Research Paper Title

What young people say about impulsivity in the short-term build up to self-harm: A qualitative study using card-sort tasks.

Background

Youth who self-harm report high levels of trait impulsivity and identify impulsive behaviour as a proximal factor directly preceding a self-harm act. Yet, impulsivity is a multidimensional construct and distinct impulsivity-related facets relate differentially to self-harm outcomes.

Studies have yet to examine if and how a multidimensional account of impulsivity is meaningful to individual experiences and understandings of self-harm in youth.

The researchers explored the salience and context of multidimensional impulsivity within narratives of self-harm, and specifically in relation to the short-term build-up to a self-harm episode.

Methods

Fifteen community-based adolescents (aged 16-22 years) attending Further Education (FE) colleges in the UK took part in individual face-to-face sessions (involving exploratory card-sort tasks and semi-structured interviews) which explored factors relating to self-harm, impulsivity and the broader emotional, developmental and cognitive context. Session data were analysed thematically.

Results

Two overarching themes, and associated subthemes, were identified:

1. ‘How I respond to strong negative emotions’; and
2. ‘Impulse versus deliberation – How much I think through what I’m doing before I do it’.

Self-harm was typically a quick, impulsive act in the context of overwhelming emotion, underpinned by cognitive processing deficits. The dynamic tension between emotion-based impulsivity and controlled deliberation was articulated in the immediate moments before self-harm. However, impulsive responses were perceived as modifiable. Where self-harm patterns were established, these related to habitual behaviour and quick go-to responses. Young people identified with a multidimensional conception of impulsivity and described the impulsive context of a self-harm act as dynamic, contextual, and developmentally charged.

Conclusions

Findings have implications for youth-focused work. Card-task frameworks are recommended to scaffold and facilitate discussion with young people, particularly where topics are sensitive, complex and multifactorial.

Reference

Lockwood, J., Townsend, E., Allen, H., Daley, D. & Sayal, K. (2020) What young people say about impulsivity in the short-term build up to self-harm: A qualitative study using card-sort tasks. PLoS One. 15(12), pp.e0244319. doi: 10.1371/journal.pone.0244319. eCollection 2020.