Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample
Restricted accessResearch articleFirst published online October, 2019
Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample
To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts.
Method:
Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data.
Results:
Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients’ suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option.
Conclusion:
Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2.
AndoverM.GibbB. (2010). Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Research, 178, 101–105.
3.
Blasco-FontecillaH.Fernandez-FernandezR.ColinoL.FajardoL.Perteguer-BarrioR.de LeonJ. (2016). The addictive model of self-harming (non-suicidal and suicidal) behavior. Frontiers in Psychiatry, 7, Article 8. doi:10.3389/fpsyt.2016.00008
4.
BraunV.ClarkeV.TerryG. (2014). Thematic analysis. In RohlederP.LyonsA. (Eds.), Qualitative research in clinical and health psychology (pp. 95–114). Basingstoke, UK: Palgrave Macmillan.
5.
BuserT.BuserJ. (2013). Conceptualizing nonsuicidal self-injury as a process addiction: Review of research and implications for counselor training and practice. Journal of Addictions & Offender Counseling, 34, 16–29.
6.
Centers for Disease Control and Prevention & National Center for Injury Prevention and Control. (2017). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/nvdrs.html
7.
CloutierP.HumphreysL. (2009). Measurement of nonsuicidal self-injury in adolescents. In NixonM. K.HeathN. L. (Eds.), Self-injury in youth: The essential guide to assessment and intervention (pp. 115–142). New York, NY: Routledge.
8.
FranklinJ.PuziaM.LeeK.PrinsteinM. (2014). Low implicit and explicit aversion toward self-cutting stimuli longitudinally predict nonsuicidal self-injury. Journal of Abnormal Psychology, 123, 463–469.
9.
GonzalesA. H.BergstromL. (2013). Adolescent non-suicidal self-injury (NSSI) interventions. Journal of Child and Adolescent Psychiatric Nursing, 26, 124–130.
GutierrezP.OsmanA.BarriosF.KopperB. (2001). Development and initial validation of the Self-Harm Behavior Questionnaire. Journal of Personality Assessment, 77, 475–490.
12.
JoinerT.RibeiroJ.SilvaC. (2012). Nonsuicidal self-injury, suicide behavior, and their co-occurrence as viewed through the lens of the interpersonal theory of suicide. Current Directions in Psychological Science, 21, 342–347.
13.
KerrP.MuehlenkampJ.TurnerJ. (2010). Nonsuicidal self-injury: A review of current research for family medicine and primary care physicians. Journal of the American Board of Family Medicine, 23, 240–259.
14.
KesslerR.WarnerC.IvanyC.PetukhovaM.RoseS.BrometE.. . . UrsanoR. (2015). Predicting suicides after psychiatric hospitalization in US Army soldiers: The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry, 72, 49–57.
15.
KlonskyE.MayA. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide and Life-Threatening Behavior, 44, 1–5.
16.
LloydE.KelleyM.HopeT. (1997, April). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. Paper presented at the Society for Behavioral Medicine, New Orleans, LA.
17.
MuehlenkampJ.ClaesL.SmitsD.PeatC.VandereyckenW. (2011). Non-suicidal self-injury in eating disordered patients: A test of a conceptual model. Psychiatry Research, 188, 102–108.
18.
MuehlenkampJ.GutierrezP. (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research, 11, 69–82.
19.
NixonM.LevesqueC.PreydeM.VanderkooyJ.CloutierP. (2015). The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child and Adolescent Psychiatry and Mental Health, 9, Article 26. doi:10.1186/s13034-015-0056-5
20.
NockM.HolmbergE.PhotosV.MichelB. (2007). Self-injurious Thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 9, 309–317.
21.
NockM.PrinsteinM. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.
22.
NockM.PrinsteinM.SterbaS. (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, 816–827.
23.
PaulE.TsypesA.EidlitzL.ErnhoutC.WhitlockJ. (2015). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225, 276–282.
24.
PosnerK.CurrierG.MelvinG.GreenhillL.ShenS.MannJ. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168, 1266–1277.
25.
QSR International Pty Ltd. (2015). NVivo qualitative data analysis Software (Version 11). Melbourne, Victoria, Australia: Author.
26.
SahlinH.MobergT.HirvikoskiT.JokinenJ. (2015). Non-suicidal self-injury and interpersonal violence in suicide attempters. Archives of Suicide Research, 19, 500–509.
27.
StewartJ.EspositoE.GlennC.GilmanS.PridgenB.GoldJ.AuerbachR. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. Journal of Psychiatric Research, 84, 105–112.
28.
TaliaferroL.MuehlenkampJ. (2014). Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year. Suicide and Life-Threatening Behavior, 44, 6–22.
29.
TaliaferroL.MuehlenkampJ.BorowskyI.McMorrisB.KuglerK. (2012). Factors distinguishing youth who report self-injurious behavior: A population-based sample. Academic Pediatrics, 12, 205–213.
30.
VictorS.GlennC.KlonskyE. (2012). Is non-suicidal self-injury an “addiction”? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry Research, 197, 73–77.
31.
VictorS.KlonskyE. (2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34, 282–297.
32.
VictorS.StyerD.WashburnJ. (2016). Functions of nonsuicidal self-injury (NSSI): Cross-sectional associations with NSSI duration and longitudinal changes over time and following treatment. Psychiatry Research, 241, 83–90.
33.
WalshB. (2012). Treating self-injury: A practical guide (2nd ed.). New York, NY: Guilford Press.
34.
WalshC.RibeiroJ.FranklinJ. (2017). Predicting risk of suicide attempts over time through machine learning. Clinical Psychological Science, 5, 457–469.
35.
Ward-CiesielskiE.SchumacherJ.BaggeC. (2016). Relations between nonsuicidal self-injury and suicide attempt characteristics in a sample of recent suicide attempters. Crisis, 37, 310–313.
WhitlockJ.MuehlenkampJ.EckenrodeJ.PuringtonA.AbramsG.BarreiraP.KressV. (2013). Nonsuicidal self-injury as a gateway to suicide in young adults. Journal of Adolescent Health, 52, 486–492.
