Emotion Dysregulation, Impulsivity, and Implicit Cognition in Adolescent with Self-Injurious Thoughts and Behaviors: A Six-Month Prospective Study.

Background/Objectives: Suicide is a leading cause of death among adolescents. Emotion dysregulation, impulsivity, and childhood trauma are key factors underlying Self-Injurious Thoughts and Behaviors (SITB), yet reliable short-term predictors are limited, especially in at-risk clinical populations. This study prospectively examined the association between SITB and clinical (psychological pain, impulsivity, childhood trauma) and cognitive measures (Implicit Association Tests, IATs). Methods: A prospective, observational study was conducted in adolescents (12-17) admitted to a university hospital psychiatry unit following recent SITB. Participants completed the Death/Suicide IAT (D/S-IAT), Self-Injury IAT (SI-IAT), and standardized instruments including the Columbia Suicide Severity Rating Scale (C-SSRS), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), and Childhood Trauma Questionnaire (CTQ-SF). SITB recurrence was assessed at six months. Results: Within six months, 28.9% of 38 participants reported suicidal thoughts, 15.8% engaged in self-injury, and 2.6% attempted suicide. The SI-IAT showed a small but significant correlation with C-SSRS, whereas D/S-IAT showed none. Neither IAT predicted SITB recurrence. Higher levels of emotion dysregulation and impulsivity were significantly associated with SITB. Specific DERS dimensions-emotional rejection, interference, and confusion-predicted future SITB, highlighting emotional dysregulation as a vulnerability factor. Conclusions: In high-risk adolescents, psychological pain and impulsivity predicted SITB more reliably than IATs. Unlike adult populations, explicit measures outperform implicit ones in suicide risk prediction. These findings emphasize emotion dysregulation as a key clinical construct that may intensify psychological pain and contribute to suicidal vulnerability.