Joint effect of emotion regulation and impulsivity on identifying adolescents with non-suicidal self-injury

Emotion dysregulation and impulsivity have been consistently recognized as risk factors for non-suicidal self-injury (NSSI). However, limited research has simultaneously examined their associations with NSSI. This study explored independent and joint effects of emotion dysregulation and impulsivity on discriminating adolescents with NSSI from controls. A total of 102 adolescents with NSSI diagnosis according to DSM-5 criteria and 97 demographically-matched controls were recruited. Emotion regulation and impulsivity were assessed via self-report questionnaires (Emotion Regulation Questionnaire, Barratt Impulsivity Scale) and experimental tasks (an emotion regulation task and the stop signal task). In addition to group comparisons using independent t-tests and analysis of variance, receiver operating characteristic (ROC) analyses were employed to investigate whether different factors alone and combined could identify NSSI diagnostic status. Results suggested that adolescents with NSSI self-reported less frequent use of cognitive reappraisal and more frequent use of expressive suppression, as well as higher trait impulsivity. The inclusion of these cognitive and emotional factors altogether showed better discriminative ability compared to a single factor alone. Using experimental tasks, however, adolescents with NSSI showed comparable capacity to down-regulate negative emotions when explicit instructions of reappraisal or distraction were available. They also did not differ from the controls in response inhibition, although their average response for Go stimuli was significantly slower. These findings indicate that trait-like emotion dysregulation and impulsivity might be important psychopathological factors associated with NSSI. Interventions focusing on increasing the access of adaptive regulation strategies, and reducing rash reactivity to negative emotions may support adolescents who self-harm.