Guest Speaker: Non-Suicidal Self-Injury

What is non-suicidal self-injury?

NSSI is intentional and self-inflicted damage to the surface of the body in the absence of suicidal ideation

Why do people usually engage in NSSI?

To reduce or communicate psychological distress

Are socially acceptable forms of body modification such as tattoos and piercings considered NSSI?

No! NSSI has a socially unacceptable nature

Is self-injurious behavior associated with severe developmental disabilities considered to be NSSI?

No!

Is Trichotillomania (hair-pulling) and Excoriation (skin-picking) considered to be NSSI?

No!

Is suicidal behavior considered to be NSSI?

No! NSSI is non-suicidal in nature

When was NSSI first reported?

Over 2400 years ago

How is NSSI currently recognized by the DSM?

As a condition for further study

Do the majority of those who engage in NSSI continue to do so long-term?

No! Most people engage in NSSI rarely and in isolated cases, the minority of whom persist in this behavior

When NSSI persists, what are 3 associated risks?

1. Excessive blood loss

2. Scarring

3. Potentially life-threatening

What is the most common form of NSSI?

Cutting

Where do most people who engage in NSSI cut themselves and why?

Most people cut on their inner forearms and thighs

→ Harm is less likely to be lethal in these areas

What are 3 other common forms of NSSI?

Burning, stabbing, or hitting oneself

What do we know about the prevalence of NSSI?

Rates vary widely based on different definitions of the disorder

What ranges of prevalence rates of NSSI have been shown in preadolescents and adolescents?

1. Preadolescents (10-14 years old): up to 8%

2. Adolescents: as much as 12% to 22%

When does the onset of NSSI occur?

Adolescence

How are rates of NSSI affected in early adolescence vs. late adolescence?

1. Early adolescence: rates of NSSI increase

2. Late adolescence: rates of NSSI decrease

What is the current proposed diagnostic criteria for NSSI?

Engage in NSSI at least 5 times within 1 year

How have gender differences in NSSI changed from later studies to current studies?

Later studies have shown females to have higher rates of NSSI while recent studies have been showing mixed results

What NSSI behaviors are females and males more likely to engage in?

1. Females: cutting

2. Males: burning and hitting

Does sexual orientation influence risk of NSSI? If so, how?

LGBTQ+ individuals are at a higher risk of engaging in NSSI, particularly transgender and bisexual youth

→ Increased risk is not due to their identity but is because of potential responses to their identity from their outside environment (ex. discrimination, bullying, and exclusion)

Is NSSI only a problem in America?

No! NSSI is widespread and international with similar rates between western countries

What are common disorders that are comorbid with NSSI?

Depressive and anxiety disorders

What is the most significant mental health condition associated with NSSI?

Suicidal behavior

Do most people who engage in NSSI eventually die by suicide?

Absolutely not! Most people who engage in NSSI will not die by suicide or even attempt suicide

What is the complex relationship between NSSI and suicidal behavior?

Having a history of NSSI increases one’s risk of suicidal behaviors, ideation, and attempts

How much more likely are those who engage in NSSI to experience suicidal ideation or make a suicide attempt?

2-4x more likely

What comorbid disorders with NSSI increase the risk for suicidal behavior even more?

Depressive disorders and substance use disorders

What was Thomas Joiner’s suggestion about NSSI and suicidal behavior?

He suggested that engaging in NSSI may be “practice” for potential suicidal behavior

When is someone who has a history of NSSI at the highest risk of suicidal behavior?

When NSSI stops functioning as an emotional regulation technique

What is the cause of NSSI?

There is no single cause of NSSI, but it may be influenced by many factors such as:

→ Being overly self-critical (psychological)

→ Experiencing harsh parental criticism (environmental)

What framework best explains the development and maintenance of NSSI?

The 4-function model of NSSI

What are the 2 dimensions that people are motivated to engage in NSSI according to the 4-function model?

1. NSSI occurs because reasons related to oneself (automatic) or reasons related to others (social)

2. NSSI occurs because it makes negative emotions go away (negative reinforcement) or it helps someone feel something instead of numbness (positive reinforcement)

What are the 4 possible motivations for engaging in NSSI according to the 4-function model?

Give an example of each.

1. Automatic negative reinforcement: to stop feeling bad about oneself

2. Automatic positive reinforcement: to feel something even if it is painful

3. Social negative reinforcement: to avoid doing something unpleasant with others

4. Social positive reinforcement: to communicate psychological pain with others

What is the most common function of NSSI for most people who engage in it?

Automatic negative reinforcement: NSSI serves as a coping behavior to quickly and effectively regulate distressing emotional states

What are the ABC’s of NSSI according to the functional behavior perspective?

1. Antecedent: negative emotions increase

2. Behavior: NSSI

3. Consequence: negative emotions decrease

What is the relationship between the function of NSSI and treatment?

The function of NSSI influences the treatment approach

How does CBT approach treatment for NSSI?

CBT aims to identify and change irrational and maladaptive thoughts

→ How we think about things affects how we feel about them

How does DBT approach treatment for NSSI?

DBT aims to change the relationship one has with their negative thoughts

→ Being able to accept negative thoughts and move on from them more easily