Abstract
Self-injurious behaviors are among the leading causes of death worldwide. However, the basic nature of self-injurious thoughts and behaviors (SITBs) is not well understood because prior studies have relied on long-term, retrospective, aggregate, self-report assessment methods. The authors used ecological momentary assessment methods to measure suicidal and nonsuicidal SITBs as they naturally occur in real time. Participants were 30 adolescents and young adults with a recent history of self-injury who completed signal- and event-contingent assessments on handheld computers over a 14-day period, resulting in the collection of data on 1,262 thought and behavior episodes. Participants reported an average of 5.0 thoughts of nonsuicidal self-injury (NSSI) per week, most often of moderate intensity and short duration (1-30 min), and 1.6 episodes of NSSI per week. Suicidal thoughts occurred less frequently (1.1 per week), were of longer duration, and led to self-injurious behavior (i.e., suicide attempts) less often. Details are reported about the contexts in which SITBs most often occur (e.g., what participants were doing, who they were with, and what they were feeling before and after each episode). This study provides a first glimpse of how SITBs are experienced in everyday life and has significant implications for scientific and clinical work on self-injurious behaviors.
Highlights
Self-injurious behaviors are among the leading causes of death and injury worldwide (Nock, Borges et al, 2008; WHO, 2008), and represent one of the most perplexing problems facing psychological scientists
Some of the distal risk factors for self-injurious thoughts and behaviors (SITBs) are well-known(Jacobson & Gould, 2007; Nock, Borges et al, 2008), very little is known about the proximal triggers for self-injurious thoughts, about what factors predict the transition from self-injurious thoughts to self-injurious behaviors, or about why people engage in SITBs
We focused on SITBs among those with a recent history of nonsuicidal self-injury (NSSI) because we were interested in this dangerous and perplexing clinical behavior in itself, and because adolescents who engage in NSSI are at significantly increased risk for suicidal thoughts and attempts (Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006; Prinstein et al, 2008)
Summary
Self-injurious behaviors are among the leading causes of death and injury worldwide (Nock, Borges et al, 2008; WHO, 2008), and represent one of the most perplexing problems facing psychological scientists. Researchers historically have favored a deductive approach in which general theories as to why people hurt themselves are generated and tested empirically, rather than using field observation and description to understand the form (i.e., topographical characteristics) and function of the phenomena of interest This limitation is not specific to the study of SITBs, but is true of psychological science more generally. Most researchers and clinicians distinguish between self-injury that is suicidal versus non-suicidal in nature based on the reported intent of the behavior, empirical data are lacking regarding the extent to which these distinct forms of SITB differ in their expression Evidence showing that these putatively different forms of SITBs differ in their frequency, severity, duration, and common precipitants would strengthen the case for distinguishing between them (i.e., rather than lumping them into one category of “parasuicide” or “deliberate self-harm” as is sometimes done in the literature). Still relying on self-report, the strengths of these methods include reduction of recall biases, increased reliability due to repeated assessment, and enhanced ecological validity due to data collection in natural settings (Hufford, 2007)
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