Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles

Selby, Edward A.; Kranzler, Amy; Fehling, Kara B.; Panza, Emily

doi:10.1016/j.cpr.2015.03.003

Cited by 71 publications

(68 citation statements)

References 101 publications

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“…Using data-driven methods, the current analyses identified that increased levels of distress, general psychopathology, and functional impairment differentiated adolescent patients reporting 25 or more days on which NSSI occurred from those reporting fewer days/acts of NSSI. This empirically derived frequency cut-off is much greater than the 5 days currently specified in the DSM-5, and supports expert suggestion and studies indicating that serious consideration should be given to raising the frequency threshold for NSSI disorder (Andover, 2014; Muehlenkamp & Brausch, 2016; Selby et al, 2015). …”

Section: Discussionsupporting

confidence: 75%

“…The minimums for this criterion originated from theoretical works suggesting that 5 or more acts of NSSI in one year would be considered repetitive, and therefore in need of clinical attention (Muehlenkamp, 2005; Shaffer & Jacobson, 2009). However, since the DSM-5 (American Psychiatric Association, 2013) criteria have been published, a handful of studies have repeatedly called into question the clinical utility of the diagnostic criteria as a whole, and specifically Criterion A in its current form (Brausch, Muehlenkamp, & Washburn, 2016; Muehlenkamp & Brausch, 2016; Selby, Kranzler, Fehling, & Panza, 2015). …”

Section: Introductionmentioning

confidence: 99%

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

Muehlenkamp

Brausch

Washburn

2017

Journal of Consulting and Clinical Psychology

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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.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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

Muehlenkamp

Brausch

Washburn

2017

Journal of Consulting and Clinical Psychology

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“…In a recent systematic review on research conducted on NSSI disorder, Selby et al (2015) described gaps in the literature regarding the separation of NSSI disorder from suicidal behaviors (i.e. with regards to functions of both behaviors).…”

Section: Objectivesmentioning

confidence: 98%

“…However, the authors proposed limited utility for NSSI disorder as a dichotomous diagnosis, but suggested the implementation of a dimensional approach to NSSI disorder (Washburn et al, 2015). In a systematic review on research conducted on NSSI disorder, Selby et al (2015) suggest further research on NSSI in five major areas in order to validate NSSI disorder to be included in the next DSM. These areas include the research on the developmental course of NSSI disorder, the creation of valid diagnostic criteria and the clear separation of NSSI disorder from other psychiatric disorders (i.e.…”

Section: Introductionmentioning

confidence: 96%

The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients

Groschwitz

Kaess

Fischer

et al. 2015

Psychiatry Research

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“…Up till the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), NSSI was solely listed as a possible symptom of the borderline personality disorder (BPD). However, given the accumulating research evidence that shows that NSSI can also occur in patients without BPD (e.g., Glenn & Klonsky, 2013; Nock et al, 2006; Selby, Kranzler, Fehling, & Panza, 2015; Turner et al, 2015), NSSI was proposed as a separate diagnosis in the DSM-5, as a Condition for Further Study (APA, 2013). To distinguish the clinical presentation of NSSI in populations with and without a diagnosis of BPD, research assessing both NSSI and BPD symptoms is urgently needed in order to clarify the presentation and treatment needs of these populations.…”

Section: Introductionmentioning

confidence: 99%

Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder

Claes¹,

Turner²,

Dierckx³

et al. 2018

Psychologica Belgica

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Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD) features are common in patients with eating disorders (ED), yet little is known regarding the clinical presentation of ED patients who present with NSSI with and without BPD. The current study compared self-injurious, female ED inpatients with (n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported clinical features. Results suggest that ED patients with NSSI+BPD differ from those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug or medication abuse, internalizing/externalizing psychopathology, interpersonal problems, and coping strategies, with the NSSI+BPD group demonstrating more impairment in each of these domains. Despite these differences in clinical presentation, however, groups did not differ in NSSI features. In sum, while self-injurious ED patients may present with similar NSSI behavior regardless of BPD diagnosis, those with NSS+BPD represent a group with much higher clinical complexity and greater treatment needs.

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Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles

Cited by 71 publications

References 101 publications

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

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

The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients

Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder

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