Course Of Non-suicidal Self-injury Research Articles

The Short-Term Course of Nonsuicidal Self-Injury Among Individuals Seeking Psychiatric Treatment.

A major portion of adolescents and adults seeking psychiatric treatment report nonsuicidal self-injury (NSSI) within the past month, yet the short-term course of NSSI among these patients remains poorly understood. To advance the understanding of the short-term course of NSSI cognitions (ie, thoughts, urges, and self-efficacy to resist self-injury) and behavior. A cohort study was conducted using an intensive longitudinal design with ecological momentary assessment, including 6 daily surveys and event registrations of self-injury for 28 days. Data were collected from June 2021 to August 2023. Individuals using mental health services in the Flanders region in Belgium reporting past-month NSSI urges and/or behavior at intake were recruited by referral. Nonsuicidal self-injury thoughts, urges, self-efficacy, and behavior. Sociodemographic and clinical baseline characteristics served as between-person variables. Descriptive and variability statistics and dynamic structural equation modeling were used. Participants completed a mean (SD) of 121 (34.5) surveys, totaling 15 098 longitudinal assessments (median adherence, 78.6%; IQR, 59.5%-88.7%). Among 125 patients (87.2% female; median age, 22.0 [range, 15-39] years; 52.8% heterosexual), NSSI thoughts and urges were present during most assessments but were low in intensity (individual means [SD] on a 0- to 6-point scale, 1.52 [1.13] for urges; 1.57 [1.18] for thoughts). The prevalence of NSSI behavior was 84.0% monthly, 49.90% weekly, and 18.19% daily. Between-patient variability was substantial (intraclass correlation coefficient, 0.43-0.47; range of individual means for cognitions, 0-6; individual frequency behavior, 0-103), with recency and frequency of NSSI thoughts and behavior at intake consistently associated with individual differences in the course of NSSI. The greatest variability was observed within patients (root mean square of successive differences from 1.31 for self-efficacy to 1.40 for instability of thoughts), characterized by changes in the intensity of cognitions by more than 1 within-person SD between assessments less than 2 hours apart in 1 of 5 instances. Nonsuicidal self-injury behavior is rare in the morning, increased in the afternoon, and most frequent in the evening. Nonsuicidal self-injury cognitions were contemporaneous and temporally associated with each other's course, with higher-than-usual thoughts and lower self-efficacy uniquely signaling heightened risk for NSSI behavior in the next 2 hours. In this cohort study of treatment-seeking individuals, NSSI cognitions and behavior appeared to be dynamic over the short term. These findings suggest the potential utility of self-monitoring outside the therapy setting and the need to focus assessment and interventions on the evening hours.

Two-year course of non-suicidal self-injury in an adolescent clinical cohort: The role of childhood adversity in interaction with cortisol secretion

AimNon-suicidal self-injury (NSSI) is a highly prevalent phenomenon during adolescence. Nonetheless, research on predictors of the clinical course of NSSI over time is still scarce. The present study aimed at investigating the impact of adverse childhood experiences (ACE) and hypothalamus-pituitary-adrenal (HPA) axis functioning on the longitudinal course of NSSI. MethodsIn a sample of n = 51 help-seeking adolescents engaging in NSSI, diurnal cortisol secretion (CAR, cortisol awakening response; DSL, diurnal slope), hair cortisol concentrations and ACE were assessed at baseline. Clinical outcome was defined by change in the frequency of NSSI in the past 6 months measured 12 and 24 months after the baseline assessments. Mixed-effects linear regression models were used to test for effects of ACE and HPA axis functioning on the course of NSSI. ResultsACE and HPA axis functioning did not show main but interaction effects in the prediction of NSSI frequency over time: Adolescents with a low severity of ACE and either an increased CAR or a flattened DSL showed a steep decline of NSSI frequency in the first year followed by a subsequent increase of NSSI frequency in the second year. ConclusionsOur findings could be interpreted in the sense of high diurnal cortisol concentrations in the absence of ACE being favorable for clinical improvement on the short-term but bearing a risk of allostatic load and subsequent increase of NSSI frequency. In contrast, adolescents with severe ACE may benefit from elevated cortisol concentrations leading to slower but lasting decreases of NSSI frequency.

Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients.

Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD). Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents' suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms. The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=-3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency. Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents' NSSI behaviors.

Treatment Motivation and Burden of Stress among Parents of Adolescents with Non-Suicidal Self-Injury Presenting to a Child and Adolescent Psychiatric Emergency Service

Introduction: The successful treatment of adolescents almost always requires parents’ involvement in the treatment process. Thus, parental involvement will impact further treatment, especially concerning the acute management of self-harming behavior of their children. Parental burden or low parental motivation for treatment can significantly affect the success of the intervention. Therefore, this study aimed at investigating how especially motivational factors of the adolescents and parents, as well as stressors of the parents, affect the course of non-suicidal self-injury (NSSI) after an acute psychiatric emergency presentation. Methods: Ninety-six adolescents aged 11–18 years who have been presented to an emergency service at a child and adolescent psychiatry clinic for suicidal and/or NSSI behavior were recruited together with their accompanying parents within the framework of a specified diagnostic procedure. This included detailed questionnaire and interview procedures for psychiatric assessment. The extent of parental stress and parents’ motivation for treatment and its relations to adolescents’ NSSI and own treatment motivation have been investigated in a follow-up examination in the aftermath of the acute presentation. We predicted adolescents’ NSSI at follow-up based on their own motivation and parental motivation and stress. Results: Data analysis demonstrated that higher adolescents’ treatment motivation was associated with higher parental stress. Also, higher parental treatment motivation was correlated with a higher degree of parental distress. Furthermore, parents showed lower treatment motivation when their children engaged in NSSI for a longer duration. Finally, lower adolescents’ motivation and lower parental stress due to own parental concerns were predictive for higher adolescents’ NSSI frequency at follow-up investigation. Discussion/Conclusion: Patients as well as their parents who present for an emergency service are especially likely to be exposed to increased stress and strain factors. During treatment, additional focus should be placed on parental stress and parental and adolescents’ treatment motivation. Identifying and addressing deficits in motivation, increases in parental stress, as well as offering support could favorably impact future NSSI behavior.

Prevalence of engagement and frequency of non-suicidal self-injury behaviors in adolescence: an investigation of the longitudinal course and the role of temperamental effortful control

Non-suicidal self-injury (NSSI) is among the most frequent maladaptive behaviors reported in adolescence, with prevalence rates around 18–22% in community samples worldwide. The onset of NSSI typically occurs between early and middle adolescence, with a peak during middle adolescence (14–15 years) and a subsequent decline during late adolescence. This study investigated the growth curves of NSSI across four years during adolescence, analyzing simultaneously the probability of engagement in NSSI at least once (i.e., prevalence) and the frequency of engagement once initiated (i.e., severity). Furthermore, the study examined the predicting role of effortful control on NSSI over time (time-varying effects), net of other key risk factors for NSSI, such as anxiety-depression and bullying victimization. A sample of 430 Italian adolescents enrolled in Grade 9 at baseline was involved in the study. Based on the Latent Growth Curve Zero-inflated Poisson methodology, the results indicated a negative quadratic trend of both NSSI prevalence, with an increase between T1 and T3 followed by a decrease in the subsequent wave, and NSSI frequency once initiated, with a peak at T2 followed by a decline over time. The results also showed that adolescents who reported low effortful control abilities had a heightened probability of involvement in NSSI at each time point, whereas no significant association was found with NSSI frequency once initiated. Findings from this study offer important insights into the developmental course of NSSI and point out the need for future in-depth investigations of the mechanisms that might underlie NSSI prevalence and severity throughout adolescence.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility.

Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

Self-Injury and Suicidality: The Impact of Trauma and Dissociation

In the growing research literature on nonsuicidal self-injury (NSSI) and suicidality (SA), there are many questions still unresolved about the role played by exposure to traumatic stressors (including but not limited to childhood maltreatment) and posttraumatic disorders (including dissociative features and disorders). In this special issue of the Journal of Trauma & Dissociation, a review article and 4 empirical studies attempt to provide additional insight into the relationship of traumatization and dissociation to NSSI and SA. The review article describes similarities and differences in the relationships that have been empirically documented between trauma exposure and posttraumatic stress or dissociative symptoms with NSSI versus SA and highlights the need for research to identify and test integrative clinical constructs, such as emotion dysregulation, in order to develop systematic risk, assessment, and intervention models. The empirical reports provide illustrative examples of conceptually and clinically integrated research on traumatic stress, dissociation, and NSSI and SA. Their findings offer a more nuanced picture of the potential role of different forms and degrees of dissociation in SA and NSSI and suggest that dissociation and emotion dysregulation may play a mediating role linking childhood maltreatment and adult or adolescent NSSI. In this introduction, we briefly summarize key points from the special issue articles and point out directions that their findings suggest for future research, including incorporating multiple predictors in studies of NSSI and SA, utilizing longitudinal studies to assess the etiology and course of NSSI and SA, and sampling diverse populations.

Non-suicidal self-injury during an exposure-based treatment in patients with posttraumatic stress disorder and borderline features

Patients with posttraumatic stress disorder (PTSD) and features of borderline personality disorder (BPD) often show non-suicidal self-injury (NSSI). However, patients with on-going NSSI are mostly excluded from PTSD treatments and NSSI during PTSD treatment has rarely been investigated. The aim of the present study was to evaluate the course of NSSI during an exposure-based PTSD treatment.This study focused on a subset (n = 34) of data from a randomised controlled trial that tested the efficacy of a residential PTSD programme (DBT-PTSD) in comparison to a treatment-as-usual wait-list. In this subset we compared a) NSSI during treatment between participants who had or had not engaged in NSSI pre-treatment and b) NSSI between treatment weeks that included exposure interventions vs. those that did not. We further compared the outcome between participants with vs. without NSSI at pre-treatment.At pre-treatment, 62% participants reported on-going NSSI. During treatment, the percentage of participants carrying out NSSI decreased to 38% (p = 0.003). The rates of NSSI were similar in treatment weeks with exposure compared to weeks without. Similar results were observed for the frequency of NSSI. At the end of treatment, participants showed comparable improvement in PTSD symptoms regardless of whether or not they had exhibited NSSI beforehand.

Nonsuicidal self-injury in adolescence: longitudinal course, trajectories, and intrapersonal predictors.

Although prevalence rates of nonsuicidal self-injury (NSSI) has been established throughout adolescence, little is known about the progression of NSSI, and consequently, about the risk factors for youth NSSI engagement. This study aimed to describe the overall longitudinal course of NSSI and the latent trajectory classes of NSSI in a population-based sample of adolescents using multi-wave data. Moreover, this study examined whether sex, lifetime history of depression, rumination, and negative attributional style predicted the longitudinal course of NSSI and trajectory group membership. Participants were 617 Chinese adolescents in Grades 10 through 12 (51.4 % girls). NSSI was assessed across eight waves of data. History of depression, rumination, and negative attributional style were assessed at baseline. Latent growth curve modeling revealed that only lifetime depression predicted the longitudinal course of NSSI from Grades 10 to 12, with depressed adolescents showing greater and more stable NSSI engagement over time than non-depressed adolescents. Group-based trajectory modeling yielded three distinct trajectory classes of NSSI engagement: low (69.2 %), moderate (26.1 %), and chronic (4.7 %). Negative attributional style distinguished adolescents in the chronic vs. low and moderate NSSI trajectory classes. Sex, rumination, and lifetime depression predicted membership in the chronic and/or moderate vs. low NSSI trajectory class. NSSI trajectory classes, based on frequency of NSSI, exist and are differentiated by sex, depression history, rumination, and negative attributional style. This study suggests that during this period of adolescence NSSI may be a relatively stable behavior, especially for some adolescents. Negative attributional style may be a salient risk factor for chronic NSSI engagement.

Prospective Prediction of Nonsuicidal Self-Injury: A 1-Year Longitudinal Study in Young Adults

Nonsuicidal self-injury (NSSI) has become a significant public health problem. Although numerous studies have examined cross-sectional psychological correlates of NSSI, there has been little research examining predictors of NSSI over time. The present study examined cross-sectional and longitudinal correlates of NSSI in 81 young adult self-injurers (M age=19, 74.1% female, 51.9% Caucasian), 51 of whom were followed up 1 year later. At baseline, participants completed self-report measures of NSSI, Axis-I disorders, borderline personality disorder (BPD), and impulsivity, as well as an implicit measure of NSSI attitudes and identity. One year later, participants completed a Timeline Followback Method whereby they indicated their engagement in NSSI over the previous 12 months. Analyses replicated many known cross-sectional correlates of NSSI, including symptoms of several Axis-I disorders and BPD. However, many of these same variables failed to predict the course of NSSI over the 1-year follow-up. The only variables to prospectively predict NSSI were past NSSI (i.e., frequency, methods, and recency of NSSI), participants' behavioral forecast of their engagement in future NSSI, and BPD features. Findings suggest that many cross-sectional correlates of NSSI may not be useful for predicting subsequent NSSI. Instead, NSSI severity and BPD features appear to best predict continued engagement in NSSI.

The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the Literature

This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.