Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents

Abstract

Background: Non-suicidal self-injury (NSSI) is a serious public health concern in adolescents. In 2013, DSM-5 recognized NSSI as a distinct clinical phenomenon and made a call for more systematic research by including Non-Suicidal Self-Injury-Disorder (NSSI-D) as a condition requiring further research. Yet, few studies have examined the prevalence of NSSI-D in adolescents using the exact DSM-5 criteria. Additionally, the few studies available criticised several of the proposed diagnostic criteria and pointed out that more research is needed. Methods: Therefore, we examined prevalence rates of NSSI-D and investigated the four most controversial criteria (i.e., criteria A, B/C, and E) in a large community sample of adolescents (N = 2,130; 54% female; M age = 15, SD = 1.81). Results: Our results show an overall NSSI-D prevalence rate of 7.6%, with significantly more girls (11.7%) than boys (2.9%) meeting the diagnosis. The prevalence of NSSI-D dropped to 5.5% when an alternative criterion A (i.e., ≥10 days of NSSI in the past year) was implemented. In our sample, 87% and 99% of adolescents with lifetime NSSI met criteria B and C, which clearly questions the clinical utility of these criteria for the DSM-5 diagnosis of NSSI-D. Importantly, however, although criterion E received relatively low endorsement, it significantly distinguished adolescents with and without NSSI-D from one another. Limitations and conclusion: Although our conclusions are restricted by the cross-sectional nature of our study, these findings show that NSSI-D is common in community adolescents and offer new insights in the endorsement and clinical utility of specific NSSI-D criteria.

Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index

“…The present study also confirmed previous studies (22,25) concerning criterion E, which had the lowest endorsement (72.4%). This has also shown to be the case in community samples of adolescents (11,12). Criterion E is a necessary prerequisite for discriminating those meeting NSSID criteria from those who do not (21,23), since the diagnosis needs to identify those who are impaired by their symptoms.…”

“…This could potentially increase utility in clinical samples. One such attempt was made by Muehlenkamp et al (18), who investigated differences between groups with low (1-4), moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and high (≥25) NSSI frequency.…”

“…The potential diagnosis of NSSID is conceptualized as a condition that can occur with or without other comorbidities, such as BPD, as well as suicidality (9). Preliminary data have shown that NSSID prevalence rates range between 5.6% and 7.6% among non-clinical samples of adolescents (10)(11)(12), and 0.2-0.8% in young adults (13,14). In clinical adolescent selfinjuring samples, between 74% and 78% meet full criteria (8,15).…”

“…The diagnostic prerequisite of functional impairment and/or distress caused by the disorder is met by criterion E. The issue of impairment or distress has also been empirically examined (21). Although criterion E is often the least commonly met in several studies (11,14,21,22), it best discriminates those with an NSSID diagnosis from those not meeting full criteria (23). Finally, criterion F describes possible exclusion and differential diagnoses that potentially better explain the self-injurious behavior (7).…”

Temperament and Character Traits of Female Eating Disorder Patients with(out) Non-Suicidal Self-Injury

“…Adolescents seem to be most vulnerable, as NSSI onset peaks in mid-adolescence, around the ages of 14 and 15 [7]. The vulnerability of adolescents is also reflected in NSSI prevalence rates; epidemiological research consistently indicates that as many as 17% of adolescents in non-clinical samples have engaged in NSSI at least once [8][9][10]. Prevalence rates rise even higher in clinical samples, with young patients with an eating disorder being particularly at risk as up to 60% of this adolescent population engages in NSSI throughout their lifetime [11][12][13][14].…”