Self-harm 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.

Quantifying the importance of factors in predicting non-suicidal self-injury among depressive Chinese adolescents: A comparative study between only child and non-only child groups

BackgroundDepression is a major global public health concern, often co-occurring with Non-Suicidal Self-Injury (NSSI). Focused on Depressive adolescents, this study aimed to quantify the importance of factors in predicting NSSI and compare them between the only child and non-only child groups, enriching knowledge to leverage tailored intervention strategies. MethodsA large multicenter survey was conducted in China. 2510 adolescents diagnosed with Major Depressive Disorder (MDD) volunteered for the study. 36 factors were included to train random forest models for NSSI prediction in only child and non-only child groups, respectively. The SHapley Additive exPlanations (SHAP) method was utilized to compute the relative importance of each factor in two groups. ResultsAdolescents with MDD exhibited a rather high prevalence of NSSI (52.0 %), among them 66.9 % were non-only children. Self-esteem was the most significant factor for both groups, while critical disparities of factors were also found. In the only child group, factors like family support, parental overprotection, drinking alcohol, sleep conditions and romantic relationship involvement showed greater importance, while higher depression degree, anxiety level and emotional abuse were more important factors for non-only children. LimitationsThe use of cross-sectional data from Chinese adolescents may limit deeper analysis of NSSI mechanisms and the generalizability to Western cultures. ConclusionsOnly and non-only child family structures may have different influence on factors related with NSSI occurrence of adolescents with MDD. Only children were more susceptible to vulnerable family environments, alcohol abuse and romantic experience, while non-only children were more disturbed by abnormal mental states.

Prefrontal oxygenation during experimental pain in adolescents engaging in non-suicidal self-injury

BackgroundThe intricate role of pain in non-suicidal self-injury (NSSI) makes the investigation of alterations in brain function during pain processing a critical yet underexplored topic. The aim of this study was to investigate fNIRS correlates of experimental pain and how these differed between adolescent patients engaging in NSSI and healthy controls. Methods154 adolescent patients with NSSI and 48 healthy controls underwent a heat pain stimulation with linearly increasing temperature from 32 °C to max. 50 °C, during which fNIRS activity was recorded. Associations between fNIRS activity and pain perception (i.e. pain threshold, pain tolerance and pain intensity) were examined using linear mixed models and linear regression analyses. ResultsAcross groups, we found a decrease in prefrontal oxygenation during increasing pain stimulation: Oxygenated hemoglobin was higher during baseline than during pain threshold (b = −0.36, p < .001) and higher during pain threshold than during pain tolerance (b = −0.10, p < .001). We did not find differential patterns of prefrontal oxygenation across the pain assessment between patients and healthy controls. Also, no association between pain intensity and fNIRS activity was found. LimitationsfNIRS was only recorded in prefrontal regions and our design did not include a non-painful stimulation as a control condition. ConclusionWhile our study adds to the understanding of prefrontal hemodynamic changes associated with pain processing, it did not contribute further evidence to the few existing findings regarding altered neural processing of pain in adolescents engaging in NSSI.

Solution-focused approaches for treating self-injurious thoughts and behaviours: a scoping review

Abstract Background Self-injurious thoughts and behaviours are a major global public health concern, not least because they are one of suicide’s strongest predictors. Solution-focused approaches are a psychotherapeutic approach currently being used to treat individuals with self-injurious thoughts and behaviours but there is little published evidence of their use. We conducted a scoping review to provide a comprehensive overview of how solution-focused approaches are being used to treat self-injurious thoughts and behaviours. Methods Publications describing a solution-focused approach being delivered to any individuals experiencing any form of self-injurious thought and/or behaviour were eligible for inclusion. Five databases were searched (EMBASE, PubMed, Web of Knowledge, PsycINFO, and Google Scholar) from inception to August 2024. Search terms contained keywords relating to both solution-focused and self-injurious thoughts and/or behaviours. Data were analysed using relevant steps from a narrative synthesis approach to summarise the participants, concepts, context and outcomes described in the included publications. Results Twenty-four publications were included in the review. Publications demonstrated a global reach although the majority were published in the UK and USA. Five publications formally assessed and reported outcomes; two randomised controlled trials, one experimental pilot study, one case study, and one single group study. Only the Beck Depression Inventory was collected in more than one study (n = 4), with a range of other psychopathology and wellbeing-related measures. Three studies reported qualitative data, finding positive perceptions of the approaches by patients and clinicians. Fifty-one unique components were identified within solution-focused approaches. Often specific adaptations were described, or components were introduced, that specifically addressed suicide or self-harm. For example, identifying and working on goals related to reducing or stopping self-harm, or scaling questions that assess how suicidal someone currently feels on a 0 to 10 scale. Conclusions This review demonstrates the application of solution-focused approaches for treating individuals with self-injurious thoughts and behaviours. The findings provide a comprehensive overview of how these approaches are delivered. The lack of outcome data and empirical studies highlights a need for more formalised evidence.

Associations of military sexual harassment and assault with nonsuicidal self-injury: Examining gender and sexual orientation as moderators

Military sexual harassment (MSH) and assault (MSA) are prevalent among service members and are linked to negative psychosocial outcomes, including self-directed violence. Veterans identifying as women or as sexual or gender minorities are at heightened risk for both MSH/MSA and self-directed violence, but their relationship remains understudied in these populations. We examined associations of MSH and MSA with nonsuicidal self-injury (NSSI) and tested whether relations varied by self-identified gender or sexual orientation in two national samples of U.S. veterans. Sample 1 included post-9/11 veterans who had recently discharged from service (n = 1,494); sample 2 included veterans from any service era (n = 1,187). Veterans self-reported MSH, MSA, gender identity and sexual orientation, and lifetime and past-month histories of NSSI. We estimated logistic regressions to examine the associations of MSH and MSA history with NSSI and evaluated gender (man or woman) and sexual orientation as moderators of these relations. Results suggested significant associations of both MSH and MSA with NSSI but largely failed to support moderation of these associations by either gender or sexual orientation identity. Screening for both MSH and MSA in veterans across gender and sexual orientation identities appears indicated in clinical assessment of NSSI.

Psychogenic non-epileptic (functional) seizures in adults with intellectual disability and epilepsy: A matched case-control study.

To describe the characteristics of psychogenic non-epileptic (functional) seizures (PNES) in adults with epilepsy and intellectual disability (ID) and to establish differences and risk factors regarding psychosocial functioning between individuals with and without PNES. Adults with ID and epilepsy living in epilepsy care facilities in The Netherlands were screened for PNES by a neurologist. A control group consisting of people with epilepsy and ID, without PNES, was matched according to age, sex, and level of ID. Objective data were retrieved retrospectively from clinical notes of the resident. Standardized questionnaires and tests, adjusted for people with ID, were obtained from participants and their nursing staff. Differences were analyzed using paired t tests, Wilcoxon signed-rank tests, or McNemar's tests, appropriate for matched case-control studies. Conditional logistic regression identified PNES risk factors. Five hundred forty individuals were screened, of which 42 had PNES (point prevalence 7.8%). In total, 35 cases and 35 controls gave consent. Proxy reports indicated that PNES impacted daily life in 79% by adjusting the individual's schedule, and caused minor injuries in one-third. Those with PNES were mainly female (69%); had a mild (46%) or moderate (37%) level of ID; showed more symptoms of depression (p = .024), anxiety (p = .030), self-injurious behavior (p = .015); and experienced more negative life events (p < .001). Clinically relevant predictors of PNES were the number of negative life events (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.12-2.53) and self-injurious behaviors (OR 5.27, 95% CI .97-28.81). Previously, PNES in individuals with ID and epilepsy were described mainly as a reinforced behavioral pattern, due to limited associations with psychiatric disorders. Our results demonstrate that this population does show individual psychosocial vulnerabilities when measured with instruments adjusted for this population, as indicated by proxy reports from daily caregivers. Viewing PNES as an involuntary response, especially for stress-prone individuals with ID, could reduce stigma and improve treatment.

Symptom Network Analysis in a Large Sample of Children and Adults with a Chronic Tic Disorder.

Chronic tic disorders (CTD) are multifaceted disorders characterized by multiple motor and/or vocal tics. They are often associated with complex tics including echophenomena, paliphenomena, and coprophenomena as well as psychiatric comorbidities such as attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Our goal was to uncover the inter-relational structure of CTD and comorbid symptoms in children and adults and to understand changes in symptom structure across development. We used network and graph analyses to uncover the structure of association of symptoms in childhood/adolescence (n = 529) and adulthood (n = 503) and how this structure might change from childhood to adulthood, pinpointing core symptoms as a main target for interventions. The analysis yielded core symptom networks in young and adult patients with CTD including complex tics and tic-related phenomena as well as touching people and objects. Core symptoms in childhood also included ADHD symptoms, whereas core symptoms in adults included symptoms of OCD instead. Interestingly, self-injurious behavior did not play a core role in the young CTD network, but became one of the central symptoms in adults with CDT. In addition, we found strong connections between complex motor and vocal tics as well as echolalia and echopraxia. Next to other complex tics, echophenomena, paliphenomena, and coprophenomena can be regarded core symptoms of CTD. ADHD symptoms are closely related to CTD in childhood, whereas symptoms of OCD and self-injurious behavior are closely associated with CTD in adults. Our results suggest that a differentiation between motor and vocal tics is somewhat arbitrary.

Physiologic and behavioral effects of long-acting subcutaneous and transdermal buprenorphine in rats.

To investigate thermoregulation, thermal antinociception, food/kaolin intake, fecal output, and behavior following long-acting buprenorphine preparations in rats. 8 adult male rats (Rattus norvegicus) were administered long-acting SC buprenorphine (SB; 0.65 mg/kg), transdermal buprenorphine (TB; 10 mg/kg), and controls in a randomized, cross-over design. Body temperature, self-injury, sedation, food/kaolin intake, fecal output, and thermal withdrawal latencies were measured 1, 4, 8, 12, 24, 48, and 72 hours posttreatment. Data analysis was performed with mixed linear models. Self-injury was present between 1 and 12 hours and 4 and 12 hours following TB and SB, respectively; sedation was associated with TB at 12 to 24 hours. Withdrawal latencies were longer in both TB and SB groups than in the control group. Food intake decreased with time in all groups but was significantly lower 24 to 48 hours after TB and 24 to 72 hours after SB versus controls. Kaolin intake decreased from baseline 48 to 72 hours in the control group. Fecal output decreased from baseline 24 to 72 hours in all groups but was significantly lower than controls 24 hours following TB and 24 to 48 hours in SB. Body temperature increased from baseline at 1 hour, 1 to 12 hours, and 1 to 24 hours in the control, TB, and SB groups, respectively, and was significantly higher than the control group 1 to 72 hours following TB and 4 to 24 hours after SB. Transdermal buprenorphine and SB in normal rats produced antinociception, self-injurious behavior, hyperthermia, and decreased food/fecal output. Although these buprenorphine preparations may produce antinociception, untoward effects such as hyperthermia, self-injurious behavior, and reduced food intake/fecal output may be seen.

Suicidal Ideation as a Maladaptive Emotion Regulation Strategy: Implications for Treatment in Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a leading psychotherapy for the reduction of suicidal and self-injurious behaviors (SIBs). However, evidence shows that DBT may be comparably less effective at reducing suicidal ideation (SI) than SIBs. Improving the effectiveness of DBT for SI is critical, given that SI poses risk for SIBs and presents a substantial clinical burden. In the following theoretical paper, we first review evidence surrounding the effectiveness of DBT for SI reduction and explore why DBT may be comparably less effective at reducing SI than SIBs. We argue that DBT’s effectiveness for treating SI may be enhanced by a functional understanding of SI as a maladaptive form of affect regulation, as put forth by recent empirical research. Finally, we discuss implications of this model for treatment in DBT and provide clinical recommendations for how to target SI more effectively using DBT’s existing repertoire for behavior change.

Dimensions of experienced gender and prospective self-injurious thoughts and behaviors in preadolescent children: A national study

ObjectivesGender diverse youth face higher risk of engaging in self-injurious thoughts and behaviors (SITBs) compared to cisgender youth. Limitations in past research include a focus on older adolescents, an emphasis on specific gender identity labels that may not be inclusive of the range of youth gender experiences, and reliance on cross-sectional data. Thus, the current study prospectively evaluated dimensions of experienced gender in relation to first-onset SITBs among preadolescents. MethodsData were drawn from the Adolescent Brain Cognitive Development Study, a longitudinal study of youth across the United States. Youth (n = 7909) were aged 10–11 during initial assessment, and follow-up was conducted one year later. Two dimensions of experienced gender, felt-gender incongruence (not feeling aligned with the gender associated with one's sex assigned at birth) and gender non-contentedness (feeling dissatisfaction with the gender associated with one's sex assigned at birth), were assessed. Primary outcomes included non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA). ResultsLogistic regressions were conducted stratified by sex assigned at birth. For youth assigned female at birth, felt-gender incongruence was prospectively associated with first-onset NSSI and SI and gender non-contentedness was prospectively associated with first-onset of NSSI. For youth assigned male at birth, gender non-contentedness was prospectively associated with first-onset SI. Diverse experienced gender did not prospectively predict SA. ConclusionsDimensions of experienced gender may be associated with subsequent first-onset SITBs among preadolescents. These findings support the need for future research on risk and protective factors that may mediate or moderate this relationship.

Non-suicidal Self-Injury Among Transgender and Gender Non-conforming Persons: A Narrative Synthesis

Non-suicidal Self-Injury Among Transgender and Gender Non-conforming Persons: A Narrative Synthesis

287 - Altered reward circuit in adolescents with non-suicidal self-injury: a study on subcortical volume and lateralization index

287 - Altered reward circuit in adolescents with non-suicidal self-injury: a study on subcortical volume and lateralization index

Editorial Comment on “The Epidemiology of Genitourinary Self-inflicted Injuries: Analysis of the National Trauma Databank”

Editorial Comment on “The Epidemiology of Genitourinary Self-inflicted Injuries: Analysis of the National Trauma Databank”

Exploring suicidal and self-injurious behaviors signal strength of biologics in treating psoriasis or psoriatic arthritis: A 10-year real-world pharmacovigilance analysis using the FDA Adverse Event Reporting System database

Exploring suicidal and self-injurious behaviors signal strength of biologics in treating psoriasis or psoriatic arthritis: A 10-year real-world pharmacovigilance analysis using the FDA Adverse Event Reporting System database

Lived Experience Views on What Contributes to Self-Injury Stigma: A Thematic Analysis

Growing research has sought to understand non-suicidal self-injury (NSSI) stigma. To build on this literature, we qualitatively explored what young adults with lived experience of NSSI believed contributed to its stigmatization. Participants (n = 97) were asked open-ended online questions about what they perceived as contributing to NSSI stigma, which were then analysed via reflexive thematic analysis. Resultant themes indicated that participants believe stigma stems from people, who do not self-injure, misunderstanding self-injury as attention-seeking or conflate it with suicide; they also believe that the media may play a role in this regard (e.g., glamourization, inaccurate portrayals of recovery). Findings offer initial support for a recent theoretical framework for NSSI stigma and point to several implications, which are discussed.

Unintentional nonsuicidal self-injury in an adolescent with perfectionism

Nonsuicidal self-injury typically involves deliberate harm without suicidal intent; however, rare cases exist where self-injury occurs unintentionally, without conscious awareness. This report presents the case of a 16-year-old boy who exhibited unintentional self-harm during sleep, associated with severe academic stress and perfectionism. Despite psychological and medical interventions, the behavior persisted until academic stress was alleviated. This case highlights the need for a differentiated clinical approach to managing unintentional self-harm, emphasizing the importance of stress management and psychological support in adolescents to address the underlying emotional and behavioral triggers.

Pengalaman Remaja Bali Yang Melakukan Perilaku Self-Injury

Adolescents face several changes that cause conflict and emotional stress during adolescence. The conflicts and emotional pressure faced by teenagers cause teenagers to experience distress so that teenagers will have difficulty controlling themselves and carry out actions that are detrimental to themselves. In dealing with stressful conditions, teenagers need to develop behavior by implementing coping strategies. However, not all teenagers are able to develop and choose appropriate coping strategies in dealing with stressful conditions, one of which is engaging in self-injury behavior. Self-injury behavior is the behavior of individuals who deliberately hurt or injure themselves with the aim of reducing the emotional problems they are facing. Self-injury behavior has the impact of feeling satisfied because it feels capable of venting negative emotions, however, another impact of self-injury behavior is addiction, which can lead to attempts to commit suicide. It is important for research to be able to describe how teenagers experience self-injury behavior. This research is a qualitative phenomenological research with semi-structured interviews with three teenagers as resource persons. The data obtained was then analyzed using interpretive phenomenology based on Kahija (2017). The results in this study include 1) motives for self-injury behavior, 2) dynamics of self-injury behavior and, 3) experience of carrying out self-injury behavior.

The effect of social anxiety, impulsiveness, self-esteem on non-suicidal self-injury among college students: A conditional process model.

Non-suicidal self-injury (NSSI) is an emerging concern in the field of public health. The objective of this study is to develop a conditional process model to investigate the relationship between social anxiety and NSSI, and the role of impulsiveness and self-esteem in this relationship. A convenience sample of 2717 university students (Mage = 19.81, 22.49% male) from Southern China was recruited. The age range of the participants is between 18 and 25 years. The data were analysed using Spearman correlation analysis, mediation analysis and moderation analysis. The study revealed a positive correlation between social anxiety and NSSI, with impulsiveness serving as a mediating factor in this association. The relationship between social anxiety and NSSI, impulsiveness and social anxiety, impulsiveness and NSSI were all found to be moderated by self-esteem. The prevalence of NSSI among college students exhibited a strong association with social anxiety and impulsiveness. The present investigation additionally demonstrated that there was no significant association between social anxiety, impulsivity and NSSI when high self-esteem was included. This finding implies that self-esteem plays a crucial role in safeguarding against NSSI.

Experiences and attitudes of psychiatric nurses in caring for patients with repeated non-suicidal self-injury in China: a qualitative study

BackgroundThe incidence of non-suicidal self-injury (NSSI) is high and often occurs repeatedly. Psychiatric nurses play a vital role in the care and treatment of NSSI patients, as they have the most frequent contact with patients. The experiences and attitudes of nurses has a direct affect on the quality of care they provide to patients. Negative care experiences and attitudes of patient aversion on behalf of nurses may delay the observation and treatment of changes in the patient’s condition, leading to irreversible risks. Although cross-sectional studies have investigated the attitudes of medical staff toward NSSI patients, quantitative research results cannot comprehensively reflect the emotional experiences and complex psychological changes of the study subjects. A few studies have focused on the psychiatric nurses’ care experiences and attitudes toward patients with repeated NSSI.ObjectiveThis study aimed to explore psychiatric nurses’ care experiences and attitudes toward patients during repeated NSSI.MethodsA thematic analysis qualitative study was used. Using purposive sampling, 18 psychiatric nurses were recruited from a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using six-phase thematic analysis.ResultsFour themes emerged from the analysis: psychiatric nurses’ care experiences, perceptions, care attitudes and coping style toward repeated NSSI patients. Psychiatric nurses have experienced negative care experiences and severe career burnout during the patient’s repeated NSSI. Nurses’ attitudes toward NSSI patients changed during repeated NSSI, from understanding to indifference to anger and resentment. At the same time, it was found that nurses’ coping style with NSSI patients could be divided into three stages, namely, active coping, neglect and perfunctory, and criticism and punishment.ConclusionsThe findings have implications for health care systems regarding interventions to improve nurses’ care experiences and attitudes toward repeated NSSI patients. These findings suggest that enhancing nurses’ understanding of NSSI, establishing standardized emergency response and intervention programs, guiding positive professional values and responsibility, and improving nurses’ caring attitudes can promote the early detection and timely intervention of NSSI.

Spine injuries among severely injured trauma patients: A retrospective single-center cohort study.

We aimed to determine the incidence and severity of spine injuries among severely injured trauma patients (Injury Severity Score (ISS)/New Injury Severity Score (NISS) > 15) treated in a single tertiary trauma center over 15 years. We also wanted to compare the demographics between patients with and without spine injuries and to determine the mortality of spine-injury patients. Data from the years 2006-2020 from the Helsinki Trauma Registry (HTR), a local trauma registry of the trauma unit of the Helsinki University Hospital (HUH), were reviewed. We divided patients into two groups, namely those with traumatic spine injury (TSI) and those without traumatic spine injury (N-TSI). TSI patients were further subdivided into groups according to the level of injury (cervical, thoracolumbar, or multilevel) and the presence of neurological symptoms. We included 2529 patients: 1336 (53%) had a TSI and 1193 (47%) had N-TSI. TSI patients were injured more frequently by a high-fall mechanism (37% vs 21%, p < 0.001). Among TSI patients, 38% of high-fall injuries were self-inflicted. High falls, young age, and female gender were overrepresented in spine-injury patients with a self-inflicted injury mechanism. Cervical spine-injury patients were mostly elderly persons injured by a low-energy mechanism. Unlike other severely injured trauma patients, severely injured trauma patients with spine injuries are more frequently injured by a high-fall mechanism and self-injury.