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Self mutilation a review of the disease

  • Bresin K, Schoenleber M;
  • However, there is some limited data supporting specific pharmacological agents as potential treatments for self-injury in adults who are not developmentally delayed;
  • The comparison condition was slightly better defined and ostensibly consisted of greater expertise in this latest study, but it was still lacking a clear description of the alternative treatment;
  • Likewise, TAU included individual problem-solving therapy, seeing a general practitioner for treatment, group therapy, psychodynamic psychotherapy, or brief counseling;
  • Compared with self-injury data from the general psychiatry inpatient unit in the same hospital, patients on the personality disorders unit evidenced significantly fewer episodes of self-injury after DBT was implemented;
  • Some of the self-report measures used to operationalize NSSI criteria include NSSI methods where there might be uncertainty whether they induce actual bleeding, bruising or pain.

Furthermore, significantly more inpatient adolescents among those who met NSSID criteria had major depression, 79. Adolescents with NSSID also had significantly more internalizing and externalizing symptoms [ 50 ]; higher levels of emotion dysregulation and general psychopathology and impairment than clinical controls [ 2350 ].

There were no differences in comorbidity and functional impairment between the groups. The BPD group, however, contained more women, 88 vs. The same sample was also used in a later study by Ward et al.

Furthermore, internal consistency was adequate and there was support for construct validity.

Self-injury (Cutting, Self-Harm or Self-Mutilation)

There was support for a two-factor solution on the ABASI, with all items assessing criterion B and criterion C loading on respective factor. Internal consistency was adequate. In-Albon and colleagues [ 50 ] constructed a clinical interview from the DSM-5 criteria which showed very good interrater reliability. They argued that NSSI may have been triggered in their sample by the inpatient clinical setting, hence influencing test—retest results.

Discussion Empirical data are now emerging on the DSM-5 [ 13 ] NSSID concerning prevalence rates, characteristics, proposed criteria, clinical correlates and independence from other disorders, which are important aspects when validating a new diagnosis [ 57 ].

Comparisons and conclusions are however limited by the fact that different versions of the criteria have been used and that not all criteria have been assessed or have been assessed indirectly [ 30 ]. In addition, the total number of empirical studies is still small, especially for those presenting the full final DSM-5 criteria, indicating that this is an area in need of further study.

In view of the fact that limited reliability prevented the inclusion of an NSSI diagnosis in DSM-5 [ 4041 ], studies with psychometric data from instruments with structural assessment of NSSID [ 5253 ] have shown promising results. NSSI disorder criteria Since NSSI has shown to be a common phenomenon in adolescents, both in clinical and community samples [ 23 ], it is important to differentiate between those who engage in the behavior once or twice and those who do so more repetitively. Previous self mutilation a review of the disease has shown support for a distinction between occasional and repetitive NSSI, with frequent NSSI being associated with more psychopathology [ 1458 ].

In several studies five instances has come to represent repetitive NSSI [ 1458 ]. With regard to the DSM-5 [ 13 ] cut-off of five instances, a study by Zetterqvist et al.

Nonsuicidal Self-Injury in Adolescents

In clinical child and adolescent psychiatry practice, adolescents often report far higher frequencies, giving the impression that five is perhaps a low limit for adolescents. This is thus an area that needs looking into in more detail. Furthermore, as criterion A is currently stated, no significance is given to potential differences between severe and minor NSSI methods in relation to the number of instances, and this also needs some further elaboration [ 30 ]. Some of the self-report measures used to operationalize NSSI criteria include NSSI methods where there might be uncertainty whether they induce actual bleeding, bruising or pain.

As Washburn and colleagues [ 52 ] pointed out, this might result in an overestimation of criterion A. To address this, some studies have excluded some methods so as to arrive at conservative estimates [ 4652 ]. That NSSI was preceded by negative feelings or relational difficulties C1 and relieved negative states B1 were commonly endorsed criteria [ self mutilation a review of the disease465052 ].

Lengel and Mullins-Sweatt [ 42 ] also found that these features were assessed by many clinicians as prototypic symptoms of the NSSID diagnosis. Criteria B2, B3 and C2, C3 were relatively less frequently endorsed. Specifically, experiencing negative emotions prior to NSSI was highly endorsed, confirming the motivation for affect regulation as a central aspect of the NSSID construct. There was a clear difference between adults and adolescents in the endorsement of criterion B2 resolving an interpersonal difficulty.

This is in line with previous research showing that interpersonal functions are more common in adolescents than in adults [ 5960 ]. In one adolescent sample [ 52 ], criterion B3 inducing positive feeling was least commonly endorsed, and there is an ongoing discussion of the positive and negative aspect of the automatic reinforcement of NSSI [ 61 — 63 ].

Based on their results, Washburn and colleagues [ 52 ] raised the issue that perhaps criterion B is superfluous in relation to criterion C and that a combination of the two would result in more parsimonious criteria.

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

Perhaps precipitating events are easier to consciously observe than consequences of behaviors. This could also imply that the wording of the B criterion needs to be clarified for a more precise definition.

Can B3 also refer to pain, stimulation and satisfaction [ 62 ]? One potential explanation why more girls than boys meet NSSID criteria is perhaps that boys traditionally are less inclined to acknowledge the emotional and motivational aspects of the diagnosis [ 4647 ].

Interpretations of gender differences should, however, be made with caution since there was female overrepresentation in samples. Several of the empirical studies in this review have drawn attention to the fact that criterion E received a relatively lower endorsement.

  1. J Affect Disord 2017; 221.
  2. National Institute for Health and Care Excellence. Furthermore, significantly more inpatient adolescents among those who met NSSID criteria had major depression, 79.
  3. How Common is Self-Injury?
  4. Differential neural processing of social exclusion in adolescents with non-suicidal self-injury.
  5. The 4 modes of treatment are structured around the 4 stages of treatment. However, as it pertains to self-injury specifically, the data about TFP published to date are relatively weak.

That NSSI tends to be regarded as a solution, reducing distress rather than causing it, has previously been problematized by Wilkinson and Goodyer [ 33 ] with regard to the wording of criterion E. Clinicians also rated criterion E as less prototypic, suggesting that while clinicians were concerned with NSSI and its consequences, individuals with NSSI may not always perceive themselves as impaired in their everyday lives [ 42 ].

  • J Abnorm Child Psychol 2015; 43;
  • Barley and colleagues 121 reported the effects of integrating skills training onto an inpatient personality disorders unit;
  • As Washburn and colleagues [ 52 ] pointed out, this might result in an overestimation of criterion A;
  • Allgemeine Z Psychiatrie 1846; 3:

It is somewhat problematic that different operationalizations of criterion E have been used in the empirical studies of NSSID. Some, for example, have assumed impairment based on the fact that participants are in psychiatric inpatient clinics, while others have asked if participants wanted help for their NSSI.

  • Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology;
  • This model postulates that BPD is a pervasive disorder of the emotion regulation system, which develops as a result of a transactional relationship between caustic and abusive conditions in one's developmental environment and a genetic predisposition toward rapid and frequent fluctuations between emotional extremities and intensities;
  • J Affect Disord 2017; 215:

In adolescents, for example, each disorder explained unique variance in emotion regulation deficits [ 23 ].