Should Nonsuicidal Self-Injury be a Putative Obsessive-Compulsive-Related Condition? A Critical Appraisal

Nonsuicidal self-injury (NSSI) has many behavioral and cognitive features that would make it appear to be closely tied to obsessive-compulsive disorder (OCD). Obsessive-compulsive-related disorders (OCRDs) have been described in the literature as conditions that share a common phenomenology, neuro- biology, and treatment response.The authors reviewed the literature describ- ing the degree that NSSI is similar to, and distinct from, OCRDs based on these hypothesized common areas.They conclude with recommendations for conceptualization that draws partly from the OCRD literature and from cognitive-behavioral models of rumination

Non-suicidal self-injury attempted suicide, and suicidal intent among psychiatric inpatients

Although attempted suicide and non-suicidal self-injury (NSSI) differ in several important ways, a significant number of individuals report histories of both behaviors. The current study further examined the relations between NSSI and attempted suicide among psychiatric inpatients. Self-report questionnaires were administered to 117 psychiatric inpatients at a general hospital (M=39.45 years old, S.D.=12.84 years, range=17–73 years). We found that presence and number of NSSI episodes were significantly related to presence and number of suicide attempts. Supporting the importance of NSSI assessment, patients\u27 history of NSSI (presence and frequency) was more strongly associated with history of suicide attempts than were patients\u27 depressive symptoms, hopelessness, and symptoms of borderline personality disorder, and as strongly associated with suicide attempt history as current levels of suicidal ideation. Finally, among patients with a history of suicide attempts, those with an NSSI history reported significantly greater lethal intent for their most severe attempt, and patients\u27 number of prior NSSI episodes was positively correlated with the level of lethal intent associated with their most severe suicide attempt

Self-Mutilation and Coping Strategies in a College Sample

The goal of this study was to examine the use of specific coping strategies among self-mutilating college students. The self-mutilating group (n = 44) reported utilizing avoidance strategies more often than did a control group (n = 44) matched for general psychological distress but with no history of self-mutilation. In addition, female, but not male, self-mutilators endorsed using problem-solving and social support seeking strategies less often than nonmutilators. These findings suggest that coping strategies in general and avoidance-based strategies in particular may be important targets for the treatment of self-mutilative behaviors

Time to Emergence of Severe Suicidal Ideation Among Psychiatric Patients as a Function of Suicide Attempt History

Background: Little is known about the emergence of suicidal ideation among psychiatric inpatients with histories of no, single, or multiple suicide attempts. We investigated differences in time to reemergence of severe suicidal ideation among psychiatric patients as a function of their suicide attempt histories. Method: One hundred seventeen individuals meeting criteria for a major depressive disorder who were recently discharged from a psychiatric hospital and participating in a larger study of treatments for depression were included in the current study. Suicidal ideation, depressive symptoms, hopelessness, and depressogenic cognitions were assessed at baseline, and suicidal ideation was assessed at 3-, 6-, 12-, and 18-month follow-up, as well as inpatient readmission if applicable. Time to the reemergence of severe suicidal ideation was analyzed using survival analysis. Results: Twenty-two percent of our sample reported the occurrence of severe suicidal ideation over an 18-month period. Severe suicidal ideation emerged earlier among patients who had a history of prior suicide attempts than those who did not, but single and multiple suicide attempters did not differ significantly in time to severe suicidal ideation. Suicide attempt history remained a significant predictor of time to severe suicidal ideation when statistically controlling for hopelessness, depressive symptoms, depressogenic cognitions, and suicidal ideation at admission and initial treatment group assignment, especially between single attempters and nonattempters. Conclusions: Although nearly a quarter of participants endorsed severe, clinically significant suicidal ideation within 18 months of discharge, those with suicide attempt histories reported the occurrence of severe suicidal ideation significantly earlier than those without suicide attempt histories

The emergence of suicidal ideation during the post-hospital treatment of depressed patients

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N=103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study-related outpatient treatments. Fifty-five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post-discharge. Seventy percent of those reporting severe suicidaiity prior to hospitalization exhibited a reemergence of suicidal ideation post-discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples

Depressive characteristics of adult psychiatric inpatients with a history of multiple versus one or no suicide attempts

Background: A growing body of research suggests that individuals with a history of multiple suicide attempts exhibit more severe psychopathology than individuals with only one or no previous suicide attempts. Given the strong link between diagnoses of major depression and suicide risk, our primary goal was to determine which specific depressive characteristics differentiate multiple attempters from patients with one or no previous attempts. Methods: Participants were 121 depressed adult psychiatric inpatients. Participants were administered diagnostic interviews to assess the course and characteristics of their depression history as well as measures of suicidal ideation, suicide attempts, depressive symptoms, hopelessness, and dysfunctional attitudes. Results: Patients with a history of multiple suicide attempts exhibited higher levels of suicidal ideation and depressive symptoms, but not hopelessness or dysfunctional attitudes, than the other two groups. In addition, multiple attempters reported an earlier age of major depression onset. Conclusions: The current results add to a growing body of research suggesting that multiple attempters may represent a distinct patient population

An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics?

Researchers have reported similar prevalence rates for non-suicidal self-injury (NSSI) among men and women, yet few studies have investigated gender differences in NSSI. This study describes and compares basic NSSI characteristics among a nonclinical sample by gender. Forty-eight individuals reporting a history of NSSI were interviewed (M= 18.52 years old, SD = 1.18 years). NSSI characteristics, including frequency, age of onset, method of NSSI, pain and control during NSSI, and degree of medical injury were compared between men (n=19) and women (n=29). Men and women differed significantly on age of onset, degree of medical injury, and NSSI methods. This study supports previous findings of gender differences in NSSI and suggests that further investigation of gender differences in NSSI is warranted

Neuropsychological Functioning in Prisoners with and without Self-Injurious Behaviors: Implications for the Criminal Justice System

Neuropsychological functioning has not yet been investigated among prisoners who engage in self-injurious behaviors, specifically attempted suicide and nonsuicidal self-injury (NSSI). The purpose of this study was to investigate neuropsychological functioning in prisoners with and without histories of NSSI and attempted suicide. The sample consisted of 173 male prisoners referred for neuropsychological evaluation. Of participants, 56% reported a history of self-injury. Performance on the neuropsychological domains of intelligence, memory, attention, motor functioning, and executive functioning was assessed. No group differences were found among those with NSSI, with NSSI and suicide attempts, and with no history of deliberate self-harm, although functioning was poor in all domains. Implications of the high prevalence of self-injury in this prison sample, as well as implications of impaired functioning on the treatment of self-injurious behaviors, are discussed