Nonsuicidal self-injury: A review of current research for family medicine and primary care physicians

Journal of the American Board of Family Medicine

Volumn 23, Issue 2, 2010, Pages 240-259

  Kerr, Patrick L ^a   Muehlenkamp, Jennifer J ^b   Turner, James M ^c  

^a West Virginia University School of Medicine Charleston   (United States)

^b UNIVERSITY OF WISCONSIN EAU CLAIRE   (United States)

^c CHARLESTON AREA MEDICAL CENTER   (United States)

Author keywords

Behavioral science; Nonsuicidal self injury; Primary health care; Psychiatric; Review; Risk assessment; Self injury

Indexed keywords

CLOZAPINE; DOXEPIN; ENDORPHIN; NALTREXONE; NEUROLEPTIC AGENT; OPIATE; RISPERIDONE; SEROTONIN UPTAKE INHIBITOR; SERTRALINE; TOPIRAMATE; VALPROIC ACID;

ALCOHOLISM; ANOREXIA NERVOSA; ANXIETY; AUTOMUTILATION; BEHAVIOR THERAPY; BINGE EATING DISORDER; BITE; BORDERLINE STATE; BULIMIA; BURN; COGNITIVE THERAPY; COMORBIDITY; DEPRESSION; DISSOCIATIVE DISORDER; DYSTHYMIA; EATING DISORDER; EMOTION; FAMILY MEDICINE; GENETIC PREDISPOSITION; GUNSHOT INJURY; HANGING; HEALTH CARE; HUMAN; IMPULSIVENESS; INTOXICATION; JUMPING; MAJOR DEPRESSION; MEDICAL CARE; MENTAL DISEASE; MOOD DISORDER; ONSET AGE; OUTCOME ASSESSMENT; PERSONALITY DISORDER; PHYSICIAN; POSTTRAUMATIC STRESS DISORDER; PREVALENCE; PRIMARY MEDICAL CARE; PROBLEM SOLVING; PSYCHODYNAMICS; PSYCHOTHERAPIST; QUESTIONNAIRE; REHABILITATION CARE; REVIEW; RISK; SCRATCHING; SOCIAL STATUS; SUICIDAL BEHAVIOR; SYSTEMATIC REVIEW;

ADOLESCENT; COMORBIDITY; CROSS-SECTIONAL STUDIES; FAMILY PRACTICE; HUMANS; MENTAL DISORDERS; PATIENT CARE TEAM; PRIMARY HEALTH CARE; REFERRAL AND CONSULTATION; RISK FACTORS; SELF-INJURIOUS BEHAVIOR; SUICIDE; SUICIDE, ATTEMPTED;

EID: 77949507657     PISSN: 15572625     EISSN: 15587118     Source Type: Journal    
DOI: 10.3122/jabfm.2010.02.090110     Document Type: Review

References (128)

1. Favazza AR. Bodies under siege: self-mutilation and body modification in culture and psychiatry, 2nd ed. London: Johns Hopkins; 1996.
2. Olfson M, Gameroff MJ, Marcus SC, Greenberg T, Shaffer D. National trends in hospitalization of youth with intentional self-inflicted injuries. Am J Psychiatry 2005;162:1328-35.
3. Whitlock J, Eckenrode J, Silverman D. Self-injurious behaviors in a college population. Pediatrics 2006;117:1939-48.
4. Regier DA, Narrow WE, Rae DS, Manderschied RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system: epidemiological catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 1993;50:85-94.
5. Simeon D, Favazza AR. Self-injurious behaviors: phenomenology and assessment. In Simeon D, Hollander E, eds. Self-injurious behaviors: assessment and treatment. Washington, D.C.: American Psychiatric Publishing; 2001.
6. Walsh BW. Treating self-injury: a practical guide. New York: Guilford Press; 2006.
7. Walsh B. Clinical assessment of self-injury: a practical guide. J Clin Psychol 2007;63:1057-66.
8. Huband N, Tantam D. Attitudes to self-injury within a group of mental health staff. Br J Med Psychol 2000;73:495-504.
9. McAllister M, Creedy D, Moyle W, Farrugia C. Nurses' attitudes towards clients who self-harm. J Adv Nurs 2002;40:578-86.
10. Briere J, Gil E. Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 1998;68:609-20.
11. Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 2003;160:1501-8.
12. Hawton K, Rodham K, Evans E. By their own young hand: deliberate self-harm and suicidal ideas in adolescents. London: Jessica Kingsley Publishers; 2006.
13. Laye-Gindhu A, Schonert-Reichl KA. Nonsuicidal self-harm among community adolescents: understanding the "whats" and "whys" or self-harm. J Youth Adolesc 2005;34:447-57.
14. Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML. Characteristics and functions of nonsuicidal self-injury in a community sample of adolescents. Psychol Med 2007;37:1183-92.
15. Muehlenkamp JJ, Gutierrez PM. Risk for suicide attempts among adolescents who engage in nonsuicidal self-injury. Arch Suicide Res 2007;11:69-82.
16. Plener P, Libal G, Keller F, Fegert JM, Muehlenkamp JJ. An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med 2009;39:1549-58.
17. Gratz KL. Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. J Psychopathol Behav Assess 2001;23:253-63.
18. Weiderman MW, Sansone R, Sansone LA. Bodily self-harm and its relationship to childhood abuse among women in a primary care setting. Violence Against Women 1999;5:155-63.
19. Claes L, Vandereycken W, Vertommen H. Self-injury in female versus male psychiatric patients: a comparison of characteristics, psychopathology and aggression regulation. Pers Individ Dif 2007;42:611-21.
20. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999;56:617-26.
21. Favazza AR. The coming of age of self-mutilation. J Nerv Ment Dis 1998;186:259-68.
22. Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 2006;115:616-23.
23. Darche MA. Psychological factors differentiating self-mutilating and non-self-mutilating adolescent inpatient females. Psychiatr Hosp1990;21:31-5.
24. Hurry J. Deliberate self-harm in children and adults. Int Rev Psychiatry 2000;12:31-6.
25. Lofthouse N, Muehlenkamp J, Adler R. Non-suicidal self-injury and co-occurrence. In Nixon MK, Heath NL, eds. Self-injury in youth: the essential guide to assessment and treatment. New York: Routledge Press; 2008:59-78.
26. Nock MK, Prinstein MJ. A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol 2004;72:885-90.
27. Nock MK, Prinstein MJ. Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol 2005;114:140-6.
28. Clarkin JF, Widiger T, Frances A, Hurt SW, Gilmore M. Prototypic typology and the borderline personality disorder. J Abnorm Psychol 1983;92:263-75.
29. Cowdry RW, Pickar D, Davies R. Symptoms and EEG findings in the borderline syndrome. Int J Psychiatry Med 1985;15:201-11.
30. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.
31. Brown MZ, Comtois KA, Linehan MM. Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol 2002;111:198-202.
32. Briere J. Child abuse trauma theory and treatment of the lasting effects Newbury Park, CA: Sage Publications; 1992.
33. Kemperman I, Russ MJ, Shearin E. Self-injurious behavior in borderline patients. J Pers Disord 1997;11:146-57.
34. Claes L, Vandereycken W, Vertommen H. Self-injurious behaviors in eating disorder patients. Eat Behav 2001;2:262-72.
35. Claes L, Vandereycken W, Vertommen H. Eating disordered patients with and without self-injurious behaviours: a comparison of psychopathological features. Eur Eat Disord Rev 2003;11:379-96.
36. Mitchell JE, Boutacoff LI, Hatsukami D, Pyle RL, Eckert ED. Laxative abuse as a variant of bulimia. J Nerv Ment Dis 1986;174:174-6.
37. Paul T, Schroeter K, Dahme B, Nutzinger DO. Self-injurious behavior in women with eating disorders. Am J Psychiatry 2002;159:408-11.
38. Welch SL, Fairburn CG. Impulsivity or comorbidity in bulimia nervosa: a controlled study of deliberate self-harm and alcohol misuse in a community sample. Br J Psychiatry 1996;169:451-8.
39. Favaro A, Santonastaso P. Self-injurious behavior in anorexia nervosa. J Nerv Ment Dis 2000;188:537-42.
40. Weiderman MW, Pryor T. Substance use and impulsive behaviors among adolescents with eating disorders. Addict Behav 1996;21:269-72.
41. Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 2006;144:65-72.
42. Jacobson CM, Muehlenkamp JJ, Miller AL, Turner B. Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol 2008;37:363-75.
43. Evans C, Lacey JH. Multiple self-damaging behaviour among alcoholic women. A prevalence study. Br J Psychiatry 1992;161:643-7.
44. Evren C, Sar V, Evren B, Dalbudak B. Self-mutilation among male patients with alcohol dependency: the role of dissociation. Compr Psychiatry 2008;49:489-95.
45. Klonsky ED, Olino TM. Identifying clinically distinct subgroups of self- injurers among young adults: a latent class analysis. J Consult Clin Psychol 2008;76:22-7.
46. Pattison EM, Kahan J. The deliberate self-harm syndrome. Am J Psychiatry 1983;140:867-72.
47. Stanley B, Winchel R, Molco A, Simeon D, Stanley M. Suicide and the self-harm continuum: phenomenological and biochemical evidence. Int Rev Psychiatry 1992;4:149-55.
48. Whitlock J, Knox KL. The relationship between self-injurious behavior and suicide in a young adult population. Arch Pediatr Adolesc Med 2007;161:634-40.
49. Whitlock J, Muehlenkamp JJ, Eckenrode J. Variation in non-suicidal self-injury: identification and features of latent classes in a college population of emerging adults. J Clin Child Adolesc Psychol 2008;37:725-35.
50. Muehlenkamp JJ. Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry 2005;75:1-10.
51. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2007;27:226-39.
52. Walsh BW, Rosen PM. Self-mutilation: theory, research, and treatment. New York: Guilford Press; 1988.
53. Favazza AR, Conterio K. Female habitual self-mutilators. Acta Psychiatr Scand 1989;79:238-89.
54. Spicer R, Miller T. Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health 2000;90:1885-91.
55. Kessler RC, Berglund P, Borges G, Nock MK, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA 2005;293:2487-95.
56. Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS) (2005). Available at http://www.cdc.gov/ injury/wisqars/. Accessed 30 July 2009.
57. Klonsky ED, Muehlenkamp JJ. Self-injury: a re-search review for the practitioner. J Clin Psychol 2007;63:1045-56.
58. Muehlenkamp JJ, Engel SG, Wadeson A, et al. Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behav Res Ther 2009;47:83-7.
59. Denning DG, Conwell Y, King D, Cox C. Method choice, intent and gender in completed suicide. Suicide Life Threat Behav 2000;30:282-8.
60. Joiner TE. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005.
61. Rudd MD, Joiner TE, Rajab MH. Treating suicidal behavior: An effective, time-limited approach. New York: Guilford Press; 2001.
62. Haw C, Houston K, Townsend E, Hawton K. Deliberate self harm patients with depressive disorders: treatment and outcome. J Affect Disord 2002;70:57-65.
63. Muehlenkamp JJ, Gutierrez P. An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide Life Threat Behav 2004;34:12-23.
64. Wedig MM, Nock MK. Parental expressed emotion and adolescent self-injury. J Am Acad Child Adolesc Psychiatry 2007;46:1171-8.
65. Nixon MK, Cloutier P, Jansson SM. Nonsuicidal self-harm in youth: a population-based survey. Can Med Assoc J 2008;178:306-12.
66. Hilt LM, Cha CB, Nolen-Hoeksema S. Nonsuicidal self-injury in young adolescent girls: moderators of the distress-function relationship. J Consult Clin Psychol 2008;76:63-71.
67. Heath NL, Schaub K, Holly S, Nixon MK. Self-injury today: review of population and clinical studies in adolescents. In Nixon MK, Heath NL, eds. Self-injury in youth: the essential guide to assessment and intervention. New York: Routledge; 2008.
68. Ross S, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 2002;31:66-77.
69. Zanarini MC. Zanarini rating scale for borderline personality disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. J Pers Disord 2003;17:233-43.
70. Sansone RA, Gaither GA, Songer DA. Self-harm behaviors across the life cycle: a pilot study of inpatients with borderline personality disorder. Compr Psychiatry 2002;43:215-8.
71. Whitlock JL, Powers JP, Eckenrode JE. The virtual cutting edge: adolescent self-injury and the Internet. Dev Psychol 2006;42:407-17.
72. Fortune S, Sinclair J, Hawton K. Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England. BMC Public Health 2008;8:369-81.
73. Wallenstein MB, Nock MK. Physical exercise for the treatment of non-suicidal self-injury: evidence from a single-case study. Am J Psychiatry 2007;164:350-1.
74. Nafisi N, Stanley B. Developing and maintaining the therapeutic alliance with self-injuring patients. J Clin Psychol 2007;63:1069-79.
75. Miller WR, Rollnick S. Motivational interviewing: preparing people to change, 2nd ed. New York: Guilford Press; 2002.
76. Kress VE, Hoffman RA. Non-suicidal self-injury and motivational interviewing: enhancing readiness for change. J Mntl Hlth Couns 2008;30:311-29.
77. Muehlenkamp JJ. Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. J Mntl Hlth Couns 2006;28:166-85.
78. Linehan MM. Validation and psychotherapy. In Bohart A, Greenberg LS, eds. Empathy reconsidered: new directions. Washington DC: American Psychological Association; 1997.
79. Skegg K. Self-harm. Lancet 2005;366:1471-83.
80. Lloyd E, Kelley ML, Hope T. Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Paper presented at the Annual Meeting of the Society for Behavioral Medicine, New Orleans, Louisiana, April 2007.
81. Sansone RA, Wiederman MW, Sansone LA. The self-harm inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol 1998;54:973-83.
82. Gutierrez PM, Osman A, Barrios FX, Kopper BA. Development and initial validation of the Self-Harm Behavior Questionnaire. J Pers Assess 2001;77:475-90.
83. Linehan MM, Comtois KA, Brown MZ, Heard HL, Wagner A. The suicide attempt self-injury interview: development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychol Assess 2006;18:303-12.
84. Nock MK, Holmberg EB, Photos VI, Michel BD. Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychol Assess 2007;19:309-17.
85. Nock MK, Wedig MW, Janis IB, Deliberto TL. Evidence-based assessment of self-injurious thoughts and behaviors. In Hunsley J, Mash EJ, eds. A guide to assessments that work. New York: Oxford University Press; 2008.
86. University of Washington. Behavioral Research and Therapy Clinics [Homepage.] Available at http://depts.washington.edu/brtc. Accessed 14 January 2010.
87. Osuch EA, Noll JG, Putnam FW. The motivations for self-injury in psychiatric inpatients. Psychiatry 1999;62:334-45.
88. Claes L, Vandereycken W. Self-injurious behavior: differential diagnosis and functional differentiation. Compr Psychiatry 2007;48:137-44.
89. Abraham PF, Shirley EF. (2006). New mnemonic for depressive symptoms. Am J Psychiatry 2006;163:329-30.
90. Kettlewell C. Skin game: a cutter's memoir. New York: St. Martin's Press; 1999.
91. Fagin L. Repeated self-injury: perspectives from general psychiatry. Adv Psychiatr Trt 2006;12:193-201.
92. Roth A, Ostroff R, Hoffman R. Naltrexone as a treatment for repetitive self-injurious behaviour: an open label trial. J Clin Psychiatry 1996;57:233-7.
93. Griengl H, Sendera A, Dantendorfer K. Naltrexone as a treatment of self-injurious behaviour. A case report. Acta Psychiatr Scand 2001;103:234-6.
94. Oquendo MA, Mann JJ. The biology of impulsivity and suicidality. Psychiatr Clin North Am 2000;23:11-23.
95. Winchel RM, Stanley M. Self-injurious behavior: a review of the behavior and biology of self-mutilation. Am J Psychiatry 1991;148:306-17.
96. Chengappa KNR, Ebeling T, Kang JS, Levine J, Parepally H. Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. J Clin Psychiatry 1999;60:477-84.
97. Ferreri M, Loze J, Rouillon F, et al. Clozapine treatment of a borderline personality disorder with severe self-mutilating behaviours. Eur Psychiatry 2004;19:177-8.
98. Chengappa RNK, Rathore D, Levine J, et al. Topiramate as add-on treatment for patients with bipolar mania. Bipolar Disord 1999;1:42-53.
99. Cassano P, Lattanzi L, Pini S, Dell'Osso L, Battistini G, Cassano GB. Topiramate for self-mutilation in a patient with borderline personality disorder. Bipolar Disord 2001;3:161.
100. Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality. Hoboken, NJ: Wiley; 1999.
101. Kernberg OF. The couch at sea: psychoanalytic studies of group and organizational leadership. Int J Group Psychother 1984;34:5-23.
102. Levy KN, Yeomans F, Diamond D. Psychodynamic treatments of self-injury. J Clin Psychology 2007;63:1105-20.
103. Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF. The development of a psychodynamic treatment for patients with borderline personality disorders: a preliminary study of behavioral change. J Pers Disord 2001;15:487-95.
104. Levy KN, Kelly KM, Meehan KB, et al. Change in attachment patterns and reflective function in a randomized control trial of transference focused psychotherapy for borderline personality disorder. J Consult Clin Psychol 2006;74:1027-40.
105. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. A mulitwave RCT evaluating three treatments for borderline personality disorder. Am J Psychiatry 2007;164:1-8.
106. Bateman AW, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999;156:1563-9.
107. Bateman AW, Fonagy P. Psychotherapy for borderline personality disorder: mentalization-based treatment. Oxford: Oxford University Press; 2004.
108. Bateman AW, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry 1999;165:631-8.
109. Evans K, Tryer P, Catalan J, et al. Manual assisted cognitive-behavioral therapy: a randomized controlled trial of a brief intervention with bibliotherapy for deliberate self-harm. Psychol Med 1999;29:19-25.
110. Tryer P, Thompson S, Schmidt U, et al. Randomized controlled trial of a brief cognitive-behavioural therapy versus treatment as usual for recurrent deliberate self-harm: the POMPACT study. Psychol Med 2003;33:969-96.
111. Ogata SN, Silk KR, Goodrich S, Lohr NE, Westen D, Hill EM. Childhood sexual and physical abuse in adult patients with borderline personality disorder. Am J Psychiatry 1990;147:1008-13.
112. Herman JL, Perry JC, van der Kolk BA. Childhood trauma in borderline personality disorder. Am J Psychiatry 1990;146:490-5.
113. Paris J, Zweig-Frank H. A critical review of the role of childhood sexual abuse in the etiology of borderline personality disorder. Can J Psychiatry 1992;37:125-8.
114. Muehlenkamp JJ, Kerr PL. Abuse subtypes and non-suicidal self-injury: preliminary evidence of complex emotion regulation patterns. J Nerv Ment Dis. In press.
115. Klonsky ED, Moyer A. Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry 2008;192:166-70.
116. Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.
117. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard H. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991;48:1060-4.
118. Linehan MM, Heard H, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically suicidal borderline patients. Arch Gen Psychiatry 1993;50:971-4.
119. Koons CR, Robins CJ, Tweed JL, et al. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther 2001;32:271-90.
120. Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63:757-66.
121. Barley WD, Buie SE, Peterson EW, et al. Development of an inpatient cognitive-behavioral treatment program for borderline personality disorder. J Pers Disord 1993;7:232-40.
122. Bohus M, Haaf B, Simms T, et al. Effectiveness of inpatient dialectical behavior therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004;42:487-99.
123. Rathus J, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav 2002;32:146-57.
124. Rathus J, Miller AL, Linehan MM. Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press; 2006.
125. Miller AL, Rathus JH, Linehan MM, Wetzler S, Leigh E. Dialectical behavior therapy adapted for suicidal adolescents. J Psychiatr Pract 1997;3:78-86.
126. Katz L, Cox BJ, Gunasekara S, Miller AL. Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. J Am Acad Child Adolesc Psychiatry 2004;43:276-82.
127. Kerr PL, Muehlenkamp JJ, Larsen AM. Implementation of DBT-informed therapy at a rural training clinic: a case study. Cogn Behav Pract 2009;16:92-100.
128. Lofthouse N, Yaeger-Schweller J. Nonsuicidal self-injury and suicide risk among adolescents. Curr Opin Pediatr 2009;21:641-5.