Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index

Abstract

Despite the inclusion of nonsuicidal self-injury disorder (NSSID) in the DSM-5, research on NSSID is limited and no studies have examined the full set of DSM-5 NSSID diagnostic criteria.Thus, this study examined the reliability and validity of a new structured diagnostic interview for NSSID (the Clinician-Administered NSSI Disorder Index; CANDI) and provides information on the clinical characteristics and features of DSM-5 NSSID. Data on the interrater reliability, internal consistency, and construct validity of the CANDI and associated characteristics of NSSID were collected in a community sample of young adults (N = 107) with recent recurrent NSSI (≥10 lifetime episodes of NSSI, at least one episode in the past year). Participants completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, as well as diagnostic interviews of borderline personality disorder (BPD) and lifetime mood, anxiety, and substance use disorders. The CANDI demonstrated good interrater reliability and adequate internal consistency. Thirty-seven percent of participants met criteria for NSSID. NSSID was associated with greater clinical and diagnostic severity, including greater NSSI versatility, greater emotion dysregulation and psychopathology, and higher rates of BPD, bipolar disorder, posttraumatic stress disorder, social anxiety disorder, and alcohol dependence. Findings provide support for the reliability, validity, and feasibility of the CANDI.Keywords deliberate self-harm; self-injury; diagnostic assessment; emotion regulation; borderline personality disorder; DSM-5Until recently, nonsuicidal self-injury (NSSI), defined as the deliberate, direct, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned Reprints and permissions: sagepub.com/journalsPermissions.nav Corresponding Author: Kim L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. KLGratz@aol.com. Katherine Dixon-Gordon is now at the Department of Psychological and Brain Sciences, University of Massachusetts. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Portions of these data were previously presented at the annual meeting of the International Society for the Study of Self-injury in Chicago, IL, in June 2014. (Chapman, Gratz, & Brown, 2006;Gratz, 2001; International Society for the Study of Selfinjury, 2007), was studied primarily in the context of borderline personality disorder (BPD;Shearer, 1994;Soloff, Lis, Kelly, Cornelius, & Ulrich, 1994). Although NSSI is a cardinal symptom of BPD (prevalent enough to be considered the "behavioral specialty" of patients with BPD; Gunderson & Ridolfi, 2006), a rapidly growing body of empirical research demonstrates that NSSI is not unique to BPD (Andover, Pepper, Ryabchenko, Orrico, & Gibb, 2005;Gratz, Breetz, & Tull, 2010...

Traumatic Stress Interacts With Bipolar Disorder Genetic Risk to Increase Risk for Suicide Attempts

“…45,46 Intent to die is not evident in NSSI, and the motives behind NSSI and suicide attempts differ. 47 Small clinical studies have found an increase in NSSI in those with BD, 48,49 yet a recent meta-analysis on risk factors for NSSI did not find an association between NSSI and BD. 50 NSSI had some different correlates than suicidal ideation and attempts in our study, because NSSI was associated with sex and age at interview, but not with trauma exposure.…”

Impact of Non-Suicidal Self-Injury Scale: Initial Psychometric Validation

“…Currently, there is not a standard measure of impairment used in the literature, which may explain prior inconsistent findings. Thus, it will be important to compare results of the INS to those impairment items used in previous studies (e.g., Andover, 2014; Gratz et al, 2015; In-Albon et al, 2013; Zetterquist et al, 2013) to examine whether the INS is capturing aspects of impairment above and beyond these items. Beyond the study of NSSI disorder, the INS will serve as a valuable measure to use in research among those with a history of NSSI.…”

“…To inform this diagnostic criterion, researchers have used a range of measures. For example, in a subset of studies examining NSSI disorder, distress and impairment have been assessed through asking a limited number of questions, either in interview or self-report format (e.g., 1–4 questions; Andover, 2014; In-Albon, Ruf, & Schmid, 2013; Gratz et al, 2015; Zetterquist, Lulndh, Dahlstrom, & Svedin, 2013). Examples of questions include, “If you have purposely hurt yourself without wanting to die, has the self-injurious behavior caused you distress?” and “If you have purposely hurt yourself without wanting to die, has the self-injurious behavior affected your schooling/interpersonal relationships/leisure time?” (Zetterquist et al, 2013).…”

Experiencing and Resisting Nonsuicidal Self‐injury Thoughts and Urges in Everyday Life

“…The extent to which individuals experience NSSI‐related thoughts and urges appears to vary substantially. In community samples of adults with NSSI histories, 19–90% endorsed NSSI‐related thoughts or urges consistent with Criterion C of NSSI disorder (Andover, ; Gratz, Dixon‐Gordon, Chapman, & Tull, ; Klonsky & Glenn, ). In clinical samples of adolescents, 74–98% endorsed NSSI‐related thoughts or urges (Nixon et al., ; Washburn, Potthoff, Juzwin, & Styer, ; Washburn et al., ).…”