Self-injury and externalizing pathology: a systematic literature review

Abstract

BackgroundDuring the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications.MethodsA systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD).ResultsFinally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors.ConclusionsBased on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.

Consumo de alcohol y factores de riesgo de conductas autolesivas en adolescentes españoles

“…Una situación parecida se da con la hiperactividad, que solo apareció asociado significativamente de forma débil a la conducta suicida en el estudio SEYLE. Estudios previos encontraron relación entre la hiperactividad como trastorno y las conductas autolesivas (Balázs et al, 2018;Bentley, Cassiello-Robbins, Vittorio, Sauer-Zavala y Barlow, 2015;Meszaros et al, 2017). También se ha postulado que la relación de la hiperactividad con las autolesiones pudiera ser indirecta a través de factores comunes como la impulsividad, como demostrarían los resultados de distintos estudios que, además, ponen de manifiesto que la asociación sería diferente en función del sexo (Hinshaw et al, 2012;Huang et al, 2017;Kashden, Fremouw, Callahan y Franzen, 1993;Meza, Owens y Hinshaw, 2016).…”

“…También se ha encontrado asociación entre autolesiones y psicopatología. La presencia de psicopatología externalizante en los adolescentes (relacionadas con las manifestaciones de agresividad, falta de atención, desobediencia y conducta delictiva) se asocia con más autolesiones no suicidas, y los adolescentes que se ven sometidos a situaciones vitales generadoras de frustración o vacío existencial presentan más conductas suicidas (Blasco-Fontecilla, 2018;Meszaros, Horvath y Balazs, 2017).…”

Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender

“…The prevalence of NSSI in an adolescent population sample was found to be 13–45% [ 23 , 24 ], while it was 4% in adults [ 25 ] and 40–80% in a clinical sample of adolescents [ 26 , 27 ]. It is also well known today that NSSI is often comorbid with both internalizing and externalizing disorders [ 28 , 29 ]. Recently, several researchers have focused on the connection between self-injurious behaviours and suicide and found that the two phenomena often overlap [ 26 , 30 , 31 ], and share comorbid conditions, such as borderline personality disorder [ 32 ], depression and/or anxiety [ 33 ], and/or alcohol dependence [ 34 ], and/or ADHD (see below).…”

“…Researchers have been recently a growing interest in a possible association between ADHD and self-injury, including NSSI – already two systematic review papers have summarized the results and found a strong association between ADHD and self-injury [ 28 , 29 ]. One of the common traits of the two phenomena is poor response inhibition, which is associated with impulsivity [ 36 , 37 ].…”

Social Representations About the Functions of Deliberate Self-Harm: Construction and Validation of a Questionnaire for Portuguese Adults

“…Due to the increased awareness about deliberate self-harm among adolescents, research about this phenomenon has also increased (Jacobson & Gould, 2007; Meszaros, Horvath, & Balazs, 2017). Additionally, studies have found that these behaviours are more present in the general media and internet (Niwa & Mandrusiak, 2012; Reddy, Rokito, & Whitlock, 2016; Swannell et al, 2010; Trewavas, Hasking, & McAllister, 2010; Whitlock, Powers, & Eckenrode, 2006; Whitlock, Purington, & Gershkovich, 2009; Zdanow & Wright, 2012).…”