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Reconsidering Criterion A for the Diagnosis of Non-Suicidal Self-Injury Disorder

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Abstract

Empirical research is needed to verify that the DSM-5 proposed diagnostic criteria for non-suicidal self-injury (NSSI) disorder provide a valid and clinically meaningful symptom set. The current study used data-driven methods to examine the diagnostic validity of the frequency and recency thresholds (i.e., Criterion A) for NSSI disorder. Data were collected from a random sample (n = 2206) of undergraduates. Participants completed counter-balanced questionnaires assessing the frequency, recency, and functions of NSSI, psychopathology symptoms, and indicators of distress and functional impairment. Discriminant functional analyses identified a significant differentiation for frequency between 10 or more acts of NSSI and 1–9 acts. Groups were also differentiated with a split on recency between less than 12-months ago and more than 12-months ago. After re-grouping the sample into categories based on the new frequency and 12-month recency threshold, the 10+ NSSI group reported significantly more functions for NSSI, including higher scores on affect regulation, self-punishment, and sensation seeking, than the subthreshold NSSI group. The 10+ NSSI group also reported significantly worse psychopathology, greater distress, and more impairment than both the subthreshold group and controls (no NSSI history). These findings indicate the current DSM-5 diagnostic criteria for NSSI disorder may be too liberal, and offer support for increasing the frequency thresholds for the diagnosis to ensure clinical validity and utility.

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References

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, 5th edition. American Psychiatric Publishing: Washington, D.C.

  • Andover, M. S. (2014). Non-suicidal self-injury disorder in a community sample of adults. Psychiatry Research, 219, 305–310.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barrocas, A. L., Hankin, B. L., Young, J. F., & Abela, J. R. Z. (2012). Rates of nonsuicidal self-injury in youth: age, sex, and behavioral methods in a community sample. Pediatrics, 130, 39–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68, 609–620.

    Article  PubMed  Google Scholar 

  • Bush, K., Kivlahan, D. R., McDonnell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor-Davidson Resilience scale (CD-RISC): validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20, 1019–1028.

    Article  PubMed  Google Scholar 

  • Claes, L., & Muehlenkamp, J. J. (2014). Non-suicidal self-injury and eating disorders: dimensions of self-harm. In L. Claes & J. J. Muehlenkamp (Eds.), Non-Suicidal Self-Injury in Eating Disorders: Advanced in Etiology and Treatment (pp. 3–18). Heidelberg, Germany: Springer.

    Chapter  Google Scholar 

  • Clara, I. P., Cox, B. J., Enns, M. W., Murray, L. T., & Torgrude, L. J. (2003). Confirmatory factor analysis of the multidimensional scale of perceived social support in clinically distressed and student samples. Journal of Personality Assessment, 81, 265–270.

    Article  PubMed  Google Scholar 

  • Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75.

    Article  PubMed  Google Scholar 

  • Eisenberg, M. E., Berge, J. M., Fulkerson, J. A., & Neumark-Sztainer, D. (2012). Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults. Journal of Behavioral Medicine, 35, 500–508.

    Article  PubMed  Google Scholar 

  • Favazza, A. R., & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Hospital & Community Psychiatry, 44(2), 134–140.

  • Field, A. (2013). Discovering statistics using IBM SPSS statistics, 4th edition. Sage Publications: Thousand Oaks, California.

  • Franklin, J. C., Hessel, E. T., & Prinstein, M. J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189, 362–367.

    Article  PubMed  Google Scholar 

  • Garnefski, N., & Kraaij, V. (2006). Cognitive emotion regulation questionnaire – development of a short 18-item version (CERQ-short). Personality and Individual Differences, 41, 1045–1053.

    Article  Google Scholar 

  • Garnefski, N., Kraaij, V., & Spinhoven, P. (2002). Manual for the use of the cognitive emotion regulation questionnaire. Leiderdorp, The Netherlands: DATEC.

    Google Scholar 

  • Glenn, C. R., & Klonsky, E. D. (2011). One-year test-retest reliability of the inventory of statements about self-injury (ISAS). Assessment, 18(3), 375–378.

    Article  PubMed  Google Scholar 

  • Glenn, C. R., & Klonsky, E. D. (2013). Nonsuicidal self-injury disorder: An empirical investigation in adolescent psychiatric patients. Journal of Clinical Child & Adolescent Psychology, 42, 496–507.

    Article  Google Scholar 

  • Hagman, B. T. (2015). Toward efficient screening for DSM-5 alcohol use disorders in college students: performance of the AUDIT-C. Addictive Disorders & Their Treatment, 14, 15.

    Article  Google Scholar 

  • Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scale (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.

    Article  PubMed  Google Scholar 

  • In-Albon, T., Ruf, C., & Schmid, M. (2013). Proposed diagnostic criteria for the DSM-5 of nonsuicidal self-injury in female adolescents: diagnostic and clinical correlates. Psychiatry Journal, 2013, 159208.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: psychometric properties of the inventory of statements about self-injury (ISAS). Journal Of Psychopathology And Behavioral Assessment, 31, 215–219.

  • Latimer, S., Meade, T., & Tennant, A. (2013). Measuring engagement in deliberate self-harm behaviours: psychometric evaluation of six scales. BMC Psychiatry, 13(4), 1–11.

    Google Scholar 

  • Lengel, G. J., & Mullins-Sweatt, S. N. (2013). Nonsuicidal self-injury disorder: clinician and expert ratings. Psychiatry Research, 210, 940–944.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75, 324–333.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J., Engel, S. G., Crosby, R. D., Wonderlich, S. A., Simonich, H., & Mitchell, J. E. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behavior Research and Therapy, 47, 83–87.

    Article  Google Scholar 

  • Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 1–9.

    Article  Google Scholar 

  • Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features and functions of nonsuicidal self-injury. Suicide and Life-threatening Behavior, 43, 67–80.

    Article  PubMed  Google Scholar 

  • Neumark-Sztainer, D., Falkner, N., Story, M., Perry, C., Hannan, P. J., & Mulert, S. (2002). Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors. International Journal of Obesity, 26, 123–131.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19, 309–317.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118, 816.

    Article  PubMed  Google Scholar 

  • Osman, A., Gutierrez, P. M., Downs, W. R., Kopper, B. A., Barrios, F. X., & Haraburda, C. M. (2001a). Development and psychometric properties of the student worry questionnaire-30. Psychological Reports, 88, 277–290.

    Article  PubMed  Google Scholar 

  • Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001b). The suicidal behaviors questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment, 8, 443–454.

    Article  PubMed  Google Scholar 

  • Pavot, W., & Diener, E. (2008). The satisfaction with life scale and the emerging construct of life satisfaction. The Journal of Positive Psychology, 3(2), 137–152.

    Article  Google Scholar 

  • Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 Field trials in the United States and Canada: test-retest reliability of selected categorical diagnoses. The American Journal of Psychiatry, 170(1), 59–70.

    Article  PubMed  Google Scholar 

  • Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31, 67–77.

    Article  Google Scholar 

  • Selby, E. A., Bender, T. W., Gordon, K. H., Nock, M. K., & Joiner Jr., T. E. (2012). Non-suicidal self-injury (NSSI) disorder: A preliminary study. Personality Disorders: Theory, Research, and Treatment, 3, 167–175.

    Article  Google Scholar 

  • Selby, E. A., Kranzler, A., Fehling, K., & Panza, E. (2015). Nonsuicidal self-injury disorder: the path to diagnostic validity and final obstacles. Clinical Psychology Review, 38, 79–91.

    Article  PubMed  Google Scholar 

  • Shaffer, D., & Jacobson, C. (2009). Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. American Psychiatric Association.

  • Steakley-Freeman, D., & Whitlock, J. L. (2015). The function accumulation model of non-suicidal self-injury. paper presented at the annual meeting of the International Society For The Study of self-injury. Heidelberg: Germany.

    Google Scholar 

  • Tabachnick, B.G., & Fidell, L.S. (2012). Using multivariate statistics (6th Ed.). Pearson Education: Boston.

  • Wakefield, J. C. (1992). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99, 232–247.

    Article  PubMed  Google Scholar 

  • Washburn, J. J., Potthoff, L. M., Juzwin, K. R., & Styer, D. M. (2015). Assessing DSM-5 nonsuicidal self-injury disorder in a clinical sample. Psychological Assessment, 27, 31–41.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Muehlenkamp, J. J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child & Adolescent Psychology, 37, 725–735.

    Article  Google Scholar 

  • Zetterqvist, M., Lundh, L.-G., Dahlstrom, O., & Goran Svedin, C. (2013). Prevalence and function of nonsuicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Journal of Abnormal Child Psychology, 41, 759–773.

    Article  PubMed  Google Scholar 

  • Zimet, G. D., Dahlem, N. W., & Farley, G. K. (1989). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Wisconsin-Eau Claire, 105 Garfield Ave, Eau Claire, WI, 54702, USA

    Jennifer J. Muehlenkamp

  2. Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY, USA

    Amy M. Brausch

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  1. Jennifer J. Muehlenkamp
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Correspondence to Jennifer J. Muehlenkamp.

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Jennifer J. Muehlenkamp and Amy M. Brausch report no conflicts of interest related to this research.

Experiment Participants

All procedures performed in this study were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all human participants prior to beginning the study and the data collection for this study was approved by an ethics review committee (IRB).

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Muehlenkamp, J.J., Brausch, A.M. Reconsidering Criterion A for the Diagnosis of Non-Suicidal Self-Injury Disorder. J Psychopathol Behav Assess 38, 547–558 (2016). https://doi.org/10.1007/s10862-016-9543-0

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