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European Child & Adolescent Psychiatry

, Volume 20, Issue 2, pp 103–108 | Cite as

Non-suicidal self-injury

  • Paul Wilkinson
  • Ian Goodyer
Original Contribution

Abstract

Self-injury is a relatively common phenomenon in adolescence. Often there is no suicidal intent; rather, the action is used for one or more reasons that relate to reducing distressing affect, inflicting self-punishment and/or signalling personal distress to important others. Non-suicidal self-injury (NSSI) is both deliberate and contains no desire to die and therefore aetiology is likely to be at least partly different to suicidal behaviour per se. Interestingly, NSSI is associated with subsequent suicide attempts suggesting that these behaviours and their related psychology may lie on the same risk trajectory. NSSI neither appears in DSM-IV or ICD 10 as a disorder nor does it constitute a component of any current anxious or depressive syndrome. This lack of nosological recognition coupled with clear psychopathological importance is to be recognised in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), with NSSI being classified as a syndrome in its own right. We agree that this is appropriate and is likely to have several positive consequences including: (1) improving communication between professionals and patients; (2) informing treatment and management decisions; (3) increasing research into the nature, course and outcome of NSSI. We agree with the proposed DSM-5 diagnostic criteria, although believe the impairment criterion would be better phrased if it stated that self-injury is associated with, rather than causal for, intense distress.

Keywords

Non-suicidal self-injury Adolescence Suicide Depression Borderline personality disorder 

Abbreviations

NSSI

Non-suicidal self-injury

DSM-5

5th Edition of the Diagnostic and Statistical Manual of Mental Disorders

Notes

Conflict of interest

The authors have no conflicts of interests to declare.

References

  1. 1.
    Hawton K, James A (2005) Suicide and deliberate self harm in young people. BMJ 330(7496):891–894CrossRefPubMedGoogle Scholar
  2. 2.
    Briere J, Gil E (1998) Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 68(4):609–620CrossRefPubMedGoogle Scholar
  3. 3.
    APA, Non-suicidal self injury, in APA DSM-5 development (2010)http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=443#.
  4. 4.
    APA and American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th, text revision edn. American Psychiatric Association, Washington, DC, p 710Google Scholar
  5. 5.
    WHO (1992) The ICD-10 classification of mental and behavioural disorders—clinical descriptions and diagnostic guidelines. World Health Organization, Geneva, p 202Google Scholar
  6. 6.
    Nock MK et al (2006) Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 144(1):65–72CrossRefPubMedGoogle Scholar
  7. 7.
    Jacobson CM et al (2008) Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol 37(2):363–375CrossRefPubMedGoogle Scholar
  8. 8.
    Brunner R et al (2007) Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolesc Med 161(7):641–649CrossRefPubMedGoogle Scholar
  9. 9.
    Zlotnick C et al (1997) Affect regulation and suicide attempts in adolescent inpatients. J Am Acad Child Adolesc Psychiatry 36(6):793–798CrossRefPubMedGoogle Scholar
  10. 10.
    Wilkinson, P (2010) Clinical and psychosocial predictors of suicide attempts and non-suicidal self-injury in the adolescent depression antidepressants and psychotherapy trial (ADAPT). Am J Psychiatry. (in press)Google Scholar
  11. 11.
    Cooper J et al (2005) Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry 162(2):297–303CrossRefPubMedGoogle Scholar
  12. 12.
    Bridge JA, Goldstein TR, Brent DA (2006) Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 47(3–4):372–394CrossRefPubMedGoogle Scholar
  13. 13.
    Katz LY et al (2004) Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. J Am Acad Child Adolesc Psychiatry 43(3):276–282CrossRefPubMedGoogle Scholar
  14. 14.
    Hazell PL et al (2009) Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial. J Am Acad Child Adolesc Psychiatry 48(6):662–670PubMedGoogle Scholar
  15. 15.
    March J et al (2004) Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: treatment for adolescents with depression study (TADS) randomized controlled trial. J Am Med Assoc 292(7):807–820CrossRefGoogle Scholar
  16. 16.
    Brent DA et al (2009) Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. Am J Psychiatry 166(4):418–426CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Developmental Psychiatry SectionUniversity of CambridgeCambridgeUK

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