Treating nonsuicidal self-injury (NSSI) in adolescents: consensus based German guidelines.

Paul L Plener,Franz Resch,Tina In-Albon,Jörg M Fegert,Romuald Brunner,Katja Becker,Rebecca C Groschwitz,Nestor D Kapusta,Michael Kaess

doi:10.1186/s13034-016-0134-3

Abstract

BackgroundNonsuicidal self-injury (NSSI) is a frequent and clinically relevant phenomenon in adolescence. Within Europe, Germany has one of the highest prevalence rates in youth with lifetime prevalence ranging between 25 and 35%. However, treatment guidelines for NSSI are not yet available.MethodsConsensus based clinical guidelines were created by a working group consisting of members of eleven medical, psychological or psychotherapeutic professional national associations, and two members of patient self-help and prevention groups. The guidelines were developed in consecutive expert meetings and literature searches and agreed on in a final consensus conference.ResultsGiven that evidence on both the psychotherapeutic and psychopharmacological treatment of NSSI is limited, a consensus based approach was chosen. The consensus indicated that due to the accumulating evidence on the efficacy of psychotherapeutic approaches, core elements of psychotherapy should be provided in treatment of NSSI. A specific psychopharmacological therapy of NSSI cannot be recommended. In addition, the guidelines provide recommendations for surgical intervention of NSSI.ConclusionsIn accordance with the heterogeneous level of evidence, recommendations for the clinical management of NSSI in adolescence were made during a consensus conference after reviewing available literature. There is still a lack of knowledge on prevention as well as clinical interventions, which needs to be addressed by further clinically relevant studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13034-016-0134-3) contains supplementary material, which is available to authorized users.

Highlights

Nonsuicidal self-injury (NSSI) is a frequent and clinically relevant phenomenon in adolescence
Many studies use terms like “Deliberate Self-Harm” (DSH), which includes all forms of self-injurious behavior regardless of its suicidal intent [3], and can best be viewed as an “umbrella term” [4] for self-harming behaviors, including NSSI and nonsuicidal self-poisoning, which is not captured in NSSI [5]
On the one hand, creating a category of NSSI can prevent especially adolescents from being automatically “labeled” as having borderline personality disorder, and acknowledges the fact that self-injury can be undertaken without suicidal intent and that consensus-based pathways can be developed for best practice treatment [8, 9]

Summary

Introduction

Nonsuicidal self-injury (NSSI) is a frequent and clinically relevant phenomenon in adolescence. Many studies use terms like “Deliberate Self-Harm” (DSH), which includes all forms of self-injurious behavior regardless of its suicidal intent [3], and can best be viewed as an “umbrella term” [4] for self-harming behaviors, including NSSI and nonsuicidal self-poisoning, which is not captured in NSSI [5]. It somehow resembles the definition of “parasuicide” provided by Power and Spencer [6], who stated that parasuicide “is a variable concept, both in terms of suicidal. Hamza et al [16] provided an integrated model of NSSI and suicidal behavior, proposing that NSSI predict suicidal behavior (Gateway theory), with the association between NSSI and suicidality being influenced by third variables like BPD (Third Variable Theory) and that NSSI will change the acquired capability to commit suicide

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