Catherine R. Glenn

Assessing the Functions of Non-suicidal Self-injury: Psychometric Properties of the Inventory of Statements About Self-injury (ISAS)

The present study reports the psychometric properties of the Inventory of Statements About Self-injury (ISAS), a measure designed to comprehensively assess the functions of non-suicidal self-injury (NSSI). The ISAS assesses 13 functions of NSSI, as well as the frequency of 12 NSSI behaviors. The ISAS was administered to 235 young adults from a college population who had performed at least one NSSI behavior. Consistent with previous research, ISAS functions comprised two factors representing interpersonal and intrapersonal functions. In addition, the ISAS factors exhibited excellent internal consistency and expected correlations with both clinical constructs (e.g., borderline personality disorder, suicidality, depression, anxiety) and contextual variables (e.g., tendency to self-injure alone). Findings support the reliability and validity of the ISAS. The ISAS may be useful in research and treatment contexts as a comprehensive measure of NSSI functions.

The Relationship Between Nonsuicidal Self-Injury and Attempted Suicide: Converging Evidence From Four Samples

Theoretical and empirical literature suggests that nonsuicidal self-injury (NSSI) may represent a particularly important risk factor for suicide. The present study examined the associations of NSSI and established suicide risk factors to attempted suicide in four samples: adolescent psychiatric patients (n = 139), adolescent high school students (n = 426), university undergraduates (n = 1,364), and a random-digit dialing sample of United States adults (n = 438). All samples were administered measures of NSSI, suicide ideation, and suicide attempts; the first three samples were also administered measures of depression, anxiety, impulsivity, and borderline personality disorder (BPD). In all four samples, NSSI exhibited a robust relationship to attempted suicide (median Phi = .36). Only suicide ideation exhibited a stronger relationship to attempted suicide (median Phi = .47), whereas associations were smaller for BPD (median rpb = .29), depression (median rpb = .24), anxiety (median rpb = .16), and impulsivity (median rpb = .11). When these known suicide risk factors and NSSI were simultaneously entered into logistic regression analyses, only NSSI and suicide ideation maintained significant associations with attempted suicide. Results suggest that NSSI is an especially important risk factor for suicide. Findings are interpreted in the context of Joiners interpersonal-psychological theory of suicide; specifically, NSSI may be a uniquely important risk factor for suicide because its presence is associated with both increased desire and capability for suicide.

EMOTION DYSREGULATION AS A CORE FEATURE OF BORDERLINE PERSONALITY DISORDER

Borderline personality disorder (BPD) is a debilitating mental illness that affects approximately 1-2% of the general population. Researchers have increasingly come to view emotion dysregulation as a core feature of BPD. The present study examines the relationship between BPD symptomatology and emotion dysregulation using the Difficulties in Emotion Regulation Scale (DERS) in two college samples. BPD symptoms were assessed by self-report (MSI-BPD) in sample 1 and by semi-structured interview (SIDP-IV) in sample 2. Results suggest that emotion dysregulation accounts for unique variance in BPD even after controlling for traditional indicators of negative emotionality, including depression, anxiety, and negative affect. Findings support theories regarding the role of emotion dysregulation in BPD and provide directions for future research.

A multimethod analysis of impulsivity in nonsuicidal self-injury.

Impulsivity has been proposed as an important construct in nonsuicidal self-injury (NSSI). Yet, research on the relationship of impulsivity to NSSI has been mixed. The present study clarified this relationship using a multifaceted measure of impulsivity (i.e., UPPS Impulsive Behavior Scale), and a computer-based behavioral measure of inhibitory control (i.e., a stop-signal task). Participants were 82 confirmed self-injurers and 86 controls recruited from a college population. Self-injurers and controls performed similarly on the stop-signal task. On the UPPS, self-injurers were best distinguished by Urgency (committing rash decisions when faced with negative emotions), and distinguished to a lesser degree by lack of Premeditation (inability to delay action in order to plan) and Sensation Seeking (seeking excitement and adventure). Among self-injurers, lack of Perseverance (inability to stay with a task through completion) predicted more recent and frequent NSSI. Conceptual and clinical implications are discussed.

Nonsuicidal Self-Injury Disorder: An Empirical Investigation in Adolescent Psychiatric Patients

Nonsuicidal self-injury (NSSI) is a growing public health concern, especially among adolescents. In the current edition of the Diagnostic and Statistical Manual of Mental Disorders, NSSI is classified as a criterion of borderline personality disorder (BPD). However, a distinct NSSI disorder will now be included in DSM–5 as a “condition requiring further study.” It is important to note that, at this time, there is little direct evidence supporting the DSM–5 proposal over the DSM–IV classification. To address this need, the current study examined the extent to which NSSI occurs independently of BPD and has clinical significance beyond a diagnosis of BPD in adolescent psychiatric patients. NSSI disorder was assessed based on the proposed DSM–5 criteria in 198 adolescents ages 12 to 18 (74% female; 64% Caucasian, 14% Hispanic, 10% African American, and 12% mixed/other ethnicity) from a psychiatric hospital. Major Axis I disorders, Axis II BPD, and suicide ideation and attempts were assessed with structured clinical interviews; emotion dysregulation and loneliness were measured with validated self-report questionnaires. First, results indicated that NSSI disorder occurred independently of BPD. Specifically, although there was overlap between the occurrence of BPD and NSSI disorder, this overlap was no greater than that between BPD and other Axis I disorders (e.g., anxiety and mood disorders). Second, NSSI disorder demonstrated unique associations with clinical impairment—indexed by suicide ideation and attempts, emotion dysregulation, and loneliness—over and above a BPD diagnosis. Taken together, findings support the classification of NSSI as a distinct and clinically significant diagnostic entity.

Improving the Short-Term Prediction of Suicidal Behavior

Aspirational Goal 3 of the National Action Alliance for Suicide Preventions Research Prioritization Task Force is to predict who is at risk for attempting suicide in the near future. Despite decades of research devoted to the study of risk and protective factors for suicide and suicidal behavior, surprisingly little is known about the short-term prediction of these behaviors. In this paper, we propose several questions that, if answered, could improve the identification of short-term, or imminent, risk for suicidal behavior. First, what factors predict the transition from suicidal thoughts to attempts? Second, what factors are particularly strong predictors of making this transition over the next hours, days, or weeks? Third, what are the most important objective markers of short-term risk for suicidal behavior? And fourth, what method of combining information about risk and protective factors yields the best prediction? We propose that the next generation of research on the assessment and prediction of suicidal behavior should shift, from cross-sectional studies of bivariate risk and protective factors, to prospective studies aimed at identifying multivariate, short-term prediction indices, examining methods of synthesizing this information, and testing the ability to predict and prevent suicidal events.

(Why) Do I Think What You Think? Epistemic Social Tuning and Implicit Prejudice

This research examines whether people who experience epistemic motivation (i.e., a desire to acquire knowledge) came to have implicit attitudes consistent with the apparent beliefs of another person. People had lower implicit prejudice when they experienced epistemic motivation and interacted with a person who ostensibly held egalitarian beliefs (Experiments 1 and 2). Implicit prejudice was not affected when people did not experience epistemic motivation. Further evidence shows that this tuning of implicit attitudes occurs when beliefs are endorsed by another person, but not when they are brought to mind via means that do not imply that persons endorsement (Experiment 3). Results suggest that implicit attitudes of epistemically motivated people tune to the apparent beliefs of others to achieve shared reality.

Evidence-Based Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth

The purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following hospital discharge).

The development of fear learning and generalization in 8-13 year-olds.

The current study examined developmental changes in fear learning and generalization in 40 healthy 8-13 year-olds using an aversive conditioning paradigm adapted from Lau et al. [Lau et al. [2008] Journal of the American Academy of Child and Adolescent Psychiatry 47:94-102]. In this task, the conditioned stimuli (CS+/CS-) are two neutral female faces, and the unconditioned stimulus is a fearful, screaming face. The second phase of the study also included a generalization stimulus (GS): a 50% blend of the CS± faces. The eye-blink startle reflex was utilized to measure defensive responding. Patterns of fear learning and generalization were qualified by child age. Older children demonstrated greater fear learning (i.e., larger startle during CS+ than CS-) than younger children. In addition, older children exhibited the typical pattern of generalization observed in adults, whereas younger children did not. Finally, fear learning also related to contingency awareness; only children who correctly identified the CS+ demonstrated fear-potentiated startle to the CS+. Clinical implications and future directions are discussed.

One-year test-retest reliability of the Inventory of Statements about Self-Injury (ISAS).

Nonsuicidal self-injury (NSSI) is a growing public health problem among adolescents and young adults. The Inventory of Statements About Self-Injury (ISAS) is a self-report measure designed to assess NSSI behaviors and functions. The current study examines the one-year test—retest reliability of the ISAS in a sample of young adult self-injurers. Results indicate that the ISAS behavioral and functional scales demonstrate good stability over one year. For the behavioral scales, test—retest correlations ranged from .52 (biting) to .83 (burning), with a median of .68. For the functional scales, test—retest correlations were .60 for the superordinate intrapersonal functions scale and .82 for the superordinate interpersonal functions scale. Regarding individual functions, test—retest correlations ranged from .35 (affect regulation) to .89 (peer bonding), with a median of .59. Findings suggest the ISAS has good test—retest reliability and contributes to the growing literature on the psychometric properties of the ISAS.