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Luo D, Tan L, Huang X, Lai M, Shi H, Li J, Chen X, Xu J, Guo W. Functions of nonsuicidal self-injury and repeated nonsuicidal self-injury among adolescents: A moderating role of addictive features. J Psychiatr Res 2024; 175:251-258. [PMID: 38749299 DOI: 10.1016/j.jpsychires.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/27/2023] [Accepted: 04/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE The high prevalence and addictive features of nonsuicidal self-injury (NSSI) in adolescents have been documented, but the role of addictive features in the process from NSSI functions to behaviour remains unclear. The major aim of this study was to investigate the effect of addictive features on NSSI functions and the severity of repeated NSSI. METHODS A total of 10,781 students from primary and middle schools in Chengdu and Karamay were invited to participate in the online cross-sectional survey, and 10,501 completed the survey. Two self-report questionnaires, the Ottawa Self-Injury Inventory (OSI) and the Adolescent Self-Harm Scale (ASHS), were used to collect data from all participants. RESULTS Among the students, 23.45% and 6.64% reported having engaged in NSSI at least once or at least five times in the past year. Being a girl, being an only child, and being in a single-parent family were significantly associated with more severe NSSI. Addictive features have high value for predicting repeated NSSI. In addition to their significant independent/direct additive effects, addictive features mediated and moderated the relationship between NSSI functions and increased severity of NSSI in adolescents. DISCUSSION AND CONCLUSIONS The findings suggest that addictive features play a critical role in the development of repeated NSSI in adolescents, which indicates that addiction models may partially explain the mechanism underlying increased severity of NSSI. This may enhance understanding of the reasons for repeated NSSI and inform interventions for repeated NSSI among adolescents.
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Affiliation(s)
- Dan Luo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingfeng Lai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxia Shi
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiacan Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China.
| | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Wanjun Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Gao Y, Liu J, Liu X, Wang Y, Qiu S. Dimensions of family stress and repetitive nonsuicidal self-injury in adolescence: Examining the interactive effects of impulsivity and emotion dysregulation. CHILD ABUSE & NEGLECT 2024; 152:106804. [PMID: 38636157 DOI: 10.1016/j.chiabu.2024.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/16/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Repetitive non-suicidal self-injury (R-NSSI) in adolescence represents a significant risk factor for suicide. Although exposure to family stress is robustly associated with the risk of non-suicidal self-injury (NSSI), studies have not examined the potential mechanisms linking different forms of family stress and R-NSSI. OBJECTIVE This study examined how unique dimensions of family stress (threat and deprivation) relate to R-NSSI via interactions between impulsivity and emotion dysregulation. PARTICIPANTS AND SETTING The current sample included 3801 middle-school adolescents (42.2 % girls, Mage = 13.21 years). METHODS We conducted a two-wave study with 6-month intervals. Participants completed self-report measures assessing family stress, impulsivity, emotion dysregulation, and NSSI. RESULTS Moderate mediation analyses showed that threat was indirectly associated with NSSI frequency through the interaction of impulsivity and emotion dysregulation in the R-NSSI group and indirectly through impulsivity in the occasional NSSI (O-NSSI) group. Deprivation did not predict subsequent NSSI frequency in either group. CONCLUSIONS These findings lend empirical support to dimensional models of adversity and suggest that adolescents who experience threat-related family stress may have greater impulsivity and are more likely to report R-NSSI in the context of emotion dysregulation.
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Affiliation(s)
- Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
| | - Yumeng Wang
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Shaojie Qiu
- Faculty of Psychology, Beijing Normal University, Beijing, China
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Lin L, Liu Y, Qiu S, Yang Y, Yang Y, Tian M, Wang S, Zhang J, Bai X, Xu Z. Orbital frontal cortex functional connectivity during gain anticipation linking the rumination and non-suicidal self-injury in late adolescence. J Affect Disord 2024; 350:673-680. [PMID: 38228278 DOI: 10.1016/j.jad.2024.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is prevalent and especially among the adolescence population. It has been argued that abnormal brain activations in reward processing could be regarded as objective biomarkers in NSSI, but the evidence is mixed. This study aims to explore the reward processing mechanism of NSSI from the perspective of functional brain circuitry and investigate the role of a cognitive factor (rumination). METHOD Seventy-one 17-21 years old participants performed a monetary incentive delay (MID) task during functional magnetic resonance imaging scanning. Psychophysiological interaction (PPI) analysis was used to test the inner-group differences of brain functional connectivity. In addition, a mediation model was established with the mediation effect of rumination on the relationship between functional brain circuitry and NSSI. RESULTS PPI analysis suggested that functional connectivity of the orbital frontal cortex (OFC) (with precuneus, SMA) was significantly enhanced in NSSI in the gain > loss contrast, but not in the loss > gain contrast. Mediation analysis revealed that rumination mediated the relationship between NSSI and the OFC- precuneus functional connectivity in the gain > loss contrast. CONCLUSION Our research revealed that the abnormal OFC functional connectivity in gain (not loss) anticipation can be served as the sensitive biomarkers of NSSI. And there was a chain path for NSSI, that was from functional brain circuitry to negative cognition and then to problem behavior.
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Affiliation(s)
- Lin Lin
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Yu Liu
- Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua 321004, Zhejiang, China; Department of Psychology, Zhejiang Normal University, Jinhua 321004, Zhejiang, China
| | - Shaojie Qiu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yanan Yang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Yang Yang
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Beijing 100875, China
| | - Mingyangjia Tian
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- Central University of Finance and Economics, Beijing 100081, China; Buffalo State Department of Sociology, State University of New York, Buffalo 10001, USA
| | - Xuejun Bai
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Zhansheng Xu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Center of Cooperative Innovation for Assessment and Promotion of National Mental Health under Ministry of Education, Tianjin 300387, China; Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China.
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Liu B, Jiang L, Yuan M, Zhu H, Zhang W. Pica in a girl with non-suicidal self-injury: a case report. Front Psychiatry 2023; 14:1320079. [PMID: 38179246 PMCID: PMC10765586 DOI: 10.3389/fpsyt.2023.1320079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Non-suicidal self-injury (NSSI) is on the rise globally, posing a significant societal challenge. Pica, an eating disorder, presents difficulties in treatment due to the absence of effective medications. In this report, we discuss a complex case involving the co-occurrence of pica and non-suicidal self-injury. A 13-year-old girl was admitted to our hospital due to ingesting two batteries. She features a persistent, intense appetite along with sudden and compulsive behaviors such as consuming inedible items or self-inflicted cutting. After receiving a combination of pharmacological treatments (quetiapine, lithium and sertraline), cognitive behavioral therapy (CBT) and modified electroconvulsive therapy (MECT) for 25 days, she was discharged with relief from her clinical symptoms.
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Affiliation(s)
- Bo Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
- Zigong Mental Health Center, Zigong, China
| | - Lijun Jiang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Hongru Zhu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
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Jacobucci R, Ammerman BA. Examining the dynamic relationship between nonsuicidal self-injury and alcohol use experiences. Suicide Life Threat Behav 2023; 53:1108-1116. [PMID: 37888891 DOI: 10.1111/sltb.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/13/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Nonsuicidal self-injury (NSSI) is a prevalent and concerning behavior and its risk pathways require a greater understanding, particularly in predicting short-term risk. Although the literature has supported a between-person link among NSSI and alcohol use, limited research has directly examined the nuances of this relationship at the within-person level using intensive longitudinal data. METHOD Utilizing two independent samples (total n = 85), the current study examined bidirectional, concurrent and prospective risk relationships between NSSI and alcohol, considering both urges and behavior engagement, via ecological momentary assessment. RESULTS Findings demonstrate concurrent, within-person relationships between NSSI urges and alcohol urges, as well as alcohol use. Alternatively, prospective between-person findings demonstrated negative relationships between NSSI urges and alcohol use, as well as alcohol urges and NSSI acts; however, this may represent suppression effects as associations were positive with the removal of autoregressive effects. CONCLUSIONS Together, findings support proximal risk relationships between NSSI and alcohol experiences that, for urges in particular, is bidirectional.
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Affiliation(s)
- Ross Jacobucci
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Brooke A Ammerman
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
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Pape VR, Braun S, Peters S, Stingl M, Tucha O, Sammer G. The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls. Personal Ment Health 2023; 17:328-351. [PMID: 37042027 DOI: 10.1002/pmh.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.
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Affiliation(s)
- Valeska Reichel Pape
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silke Braun
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Svenja Peters
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Markus Stingl
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Oliver Tucha
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Gebhard Sammer
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
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Niu Z, Luo H, Zhang X, Wu X, Tang Q, Chen C, Li J. Brain-gut axis mechanism of subthreshold nonsuicidal self-injury addictive features in adolescents. Cereb Cortex 2023; 33:10784-10792. [PMID: 37724424 DOI: 10.1093/cercor/bhad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/20/2023] Open
Abstract
Nonsuicidal self-injury (NSSI) is associated with an increased risk of suicide. As the diagnostic criteria outlined in DSM-5 and other related clinical studies, a patient must have engaged in self-injurious behavior at least 5 times within the past year. However, patients with fewer than 5 self-injury behaviors should not be ignored. Our study included 46 adolescents aged 10-19 years with subthreshold NSSI (sNSSI), along with a control group of 50 healthy adolescents matched for age and other factors. We collected resting-state functional magnetic resonance imaging data and stool samples. The Ottawa Self-Injury Inventory and Deliberate Self-Harm Inventory were used to evaluate self-harm behaviors and addictive features. Local brain activity was assessed using fractional amplitude of low-frequency fluctuations (fALFF), and brain regions with abnormal fALFF were selected as seeds for whole-brain functional connectivity analysis. Stool samples were identified using 16S rDNA amplicon sequencing, and the LDA Effect Size method was used to explore significant differences between grouped samples. Mediation analysis was performed to investigate the brain-gut axis mechanisms of addictive features in sNSSI. We found that compared with healthy controls, sNSSI patients have abnormal fALFF in left thalamus and posterior cingulate cortex, dysconnectivities of left thalamus, and decreased Prevotellaceae. Our results suggested that addictive features of sNSSI may have a brain-gut mechanism. Furtherly, patients with 1-4 NSSI behaviors in the past year should have separate name for identification, such as "subthreshold NSSI".
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Affiliation(s)
- Zhiang Niu
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dian Xin Nan Road, Chengdu, Sichuan 610041, China
| | - Huiting Luo
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dian Xin Nan Road, Chengdu, Sichuan 610041, China
| | - Xun Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Xiaohui Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wan Ping Road, Xuhui District, Shanghai 200030, China
| | - Qiao Tang
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dian Xin Nan Road, Chengdu, Sichuan 610041, China
| | - Chen Chen
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dian Xin Nan Road, Chengdu, Sichuan 610041, China
| | - Jing Li
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dian Xin Nan Road, Chengdu, Sichuan 610041, China
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Wu B, Zhang H, Chen J, Chen J, Liu Z, Cheng Y, Yuan T, Peng D. Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review. Gen Psychiatr 2023; 36:e100946. [PMID: 37655114 PMCID: PMC10465892 DOI: 10.1136/gpsych-2022-100946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive. Aims To review present evidence related to the potential mechanisms of NSSI in MDD. Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality. Results A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study). Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.
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Affiliation(s)
- Baichuan Wu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifeng Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghong Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- General Psychiatry Editorial Office, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaye Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Thomas D, Bonnaire C. Non-Suicidal Self-Injury and Emotional Dysregulation in Male and Female Young Adults: A Qualitative Study. Soa Chongsonyon Chongsin Uihak 2023; 34:159-168. [PMID: 37426830 PMCID: PMC10326353 DOI: 10.5765/jkacap.230033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives Non-suicidal self-injury (NSSI) has been theoretically, clinically, and empirically associated with emotional dysregulation. NSSI is a means of regulating emotional states, particularly negative emotions. However, empirical studies on this topic are scarce and the literature lacks qualitative research on individuals' perceptions and comprehension of the function of self-injury. Thus, this qualitative study aimed to provide novel insights into the relationship between NSSI and emotional dysregulation in young adults. Methods Twelve participants (mean age=22.7 years, 9 females and 3 males) from different support groups and a healthcare center participated in semi-structured interviews on NSSI-related emotional processes. Three aspects were investigated: reasons for NSSI, function of NSSI, and emotions. Each interview was voice recorded and typically lasted between 20 and 40 minutes. All responses were analyzed using thematic analysis. Results Four major themes were identified. The results showed that NSSI had both intrapersonal and interpersonal functions, within which emotional regulation played a significant role. NSSI was also used to regulate positive emotions. The results also showed a sequence of emotions among the participants, going from feeling overwhelmed to feeling relatively calm but guilty. Conclusion NSSI has several functions for the same individual. Thus, it would be interesting to provide integrative therapy, such as emotion-focused therapy, which focus on improving intrapersonal and interpersonal emotion regulation skills and strategies.
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Affiliation(s)
| | - Celine Bonnaire
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne Billancourt, France
- Centre de Soins d'Accompagnement et de Prévention en Addictologie Pierre Nicole, Paris, France
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Yin Q, Wilks CR. Untangling the temporal association between daily urges to die by suicide and to use substances. Psychiatry Res 2023; 323:115178. [PMID: 37012190 DOI: 10.1016/j.psychres.2023.115178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
The current study examined the potential bi-directional associations between urges to die by suicide and to use alcohol or drugs as well as sadness and anger in relation to these urges. Forty individuals with suicidal thoughts, binge drinking behaviors, and emotion regulation difficulties, who were recruited for a clinical trial of internet-delivered Dialectical Behavior Therapy skills training, completed daily diaries on suicide and substance use urges and emotions over twenty-one days. Results indicated that higher daily peak substance use urges were associated with a greater likelihood of reporting suicide urges on the next day. Participants with higher and an increase in peak substance use urges (relative to their daily average) were both more likely to report suicide urges on the same day. Furthermore, both daily peak sadness and anger ratings predicted next-day suicide urges while accounting for substance use urges, though sadness may be a stronger predictor. These findings suggested a possible unidirectional pathway from urges to use substances to subsequent urges to die by suicide and a unique role of sadness.
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Affiliation(s)
- Qingqing Yin
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Chelsey R Wilks
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd, St. Louis, MO 63121, USA
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Reinhardt M, Rice KG, Horváth Z. Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample. Front Psychiatry 2022; 13:1046576. [PMID: 36532173 PMCID: PMC9751932 DOI: 10.3389/fpsyt.2022.1046576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Adolescents with psychiatric problems are also considered a vulnerable population in terms of non-suicidal self-injury (NSSI). In the current study, we examined the associations of interpersonal and intrapersonal NSSI motivations with several NSSI severity indicators and psychopathological characteristics. Materials and methods In a cross-sectional research design, 158 adolescents (83.5% girls; mean age = 16.10 years; SD = 1.49) who have received inpatient or outpatient psychiatric treatment completed the Inventory of Statements About Self-Injury, the Strengths and Difficulties Questionnaire, and the Self-Critical Rumination Scale. Results More than two-thirds of the sample (75.3%; n = 119) reported at least one episode of NSSI in their life, and 45.38% (n = 54) have engaged in NSSI in the past month (current self-injury). The results indicated that only intrapersonal NSSI functions were linked to NSSI severity indicators (current and repetitive NSSI, versatility), interpersonal functions were not. Furthermore, a number of psychopathological features (co-occurring mental disorders, presence of a mood disorder, more internalizing mental illness symptoms, and more pronounced self-critical rumination) were associated with engaging in NSSI for intrapersonal reasons. We also identified other differences within the specific intrapersonal NSSI motivations. It should be highlighted that the anti-suicide function of NSSI behaved in exactly the opposite way as the other intrapersonal motivations. Discussion All this points to the fact that in clinical settings, detailed assessment of NSSI motivations and severity indicators can help to develop a more effective treatment plan.
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Affiliation(s)
- Melinda Reinhardt
- Department of Clinical Psychology and Addiction, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Kenneth G. Rice
- Center for the Study of Stress, Trauma, and Resilience, Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, United States
| | - Zsolt Horváth
- Department of Personality and Health Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Wang K, He Q, Zhu X, Hu Y, Yao Y, Hommel B, Beste C, Liu J, Yang Y, Zhang W. Smaller putamen volumes are associated with greater problems in external emotional regulation in depressed adolescents with nonsuicidal self-injury. J Psychiatr Res 2022; 155:338-346. [PMID: 36179414 DOI: 10.1016/j.jpsychires.2022.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
The functions of nonsuicidal self-injury (NSSI) consist of social and emotional aspects (Social influence, Sensation seeking, Internal and External emotion regulation). Previous studies have indicated that dysfunction in reward-related brain structures especially the striatum might drive this habitual behavior. However, no studies to date have investigated the associations between striatum and different functions for adolescents engaging in NSSI behaviors. Here, we recruited 35 depressed adolescents with recent NSSI behaviors and 36 healthy controls and acquired structural brain images, depressive symptoms, social, academic and family environments assessments, in addition to NSSI functions in patients only. Subcortical volumes and cortical thickness were estimated with FreeSurfer. Mixed linear regressions were performed to examine associations between striatal structures (caudate, putamen, nucleus accumbens, pallidum) and NSSI functions, with age, sex, total intracranial volume, hemisphere and depression severity included as covariates. Effect of environmental factors and potential associations with cortical thickness and other subcortical volumes were also tested. We found that, among the four functions, external emotional regulation represented the main function for NSSI engagement. Increased external emotion regulation was significantly associated with smaller putamen volume. No environmental factors biased the association with putamen. No associations with other cortical or subcortical regions were observed. Our findings suggested that smaller putamen might be a biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions. The results have potentially clinical implications in early identification and brain intervention of NSSI in youth.
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Affiliation(s)
- Kangcheng Wang
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Qiang He
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xingxing Zhu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yufei Hu
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Yuan Yao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Bernhard Hommel
- School of Psychology, Shandong Normal University, Jinan, 250358, China; Cognitive Psychology Unit, & Leiden Institute for Brain & Cognition, Institute of Psychology, Leiden University, Netherlands; Department of Child and Adolescent Psychiatry, TU Dresden, Germany
| | - Christian Beste
- School of Psychology, Shandong Normal University, Jinan, 250358, China; Department of Child and Adolescent Psychiatry, TU Dresden, Germany; University Neuropsychology Center, TU Dresden, Germany
| | - Jintong Liu
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Childhood Psychiatry Unit, Shandong Mental Health Center, Jinan, 250014, China
| | - Ying Yang
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Childhood Psychiatry Unit, Shandong Mental Health Center, Jinan, 250014, China.
| | - Wenxin Zhang
- School of Psychology, Shandong Normal University, Jinan, 250358, China.
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Abstract
We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96-129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01-1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01-1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTSNon-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt.Adolescents with NSSH with suicide attempt had relatively greater psychopathology.Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.
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Zinchuk M, Beghi M, Beghi E, Bianchi E, Avedisova A, Yakovlev A, Guekht A. Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation. Arch Suicide Res 2022; 26:776-800. [PMID: 33108991 DOI: 10.1080/13811118.2020.1833801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia. METHODS A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated. RESULTS Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8). LIMITATIONS Retrospective design, referral population, single center study, and exclusion of psychotic patients. CONCLUSIONS NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.
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Himelein-Wachowiak M, Giorgi S, Kwarteng A, Schriefer D, Smitterberg C, Yadeta K, Bragard E, Devoto A, Ungar L, Curtis B. Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm. J Behav Addict 2022; 11:128-139. [PMID: 35312631 PMCID: PMC9109623 DOI: 10.1556/2006.2022.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/21/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & AIMS Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially. METHODS To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI. RESULTS A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous. DISCUSSION & CONCLUSION Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.
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Affiliation(s)
| | - Salvatore Giorgi
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Kwarteng
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Chase Smitterberg
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Kenna Yadeta
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Elise Bragard
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Amanda Devoto
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Lyle Ungar
- Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Curtis
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Corresponding author. Biomedical Research Center, 251 Bayview Blvd. Suite 200, Baltimore, MD 21224, USA. Tel.:+ 443-740-2126. E-mail:
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16
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Lee SE, Yim M, Hur JW. Beneath the surface: Clinical and psychosocial correlates of posting nonsuicidal self-injury content online among female young adults. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Opozda-Suder S, Karteczka-Świętek K, Piasecka M. Psychometric properties and longitudinal measurement invariance of the drug craving scale: Modification of the Polish version of the Penn Alcohol Craving Scale (PACS). PLoS One 2021; 16:e0256018. [PMID: 34495966 PMCID: PMC8425527 DOI: 10.1371/journal.pone.0256018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The Penn Alcohol Craving Scale (PACS) is an instrument with good psychometric properties that is widely used to assess alcohol craving. Based on the assumption that the experience of craving is independent of substance type, the Polish version of the PACS was modified to measure drug craving, thus creating the Penn Drug Craving Scale (PDCS). The analyses presented in the paper aim to verify the hypothesis that the PDCS has a unidimensional structure, is highly reliable and features longitudinal measurement invariance. Methods The research was conducted in 14 inpatient and 13 outpatient randomly selected facilities that provide psychosocial therapy to people with substance use disorder (SUD) in Poland, during June 2018 –July 2019. The data used for the analyses came from 282 patients diagnosed on the basis of ICD-10 criteria (F11.2-F19.2). The paper presents analyses with the application of: [1] confirmatory factor analysis (CFA) conducted on the basis of a polychoric correlation matrix and the WLSMV estimator; [2] a reliability estimate using Cronbach’s alpha and coefficient omega; [3] verification of longitudinal measurement invariance between the beginning and end of therapy; [4] evaluation of criterion validity; [5] normalisation of the raw scores. Results The CFA results confirmed a unidimensional PDCS structure (RMSEA = 0.047, 95% CI: 0.000–0.103; CFI = 0.999; TLI = 0.999) and a high reliability of the scale (ω = 0.93). Moreover, a strict longitudinal measurement invariance of the instrument was confirmed. Conclusions Accurate assessment of craving is possible only with valid and reliable instruments. Therefore, the psychometric properties of the PDCS were verified based on the latest statistical approaches. The scale is a valid and highly reliable tool featuring longitudinal measurement invariance and can be usefully used for research and clinical purposes. Thus, the Polish version of the PACS has been modified and successfully applied to the population of people with SUD.
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Affiliation(s)
- Sylwia Opozda-Suder
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
- * E-mail:
| | - Kinga Karteczka-Świętek
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
| | - Małgorzata Piasecka
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
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18
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Matera E, Margari M, Serra M, Petruzzelli MG, Gabellone A, Piarulli FM, Pugliese A, Tassiello AR, Croce F, Renna C, Margari A. Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults. Brain Sci 2021; 11:brainsci11080974. [PMID: 34439593 PMCID: PMC8391479 DOI: 10.3390/brainsci11080974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann-Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.
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Affiliation(s)
- Emilia Matera
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy;
- Correspondence:
| | - Mariella Margari
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Maria Serra
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Maria Giuseppina Petruzzelli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Alessandra Gabellone
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy;
| | - Francesco Maria Piarulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Assunta Pugliese
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Anna Rita Tassiello
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Federica Croce
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
| | - Caterina Renna
- Center for Treatment and Research on Eating Disorders Mental Health Department AL, Via Miglietta 5, 73100 Lecce, Italy;
| | - Anna Margari
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.M.); (M.S.); (M.G.P.); (F.M.P.); (A.P.); (A.R.T.); (F.C.); (A.M.)
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19
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Abstract
ABSTRACT Nonsuicidal self-injury (NSSI) is a behavior that can be perplexing to many people. Usually engaged as a means of regulating intense or unwanted emotions, it seems to counter the human instinct to avoid pain and harm to the self. The language people use to talk about NSSI, and individuals who engage in the behavior, can contribute to the significant stigma that is associated with NSSI. In this data-driven commentary, we report on the language clinicians and researchers typically use when talking about NSSI, and the language they consider appropriate to use. We observed some disparity in the language people use and what they deemed appropriate. Notably, researchers and clinicians report underusing terms that people with lived experience find most appropriate (someone with a history of self-injury; someone with lived experience of self-injury). We call on all researchers and clinicians to be mindful of the language they use to discuss NSSI and adopt person-centered and respectful language at all times.
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Affiliation(s)
- Penelope A Hasking
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Mark E Boyes
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
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20
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Escelsior A, Belvederi Murri M, Corsini GP, Serafini G, Aguglia A, Zampogna D, Cattedra S, Nebbia J, Trabucco A, Prestia D, Olcese M, Barletta E, Pereira da Silva B, Amore M. Cannabinoid use and self-injurious behaviours: A systematic review and meta-analysis. J Affect Disord 2021; 278:85-98. [PMID: 32956965 DOI: 10.1016/j.jad.2020.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing availability of high-potency cannabis-derived compounds and the use of synthetic cannabinoids may be responsible for severe side effects like cognitive impairment, psychosis or self-injurious behaviours (SIB). In particular, SIB like non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) raise growing concern as a possible consequence of cannabis use. However, the research to date has not addressed the relationship between cannabinoid use and SIB systematically. METHODS We conducted a systematic review on PubMed up to March 2020, using search terms related to cannabinoids and SIB. RESULTS The search yielded a total of 440 abstracts. Of those, 37 studies published between 1995 and 2020 were eligible for inclusion. Cannabinoid use was significantly associated with SIB at the cross-sectional (OR=1.569, 95%CI [1.167-2.108]) and longitudinal (OR=2.569, 95%CI [2.207-3.256]) level. Chronic use, presence of mental disorders, depressive symptoms, emotional dysregulation and impulsive traits might further increase the likelihood of self-harm in cannabis users. Synthetic cannabinoids may trigger highly destructive SIB mainly through the psychotomimetic properties of these compounds. CONCLUSION Cannabinoid use was associated with an increased prevalence of self-injury and may act as a causative factor with a duration-dependent manner. Emotional regulation and behavioural impulsivity functions might crucially moderate this association. Future studies should further investigate the mechanisms underlying this association, while exploring potential therapeutic applications of substances modulating the endocannabinoid system.
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Affiliation(s)
- Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Pietro Corsini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Zampogna
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Cattedra
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jacopo Nebbia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alice Trabucco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Prestia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Olcese
- Department of Educational Science - Psychology Unit, University of Genoa, Genoa, Italy
| | | | - Beatriz Pereira da Silva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bout A, Kettani N, Berhili N, Aarab C, Rammouz I, Aalouane R. Les conduites d’automutilation non suicidaires dans une population recrutée pendant une hospitalisation en psychiatrie : À propos de 100 patients. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Blasco-Fontecilla H, Herranz-Herrer J, Ponte-Lopez T, Gil-Benito E, Donoso-Navarro E, Hernandez-Alvarez E, Gil-Ligero M, Horrillo I, Meana JJ, Royuela A, Rosado-Garcia S, Sánchez-López AJ. Serum β-endorphin levels are associated with addiction to suicidal behavior: A pilot study. Eur Neuropsychopharmacol 2020; 40:38-51. [PMID: 32855024 DOI: 10.1016/j.euroneuro.2020.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 01/21/2023]
Abstract
The literature provides partial support for the hypothesis that some suicide attempters develop a behavioral addiction to suicidal behavior (SB). We hypothesized that major suicide repeaters (MR) (≥5 lifetime suicide attempts) are addicted to suicide attempts as measured by modified DSM-IV criteria for substance dependence. In this cross-sectional study with 13 psychiatric controls (PC), 55 non-major suicide attempters (NMR), and 9 MR we found that MR are characterized by emotional abuse and neglect, as well as higher scores on the Personality and Life Event scale (short version). The levels of 8 AM serum ACTH, cortisol and β-endorphin were elevated in all three groups. Serum β-endorphin (pg/mL) was particularly high in PC diagnosed with schizophrenia 220.34 (±56.30). The level of 8 AM serum β-endorphin rose with increased numbers of criteria met for addiction to SB from 130.31 (±88.16) (≥ 3 criteria met for addiction to SB) to 174.84 (±114.93) (≥ 6 criteria met for addiction to SB) whereas serum ACTH and cortisol did not change. SB addicts (≥ 6 criteria) displayed higher serum β-endorphin concentrations than non-addicts (174.84 ± 114.93 vs. 116.93 ± 61.70, FET p = 0.09). The present study brings some support to the addictive hypothesis of SB. Our results delineate β-endorphin as a promising biomarker of SB addiction, and offer a good basis for future studies that test whether buprenorphine can be used to prevent repetitive suicide attempts, non-suicidal-self-injury (NSSI), and the development of an addiction to SB.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Autonoma University of Madrid, Madrid, Spain; Center of Biomedical Network Research on Mental Health (CIBERSAM), Madrid, Spain; CAS, ITA Salud Mental, Madrid, Spain.
| | - Javier Herranz-Herrer
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain
| | - Teresa Ponte-Lopez
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain
| | - Elena Gil-Benito
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain
| | - Encarnación Donoso-Navarro
- Department of Clinical Biochemistry, Puerta de Hierro University Hospital, IDIPHISA, Majadahonda, Madrid, Spain
| | - Elena Hernandez-Alvarez
- Department of Clinical Biochemistry, Puerta de Hierro University Hospital, IDIPHISA, Majadahonda, Madrid, Spain
| | - Maria Gil-Ligero
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Majadahonda, Madrid, Spain
| | - Igor Horrillo
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Madrid, Spain; Department of Pharmacology, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Spain
| | - J Javier Meana
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Madrid, Spain; Department of Pharmacology, University of the Basque Country, Biocruces Bizkaia Health Research Institute, Spain
| | - Ana Royuela
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, CIBERESP, Madrid, Spain
| | - Silvia Rosado-Garcia
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Majadahonda, Madrid, Spain
| | - Antonio J Sánchez-López
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Majadahonda, Madrid, Spain; Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Majadahonda, Madrid, Spain.
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Tao Y, Bi XY, Deng M. The Impact of Parent-Child Attachment on Self-Injury Behavior: Negative Emotion and Emotional Coping Style as Serial Mediators. Front Psychol 2020; 11:1477. [PMID: 32848972 PMCID: PMC7411466 DOI: 10.3389/fpsyg.2020.01477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
In order to explore the relationship between parent–child attachment, negative emotion, emotional coping style, and self-injury behavior, 662 junior high school students in four junior middle schools in China’s Yunnan Province were investigated using a parent–child attachment questionnaire, adolescent negative emotion questionnaire, emotional coping style scale, and adolescent self-injury behavior scale. As a result, two mediate models were created to explain how parent–child attachment affects self-injury behavior. Negative emotion and emotional coping style play serial mediating roles in mother–child and father–child attachment models, respectively. The results show that negative emotion mediates between self-injury behavior and both father–child and mother–child attachment, while emotional coping style only functions between father–child attachment and self-injury behavior. By means of bootstrap analysis, negative emotion and emotional coping style have serial mediating roles concerning the impact of parent–child attachment on self-injury behavior. By comparison, the father–child and mother–child attachment have different mediating models: the former relies on emotional coping style, while the latter is associated with emotional experiences. This implies that parent–child attachment has different mechanisms in triggering self-injury behavior, which is in line with the hypothesis of attachment specificity.
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Affiliation(s)
- Yun Tao
- College of Education Science and Management, Yunnan Normal University, Kunming, China.,Key Laboratory of Educational Information for Nationalities, Kunming, China
| | - Xiao-Yan Bi
- College of Education Science and Management, Yunnan Normal University, Kunming, China.,Key Laboratory of Educational Information for Nationalities, Kunming, China
| | - Min Deng
- Department of Psychoiogy, Honghe University, Mengzi, China.,Faculty of Psychology, Southwest University, Beibei, China
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24
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Hennings JM. Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Front Psychiatry 2020; 11:199. [PMID: 32256412 PMCID: PMC7093558 DOI: 10.3389/fpsyt.2020.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Although great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. While BPD patients continue suffering from distress and aversive emotions, therapists and relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reviewing the current knowledge of the functions and background of non-suicidal self-injury, we learned that reinforcement mechanisms play an important role to understand why individuals act in deliberate self-mutilation. While individual motives for non-suicidal self-injury and suicidal behavior including suicidal ideations can differ, the principle mechanisms appear to be transferrable. Elucidating the individual motives and function of suicidal behavior is an important therapeutic step, giving us access to very central maladaptive schemes and false believes that we need to address in order to reduce chronic suicidality in BPD patients. This Perspective article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients.
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Affiliation(s)
- Johannes M. Hennings
- Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
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25
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Timberlake LM, Beeber LS, Hubbard G. Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit[Formula: see text]. J Am Psychiatr Nurses Assoc 2020; 26:10-26. [PMID: 31592703 DOI: 10.1177/1078390319878878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND. Between 4% to 70% of inpatients engage in self-harming behaviors and effective interventions are needed to address this population. AIM. This article reviews literature from 2007 to 2017 to address treatment and management strategies specific for the treatment of nonsuicidal self-injury in the inpatient psychiatric setting. METHODS. Cochrane, PsycINFO, PubMed, and CINAHL were searched for relevant articles with 34 studies reviewed for applicability to the question, and 9 parsed into a summary of Findings table. RESULTS. Therapeutic approaches that show promise include cognitive behavioral therapy, dialectical behavior therapy, and mentalization as well as medications that act on the serotonergic, dopaminergic, and opioid systems. Effective models of care aim toward enhancing therapeutic relationships with staff, providers, and most important, encouraging the internal shift toward recovery within the patient. CONCLUSIONS. More research with controlled designs in the inpatient setting is needed, however, regardless of which approach is used, the impact of the individual caregiver on the patient's recovery is key.
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Affiliation(s)
- Laurie M Timberlake
- Laurie M. Timberlake, MSN, PMHNP-BC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda S Beeber
- Linda S. Beeber, PhD, PMHNCNS-BC, FAAN, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grace Hubbard
- Grace Hubbard, DNP, PMHCNS-BC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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26
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Duarte E, Gouveia-Pereira M, Gomes HS. Development and Factorial Validation of the Inventory of Deliberate Self-Harm Behaviours for Portuguese Adolescents. Psychiatr Q 2019; 90:761-776. [PMID: 31385122 DOI: 10.1007/s11126-019-09660-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Deliberate self-harm (DSH) is a public health problem that mainly affects adolescents and young adults. Evidence suggests that multiple methods are used with a self-aggressive intent. The present article focuses on the development and factorial validation of the Inventory of Deliberate Self-harm Behaviours for Portuguese adolescents. This instrument assesses the lifetime frequency of 13 DSH methods, with and without suicidal intent. Study 1 consisted of an exploratory factor analysis with a sample of 131 adolescents with a reported history of DSH. Results revealed a three-factor structure with acceptable internal consistency: High Severity DSH, Mild Severity DSH, and Substance Use DSH. After item reduction, this structure was tested in Study 2 through a confirmatory factor analysis with an independent sample of 109 adolescents also with a history of DSH. Results showed an acceptable model fit. This instrument presents a solid structure and acceptable psychometric properties, allowing its use in further research.
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Affiliation(s)
- Eva Duarte
- CIE-ISPA, ISPA - Instituto Universitário, Rua Jardim do Tabaco 34, 1149-041, Lisbon, Portugal.
| | - Maria Gouveia-Pereira
- CIE-ISPA, ISPA - Instituto Universitário, Rua Jardim do Tabaco 34, 1149-041, Lisbon, Portugal
| | - Hugo S Gomes
- CIPsi - Psychology Research Center, Victims, Offenders and Justice System Research Unit, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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27
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Turner BJ, Baglole JS, Chapman AL, Gratz KL. Experiencing and Resisting Nonsuicidal Self-injury Thoughts and Urges in Everyday Life. Suicide Life Threat Behav 2019; 49:1332-1346. [PMID: 30152181 DOI: 10.1111/sltb.12510] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/30/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We used a daily diary to examine (1) the frequency of three types of NSSI thoughts and urges (fleeting thoughts, persistent thoughts, and intense urges), (2) the correlates of NSSI thought and urges within and across days, (3) strategies that aid in resisting NSSI thoughts and urges, and (4) the prospective association of daily NSSI thoughts and urges with NSSI behavior over 12 months. METHOD Sixty adults (aged 18-35) completed a two-week daily diary and follow-ups every 3 months for one year. RESULTS Fleeting NSSI thoughts were reported on 48% of days, whereas persistent thoughts (11%) and intense urges (17%) were less common. Within days, earlier stress predicted more persistent NSSI thoughts, whereas earlier perceived support predicted less intense NSSI urges. Furthermore, NSSI thoughts and urges were positively associated with same-day stress and avoidant coping. Problem-focused coping was associated with greater success resisting same-day fleeting thoughts and intense urges, as well as success resisting next-day persistent thoughts. Perceived support was associated with less intense same-day urges, but also less success resisting these urges. Over the follow-up, persistent thoughts predicted less frequent NSSI, whereas intense urges predicted more frequent NSSI. CONCLUSIONS NSSI thoughts and urges are commonly experienced and deserve further attention.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | | | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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28
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Taliaferro LA, Almeida J, Aguinaldo LD, McManama O'Brien KH. Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample. Clin Child Psychol Psychiatry 2019; 24:821-830. [PMID: 31315465 DOI: 10.1177/1359104519862340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts. METHOD Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data. RESULTS Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients' suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option. CONCLUSION Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.
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Affiliation(s)
- Lindsay A Taliaferro
- Department of Population Health Sciences, College of Medicine, University of Central Florida, USA
| | | | | | - Kimberly H McManama O'Brien
- Department of Health Promotion, Practice, and Innovation, Education Development Center, USA.,Department of Psychiatry, Boston Children's Hospital, USA.,Department of Psychiatry, Harvard Medical School, USA
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29
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Victor SE, Scott LN, Stepp SD, Goldstein TR. I Want You to Want Me: Interpersonal Stress and Affective Experiences as Within-Person Predictors of Nonsuicidal Self-Injury and Suicide Urges in Daily Life. Suicide Life Threat Behav 2019; 49:1157-1177. [PMID: 30159910 PMCID: PMC6395579 DOI: 10.1111/sltb.12513] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/13/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate near-term risk for self-injurious urges, we evaluated how within-person changes in internalizing and externalizing negative affect, as well as interpersonal rejection and criticism, impact subsequent nonsuicidal self-injury (NSSI) and suicide urges in daily life. METHOD Young adult women (N = 62) from an ongoing community cohort study with past-year self-injurious thoughts completed a 21-day ecological momentary assessment protocol. We used multilevel path analyses to model within-person effects of negative affect and interpersonal stress on subsequent suicide and NSSI urges within several hours. RESULTS When modeled simultaneously, within-person changes in internalizing, but not externalizing, negative affect predicted later self-injurious urges. Rejection and criticism predicted later self-injurious urges, with rejection showing a unique relationship to NSSI urges specifically. Effects of rejection and criticism on later NSSI and suicide urges were mediated by internalizing negative affect; rejection also retained a significant direct effect on NSSI urges. CONCLUSION Interpersonal stressors may be potent near-term risk factors for self-injurious urges by increasing internalizing negative affect among vulnerable individuals. The direct role of rejection and criticism on self-injurious urges is less clear, particularly for suicide. These findings have implications for understanding processes underlying self-injurious urges, as well as designing real-time interventions for these experiences in daily life.
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Affiliation(s)
- Sarah E. Victor
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Lori N. Scott
- University of Pittsburgh School of Medicine, Department of Psychiatry.,Corresponding Author: Lori N. Scott, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213. ; Telephone: 412-383-5016; Fax: 412-383-5068
| | | | - Tina R. Goldstein
- University of Pittsburgh School of Medicine, Department of Psychiatry
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30
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Moseley RL, Gregory NJ, Smith P, Allison C, Baron-Cohen S. A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability. Mol Autism 2019; 10:18. [PMID: 31007885 PMCID: PMC6458651 DOI: 10.1186/s13229-019-0267-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 03/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group. Methods One hundred and three autistic adults who responded to an online advertisement were classified as current, historic or non-self-harmers in accordance with responses to the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT). Multinomial regression aimed to predict categorisation of participants in accordance with scores on tests of autistic traits, alexithymia, depression, anxiety, mentalising and sensory sensitivity. Linear regression examined relationships between these predictors and the range, frequency, lifetime occurrence and functional purposes of NSSI. Qualitative analysis explored the therapeutic interventions that participants had found helpful, and what they wished people understood about self-injury. Results Current, historic and non-self-harming participants did not differ in age, age at diagnosis, male-to-female ratio, level of employment or education (the majority qualified to at least degree level). The most common function of NSSI was the regulation of low-energy affective states (depression, dissociation), followed by the regulation of high-energy states such as anger and anxiety. Alexithymia significantly predicted the categorisation of participants as current, historic or non-self-harmers, and predicted use of NSSI for regulating high-energy states and communicating distress to others. Depression, anxiety and sensory-sensitivity also differentiated participant groups, and sensory differences also predicted the range of bodily areas targeted, lifetime incidence and frequency of NSSI. Sensory differences, difficulty expressing and identifying emotions also emerged as problematic in the qualitative analysis, where participants expressed the need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers, with some participants perceiving NSSI as a practical, non-problematic coping strategy. Conclusions Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.
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Affiliation(s)
- R. L. Moseley
- Social, Cognitive, Clinical and Affective Neuroscience group, Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset UK
| | - N. J. Gregory
- Social, Cognitive, Clinical and Affective Neuroscience group, Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset UK
| | - P. Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - C. Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S. Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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31
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Poon JA, Thompson JC, Forbes EE, Chaplin TM. Adolescents' Reward-related Neural Activation: Links to Thoughts of Nonsuicidal Self-Injury. Suicide Life Threat Behav 2019; 49:76-89. [PMID: 29349794 PMCID: PMC7184534 DOI: 10.1111/sltb.12418] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
Abstract
Adolescence is a critical developmental period marked by an increase in risk behaviors, including nonsuicidal self-injury (NSSI). Heightened reward-related brain activation and relatively limited recruitment of prefrontal regions contribute to the initiation of risky behaviors in adolescence. However, neural reward processing has not been examined among adolescents who are at risk for future engagement for NSSI specifically, but who have yet to actually engage in this behavior. In the current fMRI study (N = 71), we hypothesized that altered reward processing would be associated with adolescents' thoughts of NSSI. Results showed that NSSI youth exhibited heightened activation in the bilateral putamen in response to a monetary reward. This pattern of findings suggests that heightened neural sensitivity to reward is associated with thoughts of NSSI in early adolescence. Implications for prevention are discussed.
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Affiliation(s)
- Jennifer A Poon
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - James C Thompson
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tara M Chaplin
- Department of Psychology, George Mason University, Fairfax, VA, USA
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32
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Kruzan KP, Whitlock J. Processes of Change and Nonsuicidal Self-Injury: A Qualitative Interview Study With Individuals at Various Stages of Change. Glob Qual Nurs Res 2019; 6:2333393619852935. [PMID: 31218241 PMCID: PMC6558546 DOI: 10.1177/2333393619852935] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
Nonsuicidal self-injury (NSSI) is a pervasive and potentially lethal behavior that affects many youth and adolescents. Effective treatment and prevention efforts are critical but often lack a nuanced understanding of the behavior change process. To address this gap, this research employs a stage of change model to identify and understand the most salient and widespread processes that facilitate NSSI behavior change. Thirty-one semi-structured interviews were conducted with individuals with current or past self-injury. Individuals were recruited to represent all stages of change including those who have not thought about changing behavior to those who have been NSSI-free for years. We employ a directed content analysis to code for dimensions derived from the model and an inductive approach to surface more nuanced change levers. Four organizing dimensions emerged: relational, behavioral, self-knowledge, and barriers. Common change levers of value in clinical practice or in intervention modalities are discussed.
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33
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Holth F, Walby F, Røstbakken T, Lunde I, Ringen PA, Ramleth RK, Romm KL, Tveit T, Torgersen T, Urnes Ø, Kvarstein EH. Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation. Nord J Psychiatry 2018; 72:605-612. [PMID: 30348040 DOI: 10.1080/08039488.2018.1511751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Extreme self-harming behavior is a major challenge for patients and health services. Nevertheless, this patient population is poorly described in research literature. AIMS The aim of this study was to assess the volume of patients with extensive psychiatric hospitalization due to extreme self-harming behaviors, the extent of severe medical sequelae, and collaboration problems within health services. METHODS In a national screening investigation, department managers in 83 adult psychiatric inpatient institutions across all health regions in Norway were invited to participate in a brief, prepared, telephone interview. RESULTS Sixty-one interviews were completed. Extensive hospitalization (prolonged or multiple) due to extreme self-harm was reported for the last year in all health regions and in 427 individual cases. Mean number of cases did not differ by region. Psychiatric hospitalizations were more frequent in hospital units than mental health centers. In 109 of the cases, self-harming behavior had severe medical consequences, including five deaths. In 122 of the cases, substantial collaboration problems within the health services were reported (disagreements on diagnosis, treatment needs and resources). Extensive (long-term) hospitalization was particularly associated with the combination of severe medical sequelae and collaboration problems. CONCLUSION This investigation confirms a noteworthy, nationwide, population of severely self-harming inpatients with extensive health service use, prevalent severe medical complications, and unsatisfactory collaboration within health services. These preliminary results are alarming, and indicate a need for more profound understanding of highly complex and severe cases.
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Affiliation(s)
- Fredrik Holth
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Fredrik Walby
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Thea Røstbakken
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Ingeborg Lunde
- c Trauma and Suicide Prevention , Regional Centre on Violence , East, Oslo , Norway
| | | | | | | | - Tone Tveit
- e Haukeland University Hospital , Oslo , Norway
| | | | - Øyvind Urnes
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Elfrida Hartveit Kvarstein
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway.,g Institute for Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
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34
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The functions and addictive features of non-suicidal self-injury: A confirmatory factor analysis of the Ottawa self-injury inventory in a university sample. Psychiatry Res 2018; 264:316-321. [PMID: 29665561 DOI: 10.1016/j.psychres.2018.04.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/31/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
The Ottawa Self-Injury Inventory (OSI) is a comprehensive self-report measure of non-suicidal self-injury (NSSI). In an effort to build on past research and further validate the OSI, this study presents a confirmatory factor analysis of the OSI's subscales measuring the functions and addictive features of NSSI using a university sample. Participants were 316 university students aged 17-25 years (84.8% female) who had engaged in NSSI at least once in their lifetime. Consistent with past research, results confirmed the four-factor structure of the Functions items (Internal Emotion Regulation, Social Influence, External Emotion Regulation, Sensation Seeking), as well as the single-factor structure of Addictive Features items. Correlations calculated between the obtained factors and indicators of NSSI severity revealed that higher endorsement of NSSI's Internal Emotion Regulation functions, External Emotion Regulation functions, and Addictive Features were associated with more frequent lifetime NSSI, recent (past 6 months) NSSI, and greater distress regarding NSSI urges; greater endorsement of NSSI's Sensation Seeking functions was also linked with more frequent lifetime NSSI. Results provide further support for the OSI's psychometric properties in a university sample, and offer additional evidence for links between specific NSSI functions and addictive features and more severe manifestations of the behavior.
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35
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Klassen JA, Hamza CA, Stewart SL. An Examination of Correlates for Adolescent Engagement in Nonsuicidal Self-Injury, Suicidal Self-Injury, and Substance Use. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2018; 28:342-353. [PMID: 28758354 DOI: 10.1111/jora.12333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little research has examined potential risk factors for direct versus indirect self-injury among adolescents. To address this limitation, 541 clinically referred adolescents were assessed using the interRAI Child and Youth Mental Health Assessment. Logistic regression analyses revealed that older females who experienced heightened depressive symptoms and neighborhood violence were at increased risk for direct self-injury, specifically nonsuicidal and suicidal self-injury. Additionally, adolescents who experienced higher levels of caregiver distress were at greater risk of suicidal self-injury. In contrast, older adolescents who experienced heightened aggressive behavior were at increased risk for one form of indirect self-injury, substance use. Findings suggest that nonsuicidal self-injury, suicidal self-injury, and substance use are associated with differential risk factors. Implications for targeted prevention strategies are discussed.
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36
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Brown JT, Volk F, Gearhart GL. A psychometric analysis of the Ottawa self-injury inventory-f. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:23-31. [PMID: 28812444 DOI: 10.1080/07448481.2017.1366496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study seeks to evaluate the psychometric properties of the Ottawa Self-Injury Inventory-Functions (OSI-F) for assessing nonsuicidal self-injury (NSSI), a condition for further study in the DSM-5. PARTICIPANTS Participants included 345 students who indicated a history of self-injury in a university counseling center over six semesters from August 2009 to May 2012. METHOD Participants completed the OSI-F as a measure on the psychological intake for the university counseling center. RESULTS Factor analysis, Cronbach's alpha coefficients, independent sample t tests, and correlations were examined and demonstrated adequate reliability and validity. CONCLUSIONS A three-factor solution emerged from the restructured OSI-F relating to Affect Regulation, Exhilaration, and Release. Affect regulation dimensions were predictive of continuing to self-injure and related to depression, anxiety, and overall mental health. Additionally, women were more likely to attribute self-injuring to affect regulation.
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Affiliation(s)
- Joshua Travis Brown
- a Curry School of Education , University of Virginia , Charlottesville , Virginia , USA
| | - Fred Volk
- b Department of Counselor Education and Family Studies , Liberty University , Lynchburg , Virginia , USA
| | - Gabrielle L Gearhart
- c Department of Student Counseling Services , Liberty University , Lynchburg , Virginia , USA
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Drzał-Fiałkiewcz E, Makarewicz A, Walczak M, Walczak A, Futyma-Jędrzejewska M, Kozak G, Frończuk P, Karakuła-Juchnowicz H. Self-harm - an overview of the tools used to assess non-suicidal self-harming behaviors. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: Non-Suicidal Self-Injury (NSSI) is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.
The aim of the work is to present and discuss the most commonly used scales for NSSI assessment.
Method: A review of available literature was made using the databases Medline / PubMed, using the key words: “self injury”, “self-mutilation”, “non-suicidal,”, “NSSI”, “self-harm” and time descriptors: 2005-2017
Results: Available tools were divided into three groups: I- scale of self-assessment made by the patient, II- assessment made by the clinician, and III- auxiliary scale.
Conclusions: None of the available scales covers the complexity of the NSSI phenomenon. For the overall NSSI assessment, several NSSI assessment tools are suggested, taking into account both self-assessment scales and clinical evaluation.
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Affiliation(s)
| | - Agata Makarewicz
- I Department of Psychiatry, Psychotherapy and Early Intervention , Medical University of Lublin
| | - Mateusz Walczak
- I Department of Psychiatry, Psychotherapy and Early Intervention , Medical University of Lublin
| | - Aleksandra Walczak
- Department of Dermatology , Venereology and Pediatric Dermatology of Autonomous Public University Hospital No. 1 in Lublin
| | | | - Gustaw Kozak
- I Department of Psychiatry, Psychotherapy and Early Intervention , Medical University of Lublin
| | - Piotr Frończuk
- Non-public Healtcare Centre Mental Health Clinic in Biała Podlaska
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Re: The Ottawa Self-injury Inventory Version 3.1: Suggestions for Revision to the Addictive Features Section. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9831-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Baiden P, Stewart SL, Fallon B. The mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents: Findings from community and inpatient mental health settings in Ontario, Canada. Psychiatry Res 2017; 255:238-247. [PMID: 28587863 DOI: 10.1016/j.psychres.2017.05.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/28/2017] [Accepted: 05/11/2017] [Indexed: 12/17/2022]
Abstract
Although bullying victimization has been linked to a number of behavioral and emotional problems among adolescents, few studies have investigate the mechanism through which bullying victimization affect non-suicidal self-injury. The objectives of this study were to examine the effect of bullying victimization on non-suicidal self-injury and the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents. Data for this study came from the interRAI Child and Youth Mental Health dataset. A total of 1650 adolescents aged 12-18 years (M =14.56; SD =1.79; 54.2% males) were analyzed. Binary logistic and Poisson regression models were conducted to identify the mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury. Of the 1650 adolescents studied, 611 representing 37% engaged in non-suicidal self-injury and 26.7% were victims of bullying. The effect of bullying victimization on non-suicidal self-injury was partially mediated by depressive symptoms after adjusting for the effect of demographic characteristics, history of childhood abuse, social support, and mental health diagnoses. The contribution of bullying victimization and depression to non-suicidal self-injury adds to the case for the development of trauma-focused interventions in reducing the risk of non-suicidal self-injury among adolescents.
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Affiliation(s)
- Philip Baiden
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1V4.
| | - Shannon L Stewart
- Faculty of Education, Western University, 1137 Western Road, London, ON, Canada N6G 1G7
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1V4
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Blasco-Fontecilla H, Fernández-Fernández R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry 2016; 7:8. [PMID: 26869941 PMCID: PMC4734209 DOI: 10.3389/fpsyt.2016.00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. METHOD This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. RESULTS The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. CONCLUSION Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Consulting Asistencial Sociosanitario (CAS), Madrid, Spain
| | - Roberto Fernández-Fernández
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Laura Colino
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Lourdes Fajardo
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Rosa Perteguer-Barrio
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital , Lexington, KY , USA
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Brausch AM, Boone SD. Frequency of Nonsuicidal Self-Injury in Adolescents: Differences in Suicide Attempts, Substance Use, and Disordered Eating. Suicide Life Threat Behav 2015; 45:612-622. [PMID: 25682929 DOI: 10.1111/sltb.12155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
The relationship between frequency of nonsuicidal selfinjury (NSSI) and suicide attempts, substance use, and disordered eating was assessed in a community sample of 4,839 adolescents, 922 of whom reported NSSI in the past year. It was expected that the engagement in risk behaviors would significantly increase as NSSI frequency increased. Participants completed the Youth Risk Behavior Survey (Centers for Disease Control and Prevention, 2009) and were subdivided into five NSSI frequency groups: none, 1 time, 2-3 times, 4-5 times, and 6 or more times. A one-way MANOVA found significant mean differences for all variables across NSSI frequency groups. The no NSSI group was significantly lower than all other groups on all variables. For suicide attempts, all frequency groups were significantly different from each other, with attempt frequency increasing with each increase in NSSI frequency. The six or more group reported significantly more substance use and disordered eating than all other groups. Overall, adolescents with more frequent NSSI represent a group at risk for concurrent unhealthy behaviors and suicide attempts.
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Affiliation(s)
- Amy M Brausch
- Psychological Sciences, Western Kentucky University, Bowling Green, KY, USA
| | - Shannon D Boone
- Psychology, Western Kentucky University, Bowling Green, KY, USA
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Nixon MK, Levesque C, Preyde M, Vanderkooy J, Cloutier PF. The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child Adolesc Psychiatry Ment Health 2015; 9:26. [PMID: 26157482 PMCID: PMC4495629 DOI: 10.1186/s13034-015-0056-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Ottawa Self-Injury Inventory (OSI) is a self-report measure that offers a comprehensive assessment of nonsuicidal self-injury (NSSI), including measurement of its functions and addictive features. In a preliminary investigation of self injuring college students who completed the OSI, exploratory analysis revealed four function factors (Internal Emotion Regulation, Social Influence, External Emotion Regulation and Sensation Seeking) and a single Addictive Features factor. Rates of NSSI are particularly high in inpatient psychiatry youth. The OSI can assistin both standardizing assessment regarding functions and potential addictive features and aid case formulation leading to informed treatment planning. This report will describe a confirmatory factor analysis (CFA) of the OSI on youth hospitalized in a psychiatric unit in southwestern Ontario. METHODS Demographic and self-report data were collected from all youth consecutively admitted to an adolescent in-patient unit who provided consent or assent. RESULTS The mean age of the sample was 15.71 years (SD = 1.5) and 76 (81 %) were female. The CFA proved the same four function factors relevant, as in the previous study on college students (χ (2)(183) = 231.98, p = .008; χ (2)/df = 1.27; CFI = .91; RMSEA = .05). The model yielded significant correlations between factors (rs = .44-.90, p < .001). Higher NSSI frequency was related to higher scores on each function factor (rs = .24-.29, p < .05), except the External Emotion Regulation factor (r = .11, p > .05). The factor structure of the Addictive Features function was also confirmed (χ (2)(14) = 21.96, p > .05; χ (2)/df = 1.57; CFI = .96; RMSEA = .08). All the items had significant path estimates (.52 to .80). Cronbach's alpha for the Addictive Features scale was .84 with a mean score of 16.22 (SD = 6.90). Higher Addictive Features scores were related to more frequent NSSI (r = .48, p < .001). CONCLUSIONS Results show further support for the OSI as a valid and reliable assessment tool in adolescents, in this case in a clinical setting, where results can inform case conceptualization and treatment planning.
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Affiliation(s)
- Mary K Nixon
- Queen Alexandra Centre for Children’s Health, 2400 Arbutus Rd, Victoria, BC V8N 1V7 Canada
| | - Christine Levesque
- University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Michèle Preyde
- College of Social and Applied Human Sciences, University of Guelph, 50 Stone Road East Mackinnon 138, Guelph, ON N1G 2 W1 Canada
| | - John Vanderkooy
- Homewood Health Centre, 150 Delhi St, Guelph, ON N1E 6 K9 Canada
| | - Paula F. Cloutier
- Mental Health Research, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8 L1 Canada
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Crapper L, Ernst C. Comparative analysis of self-injury in people with psychopathology or neurodevelopmental disorders. Pediatr Clin North Am 2015; 62:619-31. [PMID: 26022166 DOI: 10.1016/j.pcl.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-injury is a complex and poorly understood behavior observed in people with psychopathology or neurodevelopmental disorders (NDD). Despite the differences in etiology and progression of these distinct disease domains, it is possible that overlapping molecular pathways underlie the expression of self-injurious behaviors (SIBs). This review outlines the similarities and differences at the behavioural and molecular level, where SIBs in both conditions may involve opioid, nucleoside, and dopamine signalling. These points of convergence have important implications for treatment and research of SIB in both populations.
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Affiliation(s)
- Liam Crapper
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec H3A 0G4, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec H4H 1R3, Canada
| | - Carl Ernst
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec H3A 0G4, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, Montreal, Quebec H3A 0G4, Canada; Department of Human Genetics, McGill University, Montreal, Quebec H3A 0G4, Canada.
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Ford JD, Gómez JM. The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review. J Trauma Dissociation 2015; 16:232-71. [PMID: 25758363 DOI: 10.1080/15299732.2015.989563] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.
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Affiliation(s)
- Julian D Ford
- a Department of Psychiatry , University of Connecticut School of Medicine , Farmington , Connecticut , USA
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Liang S, Yan J, Zhang T, Zhu C, Situ M, Du N, Fu X, Huang Y. Differences between non-suicidal self injury and suicide attempt in Chinese adolescents. Asian J Psychiatr 2014; 8:76-83. [PMID: 24655633 DOI: 10.1016/j.ajp.2013.11.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Self-harm behaviors are predominant health risks among adolescents. This study aimed to elucidate the lifetime prevalence and differences in social psychological factors between non-suicidal self-injury (NSSI) and suicide attempt (SA) among Chinese adolescents. METHOD Data were collected from 2131 middle school students with a mean age of 13.92 (SD 1.63) years (49.1% girls). Participants were asked to self-report NSSI and SA over their lifetime. Post hoc tests pairwise comparisons and multinomial logistic regression analyses were conducted to investigate differences and similarities between subjects with NSSI and attempted suicide. RESULTS The prevalence of lifetime NSSI and SA endorsed by the participants were 23.2% and 3.2%, respectively, and the co-occurrence of these two behaviors (NSSI+SA) was reported to 2.3%. Boys were comparable with girls in the prevalence rate of NSSI, but not in the rate of SA. It revealed that single-child was not the risk factor for self-harm behavior in Mainland China, but lower higher family cohesion and adaptability. Factors that distinguished the NSSI+SA group from the NSSI only group were female gender, lower grade, impulsivity, health risk behaviors and family cohesion. Being female gender, single-parent family, depressive symptoms and impulsivity were factors differentiating attempted suicide from NSSI. CONCLUSIONS Our findings suggest that Chinese adolescents engaging both in NSSI and SA had severe suicidal attempts and were different from those who engaged in NSSI alone.
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Affiliation(s)
- Sugai Liang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhang
- College of Public Health, Sichuan University, Chengdu 610041, China
| | - Cuizhen Zhu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Minging Situ
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Du
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueyin Fu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Does Dual Diagnosis Affect Violence and Moderate/Superficial Self-harm in Heroin Addiction at Treatment Entry? J Addict Med 2014; 8:116-22. [DOI: 10.1097/adm.0000000000000019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stewart SL, Baiden P, Theall-Honey L. Examining non-suicidal self-injury among adolescents with mental health needs, in Ontario, Canada. Arch Suicide Res 2014; 18:392-409. [PMID: 24712902 DOI: 10.1080/13811118.2013.824838] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objectives of this study were to examine the prevalence of non-suicidal self-injury (NSSI) among adolescents with mental health needs and specific factors associated with NSSI among adolescents aged 14 to 18 years who received mental health services in adult mental health facilities in Ontario, Canada. Data on 2,013 adolescents were obtained from the Ontario Mental Health Reporting System using the Resident Assessment Instrument-Mental Health (RAI-MH) and were analyzed using logistic regression. Approximately, 20.2% (407 adolescents) of the sample engaged in NSSI within the last 12 months. Results from multivariate logistic regression indicate that females were 2.19 times more likely to engage in NSSI than males. Intentional misuse of prescription medication emerged as the most important factor associated with NSSI. Other factors found to be associated with NSSI included multiple psychiatric admissions, sexual abuse, use of alcohol, mood disorders (e.g., depression), adjustment disorders, personality disorders and symptoms of depression. The article discusses the implications of the findings, with suggestions for future research.
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Adolescent self-cutting elsewhere than on the arms reveals more serious psychiatric symptoms. Eur Child Adolesc Psychiatry 2013; 22:501-10. [PMID: 23423221 DOI: 10.1007/s00787-013-0390-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
Abstract
Self-cutting as a form of self-harm is a common and multifaceted phenomenon among adolescents. The aim of this study was to investigate whether the location of self-cutting (arms or other areas of the body) could help to assess the severity of the underlying psychiatric problems. A sample of adolescents who reported self-cutting (n = 440) was drawn from a large sample of community adolescents (n = 4,019). The majority of self-cutting adolescents, 296 (67.2%), reported cutting only the upper arms, while 144 (32.8%) also cut other parts of the body. The data included a structured self-rating questionnaire, questions about self-cutting, the Youth Self-Report (YSR) for adolescents aged 11-18 years, the Beck Depression Inventory, the Toronto Alexithymia Scale and the Adolescent Dissociative Experience Scale (A-DES). The results indicate that self-cutting on other parts of body than the arms was associated with female gender, a wide range of emotional and dissociative symptoms and suicidal ideation. In logistic regression analysis, the most pronounced association between self-cutting on other places than the arms was found with YSR subscales withdrawn/depressed, social problems and thought problems, and dissociation (A-DES). We conclude that self-cutting adolescents, mostly girls, with wounds elsewhere than on the arms present with the most serious psychiatric symptoms. It is important to perform a careful physical examination when an adolescent has unexplained wounds or scars on the arms or on other parts of the body. These adolescents also need a caring and conscientious psychiatric examination and possible psychiatric treatment.
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Bresin K, Gordon KH. Endogenous opioids and nonsuicidal self-injury: A mechanism of affect regulation. Neurosci Biobehav Rev 2013; 37:374-83. [DOI: 10.1016/j.neubiorev.2013.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 12/20/2012] [Accepted: 01/11/2013] [Indexed: 01/02/2023]
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