Mental images, entrapment and affect in young adults meeting criteria of nonsuicidal self-injury disorder (NSSID) \u2013 a daily diary study

Florian Hammerle,Regina Steil,Marie Cloos,Martina Di Simplicio

doi:10.1186/s40479-019-0117-0

Abstract

BackgroundIncidents 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).MethodsAn 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.ResultsAmong 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.LimitationsDue to non-significant results among a small sample size and a low rate of NSSI among the NSSID-group, results remain preliminary.ConclusionsThe 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.RegistrationThe study was retrospectively registered with the DRKS under the number DRKS00011854.

Highlights

Nonsuicidal self-injury (NSSI) is defined as “the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned” [1] such as cutting or burning of the skin
nonsuicidal self-injury (NSSI)-images may be common among individuals who engage in NSSI; they may capture ambivalent appraisals of NSSI and play a role in NSSI and possibly a disorder such as Nonsuicidal Self-Injury Disorder (NSSID)
Baseline assessment and daily diary Out of the screening sample of N = 201, n = 32 were seen for a baseline assessment and diagnostic, and a subsample of n = 19 completed all parts. Demographic characteristics of this subsample including information on clinical diagnoses and psychotherapeutic treatment are displayed in Table 2.6 One participant reported to receive interventions that directly aimed at mental images or NSSI

Summary

Introduction

Nonsuicidal self-injury (NSSI) is defined as “the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned” [1] such as cutting or burning of the skin. Nonsuicidal self-injury disorder (NSSID) is listed in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [6]) and has not been sufficiently evaluated yet according to some [7]. Some studies have provided support for the validity of NSSID, e.g., for the positive and negative reinforcement mechanisms (for a review, see [9]) or the proposed minimum of five or more incidents during the past 12 months ([10]; while other data suggests + 10 incidents might be more valid [11]) and the use of the criteria may improve the assessment of the disorder [9]. This study investigated mental images related to NSSI (“NSSI-images”), and their relationship to the proposed Nonsuicidal Self-Injury Disorder (NSSID)

Methods

Results

Discussion

Conclusion