Psychological characteristic subtypes in adolescents with mental disorders and their associations with self-injury behavior and childhood maltreatment.
Self-injury behavior is a prevalent mental health problem among adolescents. Childhood maltreatment is closely associated with the development of alexithymia, impulsivity, and self-injury behavior in adolescents and young adults with mental disorders; however, the underlying mechanisms remain unclear. This study aims to classify psychiatric patients aged 12 to 24 years into psychological subtypes based on alexithymic and impulsive traits, to explore differences in self-injury behavior among these subtypes, and to examine whether different forms of childhood maltreatment are associated with specific psychological subtypes, thereby providing evidence for clinical intervention and prognosis improvement.
Clinical data of adolescents and young adults with mental disorders treated between 2021 and 2022 were retrospectively collected. Principal component analysis (PCA) was performed using 6 dimensions derived from the Toronto Alexithymia Scale (TAS)-20 and the Barratt Impulsiveness Scale (BIS)-11, including difficulty identifying feelings (DIF), difficulty describing feelings (DDF), externally oriented thinking (EOT), attentional impulsiveness, motor impulsivity, and non-planning impulsivity. Principal components with eigenvalues (λ) ≥1 were retained, and their scores were subjected to 2-step cluster analysis for automatic subtype classification. Differences among the subtypes were compared with respect to demographic characteristics, clinical features, and self-injury behavior-related characteristics. Multivariate Logistic regression models were subsequently used to examine associations between the identified psychological subtypes and different forms of childhood maltreatment.
A total of 634 adolescents and young adults with mental disorders were included, among whom 459 (72.4%) had a history of self-injury behavior. The diagnostic distribution comprised depressive disorders (n=295, 46.5%), bipolar disorder (n=136, 21.5%), anxiety disorders (n=61, 9.6%), schizophrenia (n=14, 2.2%), and other disorders (n=128, 20.2%), including personality disorders, obsessive-compulsive disorder, post-traumatic stress disorder, somatoform disorders, and eating disorders. PCA reduced the 6 dimensions related to alexithymia and impulsivity into 2 independent principal components (Z1 and Z2). Based on individual scores on Z1 and Z2, 2-step cluster analysis automatically classified participants into 3 clusters (K1, K2, and K3). The psychological characteristics of the K1 group were characterized by high motor impulsivity accompanied by marked difficulties in identifying and expressing emotions. The K2 group exhibited relatively low levels of impulsivity and alexithymia. The K3 group was characterized by high attentional impulsivity, high non-planning impulsivity, and externally oriented thinking. No significant differences were observed among the 3 groups in the distribution of primary psychiatric diagnoses (P>0.05). Comparisons of self-injury behavior-related characteristics showed that the K2 group had significantly lower rates of self-injury, lower self-injury frequency, lower self-injury addiction scores, and lower self-injury motivation scores than the other 2 groups (all P<0.05). No significant differences were found between the K1 and K3 groups in self-injury prevalence, self-injury addiction scores, and external emotion regulation motives (P>0.05). However, the K1 group scored significantly higher than the K3 group on the motivational dimensions of social influence, internal emotion regulation, and sensation seeking, while exhibiting a lower frequency of self-injury behavior (P<0.05) in the last year. Multivariable Logistic regression analysis revealed that childhood emotional abuse may be a risk factor for developing the K1 psychological subtype; childhood physical abuse may be a risk factor for developing both K1 and K3 psychological subtypes; and childhood emotional neglect was associated with the development of K1 and K2 psychological subtypes.
Adolescents and young adults with mental disorders can be classified into 3 distinct psychological subtypes based on alexithymia and impulsive traits. These subtypes differ in the prevalence and motivational characteristics of self-injury behavior, independent of clinical diagnosis. Furthermore, the development of different psychological subtypes may be associated with exposure to different forms of childhood maltreatment. These findings suggest that providing targeted emotional regulation and impulse-control interventions for adolescents exposed to specific childhood adversities may help reduce the occurrence and frequency of self-injury behavior.
Clinical data of adolescents and young adults with mental disorders treated between 2021 and 2022 were retrospectively collected. Principal component analysis (PCA) was performed using 6 dimensions derived from the Toronto Alexithymia Scale (TAS)-20 and the Barratt Impulsiveness Scale (BIS)-11, including difficulty identifying feelings (DIF), difficulty describing feelings (DDF), externally oriented thinking (EOT), attentional impulsiveness, motor impulsivity, and non-planning impulsivity. Principal components with eigenvalues (λ) ≥1 were retained, and their scores were subjected to 2-step cluster analysis for automatic subtype classification. Differences among the subtypes were compared with respect to demographic characteristics, clinical features, and self-injury behavior-related characteristics. Multivariate Logistic regression models were subsequently used to examine associations between the identified psychological subtypes and different forms of childhood maltreatment.
A total of 634 adolescents and young adults with mental disorders were included, among whom 459 (72.4%) had a history of self-injury behavior. The diagnostic distribution comprised depressive disorders (n=295, 46.5%), bipolar disorder (n=136, 21.5%), anxiety disorders (n=61, 9.6%), schizophrenia (n=14, 2.2%), and other disorders (n=128, 20.2%), including personality disorders, obsessive-compulsive disorder, post-traumatic stress disorder, somatoform disorders, and eating disorders. PCA reduced the 6 dimensions related to alexithymia and impulsivity into 2 independent principal components (Z1 and Z2). Based on individual scores on Z1 and Z2, 2-step cluster analysis automatically classified participants into 3 clusters (K1, K2, and K3). The psychological characteristics of the K1 group were characterized by high motor impulsivity accompanied by marked difficulties in identifying and expressing emotions. The K2 group exhibited relatively low levels of impulsivity and alexithymia. The K3 group was characterized by high attentional impulsivity, high non-planning impulsivity, and externally oriented thinking. No significant differences were observed among the 3 groups in the distribution of primary psychiatric diagnoses (P>0.05). Comparisons of self-injury behavior-related characteristics showed that the K2 group had significantly lower rates of self-injury, lower self-injury frequency, lower self-injury addiction scores, and lower self-injury motivation scores than the other 2 groups (all P<0.05). No significant differences were found between the K1 and K3 groups in self-injury prevalence, self-injury addiction scores, and external emotion regulation motives (P>0.05). However, the K1 group scored significantly higher than the K3 group on the motivational dimensions of social influence, internal emotion regulation, and sensation seeking, while exhibiting a lower frequency of self-injury behavior (P<0.05) in the last year. Multivariable Logistic regression analysis revealed that childhood emotional abuse may be a risk factor for developing the K1 psychological subtype; childhood physical abuse may be a risk factor for developing both K1 and K3 psychological subtypes; and childhood emotional neglect was associated with the development of K1 and K2 psychological subtypes.
Adolescents and young adults with mental disorders can be classified into 3 distinct psychological subtypes based on alexithymia and impulsive traits. These subtypes differ in the prevalence and motivational characteristics of self-injury behavior, independent of clinical diagnosis. Furthermore, the development of different psychological subtypes may be associated with exposure to different forms of childhood maltreatment. These findings suggest that providing targeted emotional regulation and impulse-control interventions for adolescents exposed to specific childhood adversities may help reduce the occurrence and frequency of self-injury behavior.