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=Non-Suicidal Self Injury (description, assessment and diagnosis)=

Diagnostic Changes
Whereas in DSM-IV non-suicidal self-injury (NSSI) was considered a symptom of borderline personality disorder (BPD), in the revised manual it is recognized as a distinct condition. Research suggests that NSSI can occur independent of BPD, such as in patients with depression or even in those with no other diagnosable psychopathology. Criteria for NSSI require: Socially sanctioned behaviors, like body piercing and tattooing, do not qualify for the diagnosis, nor do scab picking or nail biting. Important to note is that patients who express suicidal behavior within the past 24 months, but who don't qualify for another psychiatric disorder, now fall under the new "suicidal behavior" diagnosis category.
 * 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent within the past year
 * Patients also must engage in the self-injurious behavior with at least 1 of the following expectations:
 * to seek relief from a negative feeling or cognitive state
 * to resolve an interpersonal difficulty
 * to induce a positive state
 * The behavior must also be associated with 1 of the following criteria:
 * interpersonal difficulty or negative feelings and thoughts (eg, depression, anxiety)
 * premeditation
 * ruminating on (non-suicidal) self-injury

Demographic Information
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of Non-Suicidal Self Injury that they are likely to see in their clinical practice.

Base Rates of Adolescent NSSI in different clinical settings

 * Sources consulted: Nock (Eds.), Understanding nonsuicidal self-injury: Origins, assessment, and treatment. Washington, DC: Am. Psychol. Assoc.
 * Search terms: [Non-suicidal self-injury or NSSI or Self harm] AND [children OR adolescents] AND [prevalence OR incidence OR epidemiological] in Psychinfo and Google Scholar

Comparison of screening and outcomes measures
Suggested Clinical Interviews that Directly Assess NSSI:
 * Recommended Diagnostic Interviews:
 * The SITBI is the best clinical interview for assessing adolescent NSSI
 * The SASII was designed to assess NSSI among adults.
 * Sources consulted: Nock (Eds.), Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: Am. Psychol. Assoc.
 * Search terms: [Non-suicidal self-injury or NSSI or Self harm] AND [children OR adolescents] AND [assessment] in PsychINFO and Google Scholar

Suggested Self-report Measures that Directly Assess NSSI:
 * Recommended Self-report:
 * For baseline assessment it cannot be determined if the DSHI, FASM, or ISAS is superior.
 * The DSHI or ISAS are recommended for use as progress or outcome measures, because there is more psychometric information available on these measures.
 * Sources consulted: Nock (Eds.), Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: Am. Psychol. Assoc.
 * Search terms: [Non-suicidal self-injury or NSSI or Self harm] AND [children OR adolescents] AND [assessment] in PsychINFO and Google Scholar

Treatments
There is currently no empirically supported treatment for NSSI. Dialectical Behavior Therapy has been shown to be effective in treating individuals with Borderline Personality Disorder (BPD) who engage in NSSI; however it has not been shown to be better than treatment as usual in a sample of individuals without BPD. In the absence of a better option, a DBT approach to treatment is the most evidence based.

Local Resources
Local DBT specialists:
 * Jennifer Kirby (919-491-0175)
 * Jill Compton (919-416-2089)
 * Zack Rosenthal (919-684-6702)

Hotlines and Online Resources

 * S.A.F.E. (Self-Abuse Finally Ends) Alternatives Information and Referral Line
 * 1.800.DONT.CUT (366-8288)
 * www.selfinjury.com
 * S.A.F.E. Alternatives is a nationally recognized treatment approach, professional network, and educational resource base, which is committed to helping people achieve an end to self-injurious behavior, self-harm, or non-suicidal self-injury.


 * National Suicide Prevention Lifeline
 * 1-800-273-TALK (1-800-273-8255)
 * Hours: 24-hour
 * Languages: English and Spanish, have access for interpreters for 155 other languages
 * Can refer callers to local mental health providers. If they appear to be in immediate danger, they may link them to an emergency counselor for emergency intervention. If they think a suicide action is imminent they will send emergency personnel to the location of the call.


 * Hopeline Suicide Hotline
 * 1-800-SUICIDE (1-800-784-2433)
 * Hours: 7 a.m. – 11 p.m.
 * Languages: English and Spanish services
 * Same services offered as the National Suicide Prevention hotline. If you call the National Suicide Prevention lifeline listed above, you will be routed to this number which is specific to some areas in North Carolina like Chapel Hill.