How Often, or How Many Ways: Clarifying the Relationship Between Non-Suicidal Self-Injury and Suicidality

Abstract

This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.

Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index

“…Findings also provide support for the construct validity of the CANDI, as a diagnosis of NSSID on this interview was associated with greater clinical and diagnostic severity on a number of relevant measures as well as greater NSSI versatility (considered a marker of more severe NSSI; Turner et al, 2013). The results of this study also provide further information on (and support for) the NSSID diagnosis.…”

“…Specifically, the presence of NSSID was associated with several NSSI characteristics that have been linked to greater clinical severity (e.g., more severe NSSI, greater psychopathology and suicidality, and higher suicide risk), including the use of more NSSI methods and higher levels of intrapersonal (i.e., emotion regulation) motives (vs. interpersonal motives) for NSSI (Klonsky & Glenn, 2009;Nock & Prinstein, 2005;Turner et al, 2013). Moreover, findings that these associations remained significant when controlling for BPD suggest that an NSSID diagnosis may confer unique clinical information about NSSI severity that is not captured by a BPD diagnosis.…”

“…To this end, we examined the clinical and diagnostic correlates of NSSID as assessed with the CANDI, including the associations of NSSID with NSSI frequency, severity, versatility (i.e., use of multiple methods of NSSI; Dixon-Gordon, Tull, & Gratz, 2014;Turner, Layden, Butler, & Chapman, 2013), and motives; psychopathology and emotion dysregulation; and psychiatric disorders (including BPD and lifetime mood, anxiety, and substance use disorders). To ensure that the results of this study are relevant to NSSID per se (vs. engagement in NSSI in general), all participants in this study had a history of recent recurrent NSSI (defined as at least 10 lifetime episodes of NSSI, with at least one episode in the past year).…”

Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis

“…Although we examined a variety of potential predictors of NSSI, we were particularly interested in the roles of: (a) diagnosis (anorexia v. bulimia) and diagnostic subtype within anorexia (eating-purging v. restrictive), in line with evidence that NSSI is more prevalent in individuals with binge and purge behaviours, i.e. patients with BN or those with the binge eating-purging subtype of AN (Svirko & Hawton, 2007); (b) history of attempted suicide, in line with evidence that NSSI shows a positive association with suicide risk in various unselected and clinical populations (Jacobson & Gould, 2007;Turner et al 2013;Kostro et al 2014); and (c) history of substance abuse, in line with evidence that individuals with substance disorders are more likely to self-injure (Klonsky & Muehlenkamp, 2007). Quantifying, for the first time, the association of NSSI with each of the above predictors makes a valuable contribution to the evidence base, which is again limited by the lack of weighted aggregate data.…”

Characterizing Interpersonal Difficulties Among Young Adults Who Engage in Nonsuicidal Self-Injury Using a Daily Diary

“…First, this study examined interpersonal functioning among individuals with an established pattern of NSSI (i.e., at least 10 lifetime episodes). Moreover, the sample reported relatively severe NSSI, as evidenced by high rates of cutting and past medical treatment for NSSI, as well as the use of multiple methods of NSSI (see Turner, Layden, Butler, & Chapman, 2013). Although this is a clinically relevant population, the extent to which our findings generalize to individuals with less frequent, severe, or emerging NSSI remains unclear.…”