Emotion Dysregulation, Impulsivity, and Implicit Cognition in Adolescent with Self-Injurious Thoughts and Behaviors: A Six-Month Prospective Study

Abstract

Background/Objectives: Suicide is a leading cause of death among adolescents. Emotion dysregulation, impulsivity, and childhood trauma are key factors underlying Self-Injurious Thoughts and Behaviors (SITB), yet reliable short-term predictors are limited, especially in at-risk clinical populations. This study prospectively examined the association between SITB and clinical (psychological pain, impulsivity, childhood trauma) and cognitive measures (Implicit Association Tests, IATs). Methods: A prospective, observational study was conducted in adolescents (12–17) admitted to a university hospital psychiatry unit following recent SITB. Participants completed the Death/Suicide IAT (D/S-IAT), Self-Injury IAT (SI-IAT), and standardized instruments including the Columbia Suicide Severity Rating Scale (C-SSRS), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), and Childhood Trauma Questionnaire (CTQ-SF). SITB recurrence was assessed at six months. Results: Within six months, 28.9% of 38 participants reported suicidal thoughts, 15.8% engaged in self-injury, and 2.6% attempted suicide. The SI-IAT showed a small but significant correlation with C-SSRS, whereas D/S-IAT showed none. Neither IAT predicted SITB recurrence. Higher levels of emotion dysregulation and impulsivity were significantly associated with SITB. Specific DERS dimensions—emotional rejection, interference, and confusion—predicted future SITB, highlighting emotional dysregulation as a vulnerability factor. Conclusions: In high-risk adolescents, psychological pain and impulsivity predicted SITB more reliably than IATs. Unlike adult populations, explicit measures outperform implicit ones in suicide risk prediction. These findings emphasize emotion dysregulation as a key clinical construct that may intensify psychological pain and contribute to suicidal vulnerability.