Some notes on self-injury

Jessica GarischTamsyn GilbertsonRobyn LanglandsAngelique O’ConnellLynne RussellMarc WilsonEmma BrownTahlia Kingi

So what are we talking about…?

Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007):

“…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).”

“As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”

Why do people do it…?

Why do people do it…?

Prevalence…

• 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1

• 24% - Lifetime prevalence among community-based New Zealand adults2

• 48% of adolescents presenting to CAMHS reported SH at initial assessment3

• 20% of 9,000 secondary students reported SH in previous year4

• 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5

years5

(conflation between SSI and NSSI)

1. Hatcher et al., 2009.2. Nada-Raja et al., 2004.3. Fortune et al., 2005.4. Fortune et al., 2010.5. Pryor & Jose, 02/04 to 09/09.

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

3. 16-18 year-old School students

1,162 Lundh et al’s (2007) DSHI 14 48.7%

4. 100-level PSYC students

593 Lundh et al’s (2007) DSHI 14 43.7%

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

3. 16-18 year-old School students

1,162 Lundh et al’s (2007) DSHI 14 48.7%

4. 100-level PSYC students

593 Lundh et al’s (2007) DSHI 14 43.7%

5. 100-level PSYC students

722 Lundh et al’s (2007) DSHI (SV) 7 39.7%‡

Prevalence…

† r=.40 with suicidal behaviour‡ correlates .79 with the full 14-item DSHI

Why do those who self-injure, self-injure?

Inte

rper

sona

lIn

trap

erso

nal

ISAS subscaleGlobal

Mean (SD)Most recent Mean (SD)

Affect regulation 4.62 (1.62) 4.57 (1.74)Self-punishment 4.14 (1.91) 3.89 (2.15)Marking distress 2.82 (2.00) 2.66 (1.96)Anti-dissociation/ feeling generation 2.68 (2.16) 2.04 (2.25)Anti-suicide 2.22 (1.98) 2.02 (2.27)Self-care 1.49 (1.48) 1.34 (1.51)Toughness 1.29 (1.53) 1.04 (1.54)Interpersonal influence 1.18 (1.47) 0.92 (1.36)Interpersonal boundaries 1.16 (1.51) 0.89 (1.50)Sensation-seeking 0.77 (1.21) 0.52 (1.17)Autonomy 0.77 (1.18) 0.60 (1.17)Revenge 0.68 (1.26) 0.62 (1.37)Peer-bonding 0.14 (0.56) 0.15 (0.81)

Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed.

Myths of self-injury:

1. All people who self-injure are suicidal2. Self-injury is a female issue3. Only adolescents hurt themselves4. People who hurt themselves are mentally ill5. People who hurt themselves have been abused

Supporting people who self-injure:

1. Avoid pejorative labels2. Remember the myths!3. Aim for low-key dispassionate demeanour and respectful curiosity – be professional!4. Aim for a balance of appropriate level of concern that doesn’t alarm the person,

condone the behaviour, but also provides support5. Pass it on to the professionals – be clear of your own limits.

Useful resources Excellent factsheets developed by the team from the Cornell Research Programme on Self-injurious behaviour in adolescents and young adults: http://www.crpsib.com/resources.asp

An information booklet written by an Australian psychologist for young people who self-injure: http://www.decd.sa.gov.au/speced2/files/pages/chess/hsp/Information/revised_selfharm_finalweb.pdf An online power-point presentation for parents with children who are self-injuring: http://store.selfinjury.com/products/Parents-Webinar%3A-by-Dr.-Wendy-Lader.html

A free, downloadable copy of 'Healing the Hurt Within' by Jan Sutton: http://www.e-booksdirectory.com/details.php?ebook=2363

Our website:http://www.victoria.ac.nz/psyc/research/youth-and-wellbeing-study/news-and-events

Where next?

Towards understanding how NSSI starts, stops, and continues…

Year 9 and older

Longitudinal

Funded by the Health Research Council of New Zealand

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