BackgroundThe behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research.MethodsWe conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe.ResultsFifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization.ConclusionNSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.

Non-suicidal self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. In this practice-friendly review, the authors summarize the empirical research on who self-injures, why people self-injure, and what treatments have demonstrated effectiveness. Self-injury is more common in adolescents and young adults as compared to adults. Common forms include cutting, severe scratching, burning, and banging or hitting; most individuals who self-injure have used more than one method. Although diagnostically heterogeneous, self-injurers typically exhibit two prominent characteristics: negative emotionality and self-derogation. Self-injury is most often performed to temporarily alleviate intense negative emotions, but may also serve to express self-directed anger or disgust, influence or seek help from others, end periods of dissociation or depersonalization, and help resist suicidal thoughts. Psychotherapies that emphasize emotion regulation, functional assessment, and problem solving appear to be most effective in treating self-injury.

The current study examined whether common indicators of suicide risk differ between adolescents engaging in non-suicidal self-injury (NSSI) who have and have not attempted suicide in an effort to enhance clinicians' ability to evaluate risk for suicide within this group. Data were collected from 540 high school students in the Midwest who completed the RADS, RFL-A, SIQ, and SHBQ as part of a larger adolescent risk project. Results suggest that adolescents engaging in NSSI who also attempt suicide can be differentiated from adolescents who only engage in NSSI on measures of suicidal ideation, reasons for living, and depression. Clinical implications of the findings are discussed.

Data from 390 high school students were collected to examine potential differences between adolescents who had attempted suicide and those who engaged in self-injurious behavior on measures of depression, suicidal ideation, and attitudes toward life and death. Significant differences were found between controls and the self-harm groups on all dependent variables. A significant difference on attitudes toward life was found between the self-injury and suicide attempt groups. Post-hoc regression analyses showed that measures of depression, suicide ideation, and attitudes towards life predicted participants' self-harm categorization. These findings provide preliminary evidence that self-injurious behavior is different from attempted suicide among a community sample of adolescents.

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This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal self-injury only (NSSI only; n = 30), suicide attempt only (n = 38), and suicide attempt plus NSSI (n = 40). Those who attempted suicide were more likely to have major depressive disorder and/or posttraumatic stress disorder than those who engaged in NSSI only. Those who engaged in any type of DSH were more likely to have features of borderline personality disorder than those who did not engage in DSH. The suicidal ideation levels of those in the NSSI group were similar to those in the NoDSH group. Findings offer empirical support for the importance of distinguishing between suicidal and nonsuicidal self-harm behaviors.

NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

The field of clinical psychology may benefit from adopting a deliberate self-injury syndrome as a distinct disorder for representation in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The phenomenological and empirical data supporting a deliberate self-injury syndrome are reviewed, and arguments for and against the adoption of a distinct syndrome are explored.