User:Ongmianli/Portfolios/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 NSSI in Different Populations and Clinical Settings
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

DSM-V Criteria and 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. In the newest version of the manual (DSM-IV), non-suicidal self-injury (NSSI) is listed as a "condition for further study." The proposed preliminary criteria for NSSI are as follows:


 * 5 or more days of intentional self-inflicted damage to the surface of the body likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., without suicidal intent) within the past year.

Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual's repeated engagement in a behavior that the individual knows, or       has learned, is not likely to result in death.


 * 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)
 * preoccupation with the intended behavior that is difficult to control
 * ruminating on (non-suicidal) self-injury frequently, even when not acted upon
 * The behavior must cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.
 * The behavior can not be better explained by another mental disorder or medical condition.

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.

Comparison of Screening and Outcomes Measures
Instrument Types


 * Omnibus Measures
 * Assess several NSSI domains
 * These tests are the most comprehensive compared to other measures
 * Functional Measures
 * Helpful for understanding why people self-injure
 * These tests assess motives for, or functions of, NSSI
 * Behavioral Measures
 * Primarily assess one's history of NSSI behaviors
 * These measures are useful for assessment methods used and NSSI frequency
 * Brief Measures
 * Include a single item or a few items to assess NSSI
 * These may be best when conducting a brief assessment

Recommendations

 * Omnibus measures are highly recommended over all other types of measures.
 * The SITBI is the best clinical interview for assessing adolescent NSSI
 * The SASII was designed to assess NSSI among adults.

Psychometric Properties of Instruments for Assessing Non-suicidal Self-Injury
SASII, Suicide Attempt Self-Injury Interview (Linehan, et al., 2006); G, good; E, excellent; A, adequate; SITBI, Self-Injurious Thoughts and Behaviors Interview (Nock et al, 2007); NA, not applicable; U, unavailable; SBQ, Suicidal Behaviors Questionnaire (Linehan, 1981); SHBQ, Self-Harm Behavior Questionnaire (Gutierrez et al., 2001); FASM, Functional Assessment of Self-Mutilation (Lloyd-Richardson et al., 1997); ISAS, Inventory of Statements About Self-Harm (Glenn & Klonsky, 2007); SIQ, Self-Injury Questionnaire (Santa Mina et al., 2006); SIMS, Self-Injury Motivation Scale (Osuch et al., 1999); SHRQ, Self-Harm Reasons Questionnaire (Lewis & Santor, 2008); DSHI, Deliberate Self-Harm Inventory (Gratz, 2001); SHI, Self-Harm Inventory (Sansone et al., 1998); SNAP, Schedule for Nonadaptive and Adaptive Personality (Clark, 1996); TSI, Trauma Symptom Inventory (Briere, 1995)

Search terms: [Non-suicidal self-injury or NSSI or Self harm] AND [children OR adolescents] AND [assessment] in PsychINFO and Google Scholar

Sources consulted: Klonsky, E. D., & Lewis, S. P. (2014). Assessment of nonsuicidal self-injury. In M. K. Nock, M. K. Nock (Eds.), The Oxford handbook of suicide and self-injury (pp. 337-351). New York, NY, US: Oxford University Press.; Nock (Eds.), Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: Am. Psychol. Assoc.

Scope of Instruments for Assessing Non-suicidal Self-Injury (NSSI)
SASII, Suicide Attempt Self-Injury Interview; I, (structured) interview; S, self-report; SITBI, Self-Injurious Thoughts and Behaviors Interview; SBQ, Suicidal Behaviors Questionnaire; SHBQ, Self-Harm Behavior Questionnaire; FASM, Functional Assessment of Self-Mutilation; ISAS, Inventory of Statements About Self-Harm; SIQ, Self-Injury Questionnaire; SIMS, Self-Injury Motivation Scale; SHRQ, Self-Harm Reasons Questionnaire (* = revised SHRQ); DSHI, Deliberate Self-Harm Inventory; SHI, Self-Harm Inventory; SNAP, Schedule for Nonadaptive and Adaptive Personality, 375 items in the total measure; TSI, Trauma Symptom Inventory, 100 items in the total measure.

Search terms: [Non-suicidal self-injury or NSSI or Self harm] AND [children OR adolescents] AND [assessment] in PsychINFO and Google ScholarTreatment

Sources consulted: Klonsky, E. D., & Lewis, S. P. (2014). Assessment of nonsuicidal self-injury. In M. K. Nock, M. K. Nock (Eds.), The Oxford handbook of suicide and self-injury (pp. 337-351). New York, NY, US: Oxford University Press.; Nock (Eds.), Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: Am. Psychol. Assoc.

Treatment
According to Nock (2010), no treatment for NSSI could be considered "evidence-based." However, recent years have seen an increase in intervention trials for NSSI. Although limited due to lack of consistency in defining and measuring NSSI, this work could provide insight into potential best practices for treating this condition (Andover, 2015).

Dialectical Behavioral Therapies
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.

Cognitive/Behavioral Therapies
Few research studies have tested cognitive-behavioral therapy (CBT) as a treatment specifically for NSSI. However, some studies have evaluated the efficacy of CBT trials in treating self-injury with and without suicidal intent. Manual-assisted cognitive therapy (MACT) is a 6-session CBT intervention focusing on functions of deliberate self-harm, emotion regulation, problem-solving skills, and relapse prevention. MACT has demonstrated mixed results for decreasing NSSI frequency and severity among adults (Tyrer et al., 2003; Weinberg, Gunderson, Hennen, & Cutter, 2006). Although MACT may be a promising intervention (Muehlenkamp, 2006), it should be evaluated in future studies. In one adolescent treatment trial, the Adolescent Depression Antidepressant Psychotherapy Trial (ADAPT), a decrease in NSSI behaviors was found at post-treatment for both SSRI and SSRI+CBT groups (Goodyer et al., 2007), although no differences were found between groups. In sum, findings from efficacy trials of CBT on NSSI outcomes are mixed, and more trials examining CBT as a treatment specifically for NSSI are needed.

Pharmacology
Pharmacological interventions are especially scarce. However, one study found that fluoxetine was effective at reducing NSSI frequency in a sample of 22 adults with major depressive disorder and either BPD or schizotypal personality disorder (Markovitz et al, 1991). A second trial found that antidepressant medications alone (SSRIs and SNRIs) were as effective as medication plus CBT in reducing NSSI among adolescents with MDD (Brent et al., 2009; Goodyer et al., 2007). Ziprasidone, an atypical antipsychotic, was found to be more effective in reducing NSSI behaviors among adolescents compared to another neuroleptic medication (Libal et al., 2005). Clonidine has also been effective as an intervention for acute NSSI urges and feelings of tension among a sample of patients with BPD (Philipsen et al., 2004), although the long-term effects are unknown.

Prevention Programs
Jacobs, Walsh, McDade, and Pigeon (2009) developed the only known prevention program for NSSI, the Signs of Self-Injury program (SOSI). This school-based prevention program is designed to increase awareness about NSSI among adolescents through psychoeducation about warning signs and symptoms and improvement of help-seeking behaviors and attitudes. One test of effectiveness and acceptance found the program to be feasible and effective at changing attitudes toward NSSI and increasing help-seeking among students (Muehlenkamp et al., 2010).