In Their Own Words

Abstract

Nonsuicidal self-injury (NSSI) is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition warranting further study. Although potential advantages and disadvantages regarding this prospect have been documented, no study has examined the perspectives of those who self-injure. The goal of the current study was to give voice to these views. Seventy-six participants with an NSSI history completed quantitative and qualitative measures assessing perspectives about NSSI being included as a DSM disorder. Findings revealed mixed views overall. Thematic analysis of open-ended responses highlighted several unique advantages (i.e., enhanced understanding of NSSI, validation of the NSSI experience, facilitation of NSSI treatment, encouragement of NSSI help-seeking, reduction of NSSI stigma) and disadvantages (i.e., exacerbation of NSSI stigma, diminishment of underlying concerns). These findings speak to the need to consider the perceptions of those with lived NSSI experience; future directions and implications are discussed.

Interrogating nonsuicidal self‐injury disorder through a feminist psychiatric disability theory framework

“…Included as a ‘condition necessitating further study’ in the DSM‐5 (2013), following longstanding clinical efforts to label self‐injury as a diagnostic category (Favazza, 1992; Lewis et al., 2017; Muehlenkamp, 2005; Pattison & Kahan, 1983), the proposed diagnostic criteria for NSSID include: engagement in NSSI on 5 or more days in the past year (Criterion A); the expectation that NSSI will solve an interpersonal problem, provide relief from unpleasant thoughts and/or emotions or induce a positive emotional state (Criterion B); the experience of one or more of the following: (a) interpersonal problems or negative thoughts or emotions immediately prior to NSSI, (b) preoccupation with NSSI that is difficult to manage or (c) frequent thoughts about NSSI (Criterion C); the NSSI is not socially sanctioned or restricted to minor self‐injurious behaviours (Criterion D); the presence of NSSI‐related clinically significant distress or interference across different domains of functioning (e.g. work, relationships) (Criterion E); and the NSSI does not occur only in the context of psychosis, delirium or substance use/withdrawal and is not better accounted for by another psychiatric disorder or medical condition (Criterion F) (Gratz et al., 2015, p. 528). …”

“…These include the potential to improve research on the onset, nature and course of NSSI (Muehlenkamp, 2005); improve clinical assessment and treatment for NSSI (Selby et al., 2012); improve communication between professionals and clients, and, importantly, ‘in cases requiring a formal diagnosis for individuals to obtain medical insurance coverage (e.g. to receive psychotherapy), NSSI becoming a DSM disorder may grant individuals coverage when this was not previously possible’ (Lewis et al., 2017, p. 771) 2…”

“…Others understood NSSID as facilitating help‐seeking through a biomedical model, with one participant noting ‘[i]t would encourage individuals to seek treatment because it would help them understand that it is a mental illness that could possibly be treated by a mental health professional’ (p. 776). Importantly, Lewis et al.’s (2017) study documented critical responses to the increased medicalisation of NSSI, including the exacerbation of stigma and the diminishment of underlying concerns. For example, one participant noted that ‘It’s just another label to put on things and another reason for people to hide away under said label’ (p. 776).…”

“…Included as a 'condition necessitating further study' in the DSM-5 (2013), following longstanding clinical efforts to label self-injury as a diagnostic category (Favazza, 1992;Lewis et al, 2017;Muehlenkamp, 2005;Pattison & Kahan, 1983), the proposed diagnostic criteria for NSSID include:…”

“…In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) forwarded nonsuicidal self‐injury disorder (NSSID) as a condition necessitating further study. Preliminarily characterised by engaging in nonsuicidal self‐injury (NSSI) on five or more days in the past year, with the expectation that NSSI will relieve negative affect, induce positive affect or solve an interpersonal problem (Gratz et al., 2015), the introduction of NSSID into the DSM‐5 follows longstanding efforts by clinical researchers to distinguish NSSID from frequently associated comorbidities, such as borderline personality disorder (BPD), and to establish the efficacy of NSSID as a psychiatric disorder in its own right (Favazza, 1992; Lewis et al., 2017; Muehlenkamp, 2005; Pattison & Kahan, 1983).…”