Treating Nonsuicidal Self-Injury

Abstract

Cognitive behavioral therapy Opinion statementNonsuicidal self-injury (NSSI) evaluation and treatment are critical for comprehensive patient care. A thorough assessment of nonsuicidal self-injury(NSSI) following DSM-5-proposed criteria is critical in understanding and treating NSSI and should be informed based upon past and current self-harm behaviors, including self-injury methods, frequency, severity, and intent, along with a comprehensive suicide risk assessment. After NSSI is diagnosed, patients should be offered proper management of co-occurring psychiatric illnesses, if applicable, enhanced by an 8 -12 week trial of cognitive behavior therapy (CBT) focusing on NSSI. Cognitive strategies to be used include Socratic questioning, keeping thought records, and addressing self-derogatory and distorted beliefs about NSSI. Behavioral strategies include contingency management, behavioral activation, and addressing environmental factors maintaining NSSI. In adolescents, individual CBT work might be supplemented with family-based therapy. Dialectical strategies (acceptance and distress tolerance) and skills training (focus on improving emotion regulation, problemsolving, interpersonal, and communication skills) can be used to enhance CBT, but in some cases DBT can be cost prohibitive. If adequate psychotherapy trials are ineffective, a pharmacotherapy trial of emerging drug therapies for NSSI, e.g. naltrexone, Nacetylcysteine, or topiramate to enhance supportive psychotherapy would be recommended. We would encourage patients to continue effective treatment for at least 6 months and would continuously assess for self-harm urges and behaviors. Psychoeducation and adequate treatment of comorbid conditions should be provided on an ongoing basis along with attention to physical self-care and regular exercise.

Rethinking self-injury recovery: a commentary and conceptual reframing

“…scarring, disclosure, coping) that extend well beyond NSSI disengagement. 6,7,[20][21][22][23] Taken together, the totality of experiences expressed by individuals with lived experience of NSSI may not consistently be represented in the extant literature. Moreover, emphasis on cessation of behaviour may inadvertently place NSSI in disease-based conceptualisations of 'illness'.…”

“…Although many would not disagree that recovery is broader in scope, researchers typically focus on cessation of the behaviour, 5,[9][10][11][12] with the implicit argument that this is the desired outcome of any intervention effort. However, it is not uncommon for people with lived NSSI experience to mention ongoing NSSI thoughts or urges, 7,20 learning new ways to cope with difficult emotions, 8,20,23 disclosure-related concerns 22 and coming to terms with scarring 7,21even long after ceasing to self-injure.…”

Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury

“…Unfortunately, tailored treatments for IED are scarce 13,14. Furthermore, tailored interventions targeting self-aggression (i.e., NSSI) are rare15,16 and are usually based on treatments for other disorders, including dialectic behavioral therapy, which was developed to treat borderline personality disorder 15…”

Cognitive Behavioral Therapy untuk menurunkan perilaku menyakiti diri pada individu dengan Borderline Personality Disorder

“…Berdasarkan intervensi yang telah dilakukan dapat disimpulkan bahwa CBT merupakan metode yang tepat untuk menurunkan perilaku self-harm. Hal ini sesuai dengan temuan peneliti sebelumnya bahwa CBT adalah terapi yang dapat mengubah keyakinan negatif yang memicu timbulnya selfharm (Guerdjikova et al, 2014;Kaess et al, 2019). Selain itu, CBT terbukti dapat mengatasi pikiran untuk bunuh diri, rencana dan perilaku bunuh diri (Tarrier et al, 2008) .…”