Self-injurious behaviors in a college population

Peer influence and nonsuicidal self injury: longitudinal results in community and clinically-referred adolescent samples

Research suggests that adolescents' engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents' NSSI was examined at baseline and one year later. Adolescents' nominated best friend reported their own levels of NSSI. In Study 2, adolescents' NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents' perceptions of their friends' engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends' self-injurious behavior on adolescents' own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents' NSSI was associated with increasing perceptions of their friends' engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence.

Self-injurious behavior in adolescents

Janis Whitlock discusses the epidemiology and and care of adolescents undertaking nonsuicidal self-injury, also called “deliberate self-harm.”

Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian adolescents

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).

Suicide and self-injury among children and youth with chronic health conditions

OBJECTIVE

Chronic conditions may be associated with suicide risk. This study aimed to specify the extent to which youth chronic conditions are at risk for suicidality and self-harm.

METHODS

Logistic regression was used to estimate odds of self-harm, suicidal ideation, and suicide attempts in 10- to 19-year-olds with and without chronic physical and/or mental health conditions.

RESULTS

Independent of race, socioeconomic status, absent parent, special education status, substance use, and emotional distress, youth with co-occurring chronic physical and mental conditions (n = 4099) had significantly higher odds of self-harm (odds ratio [OR]: 2.5 [99% confidence interval (CI): 2.3-2.8), suicidal ideation (OR: 2.5 [99% CI: 2.3-2.8), and suicide attempts (OR: 3.5 [99% CI: 3.1-3.9]) than healthy peers (n = 106,967), as did those with chronic mental conditions alone (n = 8752). Youth with chronic physical conditions alone (n = 12,554) were at slightly elevated risk for all 3 outcomes. Findings were similar among male and female youth, with a risk gradient by grade.

CONCLUSIONS

Chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes. Co-occurring chronic physical and mental conditions are associated with an increased risk for self-harm and suicidal ideation that is similar to the risk in chronic mental conditions and with an attempted suicide risk in excess of that predicted by the chronic mental health conditions alone. Preventive interventions for these youth should be developed and evaluated.

Self-harm reasons, goal achievement, and prediction of future self-harm intent

Self-harm may have several reasons, and these reasons may have corresponding implied goals. The current study examined reasons for self-harm and whether the a priori goals intended by these reasons were achieved. Fifty-seven individuals with a history of self-harm were recruited online and volunteered their time to complete a series of online questionnaires assessing past self-harm frequency, self-harm reasons, whether the goal associated with these reasons was achieved, and future self-harm intent. Reasons to reduce tension and dissociation associated with more past self-harm, a higher intent to self-harm again, and it was reported that the goals associated with reasons were achieved (i.e., these internal states were extinguished). Achievement of these goals (i.e., reported reductions in tension and dissociation) mediated the relation between corresponding self-harm reasons and intent to self-harm in the future. Findings support the view that self-harm is a maladaptive coping strategy and the reinforcement component of the experiential avoidance model of self-harm. Results have clinical implications and heuristic value for future research, which are discussed.

Negative intrusive thoughts and dissociation as risk factors for self-harm

Relationships between self-harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation and childhood trauma, had lower self-worth, and reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly to the self-harmers on the dissociation and self-worth scales, and engaged in potentially maladaptive behaviors that are not defined as indicating clinical self-harm, but experienced fewer negative intrusive thoughts. This group may be at risk of future self-harm if they begin to experience negative intrusive thoughts. If negative intrusive thoughts are playing a causal role, then therapeutic approaches tackling them may help those who are currently self-harming.

Deliberate self-harm in Oxford University students, 1993-2005: a descriptive and case-control study

BACKGROUND

Deliberate self-harm (DSH; intentional self-poisoning or self-injury) is a major problem among young people and has been identified as one of the key mental health problems affecting students.

METHOD

Data on DSH presentations to the general hospital in Oxford by Oxford University students were analysed for the 12-year period from 1993 to 2005. The characteristics of the students with DSH were compared with those of age-matched DSH controls in the Oxford City area.

RESULTS

Problems with academic work, relationships with family, partners and friends were most likely to contribute to DSH episodes in students. Many experienced problems with psychiatric disorders and social isolation. The frequency of eating disorders was very high in students, and contributed to DSH significantly more often than in controls. Fewer students than controls self-poisoned in the DSH episode, fewer had personality disorder and fewer had problems with physical health, finance, housing and violence. Alcohol consumption in association with DSH and alcohol-related problems were common in both students and controls. Male students had significantly higher suicide intent than controls. Many students were referred to the university counselling service for follow-up, a resource not available to non-student controls.

CONCLUSIONS

Comparison of university students following DSH with age-matched controls has shown key differences in psychiatric characteristics, problems contributing to DSH and aftercare offered. These findings may help in the design of targeted self-harm prevention and management strategies for students.

Representations of non-suicidal self-injury in motion pictures

The aim of this study was to investigate representations of non-suicidal self-injury (NSSI) in popular media. Forty-one motion pictures were viewed, coded, and analyzed. NSSI was correlated with mental illness, child maltreatment, and substance abuse. NSSI was generally portrayed as severe, habitual and covert. Further, depictions of NSSI were often sensationalized and featured prominently. NSSI was less likely to be associated with completed suicide than other psychological factors, but more closely associated with suicide than NSSI is in the community. Although NSSI was associated with psychiatric illness, few characters were receiving psychiatric care at the time of NSSI. However a significant proportion received support after engaging in NSSI. The portrayal of NSSI is generally accurate regarding correlates and function, but is inaccurately associated with suicide. Implications of the relatively accurate portrayal of NSSI are discussed in light of the potential for imitation, and the possibility of using cinematherapy to promote effective problem resolution.

Early trauma and lifetime suicidal behavior in a nationwide sample of Korean medical students

BACKGROUND

No previous study has investigated the association between early trauma and suicidal behavior in medical students. We evaluated the types of early trauma which are the most strongly associated with a lifetime history of suicidal behavior in medical students.

METHOD

A total of 6986 medical students completed a self-administered questionnaire (response rates: 49.6% of the entire medical student body in Korea) which included lifetime suicidal behavior, stressors, and the Early Trauma Inventory Self Report-Short Form (ETISR-SF). This was used to evaluate the most serious forms of trauma experienced before the age of 18, including general trauma, physical, emotional and sexual abuse.

RESULTS

Among medical students, lifetime prevalence of suicidal behavior was 34.0% for those who experienced early trauma and 18.1% in those without a history of trauma (chi(2)=215.7, p<0.0001). Emotional abuse exhibited a higher odds ratio for lifetime suicidal behavior (OR=3.6, 95%CI=2.9-4.4) than other traumas including general trauma (OR=2.1, 95%CI=1.8-2.4), sexual (OR=2.0, 95%CI=1.5-2.8) or physical (OR=1.8, 95%CI=1.5-2.1) abuse, and current stressors including heavy stress (OR=1.5, 95%CI=1.4-1.8), poor physical health (OR=1.3, 95%CI=1.2-1.5), and poor economic status (OR=1.2, 95%CI=1.0-1.3). Emotional abuse also showed a higher odds ratio for lifetime suicidal ideation (OR=3.5, 95%CI=2.8-4.4), plan (OR=3.9, 95%CI=2.4-6.2), and attempt (OR=4.1, 95%CI=2.4-6.8) than other early traumas or stressors. In emotional abuse, a continuously cold or uncaring parental attitude exhibited a stronger association with lifetime suicidal behavior (OR=4.5, 95%CI=2.7-7.7) than other emotional abuse.

CONCLUSION

Emotional abuse, especially continuous parental emotional abuse in childhood, is significantly associated with lifetime suicidal behavior in Korean medical students.

Nonsuicidal self-injury in college students: the role of perfectionism and rumination

A paucity of research exists examining personality and cognitive characteristics that may contribute to nonsuicidal self-injury (NSSI). The purpose of the current study was to clarify the contribution of perfectionism and rumination, along with depression and anxiety, to NSSI within a sample of 170 college students. Group comparisons revealed that participants with a history of NSSI endorsed significantly more rumination and depressive and anxious symptoms then non-NSSI controls. Results regarding perfectionism were mixed, with NSSI participants differing from controls on select aspects of perfectionism. Results suggest higher levels of depression and anxiety and a ruminative cognitive style may increase vulnerability for NSSI; however, further research is needed to clarify the contribution of perfectionism.

Are self-injurers impulsive?: Results from two behavioral laboratory studies

Common clinical wisdom suggests that people who engage in self-injury are impulsive. However, virtually all prior work in this area has relied on individuals' self-report of impulsiveness, despite evidence that people are limited in their ability to accurately report on cognitive processes that occur outside awareness. To address this knowledge gap, we used performance-based measures of several dimensions of impulsiveness to assess whether people engaging in non-suicidal self-injury (NSSI) demonstrate greater impulsiveness than non-injurers. In Study 1, we compared adolescent self-injurers (n=64) to age-, sex-, and race/ethnicity-matched, non-injurious controls (n=30) on self-reported impulsiveness (Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and LifetimeVersion) and on performance-based measures of two dimensions of impulsiveness: behavioral disinhibition (Conners' Continuous Performance Test) and risky decision-making (Iowa Gambling Task). In Study 2, we compared adult female self-injurers (n=20) with age- and race/ethnicity-matched, non-injurious controls (n=20) on self-reported impulsiveness (Barratt Impulsiveness Scale-11), and performance-based measures of behavioral disinhibition, risky decision-making, and two measures of delay discounting. In both studies, self-injurers reported greater impulsiveness; however, performance-based measures of impulsiveness failed to detect any between-group differences. We propose several potential explanations for the discrepancies observed between self-report and performance-based measures of impulsiveness and discuss directions for future research on impulsiveness and self-injury.

Self injurious behavior among homeless young adults: a social stress analysis

Although self-mutilation has been studied from medical and individual perspectives, it has rarely been examined within a social stress context. As such, we use a social stress framework to examine risk factors for self-mutilation to determine whether status strains that are often associated with poorer health outcomes in the general population are also associated with self-mutilation among a sample of young adults in the United States who have a history of homelessness. Data are drawn from the Homeless Young Adult Project which involved interviews with 199 young adults in 3 Midwestern United States cities. The results of our path analyses revealed that numerous stressors including running away, substance use, sexual victimization, and illegal subsistence strategies were associated with more self-mutilation. In addition, we found that certain social statuses exacerbate the risk for self-mutilation beyond the respondents' current situation of homelessness. We discuss the implications of our findings for the social stress framework and offer suggestions for studying this unique population within this context.

The anxiogenic drug FG7142 increases self-injurious behavior in male rhesus monkeys (Macaca mulatta)

AIMS

Self-injurious behavior (SIB), which is deliberate infliction of self-injury without suicidal intent, is a significant human health problem. SIB is not unique to humans but is also manifested in a small percentage of captive macaques, typically as self-directed biting. Although the onset and maintenance of SIB have been linked to increased anxiety in both humans and nonhuman primates, no previous studies have directly tested the anxiety-SIB hypothesis. Here, we determined whether rhesus monkeys increase their self-directed biting following a challenge with the anxiogenic compound N-methyl-beta-carboline-3-carboxamide (FG7142).

MAIN METHODS

Ten rhesus monkeys (Macaca mulatta) with a veterinary record of self-wounding (SIB) as well as six age- and weight-matched non-wounding control monkeys were given intramuscular injections of 0.1, 0.3, or 1.0mg/kg FG7142. Behavior was observed following drug administration with special attention to displacement behaviors (scratching, self-grooming, and yawning), locomotor stereotypy, and self-directed biting. Plasma cortisol and ACTH were also measured as physiological indices of stress.

KEY FINDINGS

Self-directed biting rates dose-dependently increased in a subset of SIB monkeys, but did not change in control animals. Furthermore, administration of FG7142 led to an increase in scratching, yawning, and locomotor stereotypy in all monkeys, but did not affect the frequency self-grooming. Additionally, there was a dose-dependent increase in plasma cortisol concentrations, but not ACTH, in all animals.

SIGNIFICANCE

The present findings indicate that self-biting is anxiety-related in some but not all SIB monkeys, suggesting that this behavioral pathology is heterogeneous as has previously been suggested for SIB in humans.

Social support and mental health among college students

This study is the first, to our knowledge, to evaluate the relationship between mental health and social support in a large, random sample of college students. A Web-based survey was administered at a large, public university, with 1,378 students completing the measures in this analysis (response rate = 57%). The results support our hypothesis that students with characteristics differing from most other students, such as minority race or ethnicity, international status, and low socioeconomic status, are at greater risk of social isolation. In addition, the authors found that students with lower quality social support, as measured by the Multidimensional Scale of Perceived Social Support, were more likely to experience mental health problems, including a sixfold risk of depressive symptoms relative to students with high quality social support. These results may help administrators and health providers to identify more effectively the population of students at high risk for mental illness and develop effective interventions to address this significant and growing public health issue.

Persistence of mental health problems and needs in a college student population

BACKGROUND

Cross-sectional studies indicate a high prevalence of mental health problems among college students, but there are fewer longitudinal data on these problems and related help-seeking behavior.

METHODS

We conducted a baseline web-based survey of students attending a large public university in fall 2005 and a two-year follow-up survey in fall 2007. We used brief screening instruments to measure symptoms of mental disorders (anxiety, depression, eating disorders), as well as self-injury and suicidal ideation. We estimated the persistence of these mental health problems between the two time points, and determined to what extent students with mental health problems perceived a need for or used mental health services (medication or therapy). We conducted logistic regression analyses examining how baseline predictors were associated with mental health and help-seeking two years later.

RESULTS

Over half of students suffered from at least one mental health problem at baseline or follow-up. Among students with at least one mental health problem at baseline, 60% had at least one mental health problem two years later. Among students with a mental health problem at both time points, fewer than half received treatment between those time points.

LIMITATIONS

Mental health problems are based on self-report to brief screens, and the sample is from a single university.

CONCLUSIONS

These findings indicate that mental disorders are prevalent and persistent in a student population. While the majority of students with probable disorders are aware of the need for treatment, most of these students do not receive treatment, even over a two-year period.

An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA

BACKGROUND

This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools.

METHOD

Data were provided from 665 adolescents (mean age 14.8 years, S.D.=0.66, range 14-17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies-Depression Scale (CES-D).

RESULTS

A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors.

CONCLUSIONS

By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.

Personality and non-suicidal deliberate self-harm: Trait differences among a non-clinical population

Limited information is available on understanding why particular individuals engage in non-suicidal deliberate self-harm (DSH), especially among non-clinical populations. An array of personality traits, such as those included in the five-factor model of personality, may further an understanding of DSH. The purpose of this study was to examine personality traits among non-clinical groups with or without a history of DSH. College students (N=238) completed self-report measures of DSH and personality. Both multivariate (MANOVA, discriminant analysis) and univariate (ANOVA) statistical procedures supported the hypothesis that those with a history of DSH (n=59) had significantly higher levels of neuroticism and openness to experience, and significantly lower levels of agreeableness and conscientiousness. Contrary to expectations, there were no differences in extraversion between the two groups. These results indicate personality differences among those with a history of DSH, which with additional research, may prove to be risk factors or targets of intervention for future DSH or collateral problems.

Psychometric analysis of the self-harm inventory using Rasch modelling

BACKGROUND

Deliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples.

METHODS

The SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score.

RESULTS

The SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related.

CONCLUSION

The recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

Psychological subtyping finds pathological, impulsive, and 'normal' groups among adolescents who self-harm

BACKGROUND

Research to date suggests that as many as 12-15% of young people engage in self-harm behaviour; however, the current understanding of the psychological basis of adolescent self-harm is limited. The objective was to determine whether adolescents who self-harm are a psychologically homogenous group. It was hypothesised that psychological subtypes would exist and these groups would report different rates of self-harm.

METHOD

Nine hundred and forty-four school students aged 11 to 19 and 166 first-year psychology students aged 21 or younger completed a self-report questionnaire. Participants were aged 11 to 21 (mean = 15.4, SD = 2.1). Sixty-two percent of the sample were female (n = 692). Students were allocated to psychologically distinct groups. Rates of self-harm were compared for the psychological subtypes of self-harmers.

RESULTS

Two hundred and thirty-four participants reported lifetime self-harm (21.1%; 95% CI 19-23%) and 78 reported recent self-harm (7.0%; 95% CI 6.7-7.3%). The present study identified three psychologically quite distinct groups of adolescents within those who reported self-harm - a psychologically pathological group, a psychologically 'normal' group, and an impulsive group. The pathological group reported the highest rate of recent self-harm (50.9%); the psychologically 'normal' and impulsive groups reported similar rates of self-harm (28.7% and 24.6%, respectively).

CONCLUSIONS

Adolescents who self-harm are not a psychologically homogenous group. One pathological subtype of self-harmers appears to most closely reflect a number of the psychological and social factors previously associated with self-harm. However, a large proportion of the sample was allocated the psychologically 'normal' subtype. This finding highlights the importance of psychological screening of adolescents presenting for treatment for self-harm as subtypes of self-harmers may require disparate strategies for intervention. Further research is required in order to identify appropriate treatment strategies for each subtype.

Risk factors and correlates of deliberate self-harm behavior: a systematic review

OBJECTIVE

Deliberate self-harm behavior--without suicidal intent--is a serious health problem and may be studied as a clinical phenomenon in its own right. Empirical studies of sociodemographic and psychological correlates and risk factors are systematically reviewed.

METHODS

We searched Medline, PsycINFO, PSYNDEX (German psychological literature), and reference lists. We targeted self-induced bodily harm without conscious suicidal intent. Studies on suicidal behavior or self-poisoning were only included if they also assessed nonsuicidal self-harm.

RESULTS

Fifty-nine original studies met the criteria. Deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. Evidence on gender is complex. Only 5 studies realize a prospective design (6 months to 10 years) and test predictors. The majority use cross-sectional and retrospective methods. No longitudinal study (separately) examines new incidence. Evidence of correlates encompasses distal/proximal, person/environment, and state/trait factors. Many studies report associations between current self-harm behavior and a history of childhood sexual abuse. Adolescent and adult self-harmers experience more frequent and more negative emotions, such as anxiety, depression, and aggressiveness, than persons who do not self-harm. Two studies yield specific interactions between childhood trauma and current traits and states such as low emotional expressivity, low self-esteem, and dissociation with respect to a vulnerability to self-harm.

CONCLUSION

Evidence of distal, biographical stressors is fairly strong. Proximal stressors have rarely been investigated; protective factors, hardly at all. Despite many findings of correlates, the data do not yet justify terming them risk factors. Longitudinal studies are needed.

The functions of self-injury in young adults who cut themselves: clarifying the evidence for affect-regulation

The functions of non-suicidal self-injury were examined in 39 young adults with a history of skin-cutting and other self-injurious behaviors including banging, burning, and severe scratching. Consequences, affect-states, and reasons associated with self-injury were assessed by a structured interview. Results indicate that self-injury is associated with improvements in affective valence and decreases in affective arousal. Specifically, participants tended to feel overwhelmed, sad, and frustrated before self-injury, and relieved and calm after self-injury. Further, these affective changes predict lifetime frequency of self-injury, suggesting that they reinforce the behavior. Finally, although reasons for self-injury related to both affect-regulation (e.g., to release emotional pressure that builds up inside of me) and self-punishment (e.g., to express anger at myself) were endorsed by a majority of participants, affect-regulation reasons were overwhelmingly rated as primary and self-punishment reasons as secondary.

Non-suicidal self-injury and eating pathology in high school students

Although past research has explored self-injurious behaviors and disordered eating among adults in clinical settings, little research has been conducted examining nonsuicidal self-injury (NSSI) and eating pathology in community samples of adolescents. Four hundred and 40 students were screened for the presence of NSSI; a prevalence rate of 13.9% was found. Those who indicated that they engaged in NSSI (n = 59) and a comparison group of non-self-injurers (n = 57) completed the Eating Disorders Inventory. Results indicate that students who engage in NSSI display significantly more eating pathology than their non-NSSI peers, including poor interoceptive awareness; difficulties with impulse regulation; an increased sense of ineffectiveness, distrust, and social insecurity; and increased bulimic tendencies and body dissatisfaction. Relationships were found between increased lifetime frequency of NSSI behaviors and poor impulse control and deficits in affective regulation. In addition, adolescents who had stopped self-injuring reported comparable rates of eating pathology as did adolescents who continued to self-injure. The theoretical connection between NSSI and eating pathology are discussed with reference to enhancing knowledge regarding the characteristics of NSSI.

Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS)

The present study reports the psychometric properties of the Inventory of Statements About Self-injury (ISAS), a measure designed to comprehensively assess the functions of non-suicidal self-injury (NSSI). The ISAS assesses 13 functions of NSSI, as well as the frequency of 12 NSSI behaviors. The ISAS was administered to 235 young adults from a college population who had performed at least one NSSI behavior. Consistent with previous research, ISAS functions comprised two factors representing interpersonal and intrapersonal functions. In addition, the ISAS factors exhibited excellent internal consistency and expected correlations with both clinical constructs (e.g., borderline personality disorder, suicidality, depression, anxiety) and contextual variables (e.g., tendency to self-injure alone). Findings support the reliability and validity of the ISAS. The ISAS may be useful in research and treatment contexts as a comprehensive measure of NSSI functions.

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.

A prospective study of child maltreatment and self-injurious behavior in a community sample

In conjunction with prospective ratings of child maltreatment (i.e., sexual abuse, physical abuse, and physical neglect) and measures of dissociation and somatization, this study examined prospective pathways between child maltreatment and nonsuicidal, direct self-injurious behavior (SIB; e.g., cutting, burning, self-hitting). Ongoing participants in the Minnesota Longitudinal Study of Parents and Children (N = 164; 83 males, 81 females) completed a semistructured interview about SIB when they were 26 years old. SIB emerged as a heterogeneous and prominent phenomenon in this low-income, mixed-gender, community sample. Child sexual abuse predicted recurrent injuring (i.e., three or more events; n = 13), whereas child physical abuse appeared more salient for intermittent injuring (i.e., one to two events; n = 13). Moreover, these relations appeared largely independent of risk factors that have been associated with child maltreatment and/or SIB, including child cognitive ability, socioeconomic status, maternal life stress, familial disruption, and childhood exposure to partner violence. Dissociation and somatization were related to SIB and, to a lesser degree, child maltreatment. However, only dissociation emerged as a significant mediator of the observed relation between child sexual abuse and recurrent SIB. The findings are discussed within a developmental psychopathology framework in which SIB is viewed as a compensatory regulatory strategy in posttraumatic adaptation.

Development of mental health first aid guidelines for deliberate non-suicidal self-injury: a Delphi study

BACKGROUND

It is estimated that around 4% of the population engages, or has engaged, in deliberate non-suicidal self-injury. In clinical samples, the figures rise as high as 21%. There is also evidence to suggest that these figures may be increasing. A family member or friend may suspect that a person is injuring themselves, but very few people know how to respond if this is the case. Simple first aid guidelines may help members of the public assist people to seek and receive the professional help they require to overcome self-injury.

METHODS

This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 26 professionals, 16 people who had engaged in self-injurious behaviour in the past and 3 carers of people who had engaged in self-injurious behaviour in the past. Statements about providing first aid to a person engaged in self-injurious behaviour were sought from the medical and lay literature, but little was found. Panel members were asked to respond to general questions about first aid for NSSI in a variety of domains and statements were extracted from their responses. The guidelines were written using the items most consistently endorsed by the consumer and professional panels.

RESULTS

Of 79 statements rated by the panels, 18 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION

There are a number of actions which are considered to be useful for members of the public when they encounter someone who is engaging in deliberate, non-suicidal self-injury. These guidelines will be useful in revising curricula for mental health first aid and NSSI first aid training programs. They can also be used by members of the public who want immediate information about how to assist a person who is engaging in such behaviour.

Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury

BACKGROUND

Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.

AIMS

We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.

METHOD

Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10,498 consecutive episodes of self-harm at six English teaching hospitals.

RESULTS

Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.

CONCLUSIONS

Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

A rhesus monkey model of self-injury: effects of relocation stress on behavior and neuroendocrine function

BACKGROUND

Self-injurious behavior (SIB), a disorder that afflicts many individuals within both clinical and nonclinical populations, has been linked to states of heightened stress and arousal. However, there are no published longitudinal data on the relationship between increases in stress and changes in the incidence of SIB. This study investigated the short- and long-term behavioral and neuroendocrine responses of SIB and control monkeys to the stress of relocation.

METHODS

Twenty adult male rhesus macaques were exposed to the stress of relocation to a new housing arrangement in a newly constructed facility. Daytime behavior, sleep, and multiple measures of hypothalamic-pituitary-adrenocortical (HPA) axis function were investigated before and after the move.

RESULTS

Relocation induced a complex pattern of short- and long-term effects in the animals. The SIB animals showed a long-lasting increase in self-biting behavior, as well as evidence of sleep disturbance. Both groups exhibited elevated cortisol levels in saliva, serum, and hair, and also an unexpected delayed increase in circulating concentrations of corticosteroid binding globulin (CBG).

CONCLUSIONS

Our results indicate that relocation is a significant stressor for rhesus macaques and that this stressor triggers an increase in self-biting behavior as well as sleep disturbance in monkeys previously identified as suffering from SIB. These findings suggest that life stresses may similarly exacerbate SIB in humans with this disorder. The HPA axis results underscore the potential role of CBG in regulating long-term neuroendocrine responses to major stressors.

Nonsuicidal self-harm in youth: a population-based survey

BACKGROUND

Nonsuicidal self-harm includes cutting, scratching, burning and minor overdosing. There have been few studies that have examined the rate of self-harm and mental-health correlates among community-based youth. We performed a population-based study to determine the prevalence of nonsuicidal self-harm, its mental-health correlates and help-seeking behaviour.

METHODS

We used data from the Victoria Healthy Youth Survey, a population-based longitudinal survey of youth aged 14-21 in Victoria, British Columbia. The survey included questions about the history, method, frequency, age of onset and help-seeking for nonsuicidal self-harm. Youth were interviewed between February and June 2005. Univariable group differences were analyzed using students t test for continuous data and chi2 for binary or categorical data. Multivariate analyses were conducted by use of multivariate analysis of variance and logistic regression.

RESULTS

Ninety-six of 568 (16.9%) youth indicated that they had ever harmed themselves. Self-injuries such as cutting, scratching and self-hitting were the most common forms of nonsuicidal self-harm (83.2%). The mean age of onset was 15.2 years. Of those who reported nonsuicidal self-harm, 56% had sought help for this behaviour. Participants who reported 5 or more symptoms (out of 6) in a given symptom category were more likely than those who reported less than 5 symptoms to report nonsuicidal self-harm for the following categories: depressive mood (odds ratio [OR] 2.18, confidence interval [CI] 1.28-3.7) and problems with regulation of attention, impulsivity and activity (OR 2.24, CI 1.33-3.76).

INTERPRETATION

We found a high lifetime prevalence of nonsuicidal self-harm. Many mental-health symptoms were associated with this behaviour, particularly those with depressive mood and attention-related problems. Just over half of youth reported seeking help for nonsuicidal self-harm. Clinicians who encounter youth should be vigilant to assess for this behaviour in youth who present with mental health issues.

Prevalence and correlates of self-injury among university students

OBJECTIVE

The authors' purpose in this research was to establish estimates of the prevalence and correlates of nonsuicidal self-injury among university students.

PARTICIPANTS

The authors recruited participants (N = 2,843) from a random sample of 5,021 undergraduate and graduate students attending a large midwestern public university.

METHODS

Using an Internet-based survey, the authors measured the prevalence of self-injury and potential risk factors, including depression, anxiety, eating disorders, suicidal thoughts, and negative health behaviors.

RESULTS

Seven percent of students reported any self-injury over the previous 4 weeks. Factors associated with a significantly higher likelihood (p <.05) of self-injury included cigarette smoking, concurrent depressive and anxiety disorders, and for men, growing up in a family of low socioeconomic status and having symptoms of eating disorders. Only 26% of those who reported self-injury received mental health therapy or medication in the previous year.

CONCLUSIONS

Students who harm themselves experience high anxiety and distress, yet are unlikely to seek help.

Childhood sexual abuse and non-suicidal self-injury: meta-analysis

BACKGROUND

Many theorists posit that childhood sexual abuse has a central role in the aetiology of self-injurious behaviour. Studies that report statistically significant associations between a history of such abuse and self-injury are cited to support this view.

AIMS

A meta-analysis was conducted to determine systematically the magnitude of the association between childhood sexual abuse and self-injurious behaviour.

METHOD

Forty-five analyses of the association were identified. Effect sizes were converted to a standard metric and aggregated.

RESULTS

The relationship between childhood sexual abuse and self-injurious behaviour is relatively small (mean weighted aggregate phi=0.23). This figure may be inflated owing to publication bias. In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

CONCLUSIONS

Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.