Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults.

Abstract

Self-injurious behaviors are among the leading causes of death worldwide. However, the basic nature of self-injurious thoughts and behaviors (SITBs) is not well-understood because prior studies have relied on long-term, retrospective, aggregate, self-report assessment methods. We used ecological momentary assessment methods to measure suicidal and non-suicidal SITBs as they naturally occur in real-time. Participants were 30 adolescents and young adults with a recent history of self-injury who completed signal-and event-contingent assessments on handheld computers over a 14-day period, resulting in the collection of data on 1262 thought and behavior episodes. Participants reported an average of 5.0 thoughts of nonsuicidal self-injury (NSSI) per week, most often of moderate intensity and short duration (1-30 minutes), and 1.6 episodes of NSSI per week. Suicidal thoughts occurred less frequently (1.1 per week), were of longer duration, and led to self-injurious behavior (i.e., suicide attempts) less often. Details are reported about the contexts in which SITBs most often occur (e.g., what participants were doing, who they were with, and what they were feeling before and after each episode). This study provides a first glimpse of how SITBs are experienced in everyday life and has significant implications for scientific and clinical work on self-injurious behaviors.Self-injurious behaviors are among the leading causes of death and injury worldwide (Nock, Borges et al., 2008;WHO, 2008), and represent one of the most perplexing problems facing psychological scientists. Philosophers have speculated about the nature of suicidal selfinjury for centuries (e.g., Kant, Camus, Rousseau, Satre, Hobbes, Locke, Hume)(see Minois, 1999), and over the past 50 years scientists have used systematic research methods to study self-injurious thoughts and behaviors (SITBs). SITBs include both suicidal behaviors (e.g., Correspondence to: Matthew K. Nock, Ph.D., 33 Kirkland Street, 1280, Cambridge, MA 02138, nock@wjh.harvard.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/ pubs/journals/abn. HHS Public AccessAuthor manuscript J Abnorm Psychol. Author manuscript; available in PMC 2017 January 23. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript suicidal thoughts, suicide attempts) as well as non-suicidal self-injury (NSSI), which refers to the direct, deliberate destruction of body tissue in the absence of lethal intent (Nock & Favazza, 2009;Nock, Wedig, Janis, & Deliberto, 2008). This research has provided valuable info...

The role of interpersonal conflict and perceived social support in nonsuicidal self-injury in daily life.

“…Furthermore, NSSI acts were assessed with a single yes/no question. Although previous microlongitudinal work suggests that NSSI typically occurs on average one to three times total per week (Armey et al, 2011;Nock et al, 2009), it is possible that some days may have involved multiple instances of NSSI, which would not have been captured using the present assessment strategy. Finally, the current study was limited in its ability to examine how reactions to NSSI may differ depending on relationship type, as NSSI acts were almost exclusively revealed to romantic partners.…”

Characterizing Interpersonal Difficulties Among Young Adults Who Engage in Nonsuicidal Self-Injury Using a Daily Diary

“…To our knowledge, very few studies have utilized such methods to examine the relationship between interpersonal experiences and NSSI. Using a micro-longitudinal study of self-injurious thoughts and behaviors among adolescents, Nock, Prinstein, and Sterba (2009) found that NSSI thoughts commonly began when adolescents were socializing; however, being alone (vs. with others) was a significant predictor of whether adolescents acted on these thoughts. Moreover, although interpersonal functions of NSSI were endorsed less frequently than intrapersonal functions of this behavior, both interpersonally oriented emotions (e.g., feeling rejected by and angry toward others) and intrapersonally oriented emotions (e.g., anger toward self, selfhatred) increased the odds of acting on NSSI thoughts .…”

Smartphone-Based Safety Planning and Self-Monitoring for Suicidal Patients: A Conceptual Basis for the CASPAR (Continuous Assessment for Suicide Prevention and Research) Study

“…Two studies have shown the feasibility of electronic monitoring of suicidal ideation, using handheld computers [33,34]. Nock et al [33] used EMA to measure suicidal and non-suicidal self-injurious thoughts and behaviours as they occurred in real-time, demonstrating the feasibility of using EMA in this group.…”

“…Nock et al [33] used EMA to measure suicidal and non-suicidal self-injurious thoughts and behaviours as they occurred in real-time, demonstrating the feasibility of using EMA in this group. In Husky et al's study [34] the feasibility of EMA in four samples at varying risk for suicide (e.g., recent suicide attempters, past suicide attempters, affective controls and healthy controls) was determined.…”