Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction

Abstract

Non-suicidal self-injury (NSSI) involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. However, other non-suicidal behaviors that involve people mistreating or abusing themselves but that do not deliberately and directly damage bodily tissue may have much in common with NSSI. Such 'indirect' methods of self-injury might include involvement in abusive relationships, substance abuse, risky or reckless behavior, or eating disordered behavior. Using a community sample (N=156) we compared individuals engaging in NSSI (n=50), indirect (non-suicidal) self-injurers (n=38), and healthy controls (n=68) on a range of clinical and personality characteristics. As predicted, non-suicidal selfinjurers and indirect self-injurers showed more pathology than healthy controls on all measures.Comparisons of the NSSI and the Indirect self-injury groups revealed no significant differences on measures of dissociation, aggression, impulsivity, self-esteem, negative temperament, depressive symptoms, and borderline personality disorder. However, compared to people who engaged only in indirect forms of self-injury, those who engaged in NSSI were more self-critical, had higher scores on a measure of suicide proneness, and had a history of more suicide attempts.The findings suggest that NSSI and indirect self-injury are best viewed as separate and distinct clinical phenomena.Key Words = DSM-5, non-suicidal self-injury (NSSI), deliberate self-harm, suicide, borderline personality disorder, self-criticism.NSSI and Indirect Self--Injury 3 3

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

“…The results of the present review indicate that individuals who engage in NSSI self-reported greater impulsivity concurrently, relative to individuals who do not engage in NSSI (Arens et al, 2012;Claes & Muehlenkamp, 2013;Crowell et al, 2012;Di Pierro et al, 2012;Dir et al, 2013;Glenn & Klonsky, 2010;Lynam et al, 2011;Mullins-Sweatt et al, 2013;Ogle & Clements, 2008;St Germain & Hooley, 2012;Taylor et al, 2012). These differences were most pronounced for measures of negative urgency, and to a lesser extent for lack of premeditation and perseverance.…”

“…Similarly, individuals who engaged in NSSI from inpatient adolescent and adult samples reported greater impulsivity than individuals who did not engage in NSSI (i.e., motor impulsivity and non-planning as assessed on the BIS; Evren et al, 2012;Herpertz et al, 1997;McCloskey, Look, Chen, Pajoumand, & Berman, 2012). The association between impulsivity and NSSI was found with male (Evren et al, 2012) and female participants Crowell et al, 2012;Ogle & Clements, 2008), as well as among individuals with varying ethnic backgrounds, including Spanish , Italian (Di Pierro, Sarno, Perego, Gallucci, & Madeddu, 2012), American (Crowell et al, 2012;Dir et al, 2013;Ogle & Clements, 2008;St Germain & Hooley, 2012), Canadian (Cloutier et al, 2010), and German (Herpertz et al, 1997).…”

Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders

“…Second important factor effecting the development of SIB was the depression scores. Similarly, high depression scores have been also demonstrated among adolescents with SIB in the literature 3940. Other factors do not have statistically significant impact.…”

Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities

“…The terms selfinjury or non-suicidal self-injury that have gained ground in North America refer to behaviors performed without suicidal intent. Yet another distinction is made between direct and indirect self-injurious behavior (Nock, 2010;St Germain & Hooley, 2012). Indirect self-injurious behaviors might, for example, include involvement in abusive relationships, substance abuse and other risky or reckless behavior.…”

“…Indirect self-injurious behaviors might, for example, include involvement in abusive relationships, substance abuse and other risky or reckless behavior. There can be an overlap between these behaviors, but there is empirical support for separating and distinguishing between direct and indirect forms of selfinjury (St Germain & Hooley, 2012).…”