Nonsuicidal Self-injury Disorder Criteria Research Articles

Non-suicidal self-injury in eating disorders: Prevalence, characteristics, DSM-5 proposed diagnostic criteria, and correlates

Although eating disordered (ED) patients also engage in non-suicidal self-injury (NSSI), to date, little research has examined NSSI in ED patients. Thus, the present work aims to explore the prevalence, characteristics, and correlates of NSSI within a sample of Italian ED patients, also exploring NSSI disorder (NSSI-D). One hundred ED patients (F = 87; Mage=24.49; SD=10.74), recruited from mental health services were screened through mixed methods (questionnaires and interviews). Fourth-six were diagnosed with anorexia nervosa (AN), 39 with binge eating disorder (BED), and 15 with bulimia nervosa (BN). Out of the sample, 25 (F = 22; Mage=24.49; SD=10.74) have engaged in NSSI during their lifetime. The presence and characteristics of NSSI were not associated with ED subtypes. Four patients (16%; 3 AN and 1 BN) met the criteria for NSSI-D. Overall, NSSI-D was not significantly associated with ED severity. The multivariate analysis demonstrated that patients with NSSI scored lower on self-esteem and higher on depersonalization than those without NSSI. Our findings are based solely on a small sample of outpatients who represent only a subset of ED patients. Results confirm that NSSI is highly prevalent in ED patients and behaviors co-occurrence is associated with greater impairment. Potential implications for the diagnosis and avenues for future research are discussed.

Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders

This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.

Nonsuicidal Self-Injury Disorder, Borderline Personality Disorder, and Lifetime History of Suicide Attempts among Male and Female Veterans with Mental Health Disorders

BackgroundExpanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans. MethodsParticipants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts. ResultsBPD, Χ2=11.1, p<0.001, and NSSID, Χ2=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001. LimitationsCausality cannot be determined from cross-sectional analyses. ConclusionThese findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.

Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach.

In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, Mage = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.

Nail-biting, scab-picking, and tattooing as nonsuicidal self-injury (NSSI): A deviant case series analysis of the proposed NSSI disorder diagnostic criteria.

This study explored the boundaries of the proposed diagnostic criteria for nonsuicidal self-injury disorder (NSSID) as outlined in the Conditions for Further Study section of the Diagnostic and Statistical Manual, Fifth Edition. We sought to falsify the exclusion of certain NSSI behaviors from a diagnosis of NSSID (Criterion D), arguing that these exclusions are inconsistent with the broader phenomenology of the disorder outlined in the other criteria. METHOD: We describe three case studies involving NSSI (Case 1: scab-picking; Case 2: nail-biting; Case 3: tattooing) that cannot be diagnosed as NSSID because the behaviors are explicitly listed in Criterion D. Despite exclusion as a relevant NSSI behavior per Criterion D, each examined behavior is consistent with the intentionality, functionality, and distress/impairment of NSSID that represent core features of the disorder. The case studies presented here suggest that Criterion D should be revised or removed from the NSSID criteria.

Anti-Suicide Function of Nonsuicidal Self-Injury in Female Inpatient Adolescents.

BackgroundThere have been numerous studies investigating the relationship between nonsuicidal self-injury (NSSI) and suicidality. On the one side, NSSI is an important risk factor for suicidality, including suicidal thoughts and behaviors. On the other side, it has been suggested that one function of NSSI might be as a coping mechanism that can help individuals in the short term avoid suicide. The present study investigated the relationship between suicidality and NSSI in female inpatient adolescents, focusing on NSSI as an anti-suicide strategy.MethodsSubjects were 56 female adolescents, aged 12–18 years (M = 15.95 years, SD = 1.27), recruited from different inpatient child and adolescent psychiatric units. All participants fulfilled the DSM-5 research criteria for nonsuicidal self-injury disorder (NSSI-D). To assess suicidality, NSSI-D, and current and past diagnoses, a structured clinical interview was conducted.ResultsNSSI as a short-term coping strategy for avoiding suicide was indicated by one third (32.1%) of the participants. Before participants engaged in NSSI, the anti-suicide function was reported more frequently than reducing interpersonal problems (d = -.59). Getting relief from negative emotions and inducing positive feelings were reported at the same frequency as avoiding suicide before NSSI. Participants engaging in NSSI to avoid suicide and those reporting other functions did not significantly differ regarding other NSSI characteristics, suicidality, or psychopathology. Results indicate that the anti-suicide function significantly predicts the duration of current suicidal ideation (β = .557).ConclusionThis study provides preliminary support for the idea that NSSI is frequently used by female adolescents with NSSI-D to avoid suicide. Given the high co-occurrence of NSSI and suicidality, our results underline the importance of clinical assessment of suicidality and several NSSI functions, including the anti-suicide function, in adolescents with NSSI.

Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index.

Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96–100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.

Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents

BackgroundNon-suicidal self-injury (NSSI) is a serious public health concern in adolescents. In 2013, DSM-5 recognized NSSI as a distinct clinical phenomenon and made a call for more systematic research by including Non-Suicidal Self-Injury-Disorder (NSSI-D) as a condition requiring further research. Yet, few studies have examined the prevalence of NSSI-D in adolescents using the exact DSM-5 criteria. Additionally, the few studies available criticised several of the proposed diagnostic criteria and pointed out that more research is needed. MethodsTherefore, we examined prevalence rates of NSSI-D and investigated the four most controversial criteria (i.e., criteria A, B/C, and E) in a large community sample of adolescents (N = 2,130; 54% female; Mage = 15, SD = 1.81). ResultsOur results show an overall NSSI-D prevalence rate of 7.6%, with significantly more girls (11.7%) than boys (2.9%) meeting the diagnosis. The prevalence of NSSI-D dropped to 5.5% when an alternative criterion A (i.e., ≥10 days of NSSI in the past year) was implemented. In our sample, 87% and 99% of adolescents with lifetime NSSI met criteria B and C, which clearly questions the clinical utility of these criteria for the DSM-5 diagnosis of NSSI-D. Importantly, however, although criterion E received relatively low endorsement, it significantly distinguished adolescents with and without NSSI-D from one another. Limitations and conclusionAlthough our conclusions are restricted by the cross-sectional nature of our study, these findings show that NSSI-D is common in community adolescents and offer new insights in the endorsement and clinical utility of specific NSSI-D criteria.

Assessment of the frequency criterion for the diagnosis of non-suicidal self-injury disorder in female adolescents with conduct disorder

Recent studies suggest a higher threshold number of self-injuries during the past year than the one proposed in the DSM-5 criteria for non-suicidal self-injury disorder (NSSID). Therefore, we aimed to test a validity of the frequency criterion in girls with conduct disorder (CD) based on psychopathology and the level of functioning. Mixture modelling analysis revealed that the frequency of at least 8 self-harm behaviours in the previous year differentiated adolescents with CD. Thus, we divided adolescents into three subgroups: group 1: at least 8 self-harm acts; group 2: 1–7 self-harm behaviours and group 3: those who did not injure themselves during the last 12 months. Individuals from group 1 were significantly younger and had earlier age of self-harm onset. There were significant differences between groups 1 and 3 in terms of anxiety and depressive symptoms, self-esteem, aggression and the global functioning level. The group 1 scored significantly higher on depressive symptoms compared to the group 2. The group 2 scored significantly higher than the group 3 on the level of hostility. Our results provide further evidence supporting the need for modification of the NSSID frequency criterion.

The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors.

Approximately one in five college students report a history of nonsuicidal self-injury. However, it is unclear how many students meet criteria for the recently proposed DSM-5 nonsuicidal self-injury disorder (NSSI-D). In this study, we used full NSSI-D criteria to identify those students most in need of clinical care. Using data from the Leuven College Surveys (n=4,565), we examined the 12-month prevalence of DSM-5NSSI-D in a large and representative sample of incoming college students. We also explored the optimal frequency threshold as a function of interference in functioning due to NSSI, and examined comorbidity patterns with other 12-month mental disorders (i.e., major depressive disorder, broad mania, generalized anxiety disorder, panic disorder, and alcohol dependence) and suicidal thoughts and behaviors (STB). Twelve-month NSSI-D prevalence was 0.8% and more common among females (1.1%) than males (0.4%). The proposed 5+ diagnostic threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. A dose-response relationship was observed for NSSI recency-severity (i.e., 12-month NSSI-D, subthreshold 12-month NSSI-D, past NSSI, no history of NSSI) with number of 12-month mental disorders and STB. NSSI-D occurred without comorbid disorders for one in five individuals, and remained associated with severe role impairment when controlling for the number of comorbid disorders. These findings offer preliminary evidence that DSM-5NSSI-D is uncommon among incoming college students, but may help to improve the deployment of targeted resource allocation to those most in need of services. More work examining the validity of NSSI-D is required.

Nonsuicidal Self-Injury in Adolescents: Characterization of the Disorder and the Issue of Distress and Impairment.

Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study to assess the validity of the potential diagnosis and its suggested criteria. This study examined the NSSID diagnosis and investigated the distress/impairment criterion by comparing community adolescents who metall criteria for NSSID (n=186) to adolescents with five or more nonsuicidal self-injury (NSSI) episodes (n=314), and to a group of adolescents who metall criteria but negated that their NSSI caused them any distress or impairment, thus failing to meet criterion E (n=29). The NSSID group delimited from the ≥5 NSSI group by reporting significantly more frequent and severe self-injurious thoughts and behaviors, as well as having more experiences of negative life events and higher levels of trauma symptoms. There were also some differences between the NSSID group and adolescents without distress/impairment, which together contribute valuable information on the potential NSSID diagnosis, as well as the discussion of criterion E.

Descriptive Characteristics and Initial Psychometric Properties of the Non-Suicidal Self-Injury Disorder Scale

Non-suicidal self-injury (NSSI) is highly prevalent and associated with tissue damage, emotional distress, and psychiatric disorders. While often discussed in the context of Borderline Personality Disorder and suicide, research demonstrates that NSSI is distinct from these constructs and should be viewed as an independent diagnostic category. Recently, Non-Suicidal Self-Injury Disorder (NSSID) was included in the revised Diagnostic and Statistical Manual of Mental Disorders as a condition for further study. In this article, we describe the properties of a self-report measure designed to assess proposed criteria for NSSID. Undergraduate students at 2 large, public universities completed the NSSID Scale (NSSIDS) along with other measures of NSSI characteristics and psychopathology. Among participants with a history of NSSI, approximately half (54.55%) met diagnostic criteria for NSSID. Participants were most frequently excluded from an NSSID diagnosis on the basis of criterion A (frequency of NSSI) and criterion E (distress or impairment related to NSSI), while participants were least likely to be excluded from diagnosis on the basis of criterion D (NSSI method exclusions) and criterion F (diagnostic “rule-outs”). Consistent with previous literature, the most commonly reported precipitants to NSSI were negative feelings or thoughts (criterion C2). Participants who met criteria for NSSID reported more severe depression, anxiety, and NSSI than participants who engaged in NSSI but did not meet criteria for NSSID. These results support the use of the NSSIDS as a reliable and valid self-report measure of NSSID symptoms.

Nonsuicidal self-injury: a rapidly evolving global field.

Nonsuicidal self-injury: a rapidly evolving global field.

The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature.

With the presentation of nonsuicidal self-injury disorder (NSSID) criteria in the fifth version of the Statistical and Diagnostic Manual of Mental Disorders (DSM-5), empirical studies have emerged where the criteria have been operationalized on samples of children, adolescents and young adults. Since NSSID is a condition in need of further study, empirical data are crucial at this stage in order to gather information on the suggested criteria concerning prevalence rates, characteristics, clinical correlates and potential independence of the disorder. A review was conducted based on published peer-reviewed empirical studies of the DSM-5 NSSID criteria up to May 16, 2015. When the DSM-5 criteria were operationalized on both clinical and community samples, a sample of individuals was identified that had more general psychopathology and impairment than clinical controls as well as those with NSSI not meeting criteria for NSSID. Across all studies interpersonal difficulties or negative state preceding NSSI was highly endorsed by participants, while the distress or impairment criterion tended to have a lower endorsement. Results showed preliminary support for a distinct and independent NSSID diagnosis, but additional empirical data are needed with direct and structured assessment of the final DSM-5 criteria in order to reliably assess and validate a potential diagnosis of NSSID.

Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index.

Despite the inclusion of nonsuicidal self-injury disorder (NSSID) in the DSM-5, research on NSSID is limited and no studies have examined the full set of DSM-5 NSSID diagnostic criteria. Thus, this study examined the reliability and validity of a new structured diagnostic interview for NSSID (the Clinician-Administered NSSI Disorder Index; CANDI) and provides information on the clinical characteristics and features of DSM-5 NSSID. Data on the interrater reliability, internal consistency, and construct validity of the CANDI and associated characteristics of NSSID were collected in a community sample of young adults (N = 107) with recent recurrent NSSI (≥10 lifetime episodes of NSSI, at least one episode in the past year). Participants completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, as well as diagnostic interviews of borderline personality disorder (BPD) and lifetime mood, anxiety, and substance use disorders. The CANDI demonstrated good interrater reliability and adequate internal consistency. Thirty-seven percent of participants met criteria for NSSID. NSSID was associated with greater clinical and diagnostic severity, including greater NSSI versatility, greater emotion dysregulation and psychopathology, and higher rates of BPD, bipolar disorder, posttraumatic stress disorder, social anxiety disorder, and alcohol dependence. Findings provide support for the reliability, validity, and feasibility of the CANDI.