rhesus macaques: Potential glial mechanisms. J Intellect Disabil Res 2018; 62:1008-1017. [PMID: 30450801 PMCID: PMC6385863 DOI: 10.1111/jir.12558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2018] [Accepted: 09/28/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) can be classified as intentional, direct injuring of body tissue usually without suicidal intent. In its non-suicidal form it is commonly seen as a clinical sign of borderline personality disorder, autism, PTSD, depression, and anxiety affecting a wide range of ages and conditions. In rhesus macaques SIB is most commonly manifested through hair plucking, self-biting, self-hitting, and head banging. SIB in the form of self-biting is observed in approximately 5-15% of individually housed monkeys. Recently, glial cells are becoming recognised as key players in regulating behaviours. METHOD The goal of this study was to determine the role of glial activation, including astrocytes, in macaques that had displayed SIB. To this end, we performed immunohistochemistry and next generation sequence of brain tissues from rhesus macaques with SIB. RESULTS Our studies showed increased vimentin, but not nestin, expression on astrocytes of macaques displaying SIB. Initial RNA Seq analyses indicate activation of pathways involved in tissue remodelling, neuroinflammation and cAMP signalling. CONCLUSIONS Glia are most probably activated in primates with self-injury, and are therefore potential novel targets for therapeutics.
Collapse
Affiliation(s)
- Joseph Ramsey
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
| | - Elizabeth C. Martin
- Center for Stem Cell Research and Regenerative Medicine, School of Medicine, Tulane University, New Orleans, LA 70112
| | - Olivia M. Purcell
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
| | - Kim M. Lee
- Tulane National Primate Research Center, Covington, LA 70433
- Tulane Program in Biomedical Science, Tulane Medical School, New Orleans, LA 70112
| | - Andrew G. MacLean
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
- Tulane National Primate Research Center, Covington, LA 70433
- Tulane Program in Biomedical Science, Tulane Medical School, New Orleans, LA 70112
- Department of Microbiology & Immunology, Tulane Medical School, New Orleans, LA 70112
- Tulane Center for Aging, Tulane University New Orleans, LA 70112
| |
Collapse
|
16
|
Liu X, Liu ZZ, Fan F, Jia CX. Menarche and menstrual problems are associated with non-suicidal self-injury in adolescent girls. Arch Womens Ment Health 2018; 21:649-656. [PMID: 29804155 DOI: 10.1007/s00737-018-0861-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/16/2018] [Indexed: 01/13/2023]
Abstract
Menstrual problems and non-suicidal self-injury (NSSI) are common in adolescent girls. This study examined whether onset of menstruation and menstrual problems were related to NSSI in Chinese female adolescents. A total of 5696 adolescent girls participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort (SABHC) study in Shandong, China. A structured questionnaire was used to ask about participants' lifetime and last-year NSSI, age at menarche, menstrual cycle interval, menstrual flow length, menstrual irregularity, period pain, body weight and height, and demographics. Impulsivity was assessed by the Eysenck I7 impulsiveness scale. Internalizing and externalizing problems were measured by the Youth Self-Report of Child Behavior Checklist. The mean age of the sample was 15.0 years (SD = 1.4). The prevalence of lifetime and last year NSSI were 28.1% and 21.4% in Chinese adolescent girls. After adjusting for adolescent and family covariates (age, body mass index, impulsivity, internalizing and externalizing problems, paternal education, and family economic status), onset of menstruation was significantly associated with increased risk of lifetime NSSI (OR = 1.62, 95%CI = 1.20-2.20) and last year NSSI (OR = 1.92, 95%CI = 1.37-2.67). Among adolescent girls who had menarche, often irregular menstruation and period pain were significantly and independently associated with lifetime NSSI (OR = 1.36, 95%CI = 1.03-1.79; OR = 1.29, 95%CI = 1.05-1.58) and last year NSSI (OR = 1.46, 95%CI = 1.07-1.98; OR = 1.29, 95%CI = 1.03-1.61). Our findings suggest that onset of menarche, irregular periods, and period pain appear to be associated with increased risk of NSSI. These findings highlight the importance of menstruation hygiene education and treatment of menstrual problems to reduce the risk of NSSI among adolescent girls.
Collapse
Affiliation(s)
- Xianchen Liu
- Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China.
- School of Psychology, South China Normal University, Shipai, Guangzhou, 510631, China.
- The University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Kelin Health Research, Montgomery, NJ, 08502, USA.
| | - Zhen-Zhen Liu
- Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China
| | - Fang Fan
- School of Psychology, South China Normal University, Shipai, Guangzhou, 510631, China
| | - Cun-Xian Jia
- Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China.
| |
Collapse
|
17
|
Bradley V, Hiersteiner D, Rotholz D, Maloney J, Li H, Bonardi A, Bershadsky J. Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour. J Intellect Disabil Res 2018; 62:1043-1057. [PMID: 30022570 DOI: 10.1111/jir.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND For people with intellectual and developmental disabilities, self-injurious behaviour (SIB) can have serious negative effects on both health and quality of life. This descriptive analysis will provide information on the characteristics and outcomes of a subsample of individuals who are identified as needing some or extensive support for SIB in the National Core Indicators Adult Consumer Survey sample. METHODS The data for this analysis come from states that participated in the 2015-2016 data collection cycle of National Core Indicators Adult Consumer Survey which is a face-to-face survey of adults receiving services through state developmental disability agencies. RESULTS The characteristics and outcomes of individuals who need at least some support for SIB differ from those of individuals with intellectual and developmental disabilities who do not need support for SIB. Individuals with SIB support needs, for example, tend to live in more structured settings, have fewer relationships, less inclusion in their communities and poorer employment outcomes. CONCLUSIONS The exploratory descriptive analysis concludes with suggested recommendations for more standardised definitions of SIB in public systems, enhanced behaviour plan protocols and the need for additional research.
Collapse
Affiliation(s)
- V Bradley
- Human Services Research Institute, Cambridge, MA, USA
| | - D Hiersteiner
- Human Services Research Institute, Cambridge, MA, USA
| | - D Rotholz
- Department of Pediatrics, Center for Disability Resources, School of Medicine, Columbia, SC, USA
| | - J Maloney
- Human Services Research Institute, Cambridge, MA, USA
| | - H Li
- Human Services Research Institute, Cambridge, MA, USA
| | - A Bonardi
- Human Services Research Institute, Cambridge, MA, USA
| | - J Bershadsky
- Human Services Research Institute, Cambridge, MA, USA
| |
Collapse
|
18
|
Muehlmann AM, Wolfman SL, Devine DP. The role of neurotensin in vulnerability for self-injurious behaviour: studies in a rodent model. J Intellect Disabil Res 2018; 62:997-1007. [PMID: 30033601 DOI: 10.1111/jir.12519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/10/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Self-injurious behaviour is a debilitating characteristic that is commonly expressed in people with autism and other neurodevelopmental disorders, but the neurobiological basis of this maladaptive behaviour is not understood. Abnormal dopaminergic and glutamatergic neurotransmission has been implicated, especially in relation to basal ganglia and mesocorticolimbic circuits. As neurotensin is an important modulator of dopamine and glutamate in these circuits, we investigated its potential role in vulnerability for self-injury, using the pemoline model in rats. METHODS Male Long-Evans rats were injected once daily with the psychostimulant pemoline or peanut oil vehicle on each of five consecutive days. Self-injury was quantified by measuring the area of injuries for each rat on each day of the experiment. Each brain was harvested on the sixth day, and the striatum and ventral tegmentum were dissected. Neurotensin-like immunoreactivity was quantified by radioimmunoassay from the dissected brain regions of some of the rats. Membrane and intracellular neurotensin receptor NTS1 were assayed from the striata of the remaining pemoline-treated or vehicle-treated rats by Western blot. In an additional experiment, male Long-Evans rats were treated with daily injections of vehicle or pemoline, and the NTS1 neurotensin receptor agonist PD149163 or the NTS1 receptor antagonist SR48692 (or respective vehicle solutions) was co-administered twice daily throughout the pemoline treatment regimen. The areas of injured tissue were measured, and the duration of self-injurious oral contact was quantified by video-recorded time samples throughout each day. RESULTS Striatal neurotensin immunoreactivity was found to be significantly higher in pemoline-treated than in vehicle-treated rats. Moreover, both membrane-bound and intracellular levels of NTS1 receptor were significantly higher in the striata of pemoline-treated rats than in the striata of the vehicle-treated controls. When the NTS1 receptor agonist PD149163 was co-administered during the pemoline treatment regimen, it prolonged the daily durations of self-injurious oral contact and increased the severity of the injuries in the self-injurious rats. Conversely, co-administration of the NTS1 receptor antagonist SR48692 diminished the daily durations of self-injurious oral contact and decreased the severity of the injuries. CONCLUSIONS The elevation of striatal neurotensin immunoreactivity during pemoline treatment, coupled with the effects of the NTS1 agonist and antagonist, suggests that neurotensin transmission in the striatum may be an important modulator of self-injurious behaviour in the pemoline model. Overall, the convergence of the behavioural and biochemical findings suggests that neurotensin signalling could be an important target for pharmacotherapeutic interventions for self-injurious behaviour.
Collapse
Affiliation(s)
- A M Muehlmann
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - S L Wolfman
- Department of Psychology, Behavioural and Cognitive Neuroscience Program, University of Florida, Gainesville, FL, USA
| | - D P Devine
- Department of Psychology, Behavioural and Cognitive Neuroscience Program, University of Florida, Gainesville, FL, USA
| |
Collapse
|
19
|
Hagopian LP, Frank-Crawford MA. Classification of self-injurious behaviour across the continuum of relative environmental-biological influence. J Intellect Disabil Res 2018; 62:1108-1113. [PMID: 29027294 PMCID: PMC5899071 DOI: 10.1111/jir.12430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
Self-injurious behaviour (SIB) is generally considered to be the product of interactions between dysfunction stemming from the primary developmental disability and experiences that occasion and reinforce SIB. As a result of these complex interactions, SIB presents as a heterogeneous problem. Recent research delineating subtypes of SIB that are nonsocially mediated, including one that is amenable to change and one that is highly invariant, enables classification of SIB across a broader continuum of relative environmental-biological influence. Directly examining how the functional classes of SIB differ has the potential to structure research, will improve our understanding this problem, and lead to more targeted behavioural and pharmacological interventions. Recognising that SIB is not a single entity but is composed of distinct functional classes would better align research with conceptual models that view SIB as the product of interactions between environmental and biological variables.
Collapse
Affiliation(s)
- Louis P. Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
- University of Maryland, Baltimore County
| | | |
Collapse
|
20
|
Rooker GW, Hausman NL, Fisher AB, Gregory MK, Lawell JL, Hagopian LP. Classification of injuries observed in functional classes of self-injurious behaviour. J Intellect Disabil Res 2018; 62:1086-1096. [PMID: 30043452 PMCID: PMC7273834 DOI: 10.1111/jir.12535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/26/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Limited research has examined how the functions of self-injurious behaviour (SIB) relate to the production of injuries and the location, type or severity of those injuries. METHODS Clinical and medical records were coded for 64 individuals hospitalised for SIB. When injuries were present, the physical properties of SIB and injuries were assessed across groups of individuals with automatically and socially maintained SIB. RESULTS Injuries were observed for 35 of the individuals who engaged in SIB. Individuals who engaged in a single form of SIB were more likely to have injuries (P < .05). Individuals with SIB maintained by automatic reinforcement had significantly more severe injuries to the head than those in the social group (q < .05, P = .0132, H = 12.54). CONCLUSION Although results are preliminary, the results provide evidence that the function of SIB may influence the severity and location of injuries produced.
Collapse
Affiliation(s)
- G W Rooker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - N L Hausman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore, MD, USA
| | - A B Fisher
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - M K Gregory
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - J L Lawell
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - L P Hagopian
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
21
|
Tsirigotis K, Łuczak J. Indirect Self-Destructiveness in Women who Experience Domestic Violence. Psychiatr Q 2018; 89:521-532. [PMID: 29292477 PMCID: PMC6096901 DOI: 10.1007/s11126-017-9560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lives of people experiencing domestic or/and intimate partner violence abound in many unpleasant events and physical and psychological suffering, which affects their psychosocial functioning. The aim of this study was to explore indirect self-destructiveness as a generalised behavioural tendency and its manifestations in women experiencing domestic violence. The "Chronic Self-Destructiveness Scale" (CS-DS) was used to study two groups of women: 52 women aged 30-65 years (mean age: 40.15) using assistance of the Crisis Intervention Centre due to experienced domestic violence (V group) and 150 well-matched women not experiencing domestic violence (NV group). Women suffering domestic violence (V) obtained significantly higher scores than women not experiencing domestic violence (NV) for both the general index and a majority of CS-DS subscales; it was only for the A1 (Transgression and Risk) subscale that they achieved somewhat lower scores. Correlation coefficients between particular CS-DS subscales in the V group were higher than in the NV group; there were also certain differences in coefficients between the groups. Subscale factor analysis results were different too: only one factor was isolated in the V group while two were distinguished in the NV group. It can be inferred from the results that the intensity of indirect self-destructiveness as a generalised behavioural tendency as well as of most its categories was higher in women experiencing domestic violence. Tendencies and categories of indirectly self-destructive behaviours in women suffering domestic violence were more closely connected with one another, and the internal coherence of indirect self-destructiveness in those women might also be higher.
Collapse
Affiliation(s)
- Konstantinos Tsirigotis
- Department of Psychology, The Jan Kochanowski University in Kielce, Piotrków Trybunalski Branch, Słowackiego 114/118 str., 97-300, Piotrków Trybunalski, Poland.
| | - Joanna Łuczak
- Department of Psychology, The Jan Kochanowski University in Kielce, Piotrków Trybunalski Branch, Słowackiego 114/118 str., 97-300, Piotrków Trybunalski, Poland
| |
Collapse
|
22
|
Halayem S, Charfi N, Touati M, Mrabet A, Bouden A. Sensitivity to pain in autistic spectrum disorders: Its links with self-gressivity. Tunis Med 2018; 96:501-504. [PMID: 30430528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the link between pain sensitivity in autism spectrum disorders (ASD) and self-aggressive behavior. METHODS we performed a cross-sectional study which involved 50 children fulfilling DSM-V criteria for ASD; confirmed by the Autism Diagnostic Interview Revised. The severity of autism was determined using the Childhood Autism Rating Scale (CARS).The psycho-educational profile (PEP-R) was used to assess the age of development and perception. Sensitivity to pain was assessed with item IX of the CARS. Self-aggressive behavior was assessed by the Behavior Problems Inventory. RESULTS Pain sensitivity was lowered in 40% and elevated in 4% of children. In the univariate analysis, no statistically significant association was found between normal sensitivity or hyper sensitivity to pain and the presence of auto-aggressiveness. A significant association was found between the presence of hypo-sensitivity to pain and the following variables: auto-aggression (p = 0.007, OR = 5.8, 95% CI = 1.5-21) , frequency of self-aggression (p = 0.001), intensity of self-aggression (p = 0.05), location of auto-aggressiveness at head and (P = 0.007, OR = 7.6, 95% CI = 1.8-14), higher score at CARS, and lower perception score at PEP-R (p = 0.012). Multiple-varied analysis identified risk factors for hypo-sensitivity to pain: lower perceptual score (p = 0.003, adjusted OR = 4.3, 95% CI = 1.9-54) and location of self-aggression at head and hands (p = 0.001, adjusted OR = 1.09, 95% CI = 1.02-1.09). CONCLUSION It would be interesting to develop tools allowing a fine and precise evaluation of the painful sensation.
Collapse
|
23
|
Rattaz C, Michelon C, Munir K, Baghdadli A. Challenging behaviours at early adulthood in autism spectrum disorders: topography, risk factors and evolution. J Intellect Disabil Res 2018; 62:637-649. [PMID: 29797498 PMCID: PMC6790981 DOI: 10.1111/jir.12503] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/08/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Challenging behaviours are highly prevalent in children and adolescents with autism spectrum disorders (ASD), but little is known about the prevalence and course of these behaviours during adulthood. The aims of this study were to describe the topography of challenging behaviours in a cohort of 106 young adults with ASD and to identify the risk factors for challenging behaviours. Our secondary objective was to study the changes in challenging behaviours from adolescence to early adult years. METHOD The present study uses data from the EpiTED prospective follow-up study in France. The presence of challenging behaviours was assessed by the Aberrant Behaviour Checklist (ABC) completed by parent informants. Several dimensions of behaviour were studied: irritability, stereotypy, lethargy, hyperactivity and self-injury. Clinical variables were collected on ASD symptom severity, cognitive and language levels, adaptive behaviours and comorbid medical disorders. RESULTS The presence of challenging behaviours at early adulthood was related to the young adult's cognitive and language level, ASD symptom severity and comorbid gastrointestinal and sleep disorders. The main risk factor for challenging behaviours was ASD symptom severity. The level of language impairment was a significant predictor of self-injury. Gastrointestinal disorders were a significant predictor of stereotypy. The change in behaviour topography from adolescence to early adult years corresponded with decreased parent report of hyperactivity, but no significant decrease in parent reports of irritability, stereotypy, lethargy and self-injurious behaviours. CONCLUSIONS The challenging behaviours in individuals with ASD persist in early adulthood and are related to core symptom severity, levels of cognitive and language impairments and medical comorbidity. The results emphasise the importance of early interventions for children with ASD to target cognitive and language abilities and to alleviate the severity of ASD symptoms. They also underscore the need to enhance opportunities for individuals with ASD to better communicate discomforts and pain in the context of medical illness.
Collapse
Affiliation(s)
- C Rattaz
- Centre Ressources Autisme, CHRU, Montpellier, France
| | - C Michelon
- Centre Ressources Autisme, CHRU, Montpellier, France
| | - K Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Baghdadli
- Centre Ressources Autisme, CHRU, Montpellier, France
- Centre de Recherche en Épidémiologie et Santé des Populations, U1178, INSERM, Paris, France
| |
Collapse
|
24
|
Guo Y, Tang X, Zhang J, Jin S, Li J, Ding L, Zhang K, Yang C, Zhou H, He X, Xu F, Bi GQ, Xu L, Lau PM. Corticosterone Signaling and a Lateral Habenula-Ventral Tegmental Area Circuit Modulate Compulsive Self-Injurious Behavior in a Rat Model. J Neurosci 2018; 38:5251-5266. [PMID: 29760181 PMCID: PMC6596003 DOI: 10.1523/jneurosci.2540-17.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/21/2022] Open
Abstract
Self-injurious behavior (SIB) is commonly observed in patients with neuropsychiatric disorders, as well as in nonclinical populations with stress-related mental-health problems. However, the exact circuitry mechanisms underlying SIB have remained poorly understood. Here, with bilateral injection of muscimol into the entopeduncular nucleus (EP), we established a rat model of SIB. Following the muscimol injection, the male rats exhibited in a dose-dependent manner stereotypic self-biting behavior that lasted for hours and often resulted in wounds of various severities. The SIB was associated with an elevated level of serum corticosterone and could be exacerbated by enhancing the corticosterone signaling and, conversely, alleviated by inhibiting the corticosterone signaling. Activity mapping using c-fos immunostaining, combined with connectivity mapping using herpes simplex virus-based anterograde tracing from the EP and pseudorabies virus-based retrograde tracing from the masseter muscle, revealed the potential involvement of many brain areas in SIB. In particular, the lateral habenula (LHb) and the ventral tegmental area (VTA), the two connected brain areas involved in stress response and reward processing, showed a significant increase in neuronal activation during SIB. Furthermore, suppressing the LHb activity or modulating the GABAergic transmission in the VTA could significantly reduce the occurrence of SIB. These results demonstrate the importance of stress hormone signaling and the LHb-VTA circuit in modulating SIB resulting from EP malfunction, and suggest potential targets for therapeutic intervention of SIB and related disorders.SIGNIFICANCE STATEMENT Self-injurious behavior (SIB) occurs in ∼4% of the general population, with substantially higher occurrence among adolescents and patients of neuropsychiatric disorders. Stress has been linked to the occurrence of SIB, yet the underlying mechanisms have remained unclear. Using a rat model of SIB induced by disruption of activity in the entopeduncular nucleus (EP), we found that the behavior is regulated by stress and linked to corticosterone signaling. Viral tracing and c-fos immunostaining revealed the involvement of various subcortical areas, especially the EP-lateral habenula (LHb)-ventral tegmental area (VTA) circuit, in SIB. Furthermore, regulating activity in the LHb or the VTA alleviates SIB. These results may have implications in the development of new strategies for treating SIB.
Collapse
Affiliation(s)
- Yujie Guo
- Hefei National Laboratory for Physical Sciences at the Microscale
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xun Tang
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
- Key Laboratory of Animal Models and Human Disease Mechanisms, Laboratory of Learning and Memory, Center for Excellence in Brain Science and Intelligence Technology, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
| | - Jichuan Zhang
- Faculty of Medicine, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Sen Jin
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics and Center for Excellence in Brain Science and Intelligence Technology, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, Hubei 430071, China, and
| | - Jinnan Li
- Key Laboratory of Animal Models and Human Disease Mechanisms, Laboratory of Learning and Memory, Center for Excellence in Brain Science and Intelligence Technology, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
| | - Lufeng Ding
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Keming Zhang
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Chaoyu Yang
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Hua Zhou
- Faculty of Medicine, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Xiaobin He
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics and Center for Excellence in Brain Science and Intelligence Technology, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, Hubei 430071, China, and
| | - Fuqiang Xu
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics and Center for Excellence in Brain Science and Intelligence Technology, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, Hubei 430071, China, and
| | - Guo-Qiang Bi
- Hefei National Laboratory for Physical Sciences at the Microscale
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Lin Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms, Laboratory of Learning and Memory, Center for Excellence in Brain Science and Intelligence Technology, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
| | - Pak-Ming Lau
- Chinese Academy of Sciences Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui 230027, China,
| |
Collapse
|
25
|
Abstract
Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.
Collapse
Affiliation(s)
- Brooke L Maxfield
- Department of Psychology, University of Wyoming, 3415 1000 E. University Ave, Laramie, WY, 82071, USA
| | - Carolyn M Pepper
- Department of Psychology, University of Wyoming, 3415 1000 E. University Ave, Laramie, WY, 82071, USA.
| |
Collapse
|
26
|
Willis F, Kuniss S, Kleindienst N, Lis S, Naoum J, Jungkunz M, Neukel C, Bohus M, Treede R, Baumgärtner U, Schmahl C. Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain Behav 2018; 8:e00909. [PMID: 29484266 PMCID: PMC5822574 DOI: 10.1002/brb3.909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022] Open
Abstract
Objective Patients with borderline personality disorder (BPD) use nonsuicidal self-injury (NSSI) to cope with states of elevated inner tension. It is unclear to what extent remitted BPD patients experience these states and whether the experience of pain still regulates emotion. The purpose of this study was the investigation of baseline stress levels, stress reactivity, and pain-mediated stress regulation in remitted BPD patients. Method Subjective and objective stress parameters were assessed in 30 remitted BPD patients, 30 current BPD patients, and 30 healthy controls. After stress induction, a non-nociceptive tactile stimulus, a tissue-injuring, or a noninvasive pain stimulus was applied to the right volar forearm. Results Baseline stress levels of remitted BPD patients lie in between the stress levels of current BPD patients and healthy controls. Urge for NSSI increased significantly more in current than remitted BPD patients. The experience of pain led to a greater decrease of arousal in current compared to remitted BPD patients and healthy controls. Conclusions States of increased tension still seem to appear in remitted BPD patients. The role of pain-mediated stress regulation appears to be reduced in remitted patients.
Collapse
Affiliation(s)
- Franziska Willis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Janina Naoum
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Martin Jungkunz
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Corinne Neukel
- Department of Psychosocial MedicineUniversity of HeidelbergHeidelbergGermany
| | - Martin Bohus
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Faculty of HealthUniversity of AntwerpAntwerpBelgium
| | - Rolf‐Detlef Treede
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonONCanada
| |
Collapse
|
27
|
Sarchiapone M, Gramaglia C, Iosue M, Carli V, Mandelli L, Serretti A, Marangon D, Zeppegno P. The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis. BMC Psychiatry 2018; 18:22. [PMID: 29370787 PMCID: PMC5785904 DOI: 10.1186/s12888-017-1551-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Electrodermal activity (EDA) and other peripheral autonomic electrical parameters have been used as indicators of emotional states, including depressive states and suicidal state. We aimed to review EDA research systematically, focusing on EDA's usefulness as a biomarker for depression and suicidal behaviour. METHODS We searched MEDLINE, Scopus, Cochrane Library, and Web of Science databases, following PRISMA guidelines. The initial screening of articles was based on titles and abstracts; then the full text was reviewed. A preliminary synthesis of findings was developed using tables, thematic analysis and quality ratings. RESULTS 1287 articles were screened and 77 relevant studies were identified and included in the systematic review. The studies were fairly consistent in maintaining that hypoactive electrodermal response is an established feature of patients affected by depression. There is also preliminary evidence that monitoring EDA may help to differentiate the phases of mood disorders. A few studies provided evidence that EDA can be used to differentiate acutely suicidal subjects from depressed patients who are not severely suicidal. Although EDA has been shown to be a valid, sensitive marker of suicidal ideation, suicide attempts and violent suicidal behaviour, it also seems to be influenced to some extent by antidepressant treatment. CONCLUSIONS Most of the studies summarised in this review are quite outdated and employed a variety of designs and methods to evaluate EDA. This limits the generalisability of the results and makes it difficult to draw clear conclusions about the role of EDA in real-world settings. Electrodermal hypoactivity seems to be a reliable feature of depression and a valid marker of suicidal risk. Nevertheless, the potential utility of EDA in diagnosis, prevention, and treatment planning for depression and suicidal behaviour, should be thoroughly studied.
Collapse
Affiliation(s)
- Marco Sarchiapone
- Department of Health Sciences, University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy.
- National Institute for Health, Migration and Poverty, Via di S. Gallicano 25/a, 00153, Rome, Italy.
| | - Carla Gramaglia
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Miriam Iosue
- Department of Health Sciences, University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, -171 77, Stockholm, SE, Sweden
| | - Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, Institute of Psychiatry, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, Institute of Psychiatry, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Debora Marangon
- Institute of Psychiatry, Maggiore della Carità Hospital of Novara, C.so Mazzini 18, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
- Institute of Psychiatry, Maggiore della Carità Hospital of Novara, C.so Mazzini 18, 28100, Novara, Italy
| |
Collapse
|
28
|
Abstract
Skin-picking disorder (SPD) is a common mental disorder characterized by recurrent and excessive picking of dermatological irregularities. Different disorder models have been developed to explain this behavior, but empirical evidence is still scarce. One model (the disgust-related disease avoidance model) suggests that SPD might be understood as pathological grooming elicited by skin imperfections that singal possible infection. Twenty-five women with SPD and 19 matched controls viewed and rated images depicting skin irregularities and smooth skin during functional magnetic resonance imaging. The participants did not engage in picking behavior. Relative to controls, SPD patients reported more disgust and urge to pick when looking at skin irregularities. This was accompanied by greater activation in the insula and amygdala, and stronger insula-putamen coupling. Disgust feelings elicited by viewing skin irregularities were positively correlated with activation of the insula and the putamen, in the clinical group. On personality questionnaires, the SPD patients reported elevated self-loathing and problems in regulating their disgust feelings. The current study provides first evidence for altered disgust processing in SPD patients.
Collapse
Affiliation(s)
- Anne Schienle
- Clinical Psychology, BioTechMedGraz, University of Graz, Universitätsplatz 2, 8010, Graz, Austria.
| | - Sonja Übel
- Clinical Psychology, BioTechMedGraz, University of Graz, Universitätsplatz 2, 8010, Graz, Austria
| | - Albert Wabnegger
- Clinical Psychology, BioTechMedGraz, University of Graz, Universitätsplatz 2, 8010, Graz, Austria
| |
Collapse
|
29
|
McEvoy PM, Hayes S, Hasking PA, Rees CS. Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure. J Behav Ther Exp Psychiatry 2017; 57:163-171. [PMID: 28601695 DOI: 10.1016/j.jbtep.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI). METHOD Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure. RESULTS Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury. LIMITATIONS Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed. CONCLUSIONS Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.
Collapse
Affiliation(s)
- Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Sarra Hayes
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Penelope A Hasking
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Clare S Rees
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| |
Collapse
|
30
|
Bartel T. Mystery solved: Our son's autism and extreme self-injury is genetic and treatable. Am J Med Genet A 2017; 173:1190-1193. [PMID: 28322502 DOI: 10.1002/ajmg.a.38198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/01/2017] [Indexed: 11/06/2022]
Abstract
Our 17-year-old autistic son Jake is declining at the same rate his peers are developing. He has the pimples, the sudden height, and the hormones. But the right side of his body slumps like someone who has had a stroke. Once right handed, he now uses only his left hand. At 15, he knocked his eyes off their parallel tracks by slamming his temple into the corner of a wooden post. One eye looks straight ahead while the other looks up and to the side. Both optic nerves are damaged. All the damage is self-inflicted. He has been banging and punching his head since babyhood.
Collapse
|
31
|
Bitsika V, Sharpley CF, Andronicos NM, Agnew LL. What worries parents of a child with Autism? Evidence from a biomarker for chronic stress. Res Dev Disabil 2017; 62:209-217. [PMID: 28202252 DOI: 10.1016/j.ridd.2017.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 01/27/2017] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous studies have reported correlations between various aspects of the behaviour and symptomatology of children with Autism Spectrum Disorder (ASD) and their parents' self-reports of stress via standardised scales. AIMS To extend that literature, a physiological index of parental chronic stress was used instead of their self-reports-dysregulation of the Diurnal Rhythm (DR) of the Hypothalamic-Pituitary-Adrenal (HPA) axis. METHODS A sample of 149 parents of a child with ASD provided salivary cortisol at the predicted time of daily maximum cortisol concentration and at a time of daily lower concentration. Adherence to the predicted DR was assessed via a dichotomous (present/not-present) as well as a continuous measure, and MANOVA and linear regression were used to detect significant associations between ASD-related variables in their children and parents' DR. RESULTS Identified only a single significant correlate of DR dysregulation in both statistical procedures-Self-Injurious Behaviour (SIB) exhibited by their child and observed by the parents. CONCLUSIONS AND IMPLICATIONS These findings extend previous data using self-report indices of parental stress and should be included in parent-support settings to alert parents to the long-term health effects of the stress they experience in regard to their child's SIB.
Collapse
Affiliation(s)
- Vicki Bitsika
- Centre for Autism Spectrum Disorders, Bond University, Robina, Queensland 4229, Australia.
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, 2351, New South Wales, Australia.
| | | | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, 2351, Australia.
| |
Collapse
|
32
|
Boiko DI, Zhyvotovska LV, Sonnik GT, Skrypnіkov AM. Clinical and psychopathological characteristics of the autoagressive behavior in patients with the first psychotic episode with considering circadian rhythms. Wiad Lek 2017; 70:553-557. [PMID: 28713080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The high rate of autoagressive action in patients with psychotic symptoms manifested during the beginning of active psychopharmatherapy, and they are often the reason for psychiatric help. The continuous growth of autoagressive behavior indicates the number of unsolved problems in clinical suicidology. AIM The aim of this research was to explore the clinical and psychopathological characteristics of the autoagressive behavior in patients with the first psychotic episode with considering circadian rhythms. MATERIAL AND METHODS There was a research in regional clinical psychiatric hospital and 130 patients were involved in the research with autoagressive behavior during the first psychotic episodes. Clinical and psychopathological, psychodiagnostic and statistical methods were used. Characteristic clinical manifestations of first psychotic episode is determined by PANSS [1986] and BPRS [1962], level of suicidal risk is determined by Lyuban-Plotstsa's scale [2000], characteristics of biological rhythms is established by Estberg's questionnaire [1986]. RESULTS Certain psychiatric symptoms were associated with the level of suicide risk in the first episode of psychosis, such as ≪tension", ≪hostility", ≪mannerisms and posturing, ≪excitement≫, ≪suspiciousness≫, ≪somatic concern≫, ≪anxiety≫, ≪depression≫, ≪guilt≫. Circadian rhythms include the level of risk occurrence and severity autoagressive behavior such as clearly and dimly expressed evening types of daily activity. CONCLUSIONS Therefore, further research of autoagression during the first psychotic episode with considering the influence of biological rhythms is a given area of current research in psychiatry aimed to improve the prevention, treatment and rehabilitation.
Collapse
Affiliation(s)
- Dmytro I Boiko
- Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltawa, Ukraine
| | - Lilia V Zhyvotovska
- Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltawa, Ukraine
| | - Grigorij T Sonnik
- Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltawa, Ukraine
| | - Andrij M Skrypnіkov
- Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltawa, Ukraine
| |
Collapse
|
33
|
|
34
|
Hall SS, Barnett RP, Hustyi KM. Problem behaviour in adolescent boys with fragile X syndrome: relative prevalence, frequency and severity. J Intellect Disabil Res 2016; 60:1189-1199. [PMID: 27730710 PMCID: PMC5777854 DOI: 10.1111/jir.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A large proportion of boys with fragile X syndrome (FXS), the most common known inherited form of intellectual disability (ID), exhibit problem behaviours (e.g. aggression, self-injury, property destruction and stereotypy) that can negatively impact the health and safety of others as well as the individual concerned. However, data are limited concerning the relative prevalence, frequency and severity of problem behaviours exhibited by boys with FXS compared with those by boys with mixed-aetiology ID who also exhibit problem behaviours. METHOD As part of a larger study on problem behaviour, we obtained survey data on 85 adolescent boys with FXS and 155 age-matched boys with mixed-aetiology ID who exhibited at least one form of problem behaviour. RESULTS For boys with FXS, stereotypy was reported to be more prevalent (χ2 = 4.52, P = 0.012), self-injury was reported to more frequent (U = 2525, P = 0.010) and aggression was reported to be less severe (U = 4176, P = 0.029) than for boys with mixed-aetiology ID. Ratings of aggression and property destruction were highly correlated in each group in terms of both frequency and severity (r = 0.60 to 0.71). Examination of the data by age indicated that the relative frequency of self-injury decreased with age in boys with FXS (χ2 = 8.29, P = 0.040). CONCLUSIONS Taken together, these results refine and extend previous studies concerning the specificity of the behavioural phenotype in FXS and indicate that specific forms of problem behaviour shown by boys with FXS appear to differ from those exhibited by boys with mixed-aetiology ID in terms of prevalence, frequency and severity. Studies employing more objective measures of frequency and severity, including direct observations, are needed to confirm these findings.
Collapse
Affiliation(s)
- S S Hall
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - R P Barnett
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - K M Hustyi
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| |
Collapse
|
35
|
Mohamed F, Endre ZH, Pickering JW, Jayamanne S, Palangasinghe C, Shahmy S, Chathuranga U, Wijerathna T, Shihana F, Gawarammana I, Buckley NA. Mechanism-specific injury biomarkers predict nephrotoxicity early following glyphosate surfactant herbicide (GPSH) poisoning. Toxicol Lett 2016; 258:1-10. [PMID: 27288352 DOI: 10.1016/j.toxlet.2016.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 01/22/2023]
Abstract
Acute kidney injury (AKI) is common following glyphosate surfactant herbicide (GPSH) self-poisoning. Serum creatinine (sCr) is the most widely used renal biomarker for diagnosis of AKI although a recent study in rats suggested that urinary kidney injury molecule-1 predicted AKI earlier and better after GPSH-induced nephrotoxicity. We explored the utility of a panel of biomarkers to diagnose GPSH-induced nephrotoxicity in humans. In a prospective multi-centre observational study, serial urine and blood samples were collected until discharge and at follow-up. The diagnostic performance of each biomarker at various time points was assessed. AKI was diagnosed using the Acute Kidney Injury Network (AKIN) definitions. The added value of each biomarker to sCr to diagnose AKI was assessed by the integrated discrimination improvement (IDI) metric. Of 90 symptomatic patients, 51% developed AKI and 5 patients who developed AKIN≥2 died. Increased sCr at 8 and 16h predicted moderate to severe AKI and death. None of the 10 urinary biomarkers tested increased above normal range in patients who did not develop AKI or had mild AKI (AKIN1); most of these patients also had only minor clinical toxicity. Absolute concentrations of serum and urinary cystatin C, urinary interleukin-18 (IL-18), Cytochrome C (CytoC) and NGAL increased many fold within 8h in patients who developed AKIN≥2. Maximum 8 and 16h concentrations of these biomarkers showed an excellent diagnostic performance (AUC-ROC ≥0.8) to diagnose AKIN≥2. However, of these biomarkers only uCytoC added value to sCr to diagnose AKI when assessed by IDI metrics. GPSH-induced nephrotoxicity can be diagnosed within 24h by sCr. Increases in uCytoC and uIL-18 confirm GPSH-induces apoptosis and causes mitochondrial toxicity. Use of these biomarkers may help to identify mechanism specific targeted therapies for GPSH nephrotoxicity in clinical trials.
Collapse
Affiliation(s)
- Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia; TACT Research Group, Department of Pharmacology, SOMS, Sydney Medical School, University of Sydney, NSW, Australia.
| | - Zoltan H Endre
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chathura Palangasinghe
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Seyed Shahmy
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Umesh Chathuranga
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; TACT Research Group, Department of Pharmacology, SOMS, Sydney Medical School, University of Sydney, NSW, Australia
| |
Collapse
|
36
|
Quevedo K, Martin J, Scott H, Smyda G, Pfeifer JH. The neurobiology of self-knowledge in depressed and self-injurious youth. Psychiatry Res 2016; 254:145-55. [PMID: 27442923 PMCID: PMC5737906 DOI: 10.1016/j.pscychresns.2016.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 01/01/2023]
Abstract
There is limited information regarding the neurobiology underlying non-suicidal self-injury (NSSI) in clinically-referred youth. However, the salience of disturbed interpersonal relationships and disrupted self-processing associated with NSSI suggests the neural basis of social processes as a key area for additional study. Adolescent participants (N=123; M=14.75 years, SD=1.64) were divided into three groups: NSSI plus depression diagnosis (NSSI), depression only (DEP), healthy controls (HC). In the scanner, participants completed an Interpersonal Self-Processing task by taking direct (own) and indirect (mothers', best friends', or classmates') perspectives regarding self-characteristics. Across all perspectives, NSSI showed higher BOLD activation in limbic areas, and anterior and posterior cortical midline structures versus DEP and HC, while HC showed greater activity in rostrolateral, frontal pole and occipital cortex than NSSI and DEP youth. Moreover, NSSI youth showed heightened responses in amygdala, hippocampus, parahippocampus, and fusiform when taking their mothers' perspective, which were negatively correlated with self-reports of the mother's support of adolescents' emotional distress in the NSSI group. NSSI youth also yielded greater precuneus and posterior cingulate cortex activity during indirect self-processing from their classmates' perspective. Findings suggest a role for disruptions in self- and emotion-processing, and conflicted social relationships in the neurobiology of NSSI among depressed adolescents.
Collapse
Affiliation(s)
- Karina Quevedo
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
| | - Jodi Martin
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Hannah Scott
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Garry Smyda
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
37
|
Xin X, Ming Q, Zhang J, Wang Y, Liu M, Yao S. Four Distinct Subgroups of Self-Injurious Behavior among Chinese Adolescents: Findings from a Latent Class Analysis. PLoS One 2016; 11:e0158609. [PMID: 27392132 PMCID: PMC4938421 DOI: 10.1371/journal.pone.0158609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022] Open
Abstract
Self-injurious behavior (SIB) among adolescents is an important public health issue worldwide. It is still uncertain whether homogeneous subgroups of SIB can be identified and whether constellations of SIBs can co-occur due to the high heterogeneity of these behaviors. In this study, a cross-sectional study was conducted on a large school-based sample and latent class analysis was performed (n = 10,069, mean age = 15 years) to identify SIB classes based on 11 indicators falling under direct SIB (DSIB), indirect SIB (ISIB), and suicide attempts (SAs). Social and psychological characteristics of each subgroup were examined after controlling for age and gender. Results showed that a four-class model best fit the data and each class had a distinct pattern of co-occurrence of SIBs and external measures. Class 4 (the baseline/normative group, 65.3%) had a low probability of SIB. Class 3 (severe SIB group, 3.9%) had a high probability of SIB and the poorest social and psychological status. Class 1 (DSIB+SA group, 14.2%) had similar scores for external variables compared to class 3, and included a majority of girls [odds ratio (OR) = 1.94]. Class 2 (ISIB group, 16.6%) displayed moderate endorsement of ISIB items, and had a majority of boys and older adolescents (OR = 1.51). These findings suggest that SIB is a heterogeneous entity, but it may be best explained by four homogenous subgroups that display quantitative and qualitative differences. Findings in this study will improve our understanding on SIB and may facilitate the prevention and treatment of SIB.
Collapse
Affiliation(s)
- Xiuhong Xin
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
- Department of Medical Psychology, Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China
- Mental Health Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qingsen Ming
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jibiao Zhang
- Psychology Department, School Education, Jianghan University, Wuhan, Hubei, China
| | - Yuping Wang
- School of Humanities & Social Sciences, Xi’an Jiaotong University, Xi’an, China
| | - Mingli Liu
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China
| | - Shuqiao Yao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
- * E-mail:
| |
Collapse
|
38
|
Abstract
The intentional activation of autonomic dysreflexia (AD, also called "boosting"), a practice sometimes used by athletes affected by spinal cord injury (SCI), is banned by the International Paralympic Committee (IPC). Although various studies have addressed doping and AD as separate issues, studies evaluating AD as a doping method are lacking. The aim of this brief review is to contribute to better understanding of the relationship between doping and AD. We conducted a literature search of the PubMed database (from 1994 onwards). The key search terms "autonomic dysreflexia" and "boosting" were crossreferenced with "sport performance". The official Paralympic website was also viewed. AD is a potent sympathetic reflex, due to a massive release of noradrenaline, that results in marked vasoconstriction distal to the level of the lesion. Athletes with SCI often self-inflict physical suffering in order to induce this phenomenon, which carries high health risks (i.e., hypertension, cerebral hemorrhage, stroke and sudden death). Boosting is a practice that can be compared to doping methods and the IPC expressly prohibits it. Any deliberate attempt to induce AD, if detected, will lead to disqualification from the sporting event and subsequent investigation by the IPC Legal and Ethics Committee.
Collapse
|
39
|
Abstract
Individuals engaging in self-injurious behavior (SIB) frequently report absence of pain during acts of SIB. While altered pain sensitivity is discussed as a risk factor for the engagement in SIB, results have been mixed with considerable variance across reported effect sizes, in particular with respect to the effect of co-morbid psychopathology. The present meta-analysis aimed to summarize the current evidence on pain sensitivity in individuals engaging in SIB and to identify covariates of altered pain processing. Three databases were searched without restrictions. Additionally a hand search was performed and reference lists of included studies were checked for potential studies eligible for inclusion. Thirty-two studies were identified after screening 720 abstracts by two independent reviewers. Studies were included if they reported (i) an empirical investigation, in (ii) humans, including a sample of individuals engaging in (iii) SIB and a group of (iv) healthy controls, (v) receiving painful stimulation. Random-effects meta-analysis was performed on three pain-related outcomes (pain threshold, pain tolerance, pain intensity) and several population- and study-level covariates (i.e. age, sex, clinical etiology) were subjected to meta-regression. Meta-analysis revealed significant main effects associated with medium to large effect sizes for all included outcomes. Individuals engaging in SIB show greater pain threshold and tolerance and report less pain intensity compared to healthy controls. Clinical etiology and age are significant covariates of pain sensitivity in individuals engaging in SIB, such that pain threshold is further increased in borderline personality disorder compared to non-suicidal self-injury. Mechanisms underlying altered pain sensitivity are discussed.
Collapse
Affiliation(s)
- J Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry,Department of Child and Adolescent Psychiatry,Centre for Psychosocial Medicine,University of Heidelberg,Heidelberg,Germany
| | - J F Thayer
- Department of Psychology,The Ohio State University,Columbus, OH,USA
| | - M Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry,Department of Child and Adolescent Psychiatry,Centre for Psychosocial Medicine,University of Heidelberg,Heidelberg,Germany
| |
Collapse
|
40
|
Courtemanche AB, Black WR, Reese RM. The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities. Am J Intellect Dev Disabil 2016; 121:194-203. [PMID: 27119211 DOI: 10.1352/1944-7558-121.3.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain, which contradicts previous assertions of blunted pain sensitivity in this population. The purpose of this study was to measure expressions of pain among young children being evaluated for autism and other neurodevelopmental disabilities. The frequency of pain-related behaviors was assessed during everyday routines using the Non-Communicating Children's Pain Checklist (NCCPC-R) for 51 children. Significant group differences between children with and without self-injury were found for the NCCPC-R total scores. The frequency and severity of self-injury, aggression, and stereotypy were also highly correlated with the total scores on the NCCPC-R. These results continue to support that individuals with self-injury may have enhanced expressions of pain.
Collapse
|
41
|
Odlaug BL, Hampshire A, Chamberlain SR, Grant JE. Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study. Br J Psychiatry 2016; 208:168-74. [PMID: 26159604 PMCID: PMC4837383 DOI: 10.1192/bjp.bp.114.155192] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excoriation (skin-picking) disorder (SPD) is a relatively common psychiatric condition whose neurobiological basis is unknown. AIMS To probe the function of fronto-striatal circuitry in SPD. METHOD Eighteen participants with SPD and 15 matched healthy controls undertook an executive planning task (Tower of London) during functional magnetic resonance imaging (fMRI). Activation during planning was compared between groups using region of interest and whole-brain permutation cluster approaches. RESULTS The SPD group exhibited significant functional underactivation in a cluster encompassing bilateral dorsal striatum (maximal in right caudate), bilateral anterior cingulate and right medial frontal regions. These abnormalities were, for the most part, outside the dorsal planning network typically activated by executive planning tasks. CONCLUSIONS Abnormalities of neural regions involved in habit formation, action monitoring and inhibition appear involved in the pathophysiology of SPD. Implications exist for understanding the basis of excessive grooming and the relationship of SPD with putative obsessive-compulsive spectrum disorders.
Collapse
Affiliation(s)
- Brian L Odlaug
- Brian L. Odlaug, MPH, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark and Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA; Adam Hampshire, PhD, The Computational, Cognitive, and Clinical Neuroimaging Lab, Department of Medicine, Imperial College, London, UK; Samuel R. Chamberlain, MB/BChir, PhD, MRCPsych, Department of Psychiatry & MRC/Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge and Cambridge and Peterborough NHS Foundation Trust Cambridge, UK; Jon E. Grant, JD, MD, MPH, Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Adam Hampshire
- Brian L. Odlaug, MPH, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark and Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA; Adam Hampshire, PhD, The Computational, Cognitive, and Clinical Neuroimaging Lab, Department of Medicine, Imperial College, London, UK; Samuel R. Chamberlain, MB/BChir, PhD, MRCPsych, Department of Psychiatry & MRC/Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge and Cambridge and Peterborough NHS Foundation Trust Cambridge, UK; Jon E. Grant, JD, MD, MPH, Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Samuel R Chamberlain
- Brian L. Odlaug, MPH, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark and Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA; Adam Hampshire, PhD, The Computational, Cognitive, and Clinical Neuroimaging Lab, Department of Medicine, Imperial College, London, UK; Samuel R. Chamberlain, MB/BChir, PhD, MRCPsych, Department of Psychiatry & MRC/Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge and Cambridge and Peterborough NHS Foundation Trust Cambridge, UK; Jon E. Grant, JD, MD, MPH, Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Jon E Grant
- Brian L. Odlaug, MPH, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark and Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA; Adam Hampshire, PhD, The Computational, Cognitive, and Clinical Neuroimaging Lab, Department of Medicine, Imperial College, London, UK; Samuel R. Chamberlain, MB/BChir, PhD, MRCPsych, Department of Psychiatry & MRC/Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge and Cambridge and Peterborough NHS Foundation Trust Cambridge, UK; Jon E. Grant, JD, MD, MPH, Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
42
|
Abstract
Despite the growing consensus that negative reinforcement in the form of emotional relief plays a key role in the maintenance of deliberate self-harm (DSH), most of the research in this area has relied exclusively on self-report measures of the perceived motives for and emotional consequences of DSH. Thus, the primary aim of this study was to extend extant research on the role of emotional relief in DSH by examining the strength of the association of DSH with emotional relief using a novel version of the Implicit Association Test (IAT). The strength of the DSH-relief association among both participants with (vs. without) DSH and self-harming participants with (vs. without) BPD, as well as its associations with relevant clinical constructs (including DSH characteristics, self-reported motives for DSH, BPD pathology, and emotion dysregulation and avoidance) were examined in a community sample of young adults (113 with recent recurrent DSH; 135 without DSH). As hypothesized, results revealed stronger associations between DSH and relief among participants with versus without DSH, as well as among DSH participants with versus without BPD. Moreover, the strength of the DSH-relief association was positively associated with DSH frequency and versatility (both lifetime and at 6-month follow-up), BPD pathology, emotion dysregulation, experiential avoidance, and self-reported emotion relief motives for DSH. Findings provide support for theories emphasizing the role of emotional relief in DSH (particularly among individuals with BPD), as well as the construct validity, predictive utility, and incremental validity (relative to self-reported emotion relief motives) of this IAT.
Collapse
Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| |
Collapse
|
43
|
Vega D, Vilà-Balló A, Soto À, Amengual J, Ribas J, Torrubia R, Rodríguez-Fornells A, Marco-Pallarés J. Preserved Error-Monitoring in Borderline Personality Disorder Patients with and without Non-Suicidal Self-Injury Behaviors. PLoS One 2015; 10:e0143994. [PMID: 26636971 PMCID: PMC4670111 DOI: 10.1371/journal.pone.0143994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control. Method We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants. Results The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors. Conclusions This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms.
Collapse
Affiliation(s)
- Daniel Vega
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Adrià Vilà-Balló
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Àngel Soto
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Julià Amengual
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Ribas
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Rafael Torrubia
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Josep Marco-Pallarés
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Institut de Recerca en Cervell, Cognició i Conducta, IR3C, University of Barcelona, Barcelona, Spain
- * E-mail:
| |
Collapse
|
44
|
Alaimo JT, Barton LV, Mullegama SV, Wills RD, Foster RH, Elsea SH. Individuals with Smith-Magenis syndrome display profound neurodevelopmental behavioral deficiencies and exhibit food-related behaviors equivalent to Prader-Willi syndrome. Res Dev Disabil 2015; 47:27-38. [PMID: 26323055 DOI: 10.1016/j.ridd.2015.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 05/25/2023]
Abstract
Smith-Magenis syndrome (SMS) is a neurodevelopmental disorder associated with intellectual disability, sleep disturbances, early onset obesity and vast behavioral deficits. We used the Behavior Problems Inventory-01 to categorize the frequency and severity of behavioral abnormalities in a SMS cohort relative to individuals with intellectual disability of heterogeneous etiology. Self-injurious, stereotyped, and aggressive/destructive behavioral scores indicated that both frequency and severity were significantly higher among individuals with SMS relative to those with intellectual disability. Next, we categorized food behaviors in our SMS cohort across age using the Food Related Problems Questionnaire (FRPQ) and found that problems began to occur in SMS children as early as 5-11 years old, but children 12-18 years old and adults manifested the most severe problems. Furthermore, we evaluated the similarities of SMS adult food-related behaviors to those with intellectual disability and found that SMS adults had more severe behavioral problems. Many neurodevelopmental disorders exhibit syndromic obesity including SMS. Prader-Willi syndrome (PWS) is the most frequent neurodevelopmental disorder with syndromic obesity and has a well-established management and treatment plan. Using the FRPQ we found that SMS adults had similar scores relative to PWS adults. Both syndromes manifest weight gain early in development, and the FRPQ scores highlight specific areas in which behavioral similarities exist, including preoccupation with food, impaired satiety, and negative behavioral responses. SMS food-related behavior treatment paradigms are not as refined as PWS, suggesting that current PWS treatments for prevention of obesity may be beneficial for individuals with SMS.
Collapse
Affiliation(s)
- Joseph T Alaimo
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Laura V Barton
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Sureni V Mullegama
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rachel D Wills
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rebecca H Foster
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA 23298, USA.
| |
Collapse
|
45
|
Wright-Hughes A, Graham E, Farrin A, Collinson M, Boston P, Eisler I, Fortune S, Green J, House A, Owens D, Simic M, Tubeuf S, Nixon J, McCabe C, Kerfoot M, Cottrell D. Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harm. Trials 2015; 16:501. [PMID: 26537599 PMCID: PMC4634791 DOI: 10.1186/s13063-015-1007-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Self-harm is common in the community with a lifetime prevalence of 13 %. It is associated with an elevated risk of overall mortality and suicide. People who harm themselves are high users of public services. Estimates of the 1-year risk of repetition vary between 5 and 15 % per year. Currently, limited evidence exists on the effectiveness of clinical interventions for young people who engage in self-harm. Recent reviews have failed to demonstrate any effect on reducing repetition of self-harm among adolescents receiving a range of treatment approaches. Family factors are particularly important risk factors associated with fatal and non-fatal self-harm among children and adolescents. Family therapy focuses on the relationships, roles and communication patterns between family members, but there have been relatively few studies of specifically family-focused interventions with this population. The Self-Harm Intervention: Family Therapy (SHIFT) Trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (grant no. 07/33/01) following a commissioned call for this research. METHODS/DESIGN SHIFT is a pragmatic, phase III, multicentre, individually randomised, controlled trial comparing Family Therapy (FT) with treatment as usual (TAU) for adolescents aged 11 to 17 who have engaged in at least two episodes of self-harm. Both therapeutic interventions were delivered within the National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) in England. Participants and therapists were, of necessity, aware of treatment allocation, but the researchers were blind to the allocations to allow unbiased collection of follow-up data. Primary outcome data (repetition of self-harm leading to hospital attendance 18 months post-randomisation) were collected from the Health and Social Care Information Centre (HSCIC), augmented by directed searches of medical records at Acute Trusts. Secondary outcome data (including suicidal intent, depression, hopelessness and health economics) were collected at 12 and 18 months post-randomisation via researcher-participant interviews and by post at 3 and 6 months. DISCUSSION SHIFT will provide a well-powered evaluation of the clinical and cost effectiveness of Family Therapy for young people who have self-harmed on more than one occasion. The study will be reported in 2016, and the results will inform clinical practice thereafter. TRIAL REGISTRATION ISRCTN59793150 . 26 January 2009.
Collapse
Affiliation(s)
| | - Elizabeth Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Paula Boston
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| | - Ivan Eisler
- Institute of Psychiatry, King's College London, London, UK.
| | - Sarah Fortune
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| | - Jonathan Green
- Academic Department of Child and Adolescent Psychiatry, University of Manchester, Manchester, UK.
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| | - David Owens
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| | - Mima Simic
- Institute of Psychiatry, King's College London, London, UK.
| | - Sandy Tubeuf
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| | - Jane Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Christopher McCabe
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.
| | - Michael Kerfoot
- Academic Department of Child and Adolescent Psychiatry, University of Manchester, Manchester, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK.
| |
Collapse
|
46
|
Bernstein AM, Visconti KJ, Csorba J, Radvanyi K, Rojahn J. The relationship between challenging behaviours, mood and interest/pleasure in adults with severe and profound intellectual disabilities. J Intellect Disabil Res 2015; 59:1033-1041. [PMID: 26031694 DOI: 10.1111/jir.12202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 01/30/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND We investigated whether current mood and interest/pleasure ratings in adults with moderate to profound intellectual disabilities were predictive of challenging behaviour [self-injurious behaviour (SIB), aggressive/destructive behaviour and stereotypic behaviour] and vice versa. METHOD In this combined cross-sectional and longitudinal study, staff members of a Hungarian residential facility completed translated versions of the Behaviour Problems Inventory-Short Form (BPI-S), the Challenging Behaviour Interview (CBI) and the Mood, Interest and Pleasure Questionnaire-Short Form (MIPQ-S) for 50 participants at two time points, approximately 4 to 5 months apart. RESULTS Bivariate correlations from data concurrently assessed at Time-1 showed significant linear relationships between the SIB (both frequency and severity scores) and Interest/Pleasure sub-scales, and the Aggressive/Destructive Behaviour (severity scores) and the MIPQ-S Mood sub-scales (unadjusted for multiple correlations). All of these effects were found with the BPI-S data, but not with the CBI. Multiple regression analyses revealed that (1) low interest/pleasure assessed at Time-1 predicted high SIB (frequency and severity) at Time-2. (2) Interest/pleasure was not predictive of aggressive or stereotypic behaviour. (3) Mood at Time-1 did not predict any of the three types of behaviour problems at Time-2. (4) In reverse, high SIB (frequency and severity) at Time-1 predicted low interest/pleasure ratings at Time-2. (5) Surprisingly, frequent aggressive/destructive behaviour predicted high interest/pleasure. (6) Stereotypic behaviour scores at Time-1 did not predict interest/pleasure ratings at Time-2. Again, all of these effects were only found with the BPI-S data, but not with the CBI. Internal consistency, test-retest reliability and concurrent validity of the Hungarian versions of all three questionnaires had generally satisfactory outcomes. DISCUSSION The fact that increasingly frequent and severe SIB was predicted by declining measures of interest/pleasure is consistent with previous studies. Contrary to those earlier studies, however, we found that SIB was not predicted by mood and that aggressive/destructive behaviour actually predicted future elevated mood. Implications for future research regarding the directional relationship between affective states such as mood and interest and pleasure, on the one hand, and challenging behaviour, on the other, were discussed.
Collapse
Affiliation(s)
- A M Bernstein
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - K J Visconti
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - J Csorba
- Special Needs Education, ELTE University of Science, Budapest, Hungary
| | - K Radvanyi
- Special Needs Education, ELTE University of Science, Budapest, Hungary
| | - J Rojahn
- Department of Psychology, George Mason University, Fairfax, VA, USA
| |
Collapse
|
47
|
Claes L, Islam MA, Fagundo AB, Jimenez-Murcia S, Granero R, Agüera Z, Rossi E, Menchón JM, Fernández-Aranda F. The Relationship between Non-Suicidal Self-Injury and the UPPS-P Impulsivity Facets in Eating Disorders and Healthy Controls. PLoS One 2015; 10:e0126083. [PMID: 25993565 PMCID: PMC4439129 DOI: 10.1371/journal.pone.0126083] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
In the present study, we investigated the association between Non-Suicidal Self-Injury (NSSI) and the UPPS-P impulsivity facets in eating disorder patients and healthy controls. The prevalence of NSSI in eating disorder (ED) patients ranged from 17% in restrictive anorexia nervosa (AN-R) patients to 43% in patients with bulimia nervosa (BN). In healthy controls (HC), the prevalence of NSSI was 19%. Eating disorder patients from the binge eating/purging type showed significantly more NSSI compared to restrictive ED and HC participants. Binge-eating/purging ED patients also scored significantly higher on Negative/Positive Urgency, Lack of Premeditation and Lack of Perseverance compared to HC and restrictive ED patients. Comparable findings were found between ED patients and HC with and without NSSI; ED patients and HC with NSSI scored significantly higher in four of the five UPPS-P dimensions compared to participants without NSSI; Sensation Seeking was the exception. Finally, the presence of NSSI in HC/ED patients was particularly predicted by low levels of Perseverance. Therefore, the treatment of ED patients with NSSI certainly needs to focus on the training of effortful control.
Collapse
Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Mohammed A. Islam
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Ana B. Fagundo
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Elisa Rossi
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - José M. Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- * E-mail:
| |
Collapse
|
48
|
Wilderjans TF, Lambrechts G, Maes B, Ceulemans E. Revealing interdyad differences in naturally occurring staff reactions to challenging behaviour of clients with severe or profound intellectual disabilities by means of Clusterwise Hierarchical Classes Analysis (HICLAS). J Intellect Disabil Res 2014; 58:1045-1059. [PMID: 23957686 DOI: 10.1111/jir.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Investigating interdyad (i.e. couples of a client and their usual caregiver) differences in naturally occurring patterns of staff reactions to challenging behaviour (e.g. self-injurious, stereotyped and aggressive/destructive behaviour) of clients with severe or profound intellectual disabilities is important to optimise client-staff interactions. Most studies, however, fail to combine a naturalistic setup with a person-level analysis, in that they do not involve a careful inspection of the interdyad differences and similarities. METHOD In this study, the recently proposed Clusterwise Hierarchical Classes Analysis (HICLAS) method is adopted and applied to data of in which video fragments (recorded in a naturalistic setting) of a client showing challenging behaviour and the staff reacting to it were analysed. In a Clusterwise HICLAS analysis, the staff-client dyads are grouped into a number of clusters and the prototypical behaviour-reaction patterns that are specific for each cluster (i.e. interdyad differences and similarities) are revealed. RESULTS Clusterwise HICLAS discloses clear interdyad differences (and similarities) in the prototypical patterns of clients' challenging behaviour and the associated staff reactions, complementing and qualifying the results of earlier studies in which only general patterns were disclosed. CONCLUSIONS The usefulness and clinical relevance of Clusterwise HICLAS is demonstrated. In particular, Clusterwise HICLAS may capture idiosyncratic aspects of staff-client interactions, which may stimulate direct support workers to adopt person-centred support practices that take the specific abilities of the client into account.
Collapse
Affiliation(s)
- T F Wilderjans
- Methodology of Educational Sciences Research Group, Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | | | |
Collapse
|
49
|
Davis TS, Mauss IB, Lumian D, Troy AS, Shallcross AJ, Zarolia P, Ford BQ, McRae K. Emotional reactivity and emotion regulation among adults with a history of self-harm: laboratory self-report and functional MRI evidence. J Abnorm Psychol 2014; 123:499-509. [PMID: 24865373 PMCID: PMC4199303 DOI: 10.1037/a0036962] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Intentionally hurting one's body (deliberate self-harm; DSH) is theorized to be associated with high negative emotional reactivity and poor emotion regulation ability. However, little research has assessed the relationship between these potential risk factors and DSH using laboratory measures. Therefore, we conducted 2 studies using laboratory measures of negative emotional reactivity and emotion regulation ability. Study 1 assessed self-reported negative emotions during a sad film clip (reactivity) and during a sad film clip for which participants were instructed to use reappraisal (regulation). Those with a history of DSH were compared with 2 control groups without a history of DSH matched on key demographics: 1 healthy group low in depression and anxiety symptoms and 1 group matched to the DSH group on depression and anxiety symptoms. Study 2 extended Study 1 by assessing neural responding to negative images (reactivity) and negative images for which participants were instructed to use reappraisal (regulation). Those with a history of DSH were compared with a control group matched to the DSH group on demographics, depression, and anxiety symptoms. Compared with control groups, participants with a history of DSH did not exhibit greater negative emotional reactivity but did exhibit lower ability to regulate emotion with reappraisal (greater self-reported negative emotions in Study 1 and greater amygdala activation in Study 2 during regulation). These results suggest that poor emotion regulation ability, but not necessarily greater negative emotional reactivity, is a correlate of and may be a risk factor for DSH, even when controlling for mood disorder symptoms.
Collapse
Affiliation(s)
- Tchiki S. Davis
- Department of Psychology, University of California, Berkeley
| | - Iris B. Mauss
- Department of Psychology, University of California, Berkeley
| | - Daniel Lumian
- Department of Psychology, University of California, Los Angeles
| | | | | | | | - Brett Q. Ford
- Department of Psychology, University of California, Berkeley
| | | |
Collapse
|
50
|
Medeiros K, Rojahn J, Moore LL, van Ingen DJ. Functional properties of behaviour problems depending on level of intellectual disability. J Intellect Disabil Res 2014; 58:151-161. [PMID: 23464786 DOI: 10.1111/jir.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Behaviour problems are common among individuals with intellectual disabilities (ID) especially in those with more severe forms. The determination of the functional profile of a targeted behaviour has important implications for the design of customised behavioural interventions. METHOD We investigated the relationship between the level of ID and the functional profile of aggression, stereotypy and self-injurious behaviour (SIB) using the Questions about Behavioural Function (QABF). Two staff members at two time points completed the QABF for each of 115 adults with varying levels of ID participating in a day training and habilitation programme. RESULTS AND CONCLUSIONS Our results suggest that there is a differential relationship between the functions of behaviour problems and level of ID. While SIB is more often seen by raters to be maintained by escape of social demands and by attaining access to tangible items with the decline of the intellectual level, aggressive and stereotypic behaviours were identified more often as serving multiple functions equally across functioning level.
Collapse
Affiliation(s)
- K Medeiros
- Applied Developmental Psychology, George Mason University, Fairfax, VA, USA
| | | | | | | |
Collapse
|