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

Lockwood, Joanna; Townsend, Ellen; Allen, Heather; Daley, David; Sayal, Kapil

Abstract

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. We 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. 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. Two overarching themes, and associated subthemes, were identified: ‘How I respond to strong negative emotions’; and ‘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. 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.

Citation

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), Article e0244319. https://doi.org/10.1371/journal.pone.0244319

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2020
• Online Publication Date: Dec 21, 2020
• Publication Date: Dec 21, 2020
• Deposit Date: Dec 16, 2020
• Publicly Available Date: Dec 21, 2020
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 12
• Article Number: e0244319
• DOI: https://doi.org/10.1371/journal.pone.0244319
• Public URL: https://nottingham-repository.worktribe.com/output/5152669
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244319