Emotion Dysregulation In Adolescents Research Articles

New precursors of ill mental health and the “at risk” adolescent brain: Implication for prevention

Precursors are evoked upstream of the Capgras’ syndrome. Then, an analogy is suggested between the need for prognostic classification linked to the saturation of the asylum population at the dawn of the 20th century, and the current overflow of the psychiatric healthcare system. The contemporary situation justifies the search for information useful to mitigate ill mental health in at-risk adolescents. The article presents recent research reports on adolescents at-risk of emotional dysregulation, stemming from a longitudinal cohort database of European adolescents. The database analyses have revealed new brain and psychometric predictors of emotional dysregulation in adolescents. New early indicators were derived from easy-to-administer questionnaires, exploring emotions, affective symptoms and traits, sleep, early adversity and stress, puberty. Findings suggest that the physiology and stages of brain development could be taken into account for decisions regarding Mental Health. Studies on adolescent brain development have implications for public health, in terms of the age of protection for adolescents, and targeted prevention upstream of care.

Alcohol Abuse and Physical Violence towards a Partner: How Can We Attenuate the Relationship? A Study on Emotional Dysregulation in Adolescents.

The previous literature has revealed the relationship between alcohol abuse and violent behaviours; however, the results are not always conclusive, highlighting the need to explore other variables that allow us to establish risk profiles. The goal is to examine whether the relation between alcohol abuse and physical violence towards a partner can be influenced (moderate) by difficulties in emotional regulation. A public high school in Manabí (Ecuador). A total of 1519 high school students with ages between 14 and 18 years (mean = 15.77, SD = 1.22), with 54% (n = 820) being male. The measures we observed were alcohol abuse (i.e., frequency of alcohol abuse in the past 30 days), physical violence exercised towards a partner (Violence Received, Exercised and Perceived in Dating Relationships of Young People and Adolescents) and emotional dysregulation (Difficulties in Emotional Regulation Scale; DERS). It is observed that there exists significantly higher alcohol abuse in males, regardless of their age, as well as more physical violence by adolescent males towards their partners. Direct effects of alcohol abuse on physical intimate partner violence are observed in males from the age of 16 and in females from the age of 14. Moreover, the direct effects of different emotional dysregulation strategies on physical violence depend on gender. The moderating effects of emotional dysregulation strategies between alcohol abuse and physical intimate partner violence are observed only in the case of adolescent females (16-17 years). In particular, emotional dysregulation variables such as non-awareness, impulse, nonacceptance, or lack of strategies interfere as moderators in the relationship between excessive alcohol abuse and physical violence towards a partner. In the case of non-awareness, contrary to the other three, when scores are low or moderate, a statistically significant relationship between alcohol abuse and violence is observed.

Sub-groups of emotion dysregulation in youth with nonsuicidal self-injury: latent profile analysis of a randomized controlled trial

ABSTRACT Psychological treatments targeting emotion dysregulation in adolescents reduce nonsuicidal self-injury (NSSI) but predicting treatment outcome remains difficult. Identifying sub-groups based on repeated measurements of emotion dysregulation pre-treatment may guide personalized treatment recommendations. We used data from a recent trial evaluating internet-delivered emotion regulation therapy for adolescents with NSSI (n = 138). Latent profile analysis was used to identify sub-groups based on pre-treatment responses on the 16-item version of the Difficulties in Emotion Regulation Scale. The primary outcome was self-rated NSSI frequency during treatment, and secondary outcome was the proportion of participants with no NSSI 1-month post-treatment. Three sub-groups of emotion dysregulation were identified: low variability and low mean (Group 1), low variability and high mean (Group 2), and high variability and low mean (Group 3). Sub-groups did not differ in NSSI frequency during treatment (Group 2 IRR = 1.06 [95% CI 0.49–2.29], p = .88; Group 3 IRR = 1.22 [95% CI 0.31–4.76], p = .77). However, more participants in Group 1 compared to Group 2 abstained from NSSI at 1-month post-treatment (OR = 3.63 [95% CI 1.16–11.33], p = 0.01). Latent profile analysis identified sub-groups predictive of NSSI absence post-treatment, demonstrating clinical utility.

Emotion Dysregulation in Adolescents Exhibiting Depression with Elevated Anxiety: Prevalence and Associated Factors

Emotion Dysregulation in Adolescents Exhibiting Depression with Elevated Anxiety: Prevalence and Associated Factors

School Refusal Behaviors: The Roles of Adolescent and Parental Factors.

School refusal behaviors in adolescents have deleterious immediate and long-term consequences and are associated with mental ill-health such as anxiety and depression. Understanding factors that place youth at higher risk of school refusal behavior may assist in developing effective management approaches. We investigated parental and adolescent factors that may be associated with school refusal behaviors by specifically focusing on the role of parental and adolescent emotion dysregulation, their anxiety and depression, and parental rearing style. First, we hypothesized that adolescents with school refusal behaviors, as well as their parents, will report higher levels of emotion dysregulation, anxiety, and depression compared to their counterparts without school refusal behaviors. Furthermore, we hypothesized that multivariate models testing the role of parental and child factors concurrently will show that parental (emotion dysregulation, anxiety and depression, and rearing styles) and adolescent (emotion dysregulation, anxiety, and depression) factors are associated with school refusal behaviors. One hundred and six adolescents aged 12 to 18 years and their parents completed an online questionnaire measuring both parental and adolescent emotion dysregulation, anxiety, depression, parental rearing styles, and adolescents' school refusal behaviors. Adolescents with school refusal behaviors reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Multivariate analyses showed that parental emotion dysregulation and adolescent age were associated with school refusal behaviors independently. Future management for school refusal behaviors should consider age-tailored approaches by incorporating training for parental emotion regulation skills.

Efficacy of Dialectical Behavioral Therapy Skills in Addressing Emotional Dysregulation Among Adolescents: A Systematic Literature Review

Adolescence is marked by significant emotional challenges, with mood disorders becoming increasingly prevalent, necessitating effective interventions. Dialectical Behavioral Therapy (DBT) skills have emerged as promising tools for addressing emotional dysregulation in adolescents. This systematic literature review aims to evaluate the effectiveness of DBT skills in managing emotional dysregulation and reducing mood disorder symptoms among adolescents. Through meticulous analysis of existing research, this review highlights the substantial impact of DBT interventions in decreasing the frequency and intensity of maladaptive behaviors associated with emotional dysregulation. Drawing from studies involving 908 adolescents aged 12 to 18, compelling evidence suggests notable improvements in mood and related symptoms following participation in DBT skills programs. These findings underscore the potential of DBT interventions as valuable resources in supporting adolescents through their emotional challenges. Furthermore, this review emphasizes the urgent need to integrate DBT approaches into mental health interventions tailored to the unique needs of this vulnerable population. Overall, this review contributes to the growing body of literature on adolescent mental health, providing insights into the efficacy of DBT skills in promoting emotional regulation and enhancing overall well-being during this critical developmental phase.

Reactivity of Emotions in Adolescents - Caregivers' Tool (React): Development and Validation of a Novel Parent-Rated Measure for Assessing Emotional Dysregulation in Youth.

Emotional Dysregulation (ED) is characterized by the inability to manage emotions effectively, leading to maladaptive behaviors, and often co-occurs with psychiatric conditions carrying significant long-term consequences. Early diagnosis of ED is thus essential for targeted interventions. To address this need, we developed and validated the "Reactivity of Emotions in Adolescents: Caregivers' Tool" (REACT), a novel parent-rated questionnaire designed to assess ED in adolescents. The present study involved two samples, one drawn from the general population (n = 89 healthy controls from local schools) and the other composed of clinical patients (n = 76 adolescents with different psychiatric and/or neurodevelopmental conditions). Patients' diagnoses were confirmed through the clinical interview K-SADS-PL to explore the presence of any psychopathological conditions. Participants from both groups completed the RIPoSt-Y questionnaire, providing a measure of ED, while their parents filled out the ARI, measuring affective reactivity in youth. Confirmatory and exploratory factor analyses were performed to refine the questionnaire's internal structure. The final REACT questionnaire consists of 55 items distributed across three subscales, namely Negative Emotionality, Irritability, and Excitability. Psychometric evaluation showed that these subscales demonstrated excellent internal consistency and strong construct validity, with clinical patients scoring higher on all subscales compared to healthy controls. The REACT questionnaire showed also high convergent validity by exhibiting significant positive correlations with established measures of ED. This novel tool represents a valuable improvement in the assessment of ED in adolescence as it may facilitate tailored interventions to provide emotional well-being and long-term outcomes.

Exploring emotion dysregulation in adolescence and its association with social immaturity, self-representation, and thought process problems.

This study aimed to explore the complex phenomenon of emotional dysregulation, particularly in adolescence, which is associated with many mental health disorders and problems. Increasing the knowledge of clinicians and researchers in this area can be helpful in guiding future treatment plans. The aim of the study was to investigate, from an exploratory perspective, which structural aspects of adolescent functioning (assessed using the Rorschach test and administered and scored according to the Comprehensive System, CS, by Exner) were associated with different dimensions of emotional dysregulation (evaluated using the Difficulties in Emotion Dysregulation Scale, DERS). Secondary data were used for the study, which included 100 adolescents, with 50 in the clinical group (patients with complex trauma histories residing in therapeutic and socio-rehabilitative communities) and 50 in the nonclinical group (recruited from a scout group and middle and high schools). The two groups were compared on terms of the mean scores obtained in the DERS scales (one-tailed t-test) and the proportions of cases that obtained pathological values for selected Rorschach CS indicators (z-test). Partial correlations were calculated between the DERS scales and the Rorschach CS variables to explore which structural dimensions of functioning were associated with different characteristics of emotional dysregulation. The results indicated that the two groups differed in their outcomes on all DERS scales, except for Awareness and Goals, and on four Rorschach CS variables (EgoIndex, a:p, Wsum6, and MOR). Some significant positive and negative correlations between the Rorschach CS variables and the DERS scales also emerged. These results suggest that the dimensions of functioning associated with emotional dysregulation are related to self-representation, relational immaturity, and thought processes character and characterize membership in a therapeutic community. The correlations described in the article warrants further consideration. Finally, the study's limitations and future research prospects are presented.

0126 Adverse Life Events and Emotion Dysregulation in Adolescents: Sleep Disturbances as a Potential Moderator

0126 Adverse Life Events and Emotion Dysregulation in Adolescents: Sleep Disturbances as a Potential Moderator

Dynamic characteristics of parent-adolescent closeness: Predicting adolescent emotion dysregulation.

Emotion dysregulation is linked to adolescent psychological problems. However, little is known about how lability in daily closeness of parent-adolescent dyads affects the development of emotion dysregulation. This study examined how closeness lability with parents was associated with emotion dysregulation 12 months later. The sample included 144 adolescents (M = 14.62, SD = 0.83) who participated in a baseline assessment, 21-day daily diaries, and a 12-month follow-up assessment. Parents and adolescents both reported adolescent emotion dysregulation at baseline and follow-up assessments, while adolescents reported daily parent-adolescent closeness. Results indicate that lability in father-adolescent closeness was associated with increased emotion dysregulation at 12 months reported by adolescents. However, lability in mother-adolescent closeness was not associated with adolescent emotion dysregulation. Moreover, when baseline father-adolescent closeness was high, greater lability in father-adolescent closeness was associated with decreased emotion dysregulation. Findings indicate that daily fluctuations in father-adolescent closeness are a key family characteristic that links to long-term adolescent emotion dysregulation.

Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care

Background: Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI. Methods: Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants’ first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation – the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI. Results: Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters. Conclusions: Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.

Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder: Emotion Dysregulation, Abuse, and Treatment Outcomes

ABSTRACT Objective Borderline Personality Disorder (BPD) is characterized by extreme emotional dysregulation. Dialectical Behavioral Therapy (DBT) is an empirically supported and effective treatment for BPD in adolescents and adults. However, the extent to which exposure to childhood abuse (i.e. physical and sexual abuse) impacts treatment outcomes is not well understood. This open trial investigated the effectiveness of an intensive residential DBT program in reducing emotion dysregulation in adolescents with BPD symptoms, as well as the impact that severity and type of childhood abuse had on treatment outcomes. Method Participants (N = 46) were female-identifying adolescents 13–20 years of age enrolled in an intensive residential DBT treatment program. Severity of abuse exposure and abuse subtype (Childhood Trauma Questionnaire, Short Form, CTQ-SF) and difficulties with emotional dysregulation (DERS) were assessed at admission and DERS again after 1 month of treatment. Results Bivariate correlation between DERS Total Score and Abuse Exposure Total Score indicated that severity of abuse exposure had a medium positive association with emotion dysregulation at admission. Mixed model ANOVA results showed significant reductions in emotional dysregulation following 1 month of treatment, with a large effect size. Exploratory analysis testing exposure to different subtypes of childhood abuse as a moderator of treatment effects was non-significant. Conclusions Emotion dysregulation showed significant reductions following intensive residential DBT interventions. Reductions were consistent across subtypes of abuse exposure. Implications for the treatment of adolescents with abuse histories and current BPD-related problems, and the relationship between child abuse exposure and emotional dysregulation overall, are discussed.

Urgency as a predictor of change in emotion dysregulation in adolescents.

Adolescence is a key developmental period characterized by increased maladaptive risky behaviors. Two related but distinct constructs, urgency (the tendency to act rashly in response to strong negative or positive emotions) and emotion dysregulation, are important risk factors for engaging in maladaptive risky behaviors. Thus far, research has largely agreed that these two risk factors are highly correlated. However, the causal direction between these constructs is less understood. The goal of the current study is to determine whether urgency predicts emotion dysregulation change among adolescents. This project is an analysis of 544 youth (49.8% female, Mage=14.22, SD=0.52). We tested whether urgency at baseline predicts change in emotion dysregulation over a nine-week period, and whether that relationship differs across boys and girls. Two multigroup latent change score path analyses found that negative, but not positive, urgency significantly predicted emotion dysregulation change (negative urgency: b= -0.57, p=0.001; positive urgency: b=0.22, p=0.06). There was no evidence of moderation by gender. This work provides initial evidence of a temporal relationship between higher negative urgency and increased emotion dysregulation. The next step is to determine whether negative urgency imparts risk for maladaptive behaviors through its effect on emotion dysregulation. The long-term goal of this program of research is to design and test interventions to reduce the impact of negative urgency for adolescent risk-taking.

Longitudinal Associations Between Nonsuicidal Self-Injury, Depressive Symptoms, Hopelessness, and Emotional Dysregulation in Adolescents

Nonsuicidal self-injury (NSSI) in adolescents has been associated with increased depressive symptomatology, hopelessness, and emotional dysregulation; however, few studies have examined longitudinal associations between NSSI and these problems. This study examines the longitudinal relationships among these variables in community adolescents and whether the pattern of relationships varies between boys and girls. The participants were 785 adolescents (57.1% girls) aged 13 to 18 years (M = 15.64; SD = 1.08) who completed self-reported measures of NSSI, depression, hopelessness, and emotional dysregulation at least once at two moments separated by 1 year. The longitudinal model was tested through structural equation modeling and multiple group analysis. NSSI predicted increased depressive symptoms, hopelessness, and emotional dysregulation; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms; and emotional dysregulation predicted depressive symptoms and hopelessness. The pattern was similar for girls and boys, although girls scored higher on all variables. The results underscore the important bidirectional associations between NSSI and other risk factors throughout adolescence. These findings will support prevention and interventions for NSSI and internalizing symptoms in adolescents in school and clinical settings.

Differential associations and concordance across measures of parent emotion socialization: The role of parent and adolescent emotion dysregulation

AbstractAlthough parent ratings, adolescent ratings, and observations are all utilized to measure parent emotion socialization during adolescence, there is a lack of research examining measurement differences and concordance. Thus, the present study compared three measures of parent supportive and nonsupportive emotion socialization and examined whether parent and adolescent emotion dysregulation differentially related to these measures or moderated concordance across measures. Participants were a community sample of 92 adolescent‐parent dyads. Adolescents were 13–17 years‐old (M = 15.5, SD = 1.1), 41 were female and 51 were male; 87% of parents identified as mothers. Observed emotion socialization was coded during a parent‐adolescent conflict discussion task. The adolescent and parent also rated the parent's supportive and nonsupportive reactions to the adolescent's negative emotions; they each also rated their own emotion dysregulation. Due to data collection timing, COVID‐19 family stress was also assessed and explored as a covariate in analyses. Bivariate correlations indicated that there were weak and non‐significant correlations across emotion socialization measures. Multilevel models indicated that measures of parent emotion socialization were differentially associated with adolescent emotion dysregulation, with adolescent emotion dysregulation relating significantly to adolescent ratings, but not observations or parent ratings, of parent emotion socialization. In addition, multiple regressions indicated that there was less concordance across measures when parents were higher in emotion dysregulation. Results suggest that measurement may influence researchers’ conclusions about how youth adjustment relates to parent emotion socialization. Additionally, there may be even lower agreement across measures of parent emotion socialization when parents have emotional challenges.

Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging.

Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.

Daily association between parent-adolescent relationship and life satisfaction: The moderating role of emotion dysregulation.

In adolescence, life satisfaction is an early indicator of later psychological well-being. However, researchers know little about how daily family relationships shape adolescent life satisfaction. The current study examined the day-to-day associations between parent-adolescent relationships and life satisfaction, and whether adolescent emotion dysregulation moderated these associations. A total of 191 adolescents (Mage = 12.93, SDage = 0.75, 53% female) recruited from junior high schools in Taiwan participated in a 10-day daily diary protocol. We conducted multilevel analyses to examine within-family and between-family processes. At the within-family level, adolescents reported higher life satisfaction on days when parent-adolescent closeness was higher, but lower life satisfaction on days when parent-adolescent conflict was higher. At the between-family level, higher parent-adolescent closeness was associated with greater life satisfaction on average, while parent-adolescent conflict was not related to adolescent life satisfaction. Cross-level interactions indicated that within-family changes in parent-adolescent closeness and conflict were only associated with life satisfaction for adolescents with higher levels of emotion dysregulation, indicating emotion dysregulation may intensify the role of daily parent-adolescent relationships in shaping adolescent life satisfaction. This study expands current literature and provides novel evidence that changes in day-to-day parent-adolescent relationships have important implications for adolescent life satisfaction, especially for youth higher in emotion dysregulation. The findings underscore the importance of evaluating family and individual characteristics to better support adolescent well-being.

A longitudinal examination of alcohol use and emotion dysregulation in adolescence.

Underage drinking is a serious public health concern with magnified physical and psychological risks. Previous research suggests that emotion dysregulation is one factor linked to alcohol use. Limited research has examined emotion dysregulation and alcohol use in adolescent populations, thus the present study aimed to examine the links by assessing the role of emotion dysregulation and its subscales in adolescent alcohol use over time. Participants were 695 high school students, with 309 students having completed Time 2 data collection at a 6-month follow-up. Participants completed measures that assessed Alcohol Use, Emotion Dysregulation, and Emotion Dysregulation subscales. In a negative binomial hurdle model, adolescents with greater emotion regulation difficulties at baseline had significantly greater odds of endorsing any alcohol use at baseline. Greater emotion dysregulation did not significantly predict drinking status or drinking level 6 months later when controlling for baseline alcohol use. Adolescents who reported greater emotional clarity difficulties at baseline were more likely to report any alcohol use at baseline. Among adolescents who drink, reporting greater difficulties accessing emotion regulation strategies was associated with greater alcohol use at baseline and 6 months later. These findings indicate that emotion dysregulation is a cross-sectional marker of alcohol use in adolescents; however, results did not show emotion dysregulation to be a prospective predictor of greater alcohol use. Future research is needed to replicate findings in a more diverse sample of adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Frequency and types of emotional dysregulation in referrals to child and adolescent mental health services.

Emotional dysregulation (ED) is a transdiagnostic phenomenon that has received increased attention, because of its potential ability to explain the development and maintenance of various psychiatric disorders. The identification of ED may serve as a potential target for both preventive and treatment interventions, however, the frequency of transdiagnostic ED among children and adolescents has not previously been evaluated. Our aim was to evaluate the frequency and types of ED in accepted and rejected referrals to the Child and Adolescent Mental Health Center (CAMHC), Mental Health Services, Copenhagen, Denmark, regardless of psychiatric status and across diagnoses. We aimed to evaluate how often ED would be a leading cause in seeking professional help, and whether children with ED not directly reflecting symptoms of known psychopathology would have higher rejection rates than children with more distinct symptoms of psychopathology. Finally, we assessed associations between sex and age with various types of ED. We examined ED in a retrospective chart review of referrals of children and adolescents aged 3-17 years to the CAMHC between August 1st, 2020, and August 1st, 2021. We ranked problems described in the referral as primary, secondary, and tertiary depending on severity. Further, we examined group differences in the frequency of ED in accepted versus rejected referrals, as well as group differences in types of ED in age and sex distributions, and diagnoses occurring with specific types of ED. ED was present in 62.3% of the 999 referrals and was assessed as the primary issue in twice as many rejected referrals (11.4%) compared to accepted referrals (5.7%). Boys were significantly more often described with externalizing and internalizing behavior (55.5% vs. 31.6%; 35.1% vs. 26.5%) as well as incongruent affect (10.0% vs. 4.7%), whereas girls were more often described with depressed mood (47.5% vs. 38.0%) and self-harm (23.8% vs. 9.4%). The frequency of different types of ED varied with age. The present study is the first to evaluate the frequency of ED in children and adolescents referred to mental health services. The study offers insights into the high frequency of ED and the associations between ED and subsequent diagnoses, which may prove to be a method of early identification of risk of psychopathology. Our findings suggest that ED may rightly be considered a transdiagnostic factor, independent of specific psychiatric disorders, and that an ED-centered as opposed to diagnosis-specific approach to assessment, prevention, and treatment could target transversal symptoms of psychopathology in a more holistic manner.

Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality.

suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework. we conducted a retrospective study with 190 adolescents (M= 14.5, SD age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires. the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20. the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.