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Decision making and problem solving in adolescents who deliberately self-harm

Published online by Cambridge University Press:  23 June 2008

A. Oldershaw ,
E. Grima ,
F. Jollant ,
C. Richards ,
M. Simic ,
L. Taylor  and
U. Schmidt
A. Oldershaw*
Affiliation:
King's College London, Institute of Psychiatry, London, UK
E. Grima
Affiliation:
King's College London, Institute of Psychiatry, London, UK
F. Jollant
Affiliation:
King's College London, Institute of Psychiatry, London, UK Université Montpellier 1, France; Inserm U888, Montpellier, France; Department of Psychological Medicine and Psychiatry, Montpellier, France
C. Richards
Affiliation:
Croydon Child and Adolescent Mental Health Service, South London and Maudsley NHS Trust, UK
M. Simic
Affiliation:
Croydon Child and Adolescent Mental Health Service, South London and Maudsley NHS Trust, UK
L. Taylor
Affiliation:
Croydon Child and Adolescent Mental Health Service, South London and Maudsley NHS Trust, UK
U. Schmidt
Affiliation:
King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: A. Oldershaw, M.Sc., P059, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: anna.oldershaw@iop.kcl.ac.uk)
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Abstract

Background

Healthy adolescents, and adults who engage in reward-driven, risky behaviours, demonstrate poor decision-making ability. Decision making in deliberate self-harm (DSH), a reward-driven, high-risk behaviour, has received little attention. This study assessed decision making and problem solving in adolescents with current or past SH.

Method

Decision making and problem solving were assessed using the Iowa Gambling Task (IGT) and the Means–Ends Problem-Solving Procedure (MEPS) respectively in 133 adolescents (57 healthy and 22 depressed controls with no SH history and 54 with SH history). A second analysis separated the SH group into current (n=30) and past (n=24) SH.

Results

The collective performance of adolescents with SH history did not differ from depressed or healthy adolescents on the IGT. However, current self-harming adolescents had a trend towards more high-risk choices (p=0.06) than those with previous SH history and were the only group not to significantly improve over time, persisting with high-risk strategy throughout. Those who no longer self-harmed learnt to use a low-risk strategy similar to healthy and depressed controls. Recency of last SH episode correlated with IGT performance. Depressed participants performed well on the IGT but poorly on the MEPS. By contrast, both collective and divided SH groups had comparable MEPS scores to healthy controls, all performing better than depressed participants.

Conclusion

Poor decision making is present in adolescents who currently self-harm but not in those with previous history; improvement in decision-making skills may therefore be linked to cessation of self-harm. Depressed adolescents who do and do not self-harm may have distinct characteristics.

Keywords

Adolescentdecision makingIowa Gambling Taskself-harm
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 1 , January 2009 , pp. 95 - 104
Copyright
Copyright © 2008 Cambridge University Press

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