Two-year course of non-suicidal self-injury in an adolescent clinical cohort: The role of childhood adversity in interaction with cortisol secretion.

AIM: Non-suicidal self-injury (NSSI) is a highly prevalent phenomenon during adolescence. Nonetheless, research on predictors of the clinical course of NSSI over time is still scarce. The present study aimed at investigating the impact of adverse childhood experiences (ACE) and hypothalamus-pituitary-adrenal (HPA) axis functioning on the longitudinal course of NSSI. METHODS: In a sample of n = 51 help-seeking adolescents engaging in NSSI, diurnal cortisol secretion (CAR, cortisol awakening response; DSL, diurnal slope), hair cortisol concentrations and ACE were assessed at baseline. Clinical outcome was defined by change in the frequency of NSSI in the past 6 months measured 12 and 24 months after the baseline assessments. Mixed-effects linear regression models were used to test for effects of ACE and HPA axis functioning on the course of NSSI. RESULTS: ACE and HPA axis functioning did not show main but interaction effects in the prediction of NSSI frequency over time: Adolescents with a low severity of ACE and either an increased CAR or a flattened DSL showed a steep decline of NSSI frequency in the first year followed by a subsequent increase of NSSI frequency in the second year. CONCLUSIONS: Our findings could be interpreted in the sense of high diurnal cortisol concentrations in the absence of ACE being favorable for clinical improvement on the short-term but bearing a risk of allostatic load and subsequent increase of NSSI frequency. In contrast, adolescents with severe ACE may benefit from elevated cortisol concentrations leading to slower but lasting decreases of NSSI frequency.

Associations between different measures of personality pathology and resting-state autonomic function among adolescents.

Borderline personality disorder (BPD) has been associated with a reduced functional flexibility of the autonomic nervous system (ANS), indexed by decreased vagally mediated heart rate variability (vmHRV). Employing a comprehensive Section II-based assessment approach and a partial Section III-based assessment approach (including Criterion A of the alternative model of personality disorders [AMPD]), the present study investigates how different conceptualizations of personality disorders (PDs) according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition relate to ANS function. Using the BPD section of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II, a Section II-based assessment approach) and the Semistructured Interview for Personality Functioning DSM-5 (STiP-5.1, a Section III-based assessment approach), we conducted linear regression analyses to examine how categorical (BPD diagnosis) and dimensional (severity and domain) measures of PD are associated with ANS activity among adolescent psychiatric patients (N = 147, Mage = 15.25 years). Replicating earlier findings, analyses revealed a statistically significant positive association between the SCID-II measures of BPD and heart rate (HR), b = 0.43, t(59) = 3.57, p = .001, f = .57, as well as a statistically significant negative association between the SCID-II measures of BPD and vmHRV, b = -0.34, t(59) = -2.74, p = .008, f = .47. Neither the STiP-5.1 total score nor the subscales of the Level of Personality Functioning Scale (LPFS) were associated with HR or vmHRV. The present findings indicate that the SCID-II may capture features of PD that are more informative of variance in physiological function than the STiP-5.1. (PsycInfo Database Record (c) 2023 APA, all rights reserved).