DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior

Abstract

Introduction

Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior.

Methods

Data were collected from 103 outpatient adolescents (ages 12–18) with recurrent self-harm behavior.

Results

Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%.

Conclusion

This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.

Keywords:

• Non-suicidal self-injury
• suicide attempt
• adolescent

ACKNOWLEDGEMENTS

The authors wish to thank the patients, clinicians and leaders at the participating clinics.

ETHICAL APPROVAL

The study was approved by the Regional Committee for Medical Research Ethics, South-East Norway. All methods were carried out in accordance with relevant guidelines and regulations.

CONSENT FORM

Adolescents and their parents provided written informed consent prior to inclusion.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHOR NOTES

Anne Brager-Larsen and Pål Zeiner, Division of Mental Health and Addiction, Department of Research and Innovation, Child and Adolescent Mental Health Research Unit, Oslo University Hospital, Norway. Lars Mehlum, National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.

DATA AVAILABILITY STATEMENT

The datasets analyzed during the current study are available from the corresponding author on reasonable request. We have only used standard questionnaires and interviews that have been previously published elsewhere, and in according to guidelines.

Additional information

Funding

The study received funding from the Oslo University Hospital and University of Oslo and by Olafstiftelsen for Research on suicidality among children and adolescents. These funds helped finance staff for data collection. None of the funders interfered with the design of the study and collection, analysis and interpretation of data and in writing the manuscript.