Assessing DSM–5 nonsuicidal self-injury disorder in a clinical sample.

Abstract

The entry for nonsuicidal self-injury (NSI) disorder in the 5th edition of the Diagnostic and Statistical Manual o f Mental Disorders provides a criterion-based definition of clinically relevant NSI. NSI disorder is currently classified in the DSM-5 as a condition requiring further study. The present study aimed to examine the reliability, validity, and clinical utility of a self-report measure of NSI disorder, the Alexian Brothers Assessment of Self-Injury (ABASI). The sample included 511 patients admitted to an acute care treatment program designed to treat NSI. Patients were administered the ABASI as part of a clinical assessment and routine outcome evaluation. The sample included a broad age range, as well as sufficient numbers of males and Hispanics to examine sociodemographic differences. The ABASI demonstrated adequate internal consistency and test-retest reliability, and the factor structure reflects NSI disorder criteria. Among patients being treated for NSI, 74% met criteria for NSI disorder. No differences in the rate of NSI disorder were observed by sex, ethnicity, or age. Although NSI disorder is associated with a worse presentation of self-injurious behavior, NSI disorder provides limited clinical utility as a dichotomous diagnosis, at least when compared with common NSI characteristics such as number of methods of NSI and the urge to self-injure. Instead, findings support a dimensional approach to NSI disorder. Analyses of specific symptoms of NSI disorder indicate concerns with Criterion B as currently defined by the DSM-5. Recommendations for a more parsimonious revision of NSI disorder are discussed.

The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients

“…Another study also validating a selfreport measure of NSSI disorder in 511 patients found a prevalence of 74% of NSSI disorder in patients treated for NSSI. However, the authors proposed limited utility for NSSI disorder as a dichotomous diagnosis, but suggested the implementation of a dimensional approach to NSSI disorder (Washburn et al, 2015). In a systematic review on research conducted on NSSI disorder, Selby et al (2015) suggest further research on NSSI in five major areas in order to validate NSSI disorder to be included in the next DSM.…”

Emotional reactivity in a clinical sample of patients with eating disorders and nonsuicidal self-injury

“…Among those with EDs, a recent meta-analysis reported a lifetime history of NSSI of 32.7% among those with bulimia nervosa (BN) and 27.3% among those with anorexia nervosa (AN) (Cucchi et al, 2016). Among those with NSSI, one study found 19.4% of participants with a history of NSSI also experience ED symptoms (Muehlenkamp et al, 2012), while another study found 29.9% of people being treated for NSSI engaged in binging, purging, or food restriction (Washburn et al, 2015). …”

Nonsuicidal self-injury disorder: Does Criterion B add diagnostic utility?

“…While the proposed criteria have received initial empirical support (e.g., Glenn and Klonsky, 2013), they showed poor inter-rater reliability in the DSM-5 field trials (Regier et al, 2013). Recent studies have raised concerns about the clinical utility of criterion A and B because few differences have been identified between individuals who meet diagnostic criteria for NSSI disorder and those with a history of NSSI but don't meet the disorder criteria in both community and clinical samples (e.g., Andover, 2014; Muehlenkamp and Brausch, in press; Washburn et al, 2015). These studies indicate a strong need to further investigate the validity and utility of the different DSM-5 criterion sets.…”

“…Studies that were published well before the DSM-5 (APA, 2013) criteria indicate that almost all individuals who engage in NSSI report at least one function of the behavior, which is most commonly some form of affect regulation (Klonsky, 2007). Initial investigations of the DSM-5 criterion B have generally revealed that identifying specific functions has limited clinical utility, with one study finding that 87.7% of a sample of patients with current NSSI reported at least one function of NSSI and almost 25% reported all three functions assessed (Washburn et al, 2015). Almost all participants (98%) in an adolescent inpatient sample who met Criterion A reported affect regulation as a function of their NSSI, followed by marking distress (89%), self-punishment (88%), and anti-dissociation (88%), again indicating that functions of NSSI may not be adding diagnostic utility to NSSI Disorder (Glenn and Klonsky, 2013).…”

“…However, the existing studies on NSSI disorder criteria have predominantly focused on evaluating frequency and recency criteria only, or have evaluated the criterion set as a whole (e.g., Andover, 2014; Washburn et al, 2015; Zetterqvist et al, 2013), reporting on criterion B descriptively. Studies have not intentionally examined the clinical utility of criterion B, and the functions assessed have varied across studies, with some using existing measures of NSSI functions and others using novel items that were written to assess only the three functions outlined in the DSM criteria (Glenn and Klonsky, 2013; In-Albon et al, 2013; Selby et al, 2012; Washburn et al, 2015). The inconsistent methodologies and lack of a planned evaluation of criterion B's usefulness to diagnostically differentiating NSSI groups compromises the conclusions that can be drawn about the clinical utility of criterion B at this point.…”