1
|
Nagy LM, Muehlenkamp JJ. Negative self-perceptions and severity of NSSI: Testing the benefits and barriers model. J Clin Psychol 2024; 80:1365-1376. [PMID: 38401145 DOI: 10.1002/jclp.23667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
Nonsuicidal self-injury (NSSI) is theorized to be caused by negative associations with the self, including low self-esteem, but the mechanisms explaining why low self-esteem is related to more severe NSSI are unclear. The current study aimed to address this limitation by evaluating a mediation model, proposing that low self-esteem would relate to more severe NSSI through increasing self-punishment motivations. Data came from 468 undergraduate students with a history of NSSI who completed an online survey measuring NSSI characteristics and functions, self-esteem, and self-punishment motivations for NSSI. Mediation was tested using a structural equation model using bootstrapped 95% percentile-corrected confidence intervals in which NSSI severity was modeled as a latent variable composed of NSSI frequency, recency, and versatility of methods. The total model was significant and the indirect effect of self-esteem on NSSI severity through self-punishment motives was significant. Self-esteem also retained significant direct effects on NSSI severity, indicating partial mediation. These results provide support for the benefits and barriers model of NSSI, suggesting that negative self-views increase risk for more severe NSSI through self-punishment motivations. Clinical interventions that emphasize self-compassion and focus on modifying self-punishment motivations may help reduce NSSI behavior.
Collapse
Affiliation(s)
- Laura M Nagy
- Department of Psychology, High Point University, High Point, North Carolina, USA
| | - Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| |
Collapse
|
2
|
Boyne H, Hamza CA. Pain tolerance as a 'barrier' to nonsuicidal self-injury: A longitudinal study. Psychiatry Res 2024; 336:115925. [PMID: 38678744 DOI: 10.1016/j.psychres.2024.115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Theoretical perspectives underscore that low pain tolerance may be a relevant 'barrier' to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.
Collapse
Affiliation(s)
- Holly Boyne
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada.
| | - Chloe A Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada
| |
Collapse
|
3
|
Schmidt K, Fitzgerald E, Keel P. Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk? EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38760944 DOI: 10.1002/erv.3104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. METHOD We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). RESULTS SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. CONCLUSIONS OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.
Collapse
Affiliation(s)
| | | | - Pamela Keel
- Florida State University, Tallahassee, Florida, United States
| |
Collapse
|
4
|
O'Loughlin CM, McClure K, Ammerman BA. Development and validation of the self-injury stigma scale. J Psychiatr Res 2024; 173:48-57. [PMID: 38484618 DOI: 10.1016/j.jpsychires.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/27/2023] [Accepted: 02/07/2024] [Indexed: 04/17/2024]
Abstract
Non-suicidal self-injury is a prevalent and concerning behavior. Negative beliefs and stereotypes about NSSI are associated with negative outcomes, and negative, self-referential beliefs (e.g., self-stigmatizing beliefs) related to engagement in NSSI may be particularly harmful. Despite this, there is no validated measure specifically designed to assess for NSSI self-stigma. As this significantly hinders the ability to understand and quantify the effect of NSSI self-stigma, this study sought to validate the newly developed Self-Injury Stigma Scale (SISS). It was hypothesized the SISS would follow a four-factor structure that parallels a widely cited theoretical model of stigma. It was also hypothesized measures of shame and help-seeking self-stigma would be moderately, negatively, correlated with the SISS subscales, supporting the measure's validity. Participants from Study 1 were college students (n = 264, 65.8% female) with at least one lifetime NSSI act. A series of factor analytic models revealed a one-factor structure for the Application of Stigma subscale (i.e., third step of the four-step model). As this was the only SISS subscale to achieve an appropriate model fit, this scale alone was retained as the final SISS. The factor structure was tested via confirmatory factor analysis on a second sample (i.e., community participants with at least one past month of NSSI act; n = 240, 41.3% female). An acceptable fit on most, but not all, indices was reached. Convergent and discriminant validity were supported. The SISS retrospectively predicted past 3 month NSSI frequency and method versatility, and lifetime NSSI versatility, but not lifetime NSSI frequency or disclosure. Thus, the clinical utility of the SISS was partially supported. Findings offering evidence in favor of the SISS's appropriateness and utility as a measure of self-stigma of NSSI. Future work using this measure has the potential to clarify the risk associated with NSSI self-stigma and inform behavioral interventions.
Collapse
Affiliation(s)
- Caitlin M O'Loughlin
- University of Notre Dame, Department of Psychology, 339 Corbett Family Hall, Notre Dame, IN, 46617, USA.
| | - Kenneth McClure
- University of Notre Dame, Department of Psychology, 339 Corbett Family Hall, Notre Dame, IN, 46617, USA
| | - Brooke A Ammerman
- University of Notre Dame, Department of Psychology, 339 Corbett Family Hall, Notre Dame, IN, 46617, USA
| |
Collapse
|
5
|
Hofer MK, Robillard CL, Legg NK, Turner BJ. Influence of perceived peer behavior on engagement in self-damaging behaviors during the transition to university. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 38533800 DOI: 10.1111/jora.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
As students transition to university, they experience significant social changes that can affect their behaviors, including self-damaging behaviors like disordered eating, problematic alcohol/drug use, suicidal thoughts, and non-suicidal self-injury (NSSI). Building on prior work, we examined the associations between (1) perceptions of peers' engagement in self-damaging behaviors predicting one's own subsequent engagement in such behaviors (i.e., socialization) and (2) one's own engagement in self-damaging behaviors predicting perceptions of peers' subsequent engagement in such behaviors (i.e., selection). We also examined whether these associations were moderated by the source of influence (close peer/acquaintance) and degree of social disconnection experienced by the student. First-year university students (N = 704) were asked to complete seven monthly surveys. Multilevel models indicated that when students perceived their close peers had engaged in NSSI or suicidal thinking, they had seven times greater odds of future engagement in the same behavior, implying that socialization increases the risk of these behaviors among university students. Perception of acquaintances' NSSI also predicted greater odds of a student's own NSSI the following month. Social disconnection increased the likelihood of matching own behaviors to perceptions of acquaintances' alcohol abuse, highlighting the importance of fostering connections/mentors to reduce self-damaging behaviors on college campuses. Furthermore, when students engaged in alcohol abuse, they had almost four times greater odds of reporting that their acquaintances abused alcohol the following month, emphasizing the importance of the wider social network in alcohol use behaviors.
Collapse
Affiliation(s)
- Marlise K Hofer
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Christina L Robillard
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Nicole K Legg
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brianna J Turner
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
6
|
Aspeqvist E, Andersson H, Korhonen L, Dahlström Ö, Zetterqvist M. Measurement and stratification of nonsuicidal self-injury in adolescents. BMC Psychiatry 2024; 24:107. [PMID: 38326791 PMCID: PMC10848387 DOI: 10.1186/s12888-024-05535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI. METHODS The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures. RESULTS A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures. CONCLUSIONS When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.
Collapse
Affiliation(s)
- Erik Aspeqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Hedvig Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
- Barnafrid, Swedish National Center on Violence Against Children, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| |
Collapse
|
7
|
Mann AJD, Tull MT, Gratz KL. Examining the Presence, Frequency, and Associated Characteristics of Nonsuicidal Self-Injury by Proxy: Initial Validation of the Nonsuicidal Self-Injury by Proxy Questionnaire (NSSIBPQ). Behav Modif 2024; 48:3-50. [PMID: 37599465 DOI: 10.1177/01454455231191710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provide preliminary data on the validity of a new self-report measure, the NSSI by Proxy Questionnaire (NSSIBPQ). Two nationwide community samples of young adults (one general community sample and one with a history of traditional NSSI and suicidality) completed online studies. NSSI by proxy was reported by 18% of the general community sample and 45% of the self-injuring sample. Findings support the clinical relevance of NSSI by proxy and its potential to meet criteria for an NSSI disorder diagnosis. Results also provide preliminary support for the internal consistency and convergent, discriminant, and concurrent validity of the NSSIBPQ.
Collapse
|
8
|
Riva A, Bizzi F, Borgatti R, Mensi M, Charpentier Mora S, Di Guardo S, Nacinovich R. Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self-injury. Clin Psychol Psychother 2024; 31:e2955. [PMID: 38356195 DOI: 10.1002/cpp.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
Family influence is a crucial factor in the onset and maintenance of eating disorders. Nonsuicidal self-injury (NSSI) and restrictive eating disorders (REDs) co-occur in a significant percentage of subjects but family functioning of these families remains underexplored. This study examines the family functioning perceptions of 80 families with adolescents experiencing RED, comparing those with and without NSSI, alongside a control group, utilising the FACES-IV assessment. The study also aims to compare the triadic (adolescent-mother-father) perception of family functioning in the three groups. The results reveal distinct family dynamics in adolescents with both RED and NSSI, marked by problematic functioning perceptions from all family members and low parental agreement. A further understanding of the family functioning of adolescents with RED with NSSI can help clinicians in defining the treatment setting.
Collapse
Affiliation(s)
- Anna Riva
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Mensi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | | | - Simona Di Guardo
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
9
|
Dierickx S, Claes L, Buelens T, Smits D, Kiekens G. DSM-5 non-suicidal self-injury disorder in a community sample: comparing NSSI engagement, recency and severity among emerging adults. Front Psychiatry 2023; 14:1251514. [PMID: 38144473 PMCID: PMC10748385 DOI: 10.3389/fpsyt.2023.1251514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Up to one in five emerging adults engage in non-suicidal self-injury (NSSI). Providing a better understanding of factors that differentiate between who engages in lifetime NSSI and who is more likely to engage in recent and clinically severe NSSI can provide meaningful information for prevention and intervention of NSSI. The present study (n = 669) considered NSSI lifetime engagement (no prior history of NSSI vs. lifetime NSSI), recency [past NSSI (>12 months ago) vs. recent (≤12-month) NSSI], and clinical severity among those with recent NSSI (subthreshold vs. DSM-5 NSSI disorder). The prevalence of NSSI disorder was 8.4% in emerging adults aged 18 to 26 years old. Higher anxiety levels were related to NSSI engagement, but only depressive symptoms and NSSI versatility were consistently associated with more recent NSSI and NSSI disorder. A stepped-care approach may be required in addressing NSSI among emerging adults.
Collapse
Affiliation(s)
- Serafine Dierickx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
| | - Laurence Claes
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department, Odisee University of Applied Sciences, Brussel, Belgium
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| |
Collapse
|
10
|
Barnette BH, O'Loughlin CM, Park Y, Vogel K, Burke TA, Law KC, Ammerman BA. Nonsuicidal self-injury characteristics: A mixed methods analysis of differences between veterans and civilians. J Psychiatr Res 2023; 168:318-324. [PMID: 37949043 DOI: 10.1016/j.jpsychires.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a well-established risk factor for suicidal behavior, with certain NSSI characteristics being associated with increased risk. In the United States (U.S.), the veteran suicide rate is elevated, though lifetime prevalence rates of NSSI appear similar between veterans and civilians. There is limited research that directly compares veterans and civilians across multiple NSSI characteristics to examine between-group differences in NSSI behavior and provide important context for the application of NSSI research with the veteran population. This study examined differences between U.S. veterans and civilians with a history of suicidal ideation across several NSSI characteristics, including method, severity, age of onset, shame, distress, and reason for initial NSSI engagement. A sample of 527 veterans and civilians completed measures of direct and indirect NSSI behaviors along with supplemental questions designed to further assess endorsed NSSI behaviors. Additionally, respondents provided written responses to an open-ended question about their reasons for initial engagement in NSSI, which were coded for post-hoc analysis. Chi-square difference tests and t-tests were conducted, revealing significant group differences between veterans and civilians in NSSI method, lifetime versatility, age of onset, age at last occurrence, and reasons for initial engagement. No significant differences were found in NSSI frequency, severity, shame, or distress. These findings provide valuable information on similarities and differences in NSSI behavior characteristics between U.S. veterans and civilians with lifetime suicidal ideation to inform future research and the assessment of NSSI in these populations.
Collapse
Affiliation(s)
- Benjamin H Barnette
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | | | - Yeonsoo Park
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katrina Vogel
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Taylor A Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Brooke A Ammerman
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| |
Collapse
|
11
|
Schmidt K, Smith AR, Bodell LP. Influence of nonsuicidal self-injury functions on suicide risk in individuals with eating disorders. Suicide Life Threat Behav 2023; 53:1055-1062. [PMID: 37804065 DOI: 10.1111/sltb.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) display elevated rates of suicidality (i.e., suicidal ideation and behaviors) as well as nonsuicidal self-injury (NSSI) (e.g., self-harm behaviors without intent to die). NSSI-and particularly the functions of NSSI-predict suicidal ideation in general samples; however, to our knowledge, the relation between NSSI functions and suicidal ideation in ED populations has been unexplored. METHOD This study examined whether specific functions of NSSI are relevant to suicidal ideation in a treatment-seeking sample of women with EDs (n = 100). Participants completed self-report measures of suicidal ideation, NSSI, and related psychopathology upon intake to an ED treatment program. RESULTS Using the four-function model of NSSI, we found that intrapersonal and interpersonal-negative reinforcement, but not interpersonal-positive reinforcement functions, were related to suicidal ideation in women with EDs. Contrary to expectations, we did not find that endorsement of multiple NSSI functions was related to increased suicide risk. DISCUSSION Findings imply that some, but not all, functions of NSSI may be relevant to suicide risk in individuals with EDs. Implications for further research are discussed.
Collapse
Affiliation(s)
- Kendall Schmidt
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
12
|
Steele SJ, Björgvinsson T, Swenson LP. Implicit Assessment of Non-Suicidal Self-Injury: Group Differences in Temporal Stability of the Self-Injury Implicit Association Test (SI-IAT). Arch Suicide Res 2023:1-13. [PMID: 37589467 PMCID: PMC10873468 DOI: 10.1080/13811118.2023.2247042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE We examine differences on the Self-Injury Implicit Association Test (SI-IAT) by history of non-suicidal self-injury (NSSI), in a test-retest design, to examine short-term temporal stability of SI-IAT scores. METHOD Treatment-seeking participants (N = 113; 58% female; 89% White; Mage = 30.57) completed the SI-IAT and self-report measures at two time points (MTimeframe = 3.8 days). RESULTS Data suggested NSSI (51% of the sample endorsed lifetime NSSI) was related to Time 1 (T1) identity and attitude, and affected stability of scores. T1 and T2 SI-IAT identity and attitude were more strongly related for participants with NSSI history. NSSI characteristics (recency; number of methods) affected stability. CONCLUSIONS The short-term test-retest reliability of the SI-IAT is strong among those with NSSI history from T1 to T2. However, the SI-IATs use with participants without a history of NSSI was not supported beyond its established ability to differentiate between groups by NSSI history. This test may provide clinically-relevant assessment among those with a history of NSSI.
Collapse
|
13
|
Cathelyn F, Linthout T, Van Dessel P, Claes L, De Houwer J. Announcement of the Registered Report “Can a variant of the Implicit Association Test detect nonsuicidal self-injury in a clinical population? A Registered Report”. CLINICAL PSYCHOLOGY IN EUROPE 2023. [DOI: 10.32872/cpe.11499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
14
|
An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review. Brain Sci 2023; 13:brainsci13030466. [PMID: 36979278 PMCID: PMC10046685 DOI: 10.3390/brainsci13030466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Non-suicidal self-injury (NSSI) refers to the intentional and repeated physical trauma of an individual without explicit suicidal intent, which has negative effects on the physical and mental well-being of an individual, especially for adolescents. Timely and accessible nursing care may play an important role in the survival and rehabilitation process of NSSI. Methods: In this review, we systematically discuss the nursing care of NSSI behavior and provide recommendations based on an integrated nursing model for NSSI management. Results: As reported in previous studies, a variety of factors can contribute to NSSI behavior, such as personality traits, current psychological status, history of mental illnesses, as well as family and social factors. In-hospital care is the most necessary and effective care during acute episodes of NSSI behavior. To effectively manage inpatients with NSSI behaviors, nurses should first understand the motivation of NSSI, and provide comprehensive and multi-level care through nurse-patient communication, individualized psychological care, and multidisciplinary cooperation with other professionals. While the purpose of out-of-hospital nursing is to reduce the frequency of NSSI behaviors by screening high-risk individuals, providing psychological support, promoting health education, and improving self-awareness. Conclusions: An integrative model of in-hospital and out-of-hospital nursing care can help improve the clinical management and long-term prognosis of patients with NSSI and minimize the risk of suicidal ideation or suicidal behavior.
Collapse
|
15
|
Nagy LM, Shanahan ML, Seaford SP. Nonsuicidal self-injury and rumination: A meta-analysis. J Clin Psychol 2023; 79:7-27. [PMID: 35639994 PMCID: PMC10084048 DOI: 10.1002/jclp.23394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
Trait rumination is the tendency to overthink and focus on negative emotions and events and is related to a number of psychological disorders and maladaptive behaviors including nonsuicidal self-injury (NSSI). The purpose of this study was to conduct a meta-analysis of the relationship between trait rumination and NSSI behaviors. Results from 60 samples showed small effect sizes between trait rumination and NSSI engagement, NSSI frequency, and the number of methods used to self-injure in cross-sectional samples. Results from 13 samples showed small effect sizes between trait rumination and NSSI engagement and NSSI frequency in longitudinal samples. Moderator analyses indicated that this relationship is similar whether the type of rumination is depressive or not and is generally consistent across different ages, genders, and ethnicities. These results help clarify the role of trait rumination as a risk factor for NSSI.
Collapse
Affiliation(s)
- Laura M Nagy
- Department of Psychology, High Point University, High Point, North Carolina, USA
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Sara P Seaford
- Department of Psychology, High Point University, High Point, North Carolina, USA
| |
Collapse
|
16
|
Boyne H, Hamza CA. Pain analgesia or desensitization? A longitudinal lab-based study on the link between pain and nonsuicidal self-injury. Psychiatry Res 2022; 318:114943. [PMID: 36384068 DOI: 10.1016/j.psychres.2022.114943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
Mounting evidence suggests that individuals who engage in nonsuicidal self-injury (NSSI) have lower pain sensitivity (e.g., pain thresholds and tolerances) than individuals without a history of NSSI. However, research has been largely cross-sectional, so it is unclear whether low pain sensitivity may increase risk for NSSI, or whether NSSI diminishes pain sensitivity over time. In the present study, the relations among NSSI frequency, versatility (number of NSSI methods), pain threshold, and pain tolerance were examined using a longitudinal research design. Participants included 156 undergraduate students at a large university (87% female; Mage = 19.79) with a recent history of NSSI. Participants reported on their NSSI engagement and completed a cold pressor task in a baseline session, as well as at one year follow-up. Eight regression models were run to examine the nature of the association between the two pain measures (i.e., pain threshold and tolerance) and the two NSSI measures (i.e., frequency and versatility). Pain tolerance and pain threshold predicted NSSI versatility over time, but NSSI frequency and versatility did not predict pain threshold or tolerance over time. Results suggest that low pain sensitivity may be a risk factor for severe NSSI engagement.
Collapse
Affiliation(s)
- Holly Boyne
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada.
| | - Chloe A Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Moseley RL, Gregory NJ, Smith P, Allison C, Cassidy S, Baron-Cohen S. Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample. Mol Autism 2022; 13:45. [PMID: 36371252 PMCID: PMC9655904 DOI: 10.1186/s13229-022-00522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults. METHODS Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI. RESULTS While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability. LIMITATIONS Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community. CONCLUSIONS Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.
Collapse
Affiliation(s)
- Rachel L. Moseley
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Nicola J. Gregory
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Paula Smith
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Simon Baron-Cohen
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
18
|
Support for a Transdiagnostic Motivational Model of Self-Damaging Behaviors: Comparing the Salience of Motives for Binge Drinking, Disordered Eating, and Nonsuicidal Self-Injury. Behav Ther 2022; 53:1219-1232. [PMID: 36229118 DOI: 10.1016/j.beth.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022]
Abstract
Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, Mage = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.
Collapse
|
19
|
Robillard CL, Chapman AL, Turner BJ. Learning from experience: Within- and between-person associations of the consequences, frequency, and versatility of nonsuicidal self-injury. Suicide Life Threat Behav 2022; 52:836-847. [PMID: 35385177 DOI: 10.1111/sltb.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/14/2021] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Behavioral models of nonsuicidal self-injury (NSSI) propose that experiencing desirable consequences following NSSI reinforces the behavior. However, these models do not specify whether experiencing more desirable consequences relative to other people (between-person), an individual's own average (within-person), or both, predicts NSSI severity. To address this gap, this study investigated the prospective, within- and between-person associations of desirable NSSI consequences with NSSI frequency (number of episodes) and versatility (number of methods). METHODS Two hundred and ten individuals (93.81% female, Mage = 22.95) with a history of NSSI completed online surveys assessing NSSI consequences, frequency, and versatility every three months for one year. RESULTS Within-person increases in desirable emotional consequences were unrelated to NSSI frequency three months later but predicted increases in NSSI versatility. Within-person increases in desirable social consequences predicted decreases in NSSI frequency three months later but were unrelated to NSSI versatility. Between-person variability in desirable consequences was unrelated to NSSI severity. CONCLUSIONS Findings were partially consistent with behavioral models of NSSI. Going forward, we recommend that: (1) behavioral models articulate the salience of within-person fluctuations in consequences; (2) research clarifies the role of social consequences; and (3) clinicians use repeated assessments of emotional consequences to identify periods of elevated NSSI risk.
Collapse
Affiliation(s)
- Christina L Robillard
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Alexander L Chapman
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Brianna J Turner
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
20
|
Sorgi-Wilson KM, Cheung JC, Ciesinski NK, McCloskey MS. Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions. Arch Suicide Res 2022:1-17. [PMID: 35924878 PMCID: PMC9898468 DOI: 10.1080/13811118.2022.2106919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear. METHOD The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI). RESULTS The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions. CONCLUSIONS Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.
Collapse
|
21
|
Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
Collapse
Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| |
Collapse
|
22
|
Forbes CN, Tull MT, Chapman AL, Dixon-Gordon KL, Gratz KL. Implicit Associations of Nonsuicidal Self-Injury with Relief in Posttraumatic Stress and Depressive Disorders. Arch Suicide Res 2022; 26:565-580. [PMID: 32866425 DOI: 10.1080/13811118.2020.1811182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives. METHOD A subset of participants from our previous study (N = 109) completed diagnostic interviews and the laboratory-based DSH-Relief Implicit Association Test (IAT). RESULTS Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder. CONCLUSIONS Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.
Collapse
|
23
|
Forbes CN, Tull MT, Lavender JM, Dixon-Gordon KL, Gratz KL. Development and Initial Validation of the Body-focused Self-damaging Behavior Expectancies Questionnaire. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-021-09906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Simone AC, Hamza CA. A longitudinal examination of predictors of nonsuicidal self-injury disclosures among university students. J Clin Psychol 2021; 77:2860-2877. [PMID: 34773410 DOI: 10.1002/jclp.23277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is a paucity of longitudinal research on predictors of disclosures of nonsuicidal self-injury (NSSI) among emerging adults. However, understanding the factors that facilitate disclosure is critical, as disclosure may serve as a first step in accessing care. To address this gap, the present study examined predictors of prospective NSSI disclosures in a postsecondary student sample. METHODS A total of 475 university students with a history of NSSI (Mage = 17.96; 74.9% women) reported on several potential predictors of NSSI disclosure, and their disclosure history at baseline and 4- and 8-month follow-ups. RESULTS It was found that 22% of students reported disclosing NSSI during the first year of university; students who had previously disclosed, and who reported greater NSSI severity, were more likely to disclose over time. CONCLUSION Results of the present study suggest that disclosures often occur in the postsecondary context, and students who disclose NSSI may engage in more severe NSSI behaviours.
Collapse
Affiliation(s)
- Ariana C Simone
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Chloe A Hamza
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Szewczuk-Bogusławska M, Kaczmarek-Fojtar M, Halicka-Masłowska J, Misiak B. Self-Injuries and Their Functions with Respect to Suicide Risk in Adolescents with Conduct Disorder: Findings from a Path Analysis. J Clin Med 2021; 10:jcm10194602. [PMID: 34640620 PMCID: PMC8509303 DOI: 10.3390/jcm10194602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Non-suicidal self-injuries (NSSIs) have been identified as one of the most predictive factors of suicidal behaviours in adolescents. However, it remains unknown whether certain functions of NSSIs are associated with suicide risk, and what are the underlying mechanisms. Therefore, we aimed to investigate the association between functions of NSSIs and suicide risk in adolescents with conduct disorder (CD), which shares some common characteristics with NSSIs. Participants were 215 adolescents (155 females, 72.1%) with CD. Functions of NSSIs, depressive symptoms, the levels of impulsivity, anxiety, self-esteem and aggression were examined. There were 77 adolescents with lifetime history of NSSIs (35.8%). Among them, adolescents with lifetime history of suicide attempt were significantly more likely to report anti-dissociation and anti-suicide function of NSSIs. They had significantly higher levels of anxiety as well as significantly lower self-esteem. Higher lifetime number of NSSIs was associated with higher odds of reporting anti-dissociation and anti-suicide functions. Moreover, these two functions fully mediated the association between lifetime number of NSSIs and suicide risk after co-varying for depressive and anxiety symptoms as well as self-esteem. The present findings indicate that anti-suicide and anti-dissociation functions of NSSIs might be crucial predictors of suicide risk in adolescents with CD.
Collapse
Affiliation(s)
- Monika Szewczuk-Bogusławska
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.H.-M.); (B.M.)
- Correspondence: ; Tel.: +48-71-784-16-00
| | | | | | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.H.-M.); (B.M.)
| |
Collapse
|
26
|
Seong E, Noh G, Lee KH, Lee JS, Kim S, Seo DG, Yoo JH, Hwang H, Choi CH, Han DH, Hong SB, Kim JW. Relationship of Social and Behavioral Characteristics to Suicidality in Community Adolescents With Self-Harm: Considering Contagion and Connection on Social Media. Front Psychol 2021; 12:691438. [PMID: 34326799 PMCID: PMC8315269 DOI: 10.3389/fpsyg.2021.691438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
A close link has been established between self-harm and suicide risk in adolescents, and increasing attention is given to social media as possibly involved in this relationship. It is important to identify indicators of suicidality (i.e., suicide ideation or attempt) including aspects related to contagion in online and offline social networks and explore the role of social media in the relationship between social circumstances and suicidality in young adolescents with self-harm. This study explored characteristics of Korean adolescents with a recent history of self-harm and identified how behavioral and social features explain lifetime suicidality with emphasis on the impact of social media. Data came from a nationwide online survey among sixth- to ninth-graders with self-harm during the past 12 months (n = 906). We used χ2 tests of independence to explore potential concomitants of lifetime suicidality and employed a multivariate logistic regression model to examine the relationship between the explanatory variables and suicidality. Sensitivity analyses were performed with lifetime suicide attempt in place of lifetime suicidality. 33.9% (n = 306) and 71.2% (n = 642) reported to have started self-harm by the time they were fourth- and six-graders, respectively; 44.3% (n = 400) reported that they have friends who self-harm. Having endorsed moderate/severe forms and multiple forms of self-harm (OR 5.36, p < 0.001; OR 3.13, p < 0.001), having engaged in self-harm for two years or more (OR 2.42, p = 0.001), having friends who self-harm (OR 1.92, p = 0.013), and having been bullied at school were associated with an increased odds of lifetime suicidality (OR 2.08, p = 0.004). Notably, having posted content about one's self-harm on social media during the past 12 months was associated with an increased odds of lifetime suicidality (OR 3.15, p < 0.001), whereas having seen related content in the same period was not. Sensitivity analyses yielded similar results with lifetime suicide attempt, supporting our findings from the logistic regression. The current study suggests that self-harm may be prevalent from early adolescence in South Korea with assortative gathering. The relationship of vulnerable adolescents' social circumstances to suicide risk may be compounded by the role of social media. As the role of social media can be linked to both risk (i.e., contagion) and benefit (i.e., social connection and support), pre-existing vulnerabilities alongside SH and what online communication centers on should be a focus of clinical attention.
Collapse
Affiliation(s)
- Eunice Seong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Gahye Noh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon-si, South Korea
| | - Sojung Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Dong Gi Seo
- Department of Psychology, Hallym University, Chuncheon-si, South Korea
| | - Jae Hyun Yoo
- Department of Psychiatry, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyunchan Hwang
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, South Korea
| | - Chi-Hyun Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, South Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
27
|
Haliczer LA, Harnedy LE, Oakley M, Dixon-Gordon KL. Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students. J Prim Prev 2021; 42:473-492. [PMID: 34236585 DOI: 10.1007/s10935-021-00639-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
Suicidal behaviors are increasingly prevalent among college students. Although emotion dysregulation is theorized to increase suicide risk, research supporting this relationship is mixed. Engagement in self-damaging behaviors may play a role in the relationship between emotion dysregulation and suicide risk, theoretically by increasing one's capability of engaging in suicidal behaviors. Such behaviors may interact with emotion dysregulation to predict suicide risk. Alternatively, engaging in self-damaging behaviors may mediate the emotion dysregulation-suicide risk relationship. We examined the potential moderating and mediating roles of engagement in multiple self-damaging behaviors in the relationship between emotion dysregulation and suicide risk among college students. Participants were 181 undergraduate students who reported a history of self-damaging behaviors (i.e., non-suicidal self-injury, alcohol misuse, drug misuse, disordered eating), overall emotion dysregulation, and suicide risk. Findings revealed an interactive effect of emotion dysregulation and self-damaging behaviors on suicide risk, with engagement in more forms of self-damaging behaviors conferring higher risk for suicide, particularly in the context of greater emotion dysregulation. The model testing self-damaging behaviors as a mediator was also significant, such that greater emotion dysregulation had an indirect effect on elevated suicide risk via number of self-damaging behaviors. These findings help clarify associations among emotion dysregulation, self-damaging behaviors, and suicide risk, and have implications for specific targets of intervention and for the prevention of suicide by college students.
Collapse
Affiliation(s)
- Lauren A Haliczer
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
| | - Lauren E Harnedy
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
| | - Marykate Oakley
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
| | | |
Collapse
|
28
|
Sorgi KM, Ammerman BA, Cheung JC, Fahlgren MK, Puhalla AA, McCloskey MS. Relationships between Non-Suicidal Self-Injury and Other Maladaptive Behaviors: Beyond Difficulties in Emotion Regulation. Arch Suicide Res 2021; 25:530-551. [PMID: 31994980 DOI: 10.1080/13811118.2020.1715906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Non-suicidal self-injury (NSSI) co-occurs with both other maladaptive behaviors (e.g., aggression) and emotion dysregulation. However, the extent to which these maladaptive behaviors are linked to NSSI independent of emotion dysregulation is unclear. The present study examined relationships between NSSI and six other maladaptive behaviors among university undergraduates. When controlling for demographic variables, emotion dysregulation, and other maladaptive behaviors, binge eating, purging, illicit drug use, and physical aggression were each related to lifetime NSSI history and/or severity. No maladaptive behaviors were significantly related to the presence of current diagnostic-level NSSI in these multivariate analyses. Results suggest that some maladaptive behaviors may relate uniquely to NSSI risk independent of emotion dysregulation, highlighting the importance of considering such behaviors in self-injury assessment and treatment.
Collapse
|
29
|
Wang Y. The Impact of Interparental Conflicts on Online Game Addiction Symptomatology: The Mediating Roles of the Parent-Adolescent Relationship and Loneliness in Adolescents. Psychol Rep 2021; 125:2337-2356. [PMID: 34044664 DOI: 10.1177/00332941211016751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many studies have documented the close association that exists between interparental conflicts and the symptomatology of online game addiction. However, the underlying mechanism that drives this association has not been fully investigated. This cross-sectional study explores the effect of interparental conflicts on online game addiction symptomatology in adolescents, focusing on the mediating effects of the parent-adolescent relationship and of adolescent loneliness. A total of 553 middle school students completed a questionnaire that included: a perception of interparental conflict scale, a level of closeness to parents scale, a short UCLA Loneliness scale, and an online game addiction symptomatology scale. Results showed that interparental conflicts, parent-adolescent relations, and adolescent loneliness are all significantly related to online game addiction symptomatology in adolescents. Structural equation modeling results indicate that the effects of interparental conflicts on adolescent online game addiction symptomatology are partially mediated by the parent-adolescent relationship and by adolescent loneliness.
Collapse
Affiliation(s)
- Yanhua Wang
- School of Education, Anyang Normal University, Anyang, China
| |
Collapse
|
30
|
Nagy LM, Shanahan ML, Baer RA. An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury. Behav Res Ther 2021; 139:103819. [PMID: 33640591 DOI: 10.1016/j.brat.2021.103819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. Individuals who self-injure often report doing so in order to punish the self or express self-hatred. Self-criticism, or thoughts marked by shame, self-consciousness, and inferiority, is associated with higher rates of NSSI while self-compassion, or the tendency to be sympathetic and caring with oneself, is negatively associated with NSSI. The aim of the present study was to determine whether experimentally-induced self-criticism would increase and self-compassion would decrease implicit identification with NSSI. Participants were randomly assigned to either a self-criticism induction, a self-compassion induction, or a neutral, control condition and completed a measure of strength of the automatic associations that a person holds between themselves and self-harming behaviors before and after the experimental induction. Study hypotheses were partially supported. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion condition did not significantly change. These results highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.
Collapse
Affiliation(s)
- Laura M Nagy
- Department of Psychology, University of Kentucky, United States.
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University, Purdue University Indianapolis, United States
| | - Ruth A Baer
- Department of Psychology, University of Kentucky, United States
| |
Collapse
|
31
|
Cama SF, Fosbenner S. Nonsuicidal Self-Injury in Youth: A Primer for Pediatricians. Pediatr Ann 2021; 50:e72-e76. [PMID: 33576832 DOI: 10.3928/19382359-20210121-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a relatively common occurrence in youth, and pediatricians must be prepared to address this behavior in their patients in an open and nonjudgmental way. Although NSSI is done without suicidal intent, its occurrence does increase the risk for suicide and is often found with other diagnosable psychiatric conditions. Screening for NSSI should be accompanied by screening for suicidal ideation and comorbid psychiatric disorders to ensure that the patient's current risk is properly assessed and that they have access to the right resources and treatments. This article is a primer for primary care pediatricians for how to talk about and address NSSI in their patients. [Pediatr Ann. 2021;50(2):e72-e76.].
Collapse
|
32
|
How should we respond to non-suicidal self-injury disclosures?: An examination of perceived reactions to disclosure, depression, and suicide risk. Psychiatry Res 2020; 293:113430. [PMID: 32871486 DOI: 10.1016/j.psychres.2020.113430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Abstract
Identifying those who engage in non-suicidal self-injury (NSSI) rely heavily on self-disclosure. However, less than half of those who engage in NSSI disclose their self-injurious behavior often due to the fear of negative reaction. This study examined how perceived reactions to NSSI disclosure (i.e., 'negative reactions', 'tangible aid,' and 'emotional support') may be associated with suicide risk through depression. Participants were 385 undergraduate students who had a lifetime history of engaging in and disclosing at least one of their NSSI acts. Perceived reactions to NSSI disclosure were assessed through the Self-injury Social Reactions Questionnaire; suicide risk was assessed through the Suicidal Behavior Questionnaire Revised; depression was assessed through the Beck Depression Inventory-II. Path analyses were conducted to examine the indirect effects of perceived reactions to NSSI disclosure on suicide risk through depression. Exploratory analyses of independent models examining each reaction separately were conducted as well. In the full model, negative reactions and emotional support were indirectly associated with suicide risk through depression. In the independent models, all three reaction types were associated with suicide risk through depression. The current study elucidates a potential mechanism in which specific perceived reactions to NSSI disclosure may influence one's suicide risk.
Collapse
|
33
|
Whitman MR, Kremyar AJ, Ben-Porath YS. Using the MMPI-2-RF to Assess Risk of Nonsuicidal Self-Injury among College Students. J Pers Assess 2020; 103:455-464. [PMID: 32783548 DOI: 10.1080/00223891.2020.1801701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nonsuicidal self-injury (NSSI), the deliberate destruction of one's own body tissue without suicidal intent, is a prevalent problem linked to adverse outcomes. Many assessment tools designed to assess for NSSI risk are limited by their behavioral focus, which does not cover the numerous affective, cognitive, and interpersonal correlates. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a widely used inventory of personality and psychopathology that assesses a range of empirical correlates of NSSI risk. The purpose of this study was to investigate the utility of the MMPI-2-RF for assessing these NSSI-related constructs. On the basis of a review of the literature and item content, we pre-identified MMPI-2-RF measures of constructs associated with NSSI risk. Correlations between scores on these scales and the number of methods of NSSI identified several meaningful results, including some small but consistent gender differences in these associations. Zero-inflated negative binomial regression analyses indicated that scores on some expected MMPI-2-RF scales independently predicted NSSI variability. Relative risk ratio analyses demonstrated the potential clinical utility of MMPI-2-RF scale scores for assessing risk of engagement in NSSI. These findings indicate that the MMPI-2-RF may be a useful tool for assessing risk for NSSI among college students.
Collapse
Affiliation(s)
- Megan R Whitman
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Andrew J Kremyar
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | |
Collapse
|
34
|
Lear MK, Penzenik ME, Forster JE, Starosta A, Brenner LA, Nazem S. Characteristics of nonsuicidal self-injury among veterans. J Clin Psychol 2020; 77:286-297. [PMID: 32662073 DOI: 10.1002/jclp.23027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study aimed to (a) assess basic nonsuicidal self-injury (NSSI) characteristics using a validated clinical interview among a sample of veterans not recruited for specific diagnostic or environmental criteria and (b) examine the relation between NSSI and medical severity of prior suicide attempts (SAs) among veterans. DESIGN We conducted secondary data analyses among a combined sample of veterans (N = 165) from two parent studies conducted at a large VA Medical Center that implemented identical recruitment protocols. No psychiatric criteria were utilized for inclusion or exclusion purposes. RESULTS Approximately 16% of participants reported NSSI history and almost 21% reported SA history. NSSI history was associated with probability of prior SA but not the medical severity of prior SA. CONCLUSIONS NSSI is a prevalent concern among veterans and is associated with probability of SA. It remains unclear whether prior NSSI is associated with more medically serious SA in this population.
Collapse
Affiliation(s)
- Mary K Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, Oregon, USA
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
35
|
Baer MM, Tull MT, Forbes CN, Richmond JR, Gratz KL. Methods Matter: Nonsuicidal Self-Injury in the Form of Cutting is Uniquely Associated with Suicide Attempt Severity in Patients with Substance Use Disorders. Suicide Life Threat Behav 2020; 50:397-407. [PMID: 31621951 PMCID: PMC7148192 DOI: 10.1111/sltb.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the robust relation between nonsuicidal self-injury (NSSI) and suicidal behaviors, there is considerable heterogeneity in NSSI characteristics that may have implications for the strength of the NSSI-suicide attempt relation. Past research highlights the relevance of both more severe NSSI methods and NSSI in the form of cutting in particular to suicide attempts. To further explore the relations of specific NSSI methods to suicide attempts, this study examined relations between different NSSI methods (i.e., those involving cutting, burning, blunt force, or resulting in minor tissue damage) and both overall suicide attempts and two indicators of suicide attempt severity (attempts requiring medical attention and nonambivalent attempts) in 203 substance-dependent patients in residential treatment. METHOD Participants were administered questionnaires and semistructured interviews assessing the variables of interest. RESULTS Cutting was the only NSSI method to demonstrate significant relations with overall suicide attempts, nonambivalent suicide attempts, and suicide attempts requiring medical attention. Results remained when considering relevant covariates. CONCLUSION Results highlight an important link between NSSI methods involving cutting and suicide attempts among patients with substance use disorders. Findings also highlight the importance of more fine-grained characterizations of NSSI subgroups.
Collapse
Affiliation(s)
| | - Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA,Address correspondence to: Matthew T. Tull, Ph.D., Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio 43606; Telephone: 419-530-4392; Fax: 419-530-8479;
| | | | | | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| |
Collapse
|
36
|
Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
Collapse
Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| |
Collapse
|
37
|
Hagan CR, Rogers ML, Brausch AM, Muehlenkamp JJ, Joiner TE. Interoceptive deficits, non-suicidal self-injury, and suicide risk: a multi-sample study of indirect effects. Psychol Med 2019; 49:2789-2800. [PMID: 30602396 DOI: 10.1017/s0033291718003872] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interoceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior. METHODS This study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews. RESULTS Contrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance. CONCLUSIONS We found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.
Collapse
|
38
|
Pérez S, Ros MC, Folgado JEL, Marco JH. Non-suicidal Self-injury Differentiates Suicide Ideators and Attempters and Predicts Future Suicide Attempts in Patients with Eating Disorders. Suicide Life Threat Behav 2019; 49:1220-1231. [PMID: 30357895 DOI: 10.1111/sltb.12521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed first to identificate psychopathological variables differentiating between suicide ideators, suicide attempters and patients without suicide ideation or attempts, and second to identificate better predictors of suicide attempts longitudinally. METHOD We compared suicide ideation, hopelessness, borderline symptoms, frequency, types, number of different non-suicidal self-injury (NSSI) methods, intrapersonal and interpersonal functionality of NSSI in a sample of 238 patients with Eating Disorders (1) with no history of suicide ideation or suicide attempts (n = 150); (2) with recent suicide ideation (n = 65); and (3) with suicide attempts in the previous year (n = 23). In addition, we analyzed the predictive power of the mentioned variables over the number of suicide attempts 7 months after the first assessment. RESULTS The group of suicide attempters showed a major number of different methods of NSSI, higher frequency of NSSI, cutting, and more NSSI intra and interpersonal functions than the group of ideators. Unlike in previous studies, hopelessness did not differentiate between patients with ideation and suicide attempts. In addition, the best predictor of suicide attempts 7 months later was frequency of NSSI at T1 (N = 123). CONCLUSIONS Cutting, frequency and different methods of NSSI, intra and interpersonal functions were risk factors that differentiated ideators from attempters, being frequency of NSSI the best predictor of suicide attempts longitudinally. Thus, patients with ED with NSSI should be the focus of preventive interventions for suicidal behavior.
Collapse
Affiliation(s)
- Sandra Pérez
- Department of Personality, Assessment and Therapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| | | | - Jose E Layron Folgado
- School of Doctorate. Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| | - Jose H Marco
- Department of Personality, Assessment and Psychotherapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| |
Collapse
|
39
|
Ammmerman BA, Hong M, Sorgi K, Park Y, Jacobucci R, McCloskey MS. An examination of individual forms of nonsuicidal self-injury. Psychiatry Res 2019; 278:268-274. [PMID: 31238297 DOI: 10.1016/j.psychres.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a growing public health concern, and there is an increasing need to better characterize and identify severe NSSI behavior. One readily accessible, yet understudied, avenue for improving the assessment of NSSI severity is through the examination of individual forms, or methods, of the behavior. The present study aimed to address this gap in the literature by investigating the relationship between 12 different NSSI methods with three NSSI severity indicators and three distinct suicidal thoughts and behaviors among 1,436 undergraduate students with a history of NSSI (70.90% female, M age = 20.69, SD = 3.32). Results across six decision tree analyses highlighted the use self-hitting / punching, in addition to cutting oneself, as the most informative NSSI methods for differentiating outcome severity. Gender differences were only found for the outcome of suicidal ideation. The present study provides preliminary evidence that the examination of individual NSSI methods may be useful in identifying individuals at risk for negative correlates of NSSI, including NSSI-related hospital visits, unintended serious injury, and suicidal behavior. Upon replication in longitudinal work, findings have important clinical utility by providing a potential marker of prognosis and the need for higher levels of care.
Collapse
Affiliation(s)
- Brooke A Ammmerman
- University of Notre Dame, Department of Psychology, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States.
| | - Max Hong
- University of Notre Dame, Department of Psychology, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States
| | - Kristen Sorgi
- Temple University, Department of Psychology, 1701N. Broad Street, Philadelphia, PA, 19122, United States
| | - Yeonsoo Park
- University of Notre Dame, Department of Psychology, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States
| | - Ross Jacobucci
- University of Notre Dame, Department of Psychology, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States
| | - Michael S McCloskey
- Temple University, Department of Psychology, 1701N. Broad Street, Philadelphia, PA, 19122, United States
| |
Collapse
|
40
|
Williams KA, Lee EJ. Challenges of conducting qualitative research of non-suicidal self-injury in South Korea: An international nursing research collaboration. Arch Psychiatr Nurs 2019; 33:358-363. [PMID: 31280780 DOI: 10.1016/j.apnu.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/21/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
Understanding non-suicidal self-injury in foreign countries considering their cultural context requires collaboration among international researchers. Through an international collaborative approach, gaps in cultural views can be closed, thereby increasing the understanding of non-suicidal self-injury at a global level. The aim of this article was to illustrate the methodological and ethical challenges of an international collaboration that occurred during a qualitative study with South Korean young adults and the corresponding strategies that were implemented. It is hoped that the dissemination of these strategies and lessons learned can assist other researchers as they pursue international collaborative research.
Collapse
Affiliation(s)
- Kimberly A Williams
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea.
| | - Eun Jin Lee
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea.
| |
Collapse
|
41
|
Küçük A, Çetinkaya S. İntihar amaçlı olmayan kendine zarar verme davranışı ve intihar ilişkisi; tanı, borderline kişilik bozukluğu ve mizaç ve karakter özelliklerinin rolü. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.466375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
42
|
Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09739-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
43
|
Dixon LJ, Cohen RT, Baer MM, Gratz KL, Tull MT. Relations of anxiety sensitivity dimensions to nonsuicidal self-injury frequency and versatility among patients with substance use disorders. J Clin Psychol 2019; 75:1613-1625. [PMID: 30995353 DOI: 10.1002/jclp.22784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/28/2019] [Accepted: 03/28/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self-injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic background, negative affectivity). AS dimensions were expected to account for additional unique variance in NSSI outcomes. METHOD Participants included 204 patients (50.5% female) with substance use disorders in residential treatment. RESULTS In this sample, 37.2% reported a history of NSSI. The hierarchical regression models revealed a unique positive association between AS social concerns and NSSI outcomes when adjusting for model variables. In contrast, AS physical concerns were uniquely negatively associated with NSSI outcomes. CONCLUSION Findings provide support for AS social concerns as a vulnerability for engagement in NSSI behaviors and highlight this particular AS dimension as a potential treatment target for NSSI prevention and intervention programs.
Collapse
Affiliation(s)
- Laura J Dixon
- Department of Psychology, University of Mississippi, Oxford, Mississippi
| | - Rivka T Cohen
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret M Baer
- Department of Psychology, University of Toledo, Toledo, Ohio
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio
| |
Collapse
|
44
|
Knorr AC, Ammerman BA, Hamilton AJ, McCloskey MS. Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury. Psychiatry Res 2019; 273:514-522. [PMID: 30708203 DOI: 10.1016/j.psychres.2019.01.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 12/01/2022]
Abstract
Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.
Collapse
Affiliation(s)
- Anne C Knorr
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Brooke A Ammerman
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Alexander J Hamilton
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| |
Collapse
|
45
|
Ghinea D, Koenig J, Parzer P, Brunner R, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms. Psychiatry Res 2019; 273:127-133. [PMID: 30641342 DOI: 10.1016/j.psychres.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/31/2022]
Abstract
Self-injurious behavior and risk-taking behaviors are associated with adolescent borderline personality disorder (BPD). Developmental trajectories of self-injurious and risk-taking behavior in predicting BPD have not been fully understood. The aim of the present study was to examine self-injurious and risk-taking behavior development and their prospective influence on BPD symptoms in adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the German Saving and Empowering Young Lives in Europe cohort were analyzed. Self-injurious and risk-taking behaviors were assessed at baseline and one-year follow-up. BPD symptoms were assessed at two-year follow-up. In fully adjusted stepwise binominal regression analyses, recent onset, termination and maintenance of risky alcohol use and self-injurious behavior remained as significant predictors of BPD. Highest ORs were found for alcohol termination and maintenance of self-injurious behavior. Other facets of risk-taking behavior were not associated with increased ORs of BPD symptoms at two-year follow-up. These findings highlight the importance of self-injurious behavior and specific facets of risk-taking behavior in the development of adolescent BPD. Clinicians should focus on efforts in preventing adolescents from risk-taking and self-injurious behavior, since engaging in young age and therefore in potentially longer periods of these behaviors is associated with the highest risk of BPD.
Collapse
Affiliation(s)
- Denisa Ghinea
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg District Hospital, Regensburg, Germany
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medical and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| |
Collapse
|
46
|
Ammerman BA, Jacobucci R, McCloskey MS. Reconsidering important outcomes of the nonsuicidal self-injury disorder diagnostic criterion A. J Clin Psychol 2019; 75:1084-1097. [PMID: 30735571 DOI: 10.1002/jclp.22754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/24/2018] [Accepted: 01/17/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The nonsuicidal self-injury (NSSI) disorder diagnostic criteria have been the focus of empirical study. However, Criterion A (i.e., required frequency and timeframe) has received relatively limited attention. The current study aimed to examine the relationship between past 12-month NSSI frequency and eight NSSI behavior features among individuals with past 12-month and 1-month NSSI. METHOD Participants were 723 undergraduate students reporting at least 1 past 12-month NSSI act and completed online questionnaires. Decision trees and structural equation model trees were utilized to examine the relationship between NSSI frequency and behavior features. RESULTS Results highlight several potential subgroups: high (i.e., greater than 49 acts), moderate-to-high (i.e., 19-48 acts), low-to-moderate (i.e., 7-18 acts), and low (i.e., fewer than 6 acts) frequency subgroups. CONCLUSIONS Findings suggest that increasing the NSSI disorder criterion A frequency cutoff or requiring at least one past month NSSI act may better demarcate individuals with more severe NSSI behavior.
Collapse
Affiliation(s)
- Brooke A Ammerman
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana
| | - Ross Jacobucci
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana
| | | |
Collapse
|
47
|
Black EB, Garratt M, Beccaria G, Mildred H, Kwan M. Body image as a predictor of nonsuicidal self-injury in women: A longitudinal study. Compr Psychiatry 2019; 88:83-89. [PMID: 30529911 DOI: 10.1016/j.comppsych.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To determine whether Body Image Dissatisfaction (BID) predicted NonSuicidal Self-Injury (NSSI) cross-sectionally and longitudinally, independent of comorbidity between NSSI and Disordered Eating (DE). Another aim was to determine whether BID could predict number of NSSI methods present. METHOD Adult females completed measures of NSSI and DE (n = 283); and a longitudinal sample (n = 106) completed these measures again one year later. RESULTS BID was a small yet significant predictor of NSSI both cross-sectionally and longitudinally. Poorer BID significantly explained a greater number of NSSI methods cross-sectionally and longitudinally. CONCLUSIONS BID explains unique variance in NSSI (including increased number of methods), and is not a function of comorbidity with DE. This has the potential to influence theory, as well as inform early intervention initiatives for BID in females. Further research is required to determine other variables implicated in this relationship, as well as whether these findings are applicable to other groups such as adolescents and males.
Collapse
Affiliation(s)
- Emma B Black
- The University of Queensland, Australia; Deakin University, Australia.
| | | | | | | | | |
Collapse
|
48
|
Bjureberg J, Sahlin H, Hedman-Lagerlöf E, Gratz KL, Tull MT, Jokinen J, Hellner C, Ljótsson B. Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: open pilot trial and mediation analysis of a novel online version. BMC Psychiatry 2018; 18:326. [PMID: 30305103 PMCID: PMC6180600 DOI: 10.1186/s12888-018-1885-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is common among adolescents and associated with negative outcomes. However, treatments developed specifically for NSSI and the proposed NSSI disorder (NSSID) are scarce, and access to empirically supported treatments for NSSI in many areas is limited. Online treatments carry the potential to increase the availability of evidence-based treatments. Emotion regulation individual therapy for adolescents (ERITA) has shown promise in the treatment of adolescents with NSSID. METHOD The present study examined the feasibility, acceptability, and utility of an online version of ERITA. Twenty-five adolescents (aged 13-17) with NSSID and their parents were included in an uncontrolled open trial. Self-report and clinician-rated assessments of outcomes such as NSSI, self-destructive behaviors, emotion dysregulation, and global functioning were administered at pre-treatment, post-treatment, 3- and 6- month follow-up. Measures of NSSI, self-destructive behaviors, and emotion dysregulation were also assessed weekly during treatment. RESULTS Ratings of treatment credibility, expectancy, and satisfaction were acceptable, and the therapeutic alliance and treatment completion rate (96%) were high. Adolescent participation in the treatment was associated with a statistically significant increase in past-month NSSI abstinence (p = .007), large-sized improvements in past-month NSSI frequency (55% reduction, 95% confidence interval [CI]: 29, 72; Cohen's d = 0.88, 95% CI: 0.73, 1.06) and global functioning (d = 1.01, 95% CI: 0.77, 1.32), and medium-sized improvements in emotion dysregulation (d = 0.75, 95% CI: 0.59, 0.90) and NSSI versatility (d = 0.63, 95% CI: 0.54, 0.77) from pre- to post-treatment. These improvements were further strengthened at 3-month follow-up and maintained at 6-month follow-up. The online therapist-guided parent program was associated with small- to large-sized (ds = 0.47-1.22) improvements in adaptive parent behaviors, and these improvements were maintained or further improved upon at 6-month follow-up. Moreover, in line with the theoretical model underlying ERITA, change in emotion dysregulation mediated changes in both NSSI frequency and self-destructive behaviors over the course of treatment. CONCLUSIONS Together, results suggest that online ERITA is an acceptable, feasible, and promising low-intensity treatment for adolescents with NSSID. The results of this open trial must be replicated in controlled studies. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02697019 ). Registered 2 March 2016.
Collapse
Affiliation(s)
- Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364, Stockholm, Sweden.
| | - Hanna Sahlin
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- 0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
| | - Kim L. Gratz
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Matthew T. Tull
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Jussi Jokinen
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0001 1034 3451grid.12650.30Department of Clinical Sciences/Psychiatry, Umeå University, By 23, Enheten för psykiatri, 901 85 Umeå, Sweden
| | - Clara Hellner
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Brjánn Ljótsson
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
| |
Collapse
|
49
|
Mbroh H, Zullo L, Westers N, Stone L, King J, Kennard B, Emslie G, Stewart S. Double trouble: Nonsuicidal self-injury and its relationship to suicidal ideation and number of past suicide attempts in clinical adolescents. J Affect Disord 2018; 238:579-585. [PMID: 29945076 DOI: 10.1016/j.jad.2018.05.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/22/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Death by suicide is one of the leading causes of mortality among adolescents, and nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicide attempts (SAs). The underlying bases for this relationship are unknown. We derived two hypotheses from the Interpersonal Psychological Theory of Suicide (IPTS): unmet interpersonal needs would explain NSSI's association with suicidal ideation (SI) and increased capability for suicide would explain NSSI's relationship with SA. METHODS Adolescents hospitalized on a psychiatric inpatient unit (N = 289) provided measures of current SI, number of past SAs, unmet interpersonal needs (perceived burdensomeness and thwarted belongingness), capability for suicide (fearlessness about death [FAD] and pain tolerance), depressive symptoms, and number of NSSI methods utilized. RESULTS Depressive symptoms, but not unmet interpersonal needs, explained NSSI's association with SI. FAD and SI, but not depressive symptoms or pain tolerance, accounted for NSSI's relationship with SA. FAD was associated with SA, but it did not fully account for NSSI's relationship with SA. LIMITATIONS This study utilized a cross-sectional design and retrospective, self-report measures. CONCLUSIONS Our study provides partial support for the role of the IPTS variables in NSSI's relationship with SA in adolescents. The finding that depressive symptoms and not unmet interpersonal needs explained NSSI's relationship with SI contradicts the IPTS. However, in those with SI, FAD was linearly associated with SA, which is consistent with the IPTS. Future studies are needed to clarify the persistent basis for NSSI's relationship with SA beyond FAD and SI.
Collapse
Affiliation(s)
- Hayden Mbroh
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Lucas Zullo
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Nicholas Westers
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Laura Stone
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Jessica King
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Betsy Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Graham Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Sunita Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States.
| |
Collapse
|
50
|
Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder. Psychol Belg 2018; 58:243-255. [PMID: 30479820 PMCID: PMC6194535 DOI: 10.5334/pb.420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD) features are common in patients with eating disorders (ED), yet little is known regarding the clinical presentation of ED patients who present with NSSI with and without BPD. The current study compared self-injurious, female ED inpatients with (n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported clinical features. Results suggest that ED patients with NSSI+BPD differ from those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug or medication abuse, internalizing/externalizing psychopathology, interpersonal problems, and coping strategies, with the NSSI+BPD group demonstrating more impairment in each of these domains. Despite these differences in clinical presentation, however, groups did not differ in NSSI features. In sum, while self-injurious ED patients may present with similar NSSI behavior regardless of BPD diagnosis, those with NSS+BPD represent a group with much higher clinical complexity and greater treatment needs.
Collapse
|