Research with adolescents who engage in non-suicidal self-injury: ethical considerations and challenges.

Elizabeth E Lloyd-Richardson,Karen Rodham,Heather T Schatten,Janis L Whitlock,Stephen P Lewis

doi:10.1186/s13034-015-0071-6

Abstract

Non-suicidal self-injury (NSSI) has emerged as a significant psychiatric issue among youth. In addition to its high prevalence rates, NSSI is associated with a number of psychiatric issues and confers risk for varying degrees of physical injury. It is also a risk factor for attempted suicide. Thus, youth who engage in NSSI represent a vulnerable and high-risk population and researchers are likely to encounter a variety of ethical challenges when conducting NSSI research. Accordingly, it is critical that researchers be familiar with the major ethical issues involved in NSSI research and how to effectively account for and address them. This is important both prior to obtaining clearance from their Institutional Review Boards and when carrying out their research. To date, there is no consolidated resource to delineate the ethical challenges inherent to NSSI research and how these can be effectively navigated throughout the research process. The goals of this paper are to review international best practices in NSSI research across the various contexts within which it is studied, to offer guidelines for managing these issues, to identify areas in which variation in approaches prohibits decisive recommendations, and to generate questions in need of further consideration among scholars in this field.

Highlights

Non-suicidal self-injury (NSSI) is the deliberate, selfinflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned
NSSI is included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a condition requiring further research before consideration as an official diagnosis [1]
The 1949 Nuremberg Code and subsequent 1964 Declaration of Helsinki firmly establish that researchers and medical professionals should do no harm in their practice and research [5]. With this background in mind, the primary goal of this paper is to review international best practices in NSSI research across the various contexts within which it is studied

Summary

Introduction

Non-suicidal self-injury (NSSI) is the deliberate, selfinflicted destruction of body tissue (e.g., cutting, burning) without suicidal intent and for purposes not socially sanctioned. The proposed criteria require NSSI incidents on five or more days within the past year, with at least one of the following expectations: to seek relief from a negative feeling or cognitive state, to resolve an interpersonal difficulty, or to induce a positive state. The comorbidity and consequences of NSSI are significant. It is a strong risk factor for suicide and is associated with a host of psychological difficulties and disorders which include, but are not limited to: mood and anxiety disorders, borderline personality disorder, substance abuse, difficulties with negative affect (e.g., anxiety, frustration), hopelessness, self-criticism, poor body image, and low self-esteem [2, 3]

Objectives

Conclusion