Understanding self‐injury recovery: Views from individuals with lived experience

Lewis, Stephen P.; Kenny, Therese E.; Whitfield, Kristen M.; Gómez, Jennifer M.

doi:10.1002/jclp.22834

Cited by 45 publications

(117 citation statements)

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“…Nevertheless, given the clinical relevance of NSSI, including the prospect of its inclusion in the diagnostic nomenclature (e.g., American Psychiatric Association, 2013), consideration to what NSSI recovery is and what ought to be considered in its context seems warranted. Moreover, recovery is a central part of NSSI discourses among people with lived experience as well as in research, clinical, and family settings (e.g., Lewis et al, 2019; Ryan‐Vig et al, 2019).…”

Section: Self‐injury Recoverymentioning

confidence: 99%

“…Finally, the TTM focuses on behavioral change. While no longer self‐injuring might be one outward sign of recovery, thoughts and urges to self‐injure can endure which can leave people feeling as though they have not “recovered” regardless of the time since they self‐injured (Kelada et al, 2018; Lewis et al, 2019).…”

Section: Recovery Frameworkmentioning

confidence: 99%

“…Much more research explicitly addressing recovery is qualitative in nature. Here, people with lived experience have not only shared their experiences of NSSI recovery, but talked about what recovery means to them, and how they come to understand the concept (e.g., Kelada et al, 2018; Lewis et al, 2019). A key theme across these efforts is that people with lived experience do not conceptualize recovery as just behavioral cessation.…”

Section: Research On Nssi Recoverymentioning

confidence: 99%

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Self‐injury recovery: A person‐centered framework

Lewis

Hasking

2020

J Clin Psychol

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Growing interest has been paid to the concept of non‐suicidal self‐injury (NSSI) recovery. In research, and sometimes clinical practice, the focus has been on NSSI cessation, with recovery operationalised with reference to the time since someone last self‐injured. Yet, perspectives from people with lived experience of NSSI indicate that recovery is much more complex. Drawing on recent empirical work, and the voices of people with lived experience of NSSI, we outline a new framework for conceptualizing NSSI recovery. We argue that recovery is nonlinear and multifaceted, comprising: Realistic Expectations and Setbacks; Normalizing Thoughts and Urges; Fostering Self‐efficacy; Identifying Strengths; Finding Alternatives; Addressing Underlying Adversities; Addressing and Accepting Scarring; Navigating Disclosures; and Self‐acceptance. In presenting research and clinical implications of this new framework, we propose that this framing offers a more complete understanding of NSSI recovery—one conducive to optimizing wellbeing and promoting resilience among individuals with lived experience.

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Section: Self‐injury Recoverymentioning

confidence: 99%

Section: Recovery Frameworkmentioning

confidence: 99%

Section: Research On Nssi Recoverymentioning

confidence: 99%

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Self‐injury recovery: A person‐centered framework

Lewis

Hasking

2020

J Clin Psychol

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“…Even if it did, for how long must one have ceased engaging in NSSI before being considered "recovered," and what differentiates a lapse from and relapse? New research suggests that those with lived NSSI experience frequently view recovery as more than simply ceasing NSSI (Lewis, Kenny, Whitfield, & Gomez, 2019). Even though recovery is often subjective and has different meanings to different people, many view recovery as extending beyond NSSI cessation to include the absence of NSSI thoughts and urges and greater self-acceptance, among other areas requiring progress (Lewis et al, 2019).…”

mentioning

confidence: 99%

“…New research suggests that those with lived NSSI experience frequently view recovery as more than simply ceasing NSSI (Lewis, Kenny, Whitfield, & Gomez, 2019). Even though recovery is often subjective and has different meanings to different people, many view recovery as extending beyond NSSI cessation to include the absence of NSSI thoughts and urges and greater self-acceptance, among other areas requiring progress (Lewis et al, 2019). In short, recovery typically includes both the absence of NSSI and the presence of mental wellness.…”

mentioning

confidence: 99%

Not a fad: Nonsuicidal self-injury and suicide attempts

Westers

2019

Clin Child Psychol Psychiatry

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A recent meta-analysis indicated that 22.9% of adolescents across the globe report having engaged in nonsuicidal self-injury (NSSI) at least once in their lifetime and 18.6% report having engaged in NSSI in the past 12 months (Gillies et al., 2018). Although distinct from suicide behavior, NSSI is a strong risk factor for attempting suicide (Castellví et al., 2017). The World Health Organization (2018) has identified suicide as a public health priority, citing as a key fact that suicide is the second leading cause of death worldwide among 15-to 29-year-olds. This issue of Clinical Child Psychology and Psychiatry (CCPP) includes two articles that examine NSSI over time and one article that examines suicide attempts over time, all among clinical samples of adolescents in the United States, where 17.6% of adolescents in secondary school report having engaged in NSSI in the past 12 months (Monto, McRee, & Deryck, 2018) and suicide is the second leading cause of death not only among ages 15-29 but also among 10-to 14-year-olds (Centers for Disease Control and Prevention, 2017). One common myth about NSSI is that adolescents who self-injure will "grow" out of the behavior, as if it is a phase or a fad (Lewis, Mahdy, Michal, & Arbuthnott, 2014). On the contrary, research has suggested that NSSI often persists into adulthood and that many adults who engage in NSSI began self-injuring when they were teenagers (Klonsky, 2011). In this issue of CCPP, Adrian, Zeman, Erdley, Whitlock, and Sim (2019) longitudinally explore changes in the frequency of NSSI among a group of teenage girls initially admitted to a psychiatric inpatient program. Their study reveals that few participants ceased NSSI over the 2.5-year study, and the majority of those who had not engaged in NSSI at the outset of the study had begun engaging in NSSI by the end of it. There was also a significant increase in NSSI frequency over time, predicted by greater difficulty with emotion regulation and internalizing symptoms. In a second article in this issue of CCPP, Taliaferro, Almeida, Aguinaldo, and O'Brien (2019) use in-depth qualitative interviews to explore self-reported changes in NSSI over time among a group of predominantly female adolescents admitted to a psychiatric inpatient program following a suicide attempt. Their analysis of interviews reveals that, although many participants denied any relationship between their NSSI and suicide attempt, more than half noted that NSSI eventually stopped serving a helpful purpose and subsequently left them feeling the need for something more, as if suicide was the natural next step. If NSSI tends to remain stable among clinical samples of adolescents or even worsen over time, and if NSSI tends to either change function or lose effectiveness as a coping strategy over time among some youth and significantly increase risk for suicide, when is the best time to intervene

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Symptom Shifting From Nonsuicidal Self-Injury to Substance Use and Borderline Personality Pathology

Steinhoff,

Cavelti,

Koenig

et al. 2024

JAMA Netw Open

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ImportanceA decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered.ObjectiveTo examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology.Design, Setting, and ParticipantsThis cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024.Main Outcomes and MeasuresThe frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria.ResultsOverall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P &lt; .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54]).Conclusions and RelevanceIn this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.

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Understanding self‐injury recovery: Views from individuals with lived experience

Cited by 45 publications

References 45 publications

Self‐injury recovery: A person‐centered framework

Self‐injury recovery: A person‐centered framework

Not a fad: Nonsuicidal self-injury and suicide attempts

Symptom Shifting From Nonsuicidal Self-Injury to Substance Use and Borderline Personality Pathology

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