Self-harming behavior: Introduction to the special series on non-suicidal self-injury and suicide

doi:10.1016/j.appsy.2008.08.001

Applied and Preventive Psychology

Volume 12, Issue 4, October 2008, Pages 155-158

https://doi.org/10.1016/j.appsy.2008.08.001 Get rights and content

Abstract

Suicide and non-suicidal self-injury (NSSI) lie along a continuum of self-harming behaviors. Highly prevalent, NSSI is a serious public health concern. It also increases risk for suicide. The present article reviews recent research on NSSI and provides an introduction to the articles in this special edition of the journal.

Section snippets

Definitional issues

A broad term, self-injurious behavior (also referred to as self-mutilation or self-harming behavior) refers to acts that involve deliberate and direct injury to the self. Self-injurious behavior can be lethal, as in the case of suicide attempts. Self-injurious behavior can also occur in the absence of any attempt to die. A key distinction that is made is whether the self-harming behavior is motivated by a wish to end one's own life (Favazza, 1998; Pattison & Kahan, 1983). Of course, this

Psychopathology and self-harming behaviors

Research on NSSI is generally concerned with more minor forms of self-harming behaviors such as skin-cutting, picking, or burning. These cause tissue damage but are not associated with significant medical disability. Extreme forms of self-mutilation, which might involve limb amputation or self-inflicted eye injuries, are almost exclusively found in people suffering from psychotic disorders (Large, Babidge, Andrews, Storey, & Nielssen, 2008). In many cases, these injuries result from specific

Prevalence

Across the world, suicide is one of the leading causes of death. In a sample of people from 17 different countries, survey data show that the lifetime prevalence of suicidal ideation is 9.2%. For suicide attempts, the lifetime prevalence worldwide is 2.7% (Nock et al., 2008). Importantly, age appears to be negatively related to the presence of suicidal behaviors (ideation, having a plan, and making a suicide attempt). In adult samples, people aged 18–34 years are at the highest risk relative to

Understanding self-harming behavior

Self-harming behavior is far from rare, even in non-clinical samples. Yet despite its high prevalence, self-harming behavior is little understood. Rates of self-harming behavior also seem to be increasing (Heilbron & Prinstein, 2008; Klonsky, 2007). The need for models to help further the understanding and treatment of NSSI has never been more pressing. In this special issue, acknowledged experts in the areas of NSSI and suicide offer new theoretical perspectives and treatment directions.

What

Conclusion

Self-injurious behavior presents clinicians and researchers with many challenges. Although it reflects just one symptom within the DSM, it is far from a minor problem. NSSI is highly prevalent. It is also associated with many psychopathological conditions and is a major risk factor for suicide. As such, it is a major public health concern.

In all probability, self-injurious behavior reflects the result of the interaction of biological, psychological, and psychosocial factors. This is an

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Cited by (29)

Prefrontal cortex activation during cognitive interference in nonsuicidal self-injury
2018, Psychiatry Research - Neuroimaging
Citation Excerpt :
Nonsuicidal self-injury (NSSI) is deliberate behavior resulting in self-inflicted damage without suicidal intent. Although skin cutting is most common (Nock, 2009a), many engage in multiple methods of NSSI (Victor & Klonsky, 2014), including scratching, picking, burning, bruising, etc. (Hooley, 2008; Nock, 2009b). NSSI is common, with 5.9% of adults (Klonsky, 2011) and up to 23% of adolescents reporting a history of NSSI (Jacobson & Gould, 2007).
Nonsuicidal self-injury (NSSI), deliberate behavior resulting in self-inflicted damage to oneself, is common, particularly among female adolescents, and may be a form of maladaptive emotion regulation. Cognitive interference, a specific type of processing associated with inhibiting prepotent responses in favor of less automatic ones, is utilized in treatment strategies to shift patients’ thoughts and behaviors away from maladaptive responses and replace them with more adaptive ones. We examined cognitive interference processing using the Multi-Source Interference Task (MSIT) in females with NSSI behavior (n=15) and healthy control females (n=15). Functional magnetic resonance imaging (fMRI) data were collected concurrently. Results revealed similar between-group performance on the MSIT; however, women with NSSI behavior exhibited altered patterns of neural activation during the MSIT. Specifically, the NSSI group demonstrated increased cingulate cortex (CC) and decreased dorsolateral prefrontal cortex (DLPFC) activation compared to the control group. Further, within the NSSI group, DLPFC activation inversely correlated with emotional reactivity and self-reported impulsivity, suggesting that decreased DLPFC activation is associated with poorer emotional control and increased impulsivity. Taken together, these results indicate that women with NSSI behavior utilize different cortical areas during cognitive interference processing, which may have broader implications regarding the treatment efficacy of cognitive-based therapies.
Development of item bank to measure deliberate self-harm behaviours: Facilitating tailored scales and computer adaptive testing for specific research and clinical purposes
2014, Psychiatry Research
Citation Excerpt :
An important strength of the item bank is the retention of several items with differential item functioning, most notably the items related to cutting and self-hitting which are central to the construct of DSH (Skegg, 2005; Wilkinson and Goodyer, 2011). CAT delivery packages such as SmartCAT™ (Elhan et al., 2008) can accommodate items with differential item functioning by changing the order of item presentation in sub-groups (e.g., males and females) in accordance with the different estimates of item location provided by the item splitting procedure in Rasch analysis (da Rocha et al., 2012), thereby fully informing the differential prevalence rates of DSH that have been reported for age and gender (Hooley, 2008). A further strength of the item bank is the expansive set of specific DSH methods that were included.
The purpose of this study was to investigate the application of item banking to questionnaire items intended to measure Deliberate Self-Harm (DSH) behaviours. The Rasch measurement model was used to evaluate behavioural items extracted from seven published DSH scales administered to 568 Australians aged 18–30 years (62% university students, 21% mental health patients, and 17% community members). Ninety four items were calibrated in the item bank (including 12 items with differential item functioning for gender and age). Tailored scale construction was demonstrated by extracting scales covering different combinations of DSH methods but with the same raw score for each person location on the latent DSH construct. A simulated computer adaptive test (starting with common self-harm methods to minimise presentation of extreme behaviours) demonstrated that 11 items (on average) were needed to achieve a standard error of measurement of 0.387 (corresponding to a Cronbach׳s Alpha of 0.85). This study lays the groundwork for advancing DSH measurement to an item bank approach with the flexibility to measure a specific definitional orientation (e.g., non-suicidal self-injury) or a broad continuum of self-harmful acts, as appropriate to a particular research/clinical purpose.
Aberrant pain perception in direct and indirect non-suicidal self-injury: An empirical test of Joiner's interpersonal theory
2013, Comprehensive Psychiatry
Citation Excerpt :
But how specific is this association? NSSI is typically used to refer to deliberate acts (such as cutting) that directly damage the body but that are not motivated by suicidal intent [4,5]. But other non-suicidal behaviors that involve people mistreating or abusing themselves but that do not directly damage bodily tissue might warrant consideration as forms of “indirect” self-injury, and in fact many practitioners regard such behaviors and NSSI as interchangeable (e.g., [6]).
Using a community sample (N = 148) we examined pressure pain perception in 3 study groups — people who engaged in non-suicidal self-injury, people who engaged in indirect forms of self-injury, and non-self-injuring controls. In so doing we tested hypotheses derived from Joiner's (2005) interpersonal theory of suicide. Consistent with previous studies and with Joiner's model, people who engaged in NSSI endured pain for significantly longer than non-self-injuring controls. Importantly, pain endurance in the Indirect self-injury group was comparable to that found in the NSSI group and significantly elevated relative to controls. This pattern of results suggests that abnormal pain perception may not be specific to forms of self-injury (e.g., NSSI) that involve immediate physical pain (e.g., cutting). Our findings further suggest that the concept of acquired capability for suicide might have relevance for both direct and indirect forms of self-injurious behavior.
Co-calibration of deliberate self harm (DSH) behaviours: Towards a common measurement metric
2012, Psychiatry Research
Citation Excerpt :
The study was also limited by the dominance of female participants. This may be reflective of the DSH gender prevalence (Hooley, 2008), or it may be due to the greater propensity for females to volunteer for psychological studies (Birnbaum, 2000). A further limitation is the absence a procedure to control for endorsement effect (Zlotnick et al., 1996) as people who have engaged in DSH may over endorse items.
The purpose of this study was to co-calibrate items from different deliberate self-harm (DSH) behavioural scales on the same measurement metric and compare cut points and item hierarchy across those scales. Participants included 568 young Australians aged 18–30 years (62% university students, 21% mental health patients, and 17% community volunteers). Six DSH scales (containing 82 items) were administered, namely, Self-Injury Questionnaire Treatment Related (SIQTR), Self-Injurious Thoughts and Behaviours Interview (SITBI), Deliberate Self-Harm Inventory (DSHI), Inventory of Statements About Self-Injury (ISAS), Self-Harm Information Form (SHIF) and Self-Harm Inventory (SHI). Data were co-calibrated onto an underlying metric using the Rasch measurement model. The resulting calibration shows that the different scales occupy different ranges on the hierarchy of DSH methods with prevalence estimates ranging from 47.7 to 77.1%. A raw score conversion table is provided to adjust prevalence rates and to equate cut points on the six scales. A Rasch-validated hierarchy of DSH behaviours is also provided to inform the development of DSH nomenclatures and assist clinical practice.
Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction
2012, Psychiatry Research
Citation Excerpt :
Non-suicidal self-injury (NSSI) involves the direct and deliberate destruction of one's own body tissue in the absence of suicidal intent (Favazza, 1998; Nock et al., 2006). Although still little understood, this form of self-inflicted injurious behavior is now attracting a great deal of theoretical and empirical attention (Hooley, 2008; Prinstein, 2008; Nock, 2009). Non-suicidal self-injury is estimated to occur in 4% of the general adult population, and in approximately 20% of adult clinical inpatients (Briere and Gil, 1998; Favazza, 1998; Nock and Prinstein, 2005).
Non-suicidal self-injury (NSSI) involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. However, other non-suicidal behaviors that involve people mistreating or abusing themselves but that do not deliberately and directly damage bodily tissue may have much in common with NSSI. Such ‘indirect’ methods of self-injury might include involvement in abusive relationships, substance abuse, risky or reckless behavior, or eating disordered behavior. Using a community sample (N = 156) we compared individuals engaging in NSSI (n = 50), indirect (non-suicidal) self-injurers (n = 38), and healthy controls (n = 68) on a range of clinical and personality characteristics. As predicted, non-suicidal self-injurers and indirect self-injurers showed more pathology than healthy controls on all measures. Comparisons of the NSSI and the Indirect self-injury groups revealed no significant differences on measures of dissociation, aggression, impulsivity, self-esteem, negative temperament, depressive symptoms, and borderline personality disorder. However, compared to people who engaged only in indirect forms of self-injury, those who engaged in NSSI were more self-critical, had higher scores on a measure of suicide proneness, and had a history of more suicide attempts. The findings suggest that NSSI and indirect self-injury are best viewed as separate and distinct clinical phenomena.
Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian adolescents
2011, Journal of Adolescence
The aims of this study were to investigate the rates of deliberate self-harm (DSH) behavior among an Italian adolescent sample, as well as to explore its clinical correlates. On a sample of 234 adolescents in Italian secondary schools (Mean age = 16.47; SD = 1.7) were assessed the DSH as well as externalizing symptoms (including both conduct disorder [CD] and oppositional defiant disorder [ODD] symptoms), borderline personality disorder [BPD] symptoms, dissociative symptoms, and the incidence of life-stressors. Consistent with past research on DSH in youth, 42% of the adolescents in this sample engaged in DSH. Results indicate a positive association between DSH and all psychopathological correlates, including BPD, dissociative, and ODD and CD symptoms. Further, findings revealed an association between DSH and specific life-stressors (i.e., psychological and sexual abuse, natural disasters and serious accidents, the loss of someone important, and the witnessing of family violence or a serious accident).

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EditorialSelf-harming behavior: Introduction to the special series on non-suicidal self-injury and suicide

Abstract

Section snippets

Definitional issues

Psychopathology and self-harming behaviors

Prevalence

Understanding self-harming behavior

Conclusion

Applied and Preventive Psychology

Schizophrenia Research

Clinical Psychology Review

Clinical Psychology Review

Applied and Preventive Psychology

Applied and Preventive Psychology

Psychiatry Research

Applied and Preventive Psychology

Diagnostic and statistical manual of mental disorders

Vincent van Gogh: Chemicals, crises and creativity

Depression and hostility in self-mutilation

Suicide and Life Threatening Behavior

Self-mutilation in Lesch-Nyhan syndrome

Journal of Oral Pathology and Medicine

Suicide after deliberate self-harm: A 4-year cohort study

American Journal of Psychiatry

Pain insensitivity in schizophrenia: A neglected phenomenon and some implications

Schizophrenia Bulletin

The prevalence of suicidal phenomena in adolescents: A systematic review of population-based studies

Suicide and Life Threatening Behavior

Bodies under siege: Self-mutilation and body modification in culture and psychiatry

Editorial
Self-harming behavior: Introduction to the special series on non-suicidal self-injury and suicide