Risk Decision-Making Patterns in Suicidal, Non-Suicidal, and Combined types of Self-Injurious Individuals

The latest DSM-5-TR revision included independent diagnostic codes for Suicidal and Non-Suicidal Self-Injurious Behavior (SIB), emphasizing the need to differentiate subtypes. However, research on individuals who have experienced both Suicidal and Non-Suicidal SIB remains limited. This lack of understanding may hinder the recognition of a distinct subgroup within the SIB population, making it difficult to identify their unique characteristics. This study utilized the Balloon Analogue Risk Task (BART) to investigate risk decision-making patterns across four groups: Major Depressive Disorder patients with history of Suicidal SIB (MDD-SA), Non-Suicidal (MDD-NSSI), both types of SIB (MDD-Both), and a Healthy Control group (HC). Our findings revealed distinct risk-decision-making patterns in the learning curve of Cash RT. This potentially indicated features of indecisive decision-making. These pieces of evidence may significantly benefit both research and clinical communities. First, time-dimensional indices, particularly Cash RT in BART, appear to be promising discriminative markers. Additionally, at the clinical level, the distinct risk decision-making patterns observed align with the new DSM-5-TR diagnostic framework. Importantly, our findings suggest that individuals with history of combined type of SIB may be considered as an independent subgroup deserving focused attention. Future studies may elucidate the underlying mechanisms of these risk decision-making pattern differences. Keywords: Suicide, Suicide Attempt, Non-Suicidal Self-Injury, Major Depressive Disorder, Risk Decision-making, Balloon Analogue Risk Task