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Brager-Larsen A, Zeiner P, Mehlum L. DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior. Arch Suicide Res 2024; 28:523-536. [PMID: 37506259 DOI: 10.1080/13811118.2023.2192767] [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] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. METHODS Data were collected from 103 outpatient adolescents (ages 12-18) with recurrent self-harm behavior. RESULTS Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. CONCLUSION This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.
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Evseev VD, Bokhan NA, Mandel AI, Kadochnikova SV. [Prevalence and risk factors of non-suicidal self-injury behavior]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:13-19. [PMID: 38465806 DOI: 10.17116/jnevro202412402113] [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] [Indexed: 03/12/2024]
Abstract
The prevalence of non-suicidal self-injury (NSSI) behavior in adolescents has increased significantly in the early 21st century. The phenomenon of NSSI behavior has become one of the key health problems in the field of adolescent psychiatry and psychology over the past decade worldwide. However, the social characteristics and factors influencing NSSI are very different in different regions of the world. Studies of self-harming behavior indicate that the upward trend is almost equally relevant for developing and developed countries. To date, the methodological basis for the diagnosis of NSSI has not been sufficiently developed in the Russian Federation, there are only some studies of NSSI both from an empirical perspective and in the context of the search for risk factors, causes and functions, models of comorbidity with mental disorders.
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Affiliation(s)
- V D Evseev
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
| | - N A Bokhan
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
- Siberian State Medical University, Tomsk, Russia
| | - A I Mandel
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
| | - S V Kadochnikova
- Siberian State Medical University, Tomsk, Russia
- Tomsk Clinical Psychiatric Hospital, Tomsk, Russia
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Gyori D, Farkas BF, Komaromy D, Horvath LO, Kollarovics N, Garas P, Balazs J. The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders. Eur J Investig Health Psychol Educ 2023; 13:2299-2327. [PMID: 37998053 PMCID: PMC10670610 DOI: 10.3390/ejihpe13110163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023] Open
Abstract
Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
| | - Bernadett Frida Farkas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Daniel Komaromy
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lili Olga Horvath
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Pedagogical Services, 1141 Budapest, Hungary
| | - Nora Kollarovics
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Peter Garas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Psychology, Oslo New University College, 0456 Oslo, Norway
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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: 1] [Impact Index Per Article: 1.0] [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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Rockstroh F, Edinger A, Josi J, Brunner R, Resch F, Kaess M. Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:243-254. [PMID: 37487473 PMCID: PMC10568598 DOI: 10.1159/000531092] [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: 12/19/2022] [Accepted: 05/11/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT). OBJECTIVE The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years. METHODS Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported. RESULTS Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI. CONCLUSIONS The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.
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Affiliation(s)
- Franziska Rockstroh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Edinger
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Academy for Psychotherapy, SRH University Heidelberg, Heidelberg, Germany
| | - Johannes Josi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Lee SE, Shin H, Kim G, Moon H, Hur JW. Decreased gray matter volume in regions associated with affective pain processing in unmedicated individuals with nonsuicidal self-injury. Psychiatry Res 2023; 326:115314. [PMID: 37406398 DOI: 10.1016/j.psychres.2023.115314] [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: 01/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
Nonsuicidal self-injury (NSSI) has been consistently associated with a reduced aversion to physical pain. Yet, little research has been done to investigate the brain structures related to pain in individuals with NSSI. This study examined gray matter volume patterns of pain processing regions in participants engaging in NSSI (n = 63) and age-, sex-, and handedness-matched healthy controls (n = 63). Voxel-based morphometry was performed to explore gray matter volume in regions of interest (ROIs) and partial correlation analyses were conducted to identify their associations with the frequency, versatility, duration, functions, and pain intensity of self-injury. As a result, significant volume decreases were found in the right anterior insula, bilateral secondary somatosensory cortex (SII), and left inferior frontal gyrus. Moreover, individuals with smaller anterior insula and SII volume showed a higher likelihood of endorsing affect-regulation and sensation-seeking functions of NSSI, as well as engaging in self-injury with a greater perceived intensity of pain. Our results provide the first empirical evidence that individuals with NSSI may exhibit distinct characteristics in brain regions associated with the affective component of pain processing. These neurobiological changes may be associated with their maladaptive response to noxious and painful NSSI experiences.
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Affiliation(s)
- Soo-Eun Lee
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyemin Shin
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Gyumyoung Kim
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyeri Moon
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Ji-Won Hur
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea.
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Yan H, Yue W. Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review. INTERDISCIPLINARY NURSING RESEARCH 2023; 2:112-120. [PMID: 37645376 PMCID: PMC10461723 DOI: 10.1097/nr9.0000000000000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 08/31/2023]
Abstract
Nonsuicidal self-injury (NSSI) refers to the direct, deliberate infliction of harm to one's body tissue without the intention to die. The prevalence of NSSI has increased significantly globally in recent years and has become an important public health problem affecting the health of people, especially adolescents. The occurrence of NSSI in adolescents is the result of the interaction of different factors. Many scholars have proposed various theoretical models to explain the mechanism of NSSI behavior based on previous research on the influencing factors of NSSI. Moreover, advances have been made in genetic and neuroimaging mechanisms related to NSSI. Understanding the genetic and neuroimaging mechanisms of NSSI is important for both describing and treating the disorder. This literature review discusses the progress made on the risk factors, theoretical models, and biological mechanisms of NSSI.
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Affiliation(s)
- Huiru Yan
- School of Nursing and Sixth Hospital, Peking University, Beijing, China
- Institute of Mental Health, Peking University Sixth Hospital and Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder of Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health and (Peking University Sixth Hospital), Beijing, China
| | - Weihua Yue
- Institute of Mental Health, Peking University Sixth Hospital and Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder of Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health and (Peking University Sixth Hospital), Beijing, China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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Köllensperger E, Walter C, Germann G, Engel H, Reichenberger M. [Non-suicidal self-injurious Behaviour: Insights into a littleknown Patient Population in Plastic Surgery]. HANDCHIR MIKROCHIR P 2022; 54:112-118. [PMID: 35419781 DOI: 10.1055/a-1759-3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Despite its high prevalence in adolescents and young adults, non-suicidal self-injury (NSSI) is poorly known and understood in areas other than psychiatry. Due to this lack of knowledge, affected patients often face a lack of understanding as well as rejection and discrimination when seeking help from medical professionals. This not only hampers a lasting improvement of NSSI and the development of a trustful physician-patient relationship but may also lead to traumatisation of affected patients. Based on our patients' data, this article aims to inform interested plastic surgeons about NSSI and thus to support the treatment of affected patients. PATIENTS AND METHODS 600 patients with scars from NSSI presenting to our outpatient clinic for the first time during the past five years were enrolled in this study. Extensive data collected during the first contact was analysed and compared with the current literature. RESULTS 95 % of the patients were female; 5 % were male. On average, patients presented 8.4 years after the last NSSI event and with a mean age of 26 years. NSSI scars were most often located on the left forearm (48 %), followed by both forearms (40 %), the left upper arm (20 %), both upper arms (15 %) and both thighs (14 %). In 57 % of patients, scars were only present on one side. A mean of 380 cm2 of the body surface was affected by NSSI scars. 47 % of patients reported having at least one additional diagnosis, with thyroid dysfunction and depression being the most common. 21 % of patients had ongoing psychiatric or psychological therapy at the time of their first consultation in our clinic. CONCLUSION Our data provides first insight into a large population of NSSI patients seeking treatment options for their NSSI-associated scars in a plastic surgery outpatient clinic. Most patients were female with scars located on their forearms. A mean of more than 8 years had passed between their last NSSI and their first presentation to our clinic. Our findings offer a data-based approach to a group of patients with a disease pattern that is largely misunderstood in surgical disciplines and needs more attention, especially in the light of its high prevalence and life-long consequences.
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Affiliation(s)
- Eva Köllensperger
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Clara Walter
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Günter Germann
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Holger Engel
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Matthias Reichenberger
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
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Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, Heuschmann PU, Romanos M. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97. [PMID: 35101116 PMCID: PMC8802249 DOI: 10.1186/s13063-021-05973-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking. METHODS The main objective of the present study is to evaluate a newly developed universal prevention program ("DUDE - Du und deine Emotionen / You and your emotions"), based on a skills-based approach in schools, in 3200 young adolescents (age 11-14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called "Stress-free through the school day" as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change. DISCUSSION DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945.
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Affiliation(s)
- Arne Buerger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Theresa Emser
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Alexandra Seidel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Christin Scheiner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Cornelia von Schoenfeld
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Viktoria Ruecker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Strasse, 97080 Wuerzburg, Germany
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Strasse, 97080 Wuerzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
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Cella S, Cipriano A, Aprea C, Milano W, Carizzone F, Cotrufo P. Non-suicidal self-injury in eating disorders: Prevalence, characteristics, DSM-5 proposed diagnostic criteria, and correlates. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fong ZH, Loh WNC, Fong YJ, Neo HLM, Chee TT. Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review. Clin Child Psychol Psychiatry 2022; 27:61-81. [PMID: 34866412 DOI: 10.1177/13591045211055071] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED Non-suicidal self-injury (NSSI) is a worrying phenomenon that is prevalent among young people. Prior theorizing and empirical evidence suggest that parenting may play a role in the etiology of NSSI. Thus, we conducted a systematic review to examine the association between parenting behaviors and parenting styles with NSSI in young people. METHODS The following databases were searched for relevant articles in July 2020: PubMed, EMBASE, CINAHL Plus, and PsycINFO. Studies were included if they sampled young persons aged 10-25 years old with a history of NSSI, assessed parenting behavior or style, and tested associations between parenting and NSSI outcomes. RESULTS A total of 26 studies were included in this review. Among parenting behaviors, low parental support, high psychological control, and high reactive control were more consistently associated with NSSI. Conversely, the evidence for behavioral control is equivocal. There is some evidence that invalidating parenting is also associated with NSSI. CONCLUSION Consistent with the wider adolescent psychopathology literature, parenting that is perceived to be supportive, less psychologically controlling and reactive/punitive were less likely to be associated with NSSI. However, these results were largely based on child reports of parenting. Limitations and directions for future research are discussed.
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Affiliation(s)
- Zhi Hui Fong
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Wan Ning Charisse Loh
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Ying Jie Fong
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Hui Ling Michelle Neo
- Department of Psychological Medicine, 59053National University Hospital, Singapore, Singapore
| | - Tji Tjian Chee
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, 59053National University Hospital, Singapore, Singapore
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Zhou Y, Yu R, Ai M, Cao J, Li X, Hong S, Huang Q, Dai L, Wang L, Zhao L, Zhang Q, Shi L, Kuang L. A Resting State Functional Magnetic Resonance Imaging Study of Unmedicated Adolescents With Non-suicidal Self-Injury Behaviors: Evidence From the Amplitude of Low-Frequency Fluctuation and Regional Homogeneity Indicator. Front Psychiatry 2022; 13:925672. [PMID: 35782416 PMCID: PMC9247173 DOI: 10.3389/fpsyt.2022.925672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) behaviors are common in adolescents with major depressive disorder (MDD). Brain studies specifically targeting adolescents with MDD and NSSI may provide new insights into suicide warnings in adolescents with MDD. METHODS This study examined the whole-brain neural activity in adolescents aged between 12-17 years, 50 unmedicated MDD patients with (nsMDDs) or without NSSI (nnsMDDs), and 25 healthy controls (HCs) participated in this study, and analyzed the correlation between the values of amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) in significantly different brain regions and the scores of the relevant clinical psychological scale. RESULTS Compared with nnsMDDs, nsMDDs had enhanced ALFF values in left middle occipital gyrus and left median cingulate and paracingulate gyri; the fALFF values of the right caudate nucleus was weakened in the nsMDDs; the ReHo values of right middle occipital gyrus and right middle temporal gyrus weakened and the ReHo values of right medial cingulate gyrus enhanced in nsMDDs. And all of differences were statistically significant. In nsMDDs, the value of ALFF in the left calcarine fissure and surrounding cortex was negatively correlated with the score of Children's depression Inventory (CDI); the value of fALFF in the right caudate nucleus was positively correlated with the score of Beck Scale for Suicidal Ideations (BSSI); the value of ReHo in the right middle temporal gyrus was positively correlated with the score of Multidimensional Anxiety Scale for Children (MASC); and the value of ReHo in the right median cingulate and paracingulate gyri was negatively correlated with the score of BSSI. CONCLUSIONS We found that in ALFF, fALFF and ReHo, the significant differences between nsMDDs and nnsMDDs are mainly located in default mode network (DMN) and visual network (VN), and there may be brain regions related to NSSI in DMN and VN. The significant differences brain regions in ALFF, fALFF and ReHo between nsMDDs and nnsMDDs were related to the total score of the relevant clinical psychological scale, and may be related to NSSI.
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Affiliation(s)
- Yi Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Renqiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Ai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Hong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Huang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linqi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - LiXia Wang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Shi
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Peng B, Li J, Liu H, Fang H, Zhao W, Chen G, Xiu M, Zhang Y. Childhood Maltreatment, Low Serum Cortisol Levels, and Non-Suicidal Self-Injury in Young Adults With Major Depressive Disorders. Front Pediatr 2022; 10:822046. [PMID: 35722483 PMCID: PMC9203967 DOI: 10.3389/fped.2022.822046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health problem widely present among young adults and adolescents. While finding risk factors associated with NSSI among young patients with major depressive disorder (MDD) is challenging, the current study aims to measure childhood adversity and serum cortisol levels and elucidate their relationship in MDD patients with NSSI. METHODS In this cross-sectional study, 126 young patients with MDD (aged 16 to 35 years) were recruited. The depressive symptoms were assessed by the Beck Depression Inventory (BDI-II), and the childhood adversity was evaluated by the Chinese version of the Childhood Trauma Questionnaire (CTQ) scale. Serum cortisol levels were determined by the kits in patients. RESULTS Relative to MDD patients without NSSI, MDD patients with NSSI had a higher CTQ total score and its four subscores. Moreover, the cortisol levels in patients with MDD/NSSI were significantly decreased than in MDD patients without NSSI. For patients with MDD/NSSI, there is a negative association between cortisol levels and emotional neglect, but not for MDD patients without NSSI. Further regression analysis showed that low cortisol levels, BDI-II, and emotional neglect were risk factors for NSSI in young patients with MDD. CONCLUSION Our findings suggest that young MDD patients with NSSI experience more childhood adversity and have lower cortisol levels. Also, lower cortisol levels were associated with childhood adversity but not with depressive symptoms. Further, lower cortisol levels, depressive symptoms, and emotional neglect were risk factors for NSSI in young patients with MDD.
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Affiliation(s)
- Bo Peng
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen, China.,Shenzhen Mental Health Center, Shenzhen, China
| | - Jinmeng Li
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haitao Liu
- Shenzhen Longgang District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Han Fang
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen, China.,Shenzhen Mental Health Center, Shenzhen, China
| | - Weitan Zhao
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen, China.,Shenzhen Mental Health Center, Shenzhen, China
| | - Guanjie Chen
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen, China.,Shenzhen Mental Health Center, Shenzhen, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Yingli Zhang
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen, China.,Shenzhen Mental Health Center, Shenzhen, China
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14
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Co-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review. Curr Pain Headache Rep 2021; 25:70. [PMID: 34766192 DOI: 10.1007/s11916-021-00984-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Trauma and posttraumatic stress are common among individuals with chronic pain and contribute to increased morbidity and impairment. Individuals with trauma and chronic pain may be prone to non-suicidal self-injury, a relatively common yet risky self-regulatory behavior. There is a dearth of research on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). We conducted a systematic review of the extant literature. RECENT FINDINGS Five quantitative and eight case reports were identified. Only one quantitative study reported specifically on NSSI. Self-harm rates varied across studies, though appeared elevated among patients with chronic pain. Childhood trauma was linked to this co-occurrence. Causal links between trauma, NSSI, and pain are proposed, highlighting the need for a comprehensive theoretical model. We recommend assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.
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15
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Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders. Compr Psychiatry 2021; 111:152273. [PMID: 34555553 DOI: 10.1016/j.comppsych.2021.152273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/31/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.
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16
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Examining the Neurobiology of Non-Suicidal Self-Injury in Children and Adolescents: The Role of Reward Responsivity. J Clin Med 2021; 10:jcm10163561. [PMID: 34441857 PMCID: PMC8396887 DOI: 10.3390/jcm10163561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Although prior work has shown heightened response to negative outcomes and reduced response to positive outcomes in youth with a history of non-suicidal self-injury (NSSI), little is known about the neural processes underlying these responses. Thus, this study examined associations between NSSI engagement and functional activation in specific regions of interest (ROIs) and whole-brain connectivity between striatal, frontal, and limbic region seeds during monetary and social reward tasks. To test for specificity of the influence of NSSI, analyses were conducted with and without depressive symptoms as a covariate. We found that NSSI was associated with decreased activation following monetary gains in all ROIs, even after controlling for depressive symptoms. Exploratory connectivity analyses found that NSSI was associated with differential connectivity between regions including the DS, vmPFC, insula, and parietal operculum cortex when controlling for depressive symptoms. Disrupted connectivity between these regions could suggest altered inhibitory control of emotions and pain processing in individuals with NSSI. Findings suggest dysfunctional reward processes in youth with NSSI, even very early in the course of the behavior.
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17
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Ghinea D, Fuchs A, Parzer P, Koenig J, Resch F, Kaess M. Psychosocial functioning in adolescents with non-suicidal self-injury: the roles of childhood maltreatment, borderline personality disorder and depression. Borderline Personal Disord Emot Dysregul 2021; 8:21. [PMID: 34193286 PMCID: PMC8246665 DOI: 10.1186/s40479-021-00161-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/31/2021] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND There is a lack of studies examining psychosocial functioning in patients with non-suicidal self-injury (NSSI), especially in adolescents, and rates of impaired functioning in existing literature vary considerably. These variations may be attributable to further risk factors that influence psychosocial functioning. Thus, the aim of the study was to examine whether adolescent NSSI patients with childhood maltreatment (CM), a known risk factor for lower psychosocial functioning, may differ from adolescent NSSI patients without CM, and whether these differences may be explained by the severity of comorbid disorders. Specifically, we examined whether severity of borderline personality disorder (BPD), depression and posttraumatic stress disorder may explain differences in psychosocial functioning in NSSI patients with and without CM. METHODS Data of 368 adolescents with NSSI disorder from an outpatient clinic were analyzed using structural equation modeling. Clinicans' rating of the Global Assessment of Functioning Scale (GAF) was collected, in addition to clinical interviews. RESULTS Results indicate that GAF scores were lower among NSSI patients with CM and that the difference in psychosocial functioning between these groups was explained by BPD and depression severity. CONCLUSIONS Psychosocial functioning in NSSI patients varies depending on whether they have experienced CM or not. Specifically, these differences seem to be attributable to higher BPD and depression severity in adolescent NSSI patients with CM. Clinicians should ensure to assess CM and focus on BPD and depression severity in this population. Treatment of BPD and depression may notably reduce psychosocial impairment in NSSI patients with CM.
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Affiliation(s)
- Denisa Ghinea
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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18
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Davis KC, Anderson JL. Psychological pain: A moderating factor between personality psychopathology and self-harm. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021:1-9. [PMID: 34133265 DOI: 10.1080/07448481.2021.1928677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/18/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
Self-harm and personality psychopathology have been linked, with the most robust correlations existing between negative affectivity and self-harm. Psychological pain, an emotionally-based aversive feeling, has been linked to self-harm. Considering the connection between personality psychopathology and self-harm, psychological pain may enhance self-harm risk. Participants: Analyses were conducted on 525 undergraduate students in the Spring and Fall semesters of 2019. Methods/Results: Correlation analyses indicated that self-harm was moderately correlated with Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Additionally, self-harm was correlated with psychological pain. When examining if psychological pain moderates the relation between personality psychopathology and self-harm, results were mixed. In the cases of Disinhibition and Psychoticism, psychological pain enhanced self-harm. There was no moderating effect on the relations with Negative Affectivity, Detachment, or Antagonism. Conclusions: These findings support the role of psychological pain in self-harm outcomes for those experiencing personality psychopathology; however, this varies depending on the maladaptive traits.
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Affiliation(s)
- Kelci C Davis
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA
| | - Jaime L Anderson
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA
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19
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Non-suicidal self-injury in adolescents and young adults with type 1 diabetes: clinical characteristics from a German diabetes-patient registry (DPV). Psychiatry Res 2021; 297:113733. [PMID: 33486273 DOI: 10.1016/j.psychres.2021.113733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/14/2021] [Indexed: 11/21/2022]
Abstract
The aim was to examine the relations between non-suicidal self-injury (NSSI) and clinical parameters as well as other psychiatric comorbidities in adolescents and young adults with type 1 diabetes mellitus (T1D). Patients aged 8-<=25 years with T1D and documented NSSI from the DPV database (n=167) were compared to a control group with T1D without NSSI or other psychiatric comorbidities (n=76,050) using multivariable regression models, adjusted for demographics. Clinical diabetes-related outcomes (haemoglobin A1c (HbA1c), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycaemia, number of hospital days, number of hospital admissions) were analysed. NSSI patients had significantly higher HbA1c (%): (+1.1 [0.8; 1.4]), higher daily insulin doses: (+0.08 (U/kg), [0.02; 0.13]), more DKA events per patient year: (+1.79 [1.22; 2.37]), more hospital days per patient year: (+0.25 [0.20; 0.29]) and more frequent hospital admissions per patient year: (+0.93 [0.79; 1.06]) compared to T1D patients without NSSI or other psychiatric comorbidities (differences of adjusted estimates [confidence interval]). This is the first study to investigate the association between NSSI and T1D. We revealed that NSSI is significantly related to diabetes outcomes in adolescent T1D patients. There should be an increased awareness for NSSI in the care for adolescents and young adults with T1D.
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20
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Kandsperger S, Jarvers I, Ecker A, Schleicher D, Madurkay J, Otto A, Brunner R. Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service. Front Psychiatry 2021; 12:634346. [PMID: 34177642 PMCID: PMC8221288 DOI: 10.3389/fpsyt.2021.634346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers. Methods: A consecutive sample of 86 adolescents aged 11-18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents. Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI. Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.
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Affiliation(s)
- Stephanie Kandsperger
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Joseph Madurkay
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexandra Otto
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
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21
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Gyori D, Balazs J. Nonsuicidal Self-Injury and Perfectionism: A Systematic Review. Front Psychiatry 2021; 12:691147. [PMID: 34305684 PMCID: PMC8293614 DOI: 10.3389/fpsyt.2021.691147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nonsuicidal self-injury (NSSI) and perfectionism mean a huge concern related to mental health and psychopathology. Recently, there has been a growing interest in research on the exploration of the association of perfectionism and NSSI, but till today there is no systematic review has been prepared in this topic. Aims: Therefore, we performed a systematic literature review of published studies that investigated the association between NSSI and perfectionism. Methods: The systematic search was made on PubMed, OVID Medline, PsychInfo, Scopus, and Web of Science. The search terms were ("nonsuicidal self-injury" OR "nonsuicidal self-injury" OR NSSI OR "self-injury" OR "self-injurious behavior" OR SIB OR "self-harm" OR "deliberate self-harm" OR DSH) AND (perfectionism). The inclusion criteria were as follows: written in English; reported empirical data; used validated self-report measures; investigated the association of nonsuicidal self-injury and perfectionism. There were no restrictions on participants regarding age, gender, race or ethnicity. Exclusion criteria: not written in English; was a review/meta-analysis; measured suicide behavior; measured self-injury irrespective of motivation or suicidal intent; was not about the association between nonsuicidal self-injury and perfectionism. Results: After the screening process, 15 studies were included in our systematic review. The majority of studies (12) were published in the last 10 years. Nine (60%) recruited participants from community samples, four (26.7%) from clinical populations, and two (13.3%) both from community and clinical participants. Fourteen (93.3%) of the studies were cross-sectional studies, and one study contained a longitudinal investigation. The majority of studies included only or mainly female participants (62.3-87.2%) and two studies contained a balanced male-female ratio population. Fourteen (93.3%) studies from the 15 studies found a significant positive association between NSSI and perfectionism. Limitations: The heterogeneity of used instruments makes it difficult to compare the results of involved studies. Only two studies investigated populations with balanced gender ratios. Only two studies examined both clinical and community populations. Clinical investigations enrolled mainly eating-disordered (ED) patients. Conclusions: The results of the current systematic review highlight the role of perfectionism in NSSI engagement. This systematic review may help the development of effective prevention initiatives and treatment strategies.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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22
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Chou WJ, Yen CF, Jong CL. Nonsuicidal self-injury in children and adolescents. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_34_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Buelens T, Costantini G, Luyckx K, Claes L. Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach. Front Psychiatry 2020; 11:580922. [PMID: 33329123 PMCID: PMC7728714 DOI: 10.3389/fpsyt.2020.580922] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022] Open
Abstract
In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, M age = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.
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Affiliation(s)
- Tinne Buelens
- Research Unit Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Giulio Costantini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Koen Luyckx
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Laurence Claes
- Research Unit Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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24
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Moreira ÉDS, Vale RRMD, Caixeta CC, Teixeira RAG. Automutilação em adolescentes: revisão integrativa da literatura. CIENCIA & SAUDE COLETIVA 2020; 25:3945-3954. [DOI: 10.1590/1413-812320202510.31362018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Trata-se de uma revisão integrativa da literatura acerca dos conhecimentos produzidos pela comunidade científica sobre automutilação em adolescentes no período de janeiro de 2012 a junho de 2017. A busca foi realizada nas bases de dados SCIELO e Portal CAPES, em português, inglês e espanhol com amostra final de 71 artigos. Este estudo mostrou grande número de publicações a nível internacional, com destaque para artigos epidemiológicos e fragilidade na publicação de estudos de intervenção que investiguem a eficácia de terapias e programas de prevenção.
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Ulloa Flores RE, Mayer Villa PA, de la Peña Olvera F, Palacios Cruz L, Victoria Figueroa G. DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:39-43. [PMID: 32081207 DOI: 10.1016/j.rcp.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.
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Affiliation(s)
- Rosa Elena Ulloa Flores
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México.
| | - Pablo Adolfo Mayer Villa
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México
| | | | - Lino Palacios Cruz
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Levine AZ, Aljabari R, Dalrymple K, Zimmerman M. Nonsuicidal Self-Injury and Suicide: Differences Between Those With and Without Borderline Personality Disorder. J Pers Disord 2020; 34:131-144. [PMID: 30179579 DOI: 10.1521/pedi_2018_32_385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) is associated with borderline personality disorder (BPD), but it also occurs in nonclinical samples (Briere & Gil, 1998), inflicting serious harm and serving as a precursor to suicide attempts (Klonsky, May, & Glenn, 2013). Therefore, the DSM-5 proposed a nonsuicidal self-injury disorder (NSSID) and suicidal behavior disorder. Because this addition requires reconciliation with current BPD criteria, the authors' study evaluated type and frequency of NSSI and suicide attempts in 3,795 outpatients. Both were found in those without BPD, although the behaviors increased when some symptoms and full criteria for BPD were met. Wound/skin picking, scratching, and hitting were most common. Cutting was the fifth most common self-injury for those with BPD and the eighth most common for those without the disorder. Therefore, increased clinical attention is warranted for such self-injury, which may go unnoticed but indicate significant distress. Findings suggest that NSSID/suicidal behavior disorder may account for self-injury outside of BPD.
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Affiliation(s)
- Alina Z Levine
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence, Rhode Island
| | | | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence, Rhode Island
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Raffagnato A, Angelico C, Valentini P, Miscioscia M, Gatta M. Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents. Front Psychiatry 2020; 11:262. [PMID: 32322222 PMCID: PMC7158949 DOI: 10.3389/fpsyt.2020.00262] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11-18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.
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Affiliation(s)
- Alessia Raffagnato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Perla Valentini
- Department of Communication Sciences, Humanistic and International Studies: History, Culture, Languages, Literature, Arts, Media, University of Urbino 'Carlo Bo', Urbino, Italy
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy.,Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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Buelens T, Luyckx K, Kiekens G, Gandhi A, Muehlenkamp JJ, Claes L. Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents. J Affect Disord 2020; 260:314-322. [PMID: 31521868 DOI: 10.1016/j.jad.2019.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/11/2019] [Accepted: 09/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health concern in adolescents. In 2013, DSM-5 recognized NSSI as a distinct clinical phenomenon and made a call for more systematic research by including Non-Suicidal Self-Injury-Disorder (NSSI-D) as a condition requiring further research. Yet, few studies have examined the prevalence of NSSI-D in adolescents using the exact DSM-5 criteria. Additionally, the few studies available criticised several of the proposed diagnostic criteria and pointed out that more research is needed. METHODS Therefore, we examined prevalence rates of NSSI-D and investigated the four most controversial criteria (i.e., criteria A, B/C, and E) in a large community sample of adolescents (N = 2,130; 54% female; Mage = 15, SD = 1.81). RESULTS Our results show an overall NSSI-D prevalence rate of 7.6%, with significantly more girls (11.7%) than boys (2.9%) meeting the diagnosis. The prevalence of NSSI-D dropped to 5.5% when an alternative criterion A (i.e., ≥10 days of NSSI in the past year) was implemented. In our sample, 87% and 99% of adolescents with lifetime NSSI met criteria B and C, which clearly questions the clinical utility of these criteria for the DSM-5 diagnosis of NSSI-D. Importantly, however, although criterion E received relatively low endorsement, it significantly distinguished adolescents with and without NSSI-D from one another. LIMITATIONS AND CONCLUSION Although our conclusions are restricted by the cross-sectional nature of our study, these findings show that NSSI-D is common in community adolescents and offer new insights in the endorsement and clinical utility of specific NSSI-D criteria.
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Affiliation(s)
- Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium.
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Glenn Kiekens
- Centre for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - Amarendra Gandhi
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium
| | | | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
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Zetterqvist M, Perini I, Mayo LM, Gustafsson PA. Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index. Front Psychiatry 2020; 11:8. [PMID: 32116833 PMCID: PMC7034359 DOI: 10.3389/fpsyt.2020.00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.
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Affiliation(s)
- Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per A Gustafsson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
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30
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Hooley JM, Fox KR, Boccagno C. Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:101-112. [PMID: 32021203 PMCID: PMC6959491 DOI: 10.2147/ndt.s198806] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
Nonsuicidal self-injury (NSSI) involves deliberate and intentional injury to body tissue that occurs in the absence of suicidal intent. Typical examples here might include self-cutting, burning, or self-hitting. Behavior of this kind is fundamentally unsettling as well as perplexing. It is also the case that self-harming behavior of any kind runs counter to a fundamental survival instinct. In the past, behaviors such as these were viewed as self-mutilation and considered to be a form of attenuated suicide. Much has changed over time, culminating in the entry of NSSI Disorder into DSM-5 as a condition in need of further study. In this review we describe the evolution of the NSSI construct and consider current issues in its diagnosis and assessment.
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Affiliation(s)
- Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO 80210, USA
| | - Chelsea Boccagno
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
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31
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Kraus L, Schmid M, In-Albon T. Anti-Suicide Function of Nonsuicidal Self-Injury in Female Inpatient Adolescents. Front Psychiatry 2020; 11:490. [PMID: 32581870 PMCID: PMC7283589 DOI: 10.3389/fpsyt.2020.00490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There have been numerous studies investigating the relationship between nonsuicidal self-injury (NSSI) and suicidality. On the one side, NSSI is an important risk factor for suicidality, including suicidal thoughts and behaviors. On the other side, it has been suggested that one function of NSSI might be as a coping mechanism that can help individuals in the short term avoid suicide. The present study investigated the relationship between suicidality and NSSI in female inpatient adolescents, focusing on NSSI as an anti-suicide strategy. METHODS Subjects were 56 female adolescents, aged 12-18 years (M = 15.95 years, SD = 1.27), recruited from different inpatient child and adolescent psychiatric units. All participants fulfilled the DSM-5 research criteria for nonsuicidal self-injury disorder (NSSI-D). To assess suicidality, NSSI-D, and current and past diagnoses, a structured clinical interview was conducted. RESULTS NSSI as a short-term coping strategy for avoiding suicide was indicated by one third (32.1%) of the participants. Before participants engaged in NSSI, the anti-suicide function was reported more frequently than reducing interpersonal problems (d = -.59). Getting relief from negative emotions and inducing positive feelings were reported at the same frequency as avoiding suicide before NSSI. Participants engaging in NSSI to avoid suicide and those reporting other functions did not significantly differ regarding other NSSI characteristics, suicidality, or psychopathology. Results indicate that the anti-suicide function significantly predicts the duration of current suicidal ideation (β = .557). CONCLUSION This study provides preliminary support for the idea that NSSI is frequently used by female adolescents with NSSI-D to avoid suicide. Given the high co-occurrence of NSSI and suicidality, our results underline the importance of clinical assessment of suicidality and several NSSI functions, including the anti-suicide function, in adolescents with NSSI.
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Affiliation(s)
- Laura Kraus
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Germany
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry, University of Basel, Basel, Switzerland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Germany
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Cloos M, Di Simplicio M, Hammerle F, Steil R. Mental images, entrapment and affect in young adults meeting criteria of nonsuicidal self-injury disorder (NSSID) - a daily diary study. Borderline Personal Disord Emot Dysregul 2020; 7:4. [PMID: 32071721 PMCID: PMC7014591 DOI: 10.1186/s40479-019-0117-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Incidents of nonsuicidal self-injury (NSSI) are often accompanied by mental images which could be perceived as distressing and/or soothing; yet existing data is derived from participants with a history of NSSI using retrospective methods. This study investigated mental images related to NSSI ("NSSI-images"), and their relationship to the proposed Nonsuicidal Self-Injury Disorder (NSSID). METHODS An e-mail was sent to all female students of the local University providing the link to an online screening and 201 students with a history of repetitive NSSI responded. Nineteen eligible participants meeting criteria of NSSID (mean age = 25; 32% with migrant background) further completed a baseline interview and a ten-day-diary protocol. RESULTS Among the sample of N = 201, 83.6% reported NSSI-images. In the subsample of n = 19 diagnosed with NSSID, the frequencies of NSSI and NSSI-images were correlated; about 80% of the most significant NSSI-images were either of NSSI or of an instrument associated with NSSI (i.e., a razorblade). In the diary, 53% of the sample self-injured. NSSI-images were reported on 94% of NSSI-days, and on days with NSSI and NSSI-images, the images almost always occurred first; the images were overall perceived as twice more distressing than comforting. Images on NSSI-days were characterized by more comfort, intrusiveness and compellingness yet less vividness, and increased subsequent positive and negative affect compared to non-NSSI days. NSSI-days were further marked by increased entrapment beliefs and increased negative yet decreased positive affect at night. These results were non-significant. LIMITATIONS Due to non-significant results among a small sample size and a low rate of NSSI among the NSSID-group, results remain preliminary. CONCLUSIONS The study provides information on feasibility and methodological challenges such as intervention effects of the diary. NSSI-images may be common among individuals who engage in NSSI; they may capture ambivalent (positive and negative) appraisals of NSSI and thus play a role in NSSI and possibly a disorder such as NSSID. The preoccupation with NSSI (Criterion C of NSSID in DSM-5) may as well be imagery-based. REGISTRATION The study was retrospectively registered with the DRKS under the number DRKS00011854.
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Affiliation(s)
- Marie Cloos
- 1Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt Main, Germany
| | - Martina Di Simplicio
- 2Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Florian Hammerle
- 3Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Regina Steil
- 1Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt Main, Germany
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Öhlund L, Ott M, Lundqvist R, Sandlund M, Salander Renberg E, Werneke U. Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort. Ther Adv Psychopharmacol 2020; 10:2045125320947502. [PMID: 32843959 PMCID: PMC7418477 DOI: 10.1177/2045125320947502] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. METHODS A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. RESULTS Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events (p = 0.013) and numbers of events experienced (p = 0.004). These effects were preserved 2 years after CS initiation. CONCLUSIONS CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.
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Affiliation(s)
- Louise Öhlund
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, 901 87, Sweden
| | - Michael Ott
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Luleå, Sweden
| | - Mikael Sandlund
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | | | - Ursula Werneke
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Luleå, Sweden
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Davico C, Amianto F, Gaiotti F, Lasorsa C, Peloso A, Bosia C, Vesco S, Arletti L, Reale L, Vitiello B. Clinical and personality characteristics of adolescents with anorexia nervosa with or without non-suicidal self-injurious behavior. Compr Psychiatry 2019; 94:152115. [PMID: 31513949 DOI: 10.1016/j.comppsych.2019.152115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/16/2019] [Accepted: 08/04/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE About one-fifth of patients with anorexia nervosa (AN) engage in non-suicidal self-injury (NSSI). This study examined clinical and temperament profile of female adolescents with both disorders (AN+NSSI) as compared with peers with AN only. METHODS A consecutive sample of 73 female adolescents with AN (mean age: 13.77 years), who had been admitted to inpatient or day-hospital services, received clinical, cognitive, and temperament/character evaluations. Of them, 32 met DSM-5 criteria also for NSSI. Assessments included demographics, standard nutrition parameters, Youth Self-Report (YSR), Wechsler Intelligence Scale for Children IV (WISC-IV), Temperament and Character Inventory (TCI), and Global Assessment of Functioning (GAF). RESULTS No differences were detected between AN+NSSI and AN in demographics, body mass index, or age at onset of AN. AN+NSSI had higher rate of binging and purging, higher YSR scores for both internalizing and externalizing psychopathology, lower total IQ, and lower Self-directedness and Cooperativeness scores. CONCLUSIONS These data suggest that adolescents with AN+NSSI have psychopathological, cognitive and overall character features that differ from patients with AN only. These characteristics may have implications for treatment and outcome.
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Affiliation(s)
- Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy; Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Federico Amianto
- Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy; Neurosciences Department, Psychiatry Section, University of Turin, Italy.
| | - Federica Gaiotti
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Claudia Lasorsa
- Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Anna Peloso
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy; Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Chiara Bosia
- Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Serena Vesco
- Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Luca Arletti
- Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Laura Reale
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy; Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy; Department of Pediatrics and Pediatric Sciences, Regina Margherita Pediatric Hospital, Turin, Italy
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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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Kaess M, Koenig J, Bauer S, Moessner M, Fischer-Waldschmidt G, Mattern M, Herpertz SC, Resch F, Brown R, In-Albon T, Koelch M, Plener PL, Schmahl C, Edinger A. Self-injury: Treatment, Assessment, Recovery (STAR): online intervention for adolescent non-suicidal self-injury - study protocol for a randomized controlled trial. Trials 2019; 20:425. [PMID: 31300065 PMCID: PMC6626324 DOI: 10.1186/s13063-019-3501-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a clinically significant behavior affecting approximately 18% of adolescents and young adults worldwide. The importance of NSSI is supported by its association with a broad spectrum of mental disorders. Despite its high relevance, evidence-based, specific, time-, and cost-effective treatment approaches are scarce. Cognitive behavioral therapy (CBT) seems effective in reducing the frequency of NSSI in adolescents and young adults. However, young people are often reluctant to seek professional help and effective interventions adressing NSSI are not sufficiently available across all regions of Germany. Research indicates that the majority of youth with risk behavior (including NSSI) prefer technology-based interventions. To date, effective interventions for adolescents and young adults with NSSI that are deliverd online are not available. METHODS The present project aims to develop and evaluate an online intervention for adolescents and young adults with NSSI based on the content of a recently evaluated face-to-face short-term program that includes elements of CBT and dialectical behavior therapy (DBT): "The Cutting Down Programme" (CDP). The efficacy of the new online CDP intervention will be tested in a randomized controlled trial (RCT) in which n = 700 youths engaging in repetitive NSSI will participate in either an online psychoeducation (n = 350) or online CDP (n = 350). Within a postline assessment four months after baseline (end of treatment; T1), and follow-up evaluations 12 and 18 months after baseline (follow-ups; T2 and T3), NSSI and comorbid symptoms as well as quality of life will be assessed. It is hypothesized that participants receiving online CDP report a greater reduction in the frequency of NSSI within the last three months at T2 (primary endpoint) compared to those receiving online psychoeducation. Exploratory analyses will focus on predictors of treatment outcome. DISCUSSION We report on the development and evaluation of an online intervention for adolescents and young adults engaging in NSSI based on the CDP. If supported by empirical evidence, an online-based intervention for NSSI might help to overcome the limited availability of adequate interventions for youth. TRIAL REGISTRATION German Clinical Trials Register, DRKS00014623 . Registered on 22 May 2018.
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Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Centre for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Centre for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Margarete Mattern
- Department of General Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Tina In-Albon
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Michael Koelch
- Department for Child and Adolescent Psychiatry and Psychotherapy, Medical School Brandenburg, Neuruppin, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexandra Edinger
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - the STAR Consortium
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Centre for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of General Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany
- Department for Child and Adolescent Psychiatry and Psychotherapy, Medical School Brandenburg, Neuruppin, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Medeiros GC, Seger-Jacob L, Garreto AK, Kim HS, Coccaro EF, Tavares H. Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:303-309. [PMID: 30843959 PMCID: PMC6804311 DOI: 10.1590/1516-4446-2018-0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. METHODS We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. RESULTS The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. CONCLUSIONS Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.
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Affiliation(s)
- Gustavo C. Medeiros
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Liliana Seger-Jacob
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna K. Garreto
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Hyoun S. Kim
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Hermano Tavares
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Oh MA, Park C, Lee YJ, Hong M, Han JH, Oh SH, Park JH, Bahn GH. The Analysis of Self-Mutilation in Adolescence Based on the Theory of Mentalization: From Sukhvinder in the Novel 'Casual Vacancy'. Soa Chongsonyon Chongsin Uihak 2019; 30:100-108. [PMID: 32595327 PMCID: PMC7298891 DOI: 10.5765/jkacap.190014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives: Adolescence involves a number of developmental processes, as well as unique psychological characteristics and behaviors. An increased rate of internet and game addictions, school violence, and suicide may either represent aspects of adolescence or a psychopathological phenomenon. There is an urgent need to develop software programs that can prevent and resolve adolescent behavioral problems. We applied the mentalization theory to interpret and find solutions for problems faced by adolescent characters in literature. Methods: In Joan Rowling’s novel “Casual Vacancy,” Sukhvinder is a girl with problems representative of those encountered by modern adolescents; she is a victim of bullying and engages in self-mutilation. We targeted her problematic behaviors as representative of a prementalized state. Results: Born into an upper-class English family with Pakistani origins, Sukhvinder, unlike her siblings, fails her parents’ expectations. Whenever she faces a psychological crisis, she regresses into the teleological mode (the most primitive pre-mentalization stage) and regains her sense of self by cutting herself. After her friend’s suicide, however, she begins to communicate with her parents and moves toward mentalization. Conclusion: By analyzing Sukhvinder’s behavior, we assessed patterns of attachment, empathy, and mentalization, and identified corrective approaches for problematic behaviors. We believe that the presented interpretation may serve as a foundation for the development of models for understanding adolescent deviant behaviors.
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Affiliation(s)
- Mi Ae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Chanmin Park
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Yeon Jeong Lee
- Department of Psychiatry, Soonchunghyang University Seoul Hospital, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University School of Medicine, Ilsan, Korea
| | - Ju Hee Han
- Gajoksarang Neuropsychiatric Clinic, Seoul, Korea
| | - Soo Hyun Oh
- Department of Life Sciences, Ewha Womans University, Seoul, Korea
| | | | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Korea
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Siu AMH. Self-Harm and Suicide Among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies. J Adolesc Health 2019; 64:S59-S64. [PMID: 31122551 DOI: 10.1016/j.jadohealth.2018.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people.
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Affiliation(s)
- Andrew M H Siu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Demers LA, Schreiner MW, Hunt RH, Mueller BA, Klimes-Dougan B, Thomas KM, Cullen KR. Alexithymia is associated with neural reactivity to masked emotional faces in adolescents who self-harm. J Affect Disord 2019; 249:253-261. [PMID: 30780118 PMCID: PMC6724702 DOI: 10.1016/j.jad.2019.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a major, trans-diagnostic mental health problem among adolescents. Alexithymia has been identified as a developmental risk factor for NSSI. Research on how alexithymia relates to the neurobiology of automatic emotion processing is only beginning to emerge. This study evaluates the relationship between alexithymic features and neural responses to automatic processing of emotional content in adolescents with NSSI. METHODS 25 female adolescents (ages 13-21) with a history of repeated engagement in NSSI completed the Toronto Alexithymia Scale and the Difficulties with Emotion Regulation Scale and underwent functional magnetic resonance imaging (fMRI) during a task in which participants were exposed to masked emotions. RESULTS One facet of alexithymia, limited internal emotion awareness or externally-oriented thinking (EOT), was related to differential reactivity to masked emotional faces in clusters in the right supramarginal gyrus and right inferior frontal gyrus. Follow-up assessment of regional reactivity revealed that greater EOT is associated with lower activation to masked happy faces but higher activation to masked fearful faces. Other facets of alexithymia did not show relationships with reactivity to masked emotional faces. LIMITATIONS This is a cross-sectional and small sample that only includes females, which may attenuate generalizability of findings. CONCLUSIONS We report neural correlates of multiple facets of alexithymia in adolescents with NSSI. Among adolescents who self-harm, those with higher levels of EOT may be less alert to subtle positively-valenced emotion cues. For this subset of adolescents with NSSI, interventions designed to enhance mental representation of emotional responses and attention to positive emotions may be appropriate.
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Affiliation(s)
- Lauren A Demers
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA.
| | | | - Ruskin H Hunt
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN 55455, USA
| | - Kathleen M Thomas
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Tschan T, Lüdtke J, Schmid M, In-Albon T. Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group. Child Adolesc Psychiatry Ment Health 2019; 13:15. [PMID: 30923561 PMCID: PMC6419840 DOI: 10.1186/s13034-019-0275-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/28/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adolescents' nonsuicidal self-injury (NSSI) leads to distress that affects the whole family system, and siblings are reported to suffer from disrupted family communication and functioning. So far, no studies have examined the quality of relationships between adolescents with NSSI and their siblings. The aim of the present study was to examine the sibling relationship quality of adolescents with NSSI, adolescents with other mental disorders without NSSI (clinical controls, CC), and adolescents without current or past experience of mental disorders (nonclinical controls, NC). METHODS 139 female adolescents aged 13-20 years (mean age = 16.18 years, SD = 1.62, NSSI: n = 56, CC: n = 33, NC: n = 50) and 73 siblings aged 10-28 years (mean age = 16.88 years, SD = 4.02, 60.3% female) participated. Self-report measures were used to assess psychopathology and sibling relationship quality. RESULTS Siblings reported a wide range of negative emotional and familial consequences, such as feeling left alone with their sister's issues or a distressing family situation, as a result of their sister's NSSI. Siblings of adolescents with NSSI experienced significantly more coercion in the relationship with their sister compared to CC (d = 1.08) and NC (d = 0.67) siblings, indicating an imbalance of dominance and control in their relationship. Further, adolescents with NSSI reported significantly less warmth and empathy in the sibling relationship and higher rivalry scores between their siblings and themselves than NC adolescents, suggesting higher levels of parental favoritism among parents of adolescents with NSSI compared to NC parents (d = 0.93). Among siblings of adolescents with NSSI, high levels of warmth, conflict, and empathy were significantly associated with internalizing problems. For adolescents with NSSI a significant association was found between internalizing problems and coercion and externalizing problems and similarity. CONCLUSIONS Given the negative impact of NSSI on siblings' emotional well-being and family life, efforts should be made to offer siblings psychoeducation and support to help them cope with the emotional and familial consequences of their sister's NSSI. Given adequate support, siblings can in turn be a source of emotional support for their sister.
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Affiliation(s)
- Taru Tschan
- 0000 0001 0087 7257grid.5892.6Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Janine Lüdtke
- 0000 0004 1937 0642grid.6612.3Department of Child and Adolescent Psychiatry, University of Basel, 4056 Basel, Switzerland
| | - Marc Schmid
- 0000 0004 1937 0642grid.6612.3Department of Child and Adolescent Psychiatry, University of Basel, 4056 Basel, Switzerland
| | - Tina In-Albon
- 0000 0001 0087 7257grid.5892.6Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Ostbahnstraße 12, 76829 Landau, Germany
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Yuan SNV, Kwok KHR, Ougrin D. Treatment Engagement in Specific Psychological Treatment vs. Treatment as Usual for Adolescents With Self-Harm: Systematic Review and Meta-Analysis. Front Psychol 2019; 10:104. [PMID: 30778310 PMCID: PMC6369209 DOI: 10.3389/fpsyg.2019.00104] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Self-harm is a major public health problem. It is one of the best predictors of suicide in adolescents. Despite recent advances in the understanding of self-harm, poor treatment engagement remains a significant clinical obstacle. Objectives: The purpose of this meta-analysis is to update and extend previous research investigating treatment engagement with specific psychological treatments (SPT) vs. treatment as usual (TAU) in adolescents who self-harm. Methods: Data sources were identified by searching the Medline, PsychINFO, EMBASE, and PubMed databases as of October 2017. Randomized Controlled Trials (RCTs) comparing SPT and TAU in adolescents (through age 18 years) with self-harm were included. Results: The results show that 12 RCTs investigating 1,255 young people were included in the meta-analysis. The proportion of adolescents not completing four or more sessions in SPT was significantly lower (28.4%, 179/630) than TAU (45.9%, 287/625), RR = 0.64 (95% CI:0.51 -0.79), p < 0.0001. There were significantly more adolescents engaged with SPT than TAU. Conclusions: Specific psychological treatments should be offered to adolescents with self-harm to maximize treatment engagement. Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment goals.
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Westlund Schreiner M, Mueller BA, Klimes-Dougan B, Begnel ED, Fiecas M, Hill D, Lim KO, Cullen KR. White Matter Microstructure in Adolescents and Young Adults With Non-Suicidal Self-Injury. Front Psychiatry 2019; 10:1019. [PMID: 32038337 PMCID: PMC6992587 DOI: 10.3389/fpsyt.2019.01019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a growing public health concern that commonly begins in adolescence, and can persist into young adulthood. A promising approach for advancing our understanding of NSSI in youth is to examine white matter microstructure using diffusion magnetic resonance imaging (dMRI). METHOD The present study examined whole-brain group differences in structural connectivity (as measured by generalized fractional anisotropy [GFA]) between 28 female adolescents and young adults ages 13-21 years with NSSI and 22 age-matched healthy controls (HC). We also explored the association between clinical characteristics including NSSI severity and duration, impulsivity, emotion regulation and personality traits within the NSSI group and GFA of the uncinate fasciculus and cingulum. RESULTS Compared to the HC group, participants with NSSI had lower GFA in several white matter tracts, including the uncinate fasciculus, cingulum, bilateral superior and inferior longitudinal fasciculi, anterior thalamic radiation, callosal body, and corticospinal tract. When controlling for depressive symptoms, the NSSI group showed an association between NSSI duration (time since initiating NSSI behavior) and lower GFA in the left cingulum. Higher levels of attentional impulsivity were related to lower GFA in the left uncinate fasciculus within the NSSI group. CONCLUSIONS We found evidence suggesting widespread white matter microstructure deficits in adolescents and young adults with NSSI versus HC. We also report inverse associations between white matter integrity and clinical characteristics (duration of NSSI and attentional impulsivity). These white matter microstructural deficits may represent a possible neurobiologically-based vulnerability to developing maladaptive coping mechanisms, such as NSSI. Additionally, results suggest that this white matter disorganization may either worsen with prolonged engagement in NSSI or predict persistent NSSI; thereby highlighting the importance of early intervention targeting this behavior.
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Affiliation(s)
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN, United States
| | - Erin D Begnel
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN, United States
| | - Mark Fiecas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Dawson Hill
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
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Zinchuk MS, Avedisova AS, Guekht AB. Nonsuicidal self-injury behavior in non-psychotic disorders: epidemiology, social and clinical risk factors. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:108-119. [DOI: 10.17116/jnevro2019119031108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Plener PL, Kaess M, Schmahl C, Pollak S, Fegert JM, Brown RC. Nonsuicidal Self-Injury in Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:23-30. [PMID: 29366448 DOI: 10.3238/arztebl.2018.0023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/02/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND 25-35% of adolescents in random samples drawn from German schools have been found to have manifested at least one episode of nonsuicidal self-injury (NSSI). The prevalence in samples from child and adolescent psychiatric clinics is approximately 50%. NSSI can arise as a symptom in the setting of various types of mental illness. METHODS This review is based on a selective literature search carried out in the PubMed, PsycINFO, and Cochrane Library databases, with special consideration of regional study samples. RESULTS NSSI is usually resorted to as a dysfunctional coping strategy for emotional regulation. The main risk factors for NSSI include bullying, accompanying mental illnesses, and a history of abuse and neglect in childhood. Neurobiological studies have shown abnormal stress processing in persons with NSSI and an elevated pain threshold in persons with repetitive NSSI. Psychotherapeutic interventions of various kinds lessen the frequency of NSSI; to date, no particular type of psychotherapy has been found to be clearly superior to the others. Randomized controlled trials have revealed small to moderate effects from dialectic-behavioral therapy and mentalization-based therapy in adolescent patients. No psychoactive drug has yet been found to possess specific efficacy against NSSI in adolescents. CONCLUSION The first ever German-language clinical guidelines for the treatment of NSSI have now been issued. Psychotherapy is the treatment of first choice. More research is needed so that subgroups with different disease courses can be more clearly defined.
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Affiliation(s)
- Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Heidelberg University Hospital; Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim; Institute of Forensic Medicine at University Medical Center Freiburg
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Slavin-Stewart C, Boylan K, Burke JD. Subgroups of Adolescent Girls With Borderline Personality Disorder Symptoms. J Pers Disord 2018; 32:636-653. [PMID: 28926303 DOI: 10.1521/pedi_2017_31_317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine whether borderline personality disorder (BPD) can be differentiated from other disorders in a clinical sample of adolescent girls. Participants (N = 75) were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. Four latent classes were identified. The most impaired class endorsed seven BPD symptoms and an average of three comorbid disorders. An intermediate class endorsed three BPD symptoms and had the highest prevalence of PTSD (41.7%). A third class reported two BPD symptoms and had a high prevalence of anxiety disorders (62%). The fourth class had no BPD symptoms and, on average, one comorbid disorder. Only a small subset of these teenage girls met criteria for BPD, and they had distinct and severe impairment. The results suggest the modest likelihood of a BPD diagnosis in clinical samples of teenage girls, and to also be vigilant for PTSD.
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Affiliation(s)
| | | | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut
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47
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Yang X, Xin M. "Boy Crisis" or "Girl Risk"? The Gender Difference in Nonsuicidal Self-Injurious Behavior Among Middle-School Students in China and its Relationship to Gender Role Conflict and Violent Experiences. Am J Mens Health 2018; 12:1275-1285. [PMID: 29577836 PMCID: PMC6142131 DOI: 10.1177/1557988318763522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/15/2017] [Accepted: 01/31/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We attempted to test if there were gender differences in nonsuicidal self-injurious (NSSI) behaviors among Chinese middle-school students, and analyze the impact of gender role conflict and violent experiences on these behaviors among middle-school students of different genders. METHOD Based on the survey data from seven middle schools in Xi'an region of China, the gender difference in NSSI behaviors and its associated factors were analyzed in this study. RESULTS There was no significant gender difference in NSSI behaviors among middle-school students; however, female middle-school students were more likely to experience gender role conflicts while male students were more likely to experience all kinds of violence earlier. Gender role conflicts and violent experiences can explain the prevalence of NSSI behaviors by gender, to some extent. CONCLUSIONS The hypothesis on gender patterns of "boy crisis" or "girl risk" on NSSI prevalence was not verified; however, a "girl risk" for gender role conflicts and a "boy crisis" in violent experiences were found. The gender role conflicts were significantly associated with NSSI prevalence among middle-school students to some extent; however, this relationship was adjusted by variables of violent experiences. The different variables of violent experiences were the important predictors of NSSI prevalence among male and female middle-school students with specific contents varying across genders.
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Affiliation(s)
- Xueyan Yang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
| | - Moye Xin
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
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48
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Kiekens G, Hasking P, Claes L, Mortier P, Auerbach RP, Boyes M, Cuijpers P, Demyttenaere K, Green JG, Kessler RC, Nock MK, Bruffaerts R. The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors. Depress Anxiety 2018; 35:629-637. [PMID: 29697881 DOI: 10.1002/da.22754] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Approximately one in five college students report a history of nonsuicidal self-injury. However, it is unclear how many students meet criteria for the recently proposed DSM-5 nonsuicidal self-injury disorder (NSSI-D). In this study, we used full NSSI-D criteria to identify those students most in need of clinical care. METHODS Using data from the Leuven College Surveys (n = 4,565), we examined the 12-month prevalence of DSM-5 NSSI-D in a large and representative sample of incoming college students. We also explored the optimal frequency threshold as a function of interference in functioning due to NSSI, and examined comorbidity patterns with other 12-month mental disorders (i.e., major depressive disorder, broad mania, generalized anxiety disorder, panic disorder, and alcohol dependence) and suicidal thoughts and behaviors (STB). RESULTS Twelve-month NSSI-D prevalence was 0.8% and more common among females (1.1%) than males (0.4%). The proposed 5+ diagnostic threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. A dose-response relationship was observed for NSSI recency-severity (i.e., 12-month NSSI-D, subthreshold 12-month NSSI-D, past NSSI, no history of NSSI) with number of 12-month mental disorders and STB. NSSI-D occurred without comorbid disorders for one in five individuals, and remained associated with severe role impairment when controlling for the number of comorbid disorders. CONCLUSIONS These findings offer preliminary evidence that DSM-5 NSSI-D is uncommon among incoming college students, but may help to improve the deployment of targeted resource allocation to those most in need of services. More work examining the validity of NSSI-D is required.
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Affiliation(s)
- Glenn Kiekens
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,School of Psychology, Curtin University, Perth, Australia
| | | | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Randy P Auerbach
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Ronald C Kessler
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA
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49
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Brown RC, Heines S, Witt A, Braehler E, Fegert JM, Harsch D, Plener PL. The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population. BMC Psychiatry 2018; 18:181. [PMID: 29884152 PMCID: PMC5994090 DOI: 10.1186/s12888-018-1754-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/21/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Child maltreatment is an identified risk factor for Non-Suicidal Self-Injury (NSSI). The aim of the current study was to investigate effects of different types of maltreatment, and mediating effects of depression and anxiety on NSSI in the general population. METHODS A representative sample of the German population, comprising N = 2498 participants (mean age = 48.4 years (SD = 18.2), 53.3% female) participated in this study. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ),NSSI was assessed with a question on lifetime engagement in NSSI, depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-2) and anxiety symptoms by the General Anxiety Disorder questionnaire (GAD-2). RESULTS Lifetime prevalence of NSSI in this sample was 3.3, and 30.8% reported at least one type of child maltreatment. Participants in the NSSI group reported significantly more experiences of child maltreatment. Emotional abuse was endorsed by 72% of all participants with NSSI. A path analytic model demonstrated an unmediated direct effect of emotional neglect, a partially mediated effect of emotional abuse, and a fully mediated effect of sexual abuse and physical neglect by depression and anxiety on NSSI. CONCLUSIONS Especially emotional neglect and abuse seem to play a role in the etiology of NSSI above and beyond depression and anxiety, while sexual and physical abuse seem to have a rather indirect effect.
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Affiliation(s)
- Rebecca C. Brown
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany
| | - Stefanie Heines
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany
| | - Andreas Witt
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany
| | - Elmar Braehler
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,0000 0001 2230 9752grid.9647.cDepartment of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Joerg M. Fegert
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany
| | - Daniela Harsch
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany
| | - Paul L. Plener
- 0000 0004 1936 9748grid.6582.9Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr, 5, 89075 Ulm, Germany ,0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
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50
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Kranzler A, Fehling KB, Lindqvist J, Brillante J, Yuan F, Gao X, Miller AL, Selby EA. An Ecological Investigation of the Emotional Context Surrounding Nonsuicidal Self-Injurious Thoughts and Behaviors in Adolescents and Young Adults. Suicide Life Threat Behav 2018; 48:149-159. [PMID: 28758704 DOI: 10.1111/sltb.12373] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/08/2016] [Indexed: 11/29/2022]
Abstract
Ecological momentary assessment (EMA) methodology was used to examine the emotional context of nonsuicidal self-injury (NSSI). Forty-seven adolescents and young adults used a novel smartphone app to monitor their emotional experiences, NSSI thoughts, and NSSI behaviors for 2 weeks. Momentary changes in both negative and positive emotions predicted greater intensity of NSSI thoughts at the subsequent assessment, while only increases in negative emotion predicted NSSI behaviors. Immediately following NSSI behaviors participants reported reduced high-arousal negative emotions and increased low-arousal positive emotions, suggesting that NSSI may be an efficient and effective method of regulating emotion. Findings highlight the importance of addressing emotion regulation in NSSI interventions.
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Affiliation(s)
- Amy Kranzler
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Kara B Fehling
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Janne Lindqvist
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Julia Brillante
- Rutgers Graduate School of Applied and Professional Psychology, New Brunswick, NJ, USA
| | - Fengpeng Yuan
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Xianyi Gao
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Alec L Miller
- Cognitive and Behavioral Consultants of Westchester and Manhattan, White Plains, NY, USA
| | - Edward A Selby
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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