The Relationship between Cognitive Inflexibility, Social and Physical Pain Processing, and Self-Injurious Thoughts and Behaviors among Adolescents and Young Adults

Abstract

Understanding mechanisms underlying self-injurious thoughts and behaviors (SITBs) among youth is crucial for the development of targeted intervention and preventions strategies. Neurocognitive and neurobiological processes, such as cognitive inflexibility and physical pain processing, leading to engagement in these behaviors have been understudied. Two studies were conducted in order to (a) examine whether cognitive inflexibility mediates changes in suicidal ideation following discharge from psychiatric hospitalization among acutely suicidal adolescents and (b) investigate the relationship between cognitive inflexibility and social and physical pain processing among young adults at high- and low-risk for SITBs. For the first study, 229 adolescents were recruited from an adolescent inpatient unit with current suicidal ideation. Results indicated decreases in suicidal ideation and cognitive inflexibility over the 12-months following discharge from psychiatric hospitalization; however, changes in cognitive inflexibility over time were not shown to mediate decreases in suicidal ideation. A pilot study was also conducted (n = 36) to examine changes in physical pain processing following social exclusion for young adults at high-risk for SITBs by virtue of their lifetime histories of SITBs compared to those at low-risk for SITBs. Limited evidence was found indicating changes in physical pain processing following social exclusion for either group. However, the pattern of relationships between cognitive inflexibility and physical pain processing appeared different depending on risk group. Specifically, for participants at low risk for SITBs, greater cognitive inflexibility was related to increased pain threshold, whereas for participants at high risk for SITBs, greater cognitive inflexibility was associated with lower pain tolerance. Directions for future research and implications of study results are discussed.