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Impulsivity and self-harm in adolescence: a systematic review

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


Joanna Lockwood

David Daley

Ellen Townsend

Kapil Sayal


Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11-25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews, identified 4,496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision-making may offer most benefit in supporting those who self-harm.

Journal Article Type Article
Publication Date 2017-04
Journal European Child & Adolescent Psychiatry
Print ISSN 1018-8827
Electronic ISSN 1435-165X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 26
Issue 4
Pages 387-402
APA6 Citation Lockwood, J., Daley, D., Townsend, E., & Sayal, K. (2017). Impulsivity and self-harm in adolescence: a systematic review. European Child and Adolescent Psychiatry, 26(4), 387-402.
Keywords Self-harm, Non-suicidal self-injury, Impulsivity, Adolescence, Urgency
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address:
Additional Information The final publication is available at Springer via


self harm art%3A10.1007%2Fs00787-016-0915-5.pdf (611 Kb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

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