Functions Of Nonsuicidal Self-injury Research Articles

Non-suicidal self-injury (NSSI) among emerging adults: Sub-group profiles and their clinical relevance

Background: High prevalence rates and variations in patterns of non-suicidal self-injury (NSSI) necessitate the identification of profiles of distinct sub-groups of self-injurers. Aim: To identify homogenous sub-groups of NSSI in a community-based sample of emerging adults. Method: Data was collected using a cross-sectional survey design from a sample of 1,574 emerging adults aged 18-25 years, via multi-stage sampling. Cluster analysis using the k-medoid partitioning method was used to identify homogenous sub-groups in the sub-sample of 353 self-injurers. Follow-up analysis was conducted on measures of self-criticism, brooding-rumination, emotion regulation difficulties, experiential avoidance, psychological distress, attachment style and perceived social support to explore the validity of the clusters. Results: Five homogenous sub-groups were identified; Multimethod, Exclusively Severe, Female Minor, Male Minor and Experimental NSSI. The sub-groups showed distinct patterns of NSSI behaviour, differing on the basis of gender, severity, frequency, diversification, age of onset and functions of NSSI. The Multimethod and Exclusively severe NSSI group members showed significantly higher psychological distress and emotion regulation difficulties. Conclusion: Identification of distinct sub-groups highlights the heterogeneity in NSSI behaviour. This has implications for comprehensive assessment frameworks, early identification of more vulnerable groups of self-injurers, and planning of targeted interventions.

Exploring the role of anger in nonsuicidal self-injury in veterans

Up to 14% of veterans engage in nonsuicidal self-injury (NSSI) in their lifetime and this behavior is a relatively strong predictor of suicidal behavior compared to other identified risk factors. Further, NSSI is a clinically relevant behavior in its own right; it is associated with more severe psychopathology as well as bodily harm that sometimes requires medical intervention. Therefore, a better understanding of NSSI may help inform suicide prevention efforts as well as mental healthcare strategies for veterans. Anger may be relevant to understanding NSSI in veterans. Over 60% of veterans report difficulties managing anger and this emotion is strongly associated with engagement in NSSI. However, no research has explored the extent to which anger is present prior to NSSI or whether anger is associated with specific NSSI methods or functions in veterans. The purpose of this study was to explore whether anger was associated with engagement in specific NSSI methods, and whether anger uniquely predicted any functions of NSSI while controlling for the presence of other basic negative emotions (fear and sadness). An existing dataset of 61 veterans who reported engaging in NSSI in the past year was analyzed. Results indicated anger was the most common emotional antecedent to NSSI. Further, anger was associated with several methods of NSSI including burning oneself with a cigarette, carving pictures, designs or other marks into skin, sticking sharp objects into skin, severely scratching oneself, head banging, punching oneself, and punching walls or objects. Finally, when controlling for the presence of other negative emotions, anger was associated with engaging in NSSI to relieve tension, stop feeling numb, communicate with others, feel alive, get help from others, and prove to oneself how bad things are. These results highlight the importance of assessing and treating dysregulated anger in veterans who engage in self-harming behavior.

Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents

BackgroundWe consider whether nonsuicidal self-injury (NSSI) thoughts – in the absence of any NSSI behaviour – are associated with suicidal thoughts and behaviours among adolescents, before examining whether characteristics of NSSI behaviour are associated with greater suicidal thoughts and behaviours. MethodsAdolescents (n = 2,057, M age =15.56) recruited from secondary schools reported their lifetime history of NSSI, suicidal thoughts and behaviours, NSSI characteristics, and NSSI functions. Receiver Operating Characteristic analysis test whether NSSI status and characteristics of NSSI behaviour are diagnostic of clinically elevated suicidal thoughts and behaviours (a score of 7 or higher on the Suicide Behaviours Questionnaire-Revised). Regression models test whether NSSI functions predict greater suicidality. ResultsAdolescents with NSSI thoughts and those with NSSI behaviour were more likely to report lifetime suicidal ideation and past-year suicide plan(s) than adolescents with no history of NSSI. In addition, adolescents with a history of NSSI were more likely to report a lifetime history of suicide attempt(s) as well as past-year suicide attempt(s) than adolescents with no history of NSSI. A greater number of NSSI methods, requiring medical assistance for NSSI injuries, and engaging in NSSI for self-punishment, anti-suicide, and sensation-seeking functions were associated with greater severity of suicidal thoughts and behaviours. LimitationsData are cross-sectional, limiting inferences about causality. ConclusionsFindings emphasize the importance of NSSI thoughts and characteristics of NSSI behaviour in understanding the complex relationship between NSSI and suicidal thoughts and behaviours among adolescents.

Characteristics and predictive factors of non-suicidal self-injury in patients with schizophrenia spectrum disorders

Objective: We aimed to evaluate the characteristics and functions of non-suicidal self-injury (NSSI) in patients with schizophrenia spectrum disorders (SSD) and investigate predictive factors of NSSI. Methods: One hundred and two patients, aged between 18-65 with a diagnosis of SSD according to DSM-5 criteria, who were in remission were consecutively recruited to the study. Lifetime NSSI was assessed using the Inventory of Statements About Self-injury (ISAS). Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Suicide Probability Scale (SPS), Dissociation Scale (DIS-Q), Schedule for Assessing the Three Components of Insight (SAI), and Barratt Impulsivity Scale-11 (BIS-11) were administered to all patients who participated in the study. Logistic regression analysis was conducted to predict NSSI. Results: The prevalence of NSSI was 31.4% in our sample. ‘Self-cutting’ was the most common type (26.1%), and ‘affect regulation’ was the most common function of NSSI. 65.6% of the NSSI (+) group preferred to be alone while self-injurious behavior occurred. The time between the onset of feelings of an urge to injure self and the onset of NSSI was mostly less than three hours (46.9%). The significant predictors of NSSI were the previous history of suicide attempts (OR=2.693, p=0.040, 95% CI: 1.048-6.921) and greater severity of depressive symptoms (OR=1.216, p=0.001, 95% CI: 1.081-1.367). The previous history of suicide attempts was associated approximately threefold increase in the risk of NSSI. The probability of suicide was higher among patients with NSSI than patients without NSSI. Conclusion: Approximately 1/3 of the patients with SSD have NSSI. The results of our study indicate that patients with severe depressive symptoms and a history of previous suicide attempts are more at risk of injuring themselves and that the probability of suicide is higher in patients with NSSI than patients without NSSI. The reciprocal relationship of NSSI with suicide underlines the necessity of careful investigation for both clinical situations in this patient group. Assessment of NSSI should be a part of standard suicide risk assessment of SSD patients. Effective treatment of affective symptoms would help to reduce the risk of NSSI.

The environmental, interpersonal, and affective context of nonsuicidal self-injury urges in daily life.

Urges for nonsuicidal self-injury (NSSI) are important precursors to NSSI acts and may serve as a point of intervention. A close understanding of the phenomenology of NSSI urges and the contexts in which they occur is therefore warranted. We used ambulatory assessment to examine the environmental, interpersonal, and affective contexts of NSSI urges. We recruited 56 participants with borderline personality disorder who reported on urges and contexts for 21 days with six random daily prompts, resulting in 5,750 completed assessments. Twenty-two participants reported 160 NSSI urges. We provide extensive descriptive results characterizing the interaction partners, activities, and events participants reported in association with NSSI urges. Results from a logistic multilevel model using the full sample (testing associations between all contexts and urges simultaneously) revealed that urges were more likely to occur at higher levels of negative affect, when rejection was experienced, and later in the day. Urges were not associated with disagreements or feeling let down, being at home versus away, being alone versus in company, socializing versus doing another activity, and it being a weekday versus weekend. Additional growth curve analysis for negative affect using the subsample of 22 participants who reported urges showed that, over the course of urge days compared with nonurge days, negative affect increased before urges, peaked during the urge, and then decreased, approximating a quadratic curve. We conclude that urges occurred primarily in the context of negative affect and rejection, which is consistent with theories on intra- and interpersonal functions of NSSI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological inflexibility processes and nonsuicidal self-injury: Concurrent and prospective associations.

The aim of this study was to examine concurrent and 3-month prospective associations between a multidimensional measure of psychological inflexibility and nonsuicidal self-injury (NSSI) among participants with a self-harm history. Participants completed measures of NSSI, psychological inflexibility, negative urgency, and depression at baseline (N = 106, Mage = 34.70, SD = 9.43, 66% women), and were again assessed at follow-up (N = 86). Participants currently engaging in NSSI reported significantly higher psychological inflexibility as compared to those who have ceased NSSI. After controlling for covariates, psychological inflexibility was concurrently associated with NSSI recency and longitudinally predicted perceived likelihood of future NSSI. Psychological inflexibility was not associated with new NSSI acts after including baseline covariates. Finally, psychological inflexibility subscales demonstrated differential relationships with various NSSI functions. Results highlight the psychological inflexibility model's utility in understanding NSSI and have implications for future research that may inform clinical practice.

Predictors of non-suicidal self-injury cessation in adults who self-injured during adolescence

Most studies of non-suicidal self-injury (NSSI) investigate individuals who are currently self-injuring. The current study aimed to identify factors associated with continuation or cessation of NSSI from adolescence to adulthood. Adult participants (n = 724) completed an online cross-sectional survey of their experiences of NSSI in adolescence, the functions served by NSSI, and measures of current role functioning and psychological well-being. The functions of NSSI in adolescence significantly predicted cessation or continuation of NSSI in adulthood. Intrapersonal functions of NSSI increased the likelihood of ongoing self-harm, whereas interpersonal functions of NSSI increased the likelihood of cessation of self-harm in adulthood. Cessation of NSSI was also associated with increasing age and having previously received mental health treatment. Participants who had ceased NSSI in adulthood reported lower rates of psychological distress, greater life satisfaction, were more likely to be engaged in work and had achieved a higher level of education overall. The study was cross-sectional and relied on retrospective accounts of those participants who had ceased NSSI. The vast majority of participants were female and Australian, so generalizability beyond this population must consider this limitation. Many individuals who engage in NSSI in adolescence successfully cease self-harming by adulthood. Cessation of NSSI is associated with better psychological well-being and higher role functioning. Ongoing NSSI from adolescence to adulthood is likely where NSSI serves intrapersonal functions. Clinical intervention must be a priority in such cases.

Non-suicidal self-injury and its association with identity formation in India and Belgium: A cross-cultural case-control study.

The aim of the present study was to compare different features of Non-Suicidal Self-Injury (NSSI) in India and Belgium. We also explored whether the strength of the association between NSSI and disturbances in identity formation-a risk factor that can increase vulnerability to NSSI-was similar in young adults from India and Belgium. Data regarding NSSI and identity formation were collected from 182 young adults in India (56% females, mean age = 21.5 years, SD = 3.70, range = 17-38 years). The Belgian data used for matching were derived from four existing datasets. Of the 182 Indian cases, 138 cases could be matched with the Belgian sample on age, gender, and lifetime prevalence of NSSI. Lifetime prevalence of NSSI in the Indian sample was found to be around 21.4%, with higher prevalence in females than in males. Comparison of features of NSSI in India and Belgium indicated that the age of onset of NSSI was higher in the Indian sample (around 17 years) than the Belgian sample (around 15 years). Additionally, self-bruising behavior was more commonly reported in India and scratching/cutting was more often reported in Belgium. Finally, the Belgian sample reported intra-personal functions of NSSI more often than the Indian sample. Moderation analysis indicated that the associations between NSSI and identity confusion/integration were stronger in the Belgian sample compared to the Indian sample. Higher self-knowledge was protective against NSSI in both the Indian and the Belgian sample.

One-Year Consistency in Lifetime Frequency Estimates and Functions of Non-Suicidal Self-Injury in a Clinical Sample.

Non-suicidal self-injury (NSSI), the direct, deliberate destruction of one’s own bodily tissue in the absence of an intent to die, is frequently used for evaluating treatment in clinical care. One instrument for assessing NSSI is the Inventory of Statements About Self-Injury (ISAS). The ISAS is a self-rating measure examining the lifetime frequencies of NSSI behaviors and further exploring NSSI functions. The study aimed to examine the consistency of self-reported lifetime NSSI frequencies and functions (via the ISAS) in a clinical sample of individuals with current self-harm and/or recurrent suicidal behaviors over one year. Fifty-two individuals (84.6% women) completed the ISAS three times over 1 year. We found relatively good test-retest stability for most NSSI behaviors and functions, but the correlation coefficients and frequencies of NSSI behaviors varied substantially. Approximately, 50% of participants reported lower lifetime frequencies of NSSI behaviors at the later time points, with approximately 20% reporting a significant reduction in their lifetime frequencies over one year. This unexpected finding raises concerns about the accuracy of reporting lifetime NSSI frequencies among individuals with multiple psychiatric diagnoses and extensive NSSI behaviors across their lives. Further research is needed to determine more reliable ways of collecting data on the lifetime frequency of NSSI in clinical samples and the accuracy of lifetime NSSI frequency estimates in general.

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 and Intimate Partner Violence: Directionality of Violence and Motives for Self-Injury.

Nonsuicidal self-injury (NSSI) is associated with intimate partner violence (IPV) perpetration and victimization. However, extant research has not distinguished between unidirectional and bidirectional IPV and has not examined relationships between IPV and functions of self-injury. This study of 1,018 university students revealed a significantly higher prevalence of NSSI among those who reported bidirectional IPV compared with nonviolent individuals. However, rates of NSSI in the unidirectional IPV groups are more similar to rates of NSSI in the bidirectional group than in nonviolent individuals. Individuals who engaged in bidirectional IPV were more likely to endorse interpersonal functions of self-injury than those who engaged in unidirectional IPV or no IPV. In contrast, intrapersonal functions of NSSI were not associated with IPV. Findings suggest that the association between IPV and NSSI may be best understood in the context of relationship conflict, rather than as a distinct correlate of either IPV victimization or IPV perpetration.

A typology of nonsuicidal self-injury in a clinical sample: A latent class analysis.

Nonsuicidal self‐injury(NSSI) is a behavioural concern and can present in diverse ways, varying by method, frequency, severity, function and so forth. The possible combinations of these features of NSSI produce an array of profiles that makes evaluation and management of this behaviour challenging. The aim of this study was to build upon previous work that reduces the heterogeneity of NSSI patterns by using latent class analysis (LCA) to identify a typology of NSSI. Participants consisted of 235 outpatients aged 14–35 years attending a tertiary psychiatric hospital in Singapore who had reported at least one NSSI behaviour within the last year. Eight indicators captured using the Functional Assessment of Self‐Mutilation were used in the LCA: frequency of NSSI, length of contemplation before engaging in NSSI, usage of more than three NSSI methods, suicidal ideation and four psychological functions of NSSI, that is, social‐positive, social‐negative, automatic‐positive and automatic‐negative. The LCA revealed three distinct groups: Class 1—Experimental/Mild NSSI, Class 2—Multiple functions NSSI/Low Suicide Ideation and Class 3—Multiplefunctions NSSI/Possible Suicide Ideation. Multinomial logistic regression analyses were conducted to examine the associations between class membership and sociodemographic variables as well as measures of emotion dysregulation, childhood trauma, depression and quality of life. Females were overrepresented in Class 3. In general, Class 3 had the poorest scores followed by Class 2. Our analyses suggest that different NSSI subtypes require different treatment indications. Profiling patterns of NSSI may be a potentially useful step in guiding treatment plans and strategies.

Functions and Prevalence of Self-Directed Violence in Adolescence

ABSTRACT The prevalence of self-directed violence (SDV) is increasing in adolescents. SDV, defined as behavior that is self-directed and deliberately results in actual injury or the potential for injury to self, includes both nonsuicidal self-injury (NSSI) and suicidal behavior. In this study, an intact group of students in grades 8–12 at their school were surveyed about their history of SDV, the size of their peer groups and the strength of relationships with peers, and the function that SDV served for those who reported a history of SDV. Approximately one-third of the youth surveyed reported engaging in one or more SDV behaviors. Functions of both NSSI and suicidal ideation and behavior were primarily for emotion regulation, with youth who engaged in both NSSI and suicidal behaviors reporting a greater need for emotion regulation. While the size of peer groups reported did not differ for youth who engaged in SDV versus those who did not, the more friends an adolescent identified, the less likely the youth was to engage in SDV for emotion regulation.

Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization

Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients’ reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.

Big Five Personality Clusters in Relation to Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a complex behavior that serves many functions and may be motivated by several factors. Although previously limited to the context of personality disorders, consideration of how general personality traits might be related to NSSI warrants examination. Our aims were to investigate whether clusters based upon the Big Five personality traits exist among people who have engaged in NSSI, and explore systematic differences with regard to gender, age, key indicators of NSSI severity, functions of NSSI, emotional avoidance, alexithymia, psychological distress, and emotion regulation strategies. A sample of 236 university students (83% female, M age = 21.59, SD = 5.43) who had engaged in NSSI completed an anonymous online questionnaire. Cluster analysis yielded three subgroups who were characterized by tendencies for resilience, dysregulation, and disagreeableness. Resilient and dyregulated profiles fell within opposite ends of a continuum with regard to severity of NSSI, psychological distress and alexithymia, and adaptive vs less adaptive emotion regulation strategies. Dysregulated characteristics were also associated with affect regulation and self-punishment functions of NSSI. Disagreeable characteristics were associated with high alexithymia and psychological distress. Implications of these findings for theory and tailored treatment approaches to NSSI are discussed.

Sexual orientation differences in non-suicidal self-injury, suicidality, and psychosocial factors among an inpatient psychiatric sample of adolescents

Within broader community samples, sexual minority adolescents (SMA, e.g., lesbian, gay, bisexual, queer) are at greater risk than their heterosexual counterparts for nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors. The present study investigated whether sexual minority orientation continues to confer additional risk for these behaviors in an already higher-risk sample of youth. Frequency and function of NSSI, suicidal behavior, and psychosocial factors were assessed in a sample of 52 adolescents (aged 12–18 years) admitted to an inpatient psychiatric unit due to suicide risk; 27 of them identified as SMA, and 25 as heterosexual (HA). Greater proportions of SMA reported engaging in lifetime NSSI, compared to HA, with a greater variety and frequency of NSSI behaviors and greater endorsement of intrapersonal NSSI functions. SMA reported higher levels of suicide ideation than HA, but not suicidal behavior. Group differences in NSSI and SI persisted when controlling for the greater prevalence of abuse and levels of peer-victimization reported by SMA. In inpatient clinical settings, SMA may be more likely than heterosexual youth to engage in NSSI, including more severe forms, and to experience suicide ideation. Providing alternative coping mechanisms may serve as treatment goals for reducing NSSI in SMA.

Non-Suicidal Self-Injury(NSSI) of Korean Adults: Gender Differences in Types and Functions of NSSI

Non-Suicidal Self-Injury(NSSI) of Korean Adults: Gender Differences in Types and Functions of NSSI

The prevalence, nature, and functions of non-suicidal self-injury (NSSI) in a South African student sample

Non-suicidal self-injury (NSSI) has become an increasingly worrying phenomenon among adolescents and young adults. This study sought to address the paucity of data about the prevalence, nature, and functions of NSSI in the South African context. The Inventory of Statements about Self-harm and the Beck Depression Inventory-II were administered to 623 high school and university students recruited for the study. The results indicate an NSSI prevalence rate of 56.2% of the sample, with interfering with wounds, pulling hair, banging heads and cutting being the most common NSSI behaviour. The behaviour appeared to be associated more with intrapersonal functions like affect regulation and self-punishment than with interpersonal functions like communicating distress and maintaining boundaries. The implications of the findings for interventions and future research are discussed. Keywords: nature; non-suicidal self-injury; prevalence; South Africa; students

Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample.

To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts. Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data. Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients' suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option. Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.

Functions of Non-Suicidal Self-Injury in Late Adolescence: A Latent Class Analysis

This study employed latent class analysis utilizing an array of features of non-suicidal self-injury (NSSI) in order to identify distinct subgroups of self-injurers. Participants were 359 undergraduates with NSSI history. Indicator variables were lifetime and last year frequency rates, number of methods, scarring, pain during self-injury, and functions of NSSI. Analyses yielded mild/experimental NSSI, moderate NSSI, moderate multiple functions NSSI, and severe NSSI groups, endorsing low, moderate, moderate multiple functions, and high frequencies of self-injury and presence of functions, respectively. Following class assignment, groups differed on self-esteem, social support and belongingness, internalizing symptoms, suicidal ideation and behaviors, and additional NSSI constructs. These subtype analyses emphasize matching phenotypes of NSSI to specific interventions considering dimensions of clinical functioning.