The situation of former adolescent self-injurers as young adults: a follow-up study

Abstract

BackgroundNonsuicidal self-injury (NSSI) in adolescence has been described as comorbid condition in affective or anxiety disorders, as well as borderline personality disorder (BPD) and is a risk factor for later suicide attempts. Prevalence rates of NSSI decline steeply from adolescence to young adulthood. Yet, to the best of our knowledge, the longitudinal development of adolescent psychiatric patients with NSSI into their young adulthood has not been investigated. The aim of this study was to assess current NSSI and psychological impairment of young adults, who had been in treatment for NSSI in their adolescence.MethodsFormer patients of the departments of child and adolescent psychiatry and psychotherapy in Ulm and Ravensburg, Germany (N = 52), who presented with NSSI in their adolescence, were recruited (average age: 21.5 years (SD = 2.6)). Data was assessed using questionnaires and structured clinical interviews. Two groups of participants with prevailing NSSI and ceased NSSI were compared concerning their current psychological impairment, history of NSSI, suicide attempts, and BPD diagnosis.ResultsAround half of all participants had engaged in NSSI within the last year, and around half met diagnostic criteria for BPD. Although there was no significant association between current NSSI and BPD, an earlier age of onset of NSSI and a longer duration of NSSI during adolescence was significantly predictive of adult BPD. Two thirds of participants still met criteria of an axis 1 psychiatric disorder. Suicide attempts were reported by 53.8 % of all participants. Participants with current NSSI were more likely to meet criteria for a current axis 1 disorder, had engaged in NSSI more often in their lifetime, and reported more suicide attempts.ConclusionsReduction of NSSI from adolescence to young adulthood was lower than described in previous community samples. This may be due to the initial high psychiatric impairment of this sample in adolescence. Early onset of NSSI seemed to be a risk factor for a longer duration of NSSI during adolescence but not for NSSI prevailing into adulthood. However, it was a risk factor for adult BPD. Furthermore, the occurrence of suicidal thoughts and behaviors and prevailing NSSI was highly associated.

Confirmatory factor analysis of the Inventory of Statements About Self‐injury in a Spanish clinical sample

“…Nonsuicidal self‐injury (NSSI) is any deliberate self‐inflicted damage to the surface of the body with no suicidal intent and for purposes that are not socially sanctioned (Klonsky, Muehlenkamp, Lewis, & Walsh, ). Rates of NSSI of around 20–30% have been reported in clinical adults in countries such as Turkey (e.g., Toprak et al, ) or Belgium (Claes, Norré, Van Assche, & Bijttebier, ), and 30–50% in clinical adolescents in American (Nock & Prinstein, ) or German samples (Groschwitz et al, ). In Spain, Díaz de Neira et al () found that 21.7% of clinical adolescents self‐injured, and Calvete et al () found that 32% of community adolescents had carried out severe NSSI.…”

The neurobiology of self-knowledge in depressed and self-injurious youth

“…Identifying neural signatures distinguishing NSSI from comorbid disorders may elucidate unique neural signatures of higher risk trajectories. For instance, NSSI may facilitate severe negative outcomes such as suicide attempts (Whitlock et al, 2013a), and BPD diagnosis (Groschwitz et al, 2015), which is associated with high societal costs (Brettschneider et al, 2014). …”

Are neurocognitive factors associated with repetition of self-harm? A systematic review

“…Some may argue that NSSI is not related to suicide attempts, especially in the United States where NSSI has been segregated from "suicidal behaviour syndrome" in the new DSM-5 (APA, 2015). However, the majority of the evidence indicates that any form of self-harm, regardless of intent, increases the risk of future self-harm and suicide (Brent, 2011;Groschwitz et al, 2015;Owens et al, 2002;Wilkinson et al, 2011).…”