How much is enough? Examining frequency criteria for NSSI disorder in adolescent inpatients.

Abstract

Objective To empirically evaluate the diagnostic relevance of the proposed DSM-5 Criterion A frequency threshold for Non-Suicidal Self-Injury (NSSI) Disorder. Method Archival, de-identified self-reported clinical assessment data from 746 adolescent psychiatric patients (Mage = 14.97; 88% female; 76% white) were used. The sample was randomly split into two unique samples for data analyses. Measures included assessments of NSSI, proposed DSM-5 NSSI Disorder criteria, psychopathology, dysfunction, distress, functional impairment, and suicidality. Results Discriminant function analyses ran with sample A identified a significant differentiation of groups based on a frequency of NSSI at 25 or more days in the past year, Λ = .814, χ2 (54) = 72.59, p < .05, canonical R2 = .36. This cut-off was replicated in the second sample. All patients were coded into empirically derived frequency cut-off groups: High-NSSI (25+ days of NSSI), Moderate-NSSI (5–24 days of NSSI), and Low-NSSI (1–4 days of NSSI) and compared. The High-NSSI group scored higher on most NSSI features including DSM-5 proposed Criterion B and C symptoms, Depression, Psychotic symptoms, Substance Abuse, Borderline Personality Disorder features, suicidal ideation and suicide plans than the Moderate- and Low-NSSI groups, who did not differ from each other on many of the variables. Conclusions The currently proposed DSM-5 Criterion A frequency threshold for NSSI disorder lacks validity and clinical utility. The field needs to consider raising the frequency threshold to ensure a meaningful and valid set of diagnostic criteria are established, and to avoid over-pathologizing individuals who infrequently engage in NSSI.

The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors

“…Second, the proposed 5+ threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. While this is in line with other work in college students (Ammerman et al., ), derived thresholds were higher in clinical samples (Muehlenkamp et al., ). However, given the characteristics of such data, empirically derived thresholds can always be assumed to yield higher cutoffs in clinical samples.…”

Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index

“…Since the criteria were published, they have been subject to discussion (e.g., 6,8,[16][17][18][19]. Based on recent empirical data, revisions of the criteria have been suggested, including proposals that a dimensional approach to the disorder would be more beneficial (8).…”

“…The validity of criterion A has been examined and debated. Recent studies suggest that the cutoff level needs to be increased and/or the time period needs to be decreased to better delimit individuals with more severe NSSI (16)(17)(18). Furthermore, severity needs to be taken into account (16)(17)(18).…”

“…Recent studies suggest that the cutoff level needs to be increased and/or the time period needs to be decreased to better delimit individuals with more severe NSSI (16)(17)(18). Furthermore, severity needs to be taken into account (16)(17)(18). Currently, no distinction is made based on severity between five incidents of less serious damage to body tissue by scratching, for instance, and five episodes of severe cutting that need to be stitched.…”

“…Earlier empirical research on NSSID has predominately been done on (young) adults and/or in community/college samples. Only very few studies have focused on clinical and adolescent populations (8,15,18,25). Thus, further research is sorely needed to test the clinical utility of the NSSID diagnosis, as A.…”