Sarah E. Victor

Correlates of suicide attempts among self-injurers: A meta-analysis

Suicide attempts (SAs) are common among those who engage in non-suicidal self-injury (NSSI). It is therefore important to determine which suicide risk factors are most predictive of SA among those who self-injure. Toward this aim, we conducted a systematic review of studies examining predictors of SA history among self-injurers. A total of 52 empirical articles provided data comparing self-injurers with and without SA. From these studies we focused our meta-analysis on the 20 variables that were evaluated with respect to SA history in five or more different samples. The strongest correlate of SA history was suicidal ideation. After suicidal ideation, the strongest predictors of SA history were NSSI frequency, number of NSSI methods, and hopelessness. Additional, moderate predictors of SA history included Borderline Personality Disorder, impulsivity, Post-Traumatic Stress Disorder, the NSSI method of cutting, and depression. Demographic characteristics, such as gender, ethnicity, and age, were weakly associated with SA history. Notably, some oft-cited risk factors for SA displayed small or negligible associations with SA among self-injurers, including histories of sexual and physical abuse, anxiety, substance use, and eating disorders. Findings have implications for conceptual models of the NSSI-SA relationship and the evaluation of suicide risk among self-injuring populations.

Daily Emotion in Non‐Suicidal Self‐Injury

OBJECTIVE While major theories of non-suicidal self-injury (NSSI) emphasize the behaviors role in emotion regulation, little is known about the daily emotional experiences of self-injurers. This study investigated the specific emotions that are characteristic of those who engage in NSSI. METHOD University students (n = 84) with either no history or a recent history of NSSI completed daily diary and retrospective measures of emotional experience. To evaluate generalizability of findings, the retrospective measure was also administered to a diverse sample of U.S. adults (n = 92) with and without histories of NSSI. RESULTS Results indicate that self-injurers experience greater negative emotionality, particularly self-dissatisfaction, compared to individuals with no NSSI history. Self-injurers also reported less positive emotion, but these effects were smaller. The pattern of results was similar when controlling for Axis I psychopathology and borderline personality disorder symptoms. CONCLUSIONS Individuals who engage in NSSI experience more negative emotions, generally, and more self-dissatisfaction, specifically. Findings contribute to the growing literature on the role of emotion in the etiology and functions of NSSI.

Is non-suicidal self-injury an “addiction”? A comparison of craving in substance use and non-suicidal self-injury

There is debate among researchers regarding the most appropriate conceptual model of non-suicidal self-injury (NSSI). Some argue that NSSI is best viewed within an addictions framework. Because craving of substances is a key concept in the addictions literature, we sought to compare the nature of craving in NSSI and substance use. Measures of NSSI, substance use, and craving were administered to a sample of adolescents (n=58) receiving psychiatric treatment. It was found that total craving scores were significantly lower for NSSI than for substances. Item-level analyses suggested that substances are craved in a variety of contexts, whereas NSSI is typically craved in the context of negative emotions. The pattern of results remained the same when analyses were limited to patients who engaged in both NSSI and substance use. Thus, findings appear to be due to differences in the nature of the behaviors themselves rather than to individual differences between those who engage in NSSI or use substances. We conclude that, while both behaviors have powerful reinforcement contingencies, NSSI appears to be almost exclusively maintained by negative reinforcement (e.g., the reduction of aversive emotions). Findings are more consistent with emotion regulation than addiction models of NSSI.

Quality of life and impulsivity in bipolar disorder

Victor SE, Johnson SL, Gotlib IH. Quality of life and impulsivity in bipolar disorder.
Bipolar Disord 2011: 13: 303–309.

Nonsuicidal Self-Injury: What We Know, and What We Need to Know

For decades, knowledge about nonsuicidal self-injury (NSSI) was limited to only a small handful of empirical studies. However, the last 10 to 15 years have witnessed an explosion of research and significant advances in knowledge about NSSI. We now understand much about the classification, prevalence, correlates, forms, and functions of NSSI, and have dispelled many misconceptions. It is time for NSSI researchers to apply tills basic knowledge to develop empirically grounded theoretical models and effective treatments. Tills In Review on NSSI was developed to help the field of mental health move forward in these 2 areas. First, tills editorial briefly reviews what we now know about NSSI. Next, Margaret S Andover and Blair W Morris1 describe an emotion regulation model for understanding and potentially treating NSSI and for explaining the emotion regulation function of NSSI in terms of basic emotion models. Finally, Brianna J Turner, Sara B Austin, and Alexander L Chapman2 provide a systematic review of NSSI treatment outcome research, and note the need for new treatment approaches specifically tailored to targetNSSI. We hope that tills In Review not only provides state-of-the-art knowledge but also motivates and facilitates future efforts to better understand and treat NSSI.NSSI refers to the intentional destmction of ones own body tissue without suicidal intent and for purposes not socially sanctioned.3 4 Coimnon examples include cutting, burning, scratching, and banging or hitting, and most people who self-injure have used multiple methods.3 Because NSSI is typically associated with emotional and psychiatric distress,5,6 and because NSSI increases risk for suicide,7,8 it is cmcial to establish accurate conceptual and clinical models of tills behaviour. In tills introduction to the In Review on NSSI, we summarize what is now known about NSSI (much of which lias been learned in just the past 10 to 15 years), dispel common myths, and describe the 2 review articles featured in tills special section.What We Now KnowDespite some notable exceptions,9-11 few researchers focused attention on NSSI until recently. One might identify the early 2000s as a turning point. Kim L Gratz12 published an influential measure that facilitated research on NSSI, E David Klonsky and colleagues5 found that NSSI is present and associated with psychiatric morbidity even in nonclinical populations, Matthew K Nock and Mitch J Prinstein13 drew attention to the reasons why people engage in NSSI, and Jennifer J Muehlenkamp (see Muehlenkamp14 and Muehlenkamp and Gutierrez15) argued that NSSI should be distinguished from other SIBs, such as attempted suicide, and regarded as an independent clinical syndrome. Each of these publications has been cited in hundreds of subsequent articles, and together they arguably provided a foundation for subsequent work that has answered many key questions about the nature of NSSI, including who self-injures, why people self-injure, and the complex relation between NSSI and suicidal behaviour.Who Self-injures?NSSI is most common among adolescents and young adults. Lifetime rates in these populations are about 15% to 20%,16,17 and onset typically occurs around age 13 or 14.6,18 In contrast, about 6% of adults report a history of NSSI.19,20 It is unclear whether the lower lifetime rate in adults reflects an increase in NSSI among recent cohorts of adolescents or an artifact of memory by which most adults who self- injured as adolescents do not recall their NSSI. Generally speaking, rates of NSSI appear to be similar across different countries.21In both adolescents and adults, rates of NSSI are highest among psychiatric populations, particularly people who report characteristics associated with emotional distress, such as negative emotionality, depression, anxiety, and emotion dysregulation.5,18,22,23 NSSI is especially common in people prone to self-directed negative emotions and self-criticism. …

Characteristics of nonsuicidal self-injury associated with suicidal ideation: evidence from a clinical sample of youth

BackgroundNonsuicidal self-injury (NSSI) and suicidal ideation (SI) are both distressing and quite common, particularly in youth. Given the relationship between these two phenomena, it is crucial to learn how we can use information about NSSI to understand who is at greatest risk of suicidal thoughts. In this study, we investigated how characteristics of nonsuicidal self-injury related to SI among treatment-seeking adolescents and young adults.MethodsData were collected during routine program evaluation for a self-injury treatment program. Correlations between recent SI and NSSI characteristics were calculated for adolescent and young adult patients (N = 1502).ResultsLow severity methods of NSSI (e.g. banging) were more strongly associated with SI than high severity methods (e.g. breaking bones). SI was associated with intrapersonal (automatic) NSSI functions. SI was associated with some indices of NSSI severity, such as number of methods and urge for NSSI, but not with others, such as age of onset.ConclusionsThis study provides a valuable opportunity to expand our knowledge of suicide risk factors beyond those that may apply broadly to self-injurers and to non-injurers (e.g., depression, substance use) to NSSI-related factors that might be specifically predictive of suicidal thoughts among self-injurers. Findings inform clinical risk assessment of self-injurious youth, a population at high risk of suicidal thoughts and behaviors, and provide further insight into the complex NSSI/suicide relationship.

From ideation to action: recent advances in understanding suicide capability

Suicide capability is one of few risk factors associated with suicide attempts among ideators. In the decade since the Interpersonal Psychological Theory of Suicide introduced the concept of acquired capability (i.e. the ability to face the fear and pain associated with death), understanding of the capability to attempt suicide has grown. Acquired (e.g. NSSI), dispositional (e.g. genetic), and practical contributors (e.g. access to firearms) appear to influence suicide capability via mechanisms such as the fear of death, persistence through pain, and familiarity with suicide methods. Self-report methods have shown mixed results, highlighting the importance of developing behavioral measures of suicide capability.

Characterizing Positive and Negative Emotional Experiences in Young Adults With Borderline Personality Disorder Symptoms.

OBJECTIVES Some researchers suggest that borderline personality disorder (BPD) is characterized by elevated negative emotion; others argue that BPD involves both reduced positive and increased negative emotion. This study characterizes the emotional experiences of individuals with BPD symptoms in a combined university and community sample. METHOD Participants (N = 150) completed a clinical interview assessing BPD symptoms and self-report measures of positive and negative emotion. A subset (n = 106) completed a measure of emotion daily for 2 weeks. Pearsons correlations and multilevel modeling were used to examine the cross-sectional and longitudinal relationships between BPD symptoms and emotions. RESULTS BPD symptoms were robustly related to increased negative emotion; this relationship remained after accounting for positive emotion. BPD symptoms were weakly related to decreased positive emotion; this relationship was no longer significant after accounting for negative emotion. BPD symptoms predicted higher levels of negative and not positive emotion over 14 days. These patterns held for subscales assessing intensity, frequency, and duration of negative and positive emotions. CONCLUSION Findings suggest that individuals with BPD features are chiefly distinguished by elevated negative emotional experience.

Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults

While nonsuicidal self-injury (NSSI) is common in both men and women, research exploring the intersection of NSSI and gender has been limited by the use of small samples of males drawn primarily from non-clinical populations. To address these limitations, we analyzed data from a large sample of patients enrolled in an NSSI partial hospitalization program (PHP) to compare males and females across several variables, including NSSI characteristics, correlates, and pre-post treatment outcomes. Results indicated similar NSSI characteristics and treatment outcomes for males and females, with few exceptions. Males notably reported lower severity levels for most NSSI correlates (e.g., psychopathology, suicidality), highlighting the need to screen males for NSSI even when reporting comparatively less impairment. Finally, our results also suggest that PHP treatment for NSSI can be beneficial for both males and females. These findings have implications for the assessment, diagnosis, conceptualization, and treatment of NSSI in males and females.

Descriptive Characteristics and Initial Psychometric Properties of the Non-Suicidal Self-Injury Disorder Scale

Non-suicidal self-injury (NSSI) is highly prevalent and associated with tissue damage, emotional distress, and psychiatric disorders. While often discussed in the context of Borderline Personality Disorder and suicide, research demonstrates that NSSI is distinct from these constructs and should be viewed as an independent diagnostic category. Recently, Non-Suicidal Self-Injury Disorder (NSSID) was included in the revised Diagnostic and Statistical Manual of Mental Disorders as a condition for further study. In this article, we describe the properties of a self-report measure designed to assess proposed criteria for NSSID. Undergraduate students at 2 large, public universities completed the NSSID Scale (NSSIDS) along with other measures of NSSI characteristics and psychopathology. Among participants with a history of NSSI, approximately half (54.55%) met diagnostic criteria for NSSID. Participants were most frequently excluded from an NSSID diagnosis on the basis of criterion A (frequency of NSSI) and criterion E (distress or impairment related to NSSI), while participants were least likely to be excluded from diagnosis on the basis of criterion D (NSSI method exclusions) and criterion F (diagnostic “rule-outs”). Consistent with previous literature, the most commonly reported precipitants to NSSI were negative feelings or thoughts (criterion C2). Participants who met criteria for NSSID reported more severe depression, anxiety, and NSSI than participants who engaged in NSSI but did not meet criteria for NSSID. These results support the use of the NSSIDS as a reliable and valid self-report measure of NSSID symptoms.