Self-injury is a dangerous behavior that is different from suicidal behavior but is associated with increased risk of suicide attempts. Some effective psychological treatments for self-injury exist. Physicians in family medicine and primary care settings play a vital role as a first step in the treatment process for those who selfinjure. Physicians can enhance the care provided to those who self-injure via the accurate assessment of risk, the understanding of the functions of the behavior, assisting the patient in identifying motivations for treatment and treatment options, and provision of long-term behavioral and risk monitoring. This article summarizes the current scientific knowledge regarding the clinical features, epidemiology, assessment methods, and existing treatments of self-injury. The role of the primary care physician in the treatment of patients who self-injure is specifically outlined. (J Am Board Fam Med 2010;23:240 -259.)

Objective: Our original aim was to validate and norm common eating disorder (ED) symptom measures in a large, representative community sample of transgender adults in the United States. We recruited via Amazon Mechanical Turk (MTurk), a popular online recruitment and data collection platform both within and outside of the ED field. We present an overview of our experience using MTurk. Method: Recruitment began in Spring 2020; our original target N was 2,250 transgender adults stratified evenly across the United States. Measures included a demographics questionnaire, the Eating Disorder Examination-Questionnaire, and the Eating Attitudes Test-26. Consistent with current literature recommendations, we implemented a comprehensive set of attention and validity measures to reduce and identify bot responding, data farming, and participant misrepresentation.Results: Recommended validity and attention checks failed to identify the majority of likely invalid responses. Our collection of two similar ED measures, thorough weight history assessment, and gender identity experiences allowed us to examine response concordance and identify impossible and improbable responses, which revealed glaring discrepancies and invalid data. Furthermore, qualitative data (e.g., emails received from MTurk workers) raised concerns about economic conditions facing MTurk workers that could compel misrepresentation.Discussion: Our results strongly suggest most of our data were invalid, and call into question results of recently published MTurk studies. We assert that caution and rigor must be applied when using MTurk as a recruitment tool for ED research, and offer several suggestions for ED researchers to mitigate and identify invalid data.

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Although research on nonsuicidal self-injury (NSSI) is accumulating, there is as yet little data on psychopathological features associated with NSSI in nonclinical samples. College students may be particularly susceptible to engaging in NSSI and NSSI may be phenomenologically and etiologically different for males and females. This archival study examined differences between college student women with (n = 34) and without (n = 32) a history of NSSI in scores on the clinical scales and subscales of the Personality Assessment Inventory (PAI). Multivariate analyses revealed significantly higher levels of depression, anxiety, borderline personality features, suicidality, and certain psychotic features in self-injurers. Follow-up analysis identified four symptom themes associated with NSSI across diagnostic categories: emotional distress, physiological distress, cognitive distortion, and interpersonal difficulties. This study confirms previous findings of higher levels of affective symptoms in self-injurers. Unique findings of this study included significantly higher scores for self-injurers on the PAI Thought Disorder, Psychotic Experiences, and Hypervigilance subscales. This suggests a need to expand the conceptualization of the clinical correlates of NSSI to encompass a broader array of symptomatology. Implications for clinical practice are discussed.