Self-injurious behaviors in a college population

Clinical assessment of self-injury: a practical guide

In this article, the author provides a practice-friendly guide to the psychological assessment of self-injury, such as self-inflicted cutting, burning, hitting, and excoriation of wounds. The crucial distinction between self-injury and suicide is emphasized. The author presents a structure for the assessment of self-injury that focuses first on the therapeutic relationship, and thereafter on the history and specifics of the behavior, its intrapersonal and interpersonal functions, and its antecedents and consequences. Types of self-injury that are atypical, and especially alarming, are identified. A case example illustrates both the style and content of a thorough assessment.

Non-suicidal self-injury: an introduction

This issue of Journal of Clinical Psychology: In Session is devoted to the assessment and treatment of non-suicidal self-injury (henceforth self-injury). In this introductory article, the author describes the scope of behaviors referenced by the term self-injury, establishes the historical and current relevance of self-injury for clinical practice, and summarizes the articles that appear in this issue. Self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. This issue addresses many aspects of self-injury, including its prevalence, functions, assessment, and treatment. The articles feature case illustrations and treatment recommendations, and all have direct implications for clinical practice.

The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults

This study aimed to examine the nature, extent and correlates of non-suicidal self injury (NSSI) in a non-clinical sample of young adults. Two hundred and eleven participants (18-30 years) completed self-report questionnaires assessing history of NSSI, emotional regulation, coping strategies, symptoms of psychopathology, and alcohol use. Of the sample, 43.6% reported engaging in NSSI; approximately 10% engaged in moderate/severe NSSI. Those that reported NSSI reported greater psychopathology, avoidant coping and alcohol use than those who did not self-injure. The extent of these differences was magnified as the severity of NSSI increased. These findings highlight the need to consider any form of NSSI, no matter how mild, as an indication of distress and ineffective coping.

Epidemiology, risk factors, and psychopharmacological management of suicidal behavior in borderline personality disorder

Borderline personality disorder (BPD) is a chronic psychiatric condition characterized by a pervasive pattern of instability in affect regulation and impulse control. These maladaptive coping strategies predispose individuals with BPD to suicidal behavior, and this diagnosis increases the risk for completed suicide. Empirical data indicate that adverse life events; a history of childhood trauma; and the presence of comorbid psychiatric conditions, in particular major depressive disorder and substance use disorders; confer an elevated risk of suicidal behavior in patients with BPD. Psychopharmacological interventions, including the use of antidepressants, anti-psychotics, and mood stabilizers, are considered in this review in terms of the evidence for their utility in reducing the risk of suicidal behavior in BPD.

An exploratory study of correlates, onset, and offset of non-suicidal self-injury

The study of non-suicidal self-injury (NSSI) has focused largely on identifying diagnostic correlates and the functions of this behavior; however, little is known about the broader range of factors related to NSSI. We examined a wide array of factors hypothesized to correlate with non-suicidal self-injury (NSSI) and provided a qualitative analysis of adolescents' self-reported motivations for starting and stopping this behavior. Participants were 64 adolescents with a history of NSSI and 30 comparison adolescents without such a history matched on age, sex, and ethnicity recruited from the community and assessed during one laboratory visit. The presence of NSSI was associated with a family history of suicidal ideation, violence, and drug and alcohol abuse, but not with more general forms of psychopathology. NSSI also was associated with the presence of in utero complications, the occurrence of non-injurious repetitive behaviors during childhood, and endorsement of a homosexual or bisexual orientation. Self-injurers reported getting the idea to self-injure from peers (38%) more often than any other source, and most (78%) reported at least one reason for wanting to stop self-injury. Less than half were currently receiving treatment. This exploratory study provides new information about the correlates of NSSI that has implications for research and clinical work in this area.

Online behavior of youth who engage in self-harm provides clues for preventive intervention

OBJECTIVE

To explore the Internet use and interpersonal interactions of youth reporting deliberate self-harm as defined by any non-fatal act, regardless of intention.

METHOD

The Second Youth Internet Safety Survey is a nationally representative telephone survey of 1500 Internet users (ages 10-17) in the United States, conducted March to June 2005.

RESULTS

Youth reporting deliberate self-harm in the past 6 months (3%) were significantly more likely than other youth to have a sexual screen name or to talk with people known only online about sex (35% versus 5%) and to use chat rooms (57% versus 29%). All youth were equally likely to talk online with people known in person, yet youth engaging in deliberate self-harm were significantly more likely also to have a close relationship with someone met online (38% versus 10%). Three quarters (76%) of youth reporting self-harm used instant messaging.

CONCLUSION

Findings suggest that youth who engage in self-harm may be more likely to engage in online behaviors that have the potential to place them in risky situations. Programs aimed at preventing deliberate self-harm should consider adding chat room and instant messaging to their telephone hotline capabilities.

Suicide in deaf populations: a literature review

BACKGROUND

Studies have found that deaf individuals have higher rates of psychiatric disorder than those who are hearing, while at the same time encountering difficulties in accessing mental health services. These factors might increase the risk of suicide. However, the burden of suicidal behaviour in deaf people is currently unknown. The aim of the present review was to provide a summary of literature on suicidal behaviour with specific reference to deaf individuals. The objectives of the review were to establish the incidence and prevalence of suicidal behaviour in deaf populations; describe risk factors for suicidal behaviour in deaf populations; describe approaches to intervention and suicide prevention that have been used in deaf populations.

METHODS

A number of electronic databases (e.g. Medline, PsycINFO, CINAHL, EMBASE, Dissertation Abstracts International, Web of Science, ComDisDome, ASSIA, Education Sage Full Text, Google Scholar, and the grey literature databases FADE and SIGLE) were explored using a combination of key words and medical subject headings as search terms. Reference lists of papers were also searched. The Science and Social Sciences Citation Index electronic databases were used to identify studies that had cited key papers. We also contacted experts and organisations with an interest in the field.

RESULTS

Very few studies focussed specifically on suicide in deaf populations. Those studies that were included (n = 13) generally involved small and unrepresentative samples. There were limited data on the rate of suicidal behaviour in deaf people. One study reported evidence of hearing impairment in 0.2% of all suicide deaths. Another found that individuals with tinnitus seen in specialist clinics had an elevated rate of suicide compared to the general population. The rates of attempted suicide in deaf school and college students during the previous year ranged from 1.7% to 18%, with lifetime rates as high as 30%. Little evidence was found to suggest that risk factors for suicide in deaf people differed systematically from those in the general population. However, studies did report higher levels of depression and higher levels of perceived risk among deaf individuals than hearing control groups. No firm evidence was found regarding the effectiveness of suicide prevention strategies in deaf people, but suggested strategies include developing specific screening tools, training clinical staff, promoting deaf awareness, increasing the availability of specialist mental health services for deaf people.

CONCLUSION

There is a significant gap in our understanding of suicide in deaf populations. Clinicians should be aware of the possible association between suicide and deafness. Specialist mental health services should be readily accessible to deaf individuals and specific preventative strategies may be of benefit. However, further research using a variety of study designs is needed to increase our understanding of this issue.

Parental expressed emotion and adolescent self-injury

OBJECTIVE

This study examined the relationship between parental expressed emotion (EE) and adolescent self-injurious thoughts and behaviors (SITB), as well as potential mediators and moderators of this relationship.

METHOD

Thirty-six adolescents ages 12 to 17 years recruited from the community (2004-2005) provided data. Parents of the adolescents completed the Five-Minute Speech Sample, a performance-based measure of EE, and adolescents completed interviews and rating scales assessing SITB, mental disorders, and related constructs.

RESULTS

Analyses revealed that high parental EE was associated with each type of SITB assessed: suicide ideation, suicide plans, suicide attempts, and non-suicidal self-injury. Analyses also revealed that one specific component of EE (i.e., parental criticism) was strongly associated with SITB, whereas the other (i.e., emotional overinvolvement) was not and that the relationship between EE and SITB was not explained by the presence of mental disorders. Finally, a moderation model was supported in which the relationship between parental criticism and SITB was especially strong among adolescents with a self-critical cognitive style.

CONCLUSIONS

This study indicates that parental criticism is significantly associated with SITB and suggests one specific pathway through which the family may influence adolescent SITB. Future research is needed to replicate these findings and examine the direction of these relationships.

Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism

We examined the relation between child maltreatment and non-suicidal self-injury (NSSI). Participants were 86 adolescents who completed measures of child maltreatment, self-criticism, perceived criticism, depression, and NSSI. Analyses revealed significant, small-to-medium associations between specific forms of child maltreatment (physical neglect, emotional abuse, and sexual abuse) and the presence of a recent history of NSSI. Emotional and sexual abuse had the strongest relations with NSSI, and the data supported a theoretical model in which self-criticism mediates the relation between emotional abuse and engagement in NSSI. Specificity for the mediating role of self-criticism was demonstrated by ruling out alternative mediation models. Taken together, these results indicate that several different forms of childhood maltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associated with NSSI. Future research is needed to test the temporal relation between maltreatment and NSSI and should aim to identify additional pathways to engagement in NSSI.

Past and recent deliberate self-harm: Emotion and coping strategy differences

Only limited information on nonsuicidal deliberate self-harm behavior among nonclinical populations is available, and it is unclear whether coping and emotional difficulties remain among those with a past history of self-harm behavior. The purpose of this study is to examine emotions and coping strategies among three nonclinical groups with a recent, past, and no history of nonsuicidal deliberate self-harm behavior. College students completed self-report measures of self-harm behavior, suicidal thoughts, emotional dispositions, and coping strategies. Contrary to expectations, there were few differences in coping strategies among the three groups ( p > .0033). Those with a recent history (n = 23; in the last 12 months) and past history (n = 32; more than 12 months ago) of self-harm behavior reported greater levels of negative emotion (e.g., hostility, guilt, sadness) than those who have never self-harmed (n = 161; p < .0045). This indicates that although self-harm behavior had discontinued (>12 months ago), negative emotion differences were present, and both recent and past self-harmers merit concern in managing their negative emotions to lower their risk for future difficulties.

The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature

This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.

The functions of deliberate self-injury: a review of the evidence

Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.