Academic journal article Journal of Mental Health Counseling

Brief Severity Index for Nonsuicidal Self-Injury: Initial Validation of a Self-Report Measure

Academic journal article Journal of Mental Health Counseling

Brief Severity Index for Nonsuicidal Self-Injury: Initial Validation of a Self-Report Measure

Article excerpt

The aim of this study was to develop and provide validation evidence for a self-report measure of nonsuicidal self-injury (NSSI), the Brief Severity Index for NSSI (BSI-NSSI). We dev eloped items to tap the new diagnostic classification for NSSI in the Diagnostic and Statistical Manual of Mental Disorders (3th ed., DS.Yf-5; American Psychiatric Association [APA], 2013). We also designed the measure to distinguish among gradations of NSSI severity. Data were collected from a sample of 843 young adults, 72 of whom had performed NSSI in the past year. Using Rasch analysis, we reached initial support for the validity and reliability of the BSI-NSSI. Implications for counseling and research are discussed.

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Nonsuicidal self-injury (NSSI) pertains to the self-inflicted, deliberate damaging of a superficial or moderate amount of tissue without the intent to die and outside of social sanction (Favazza, 1998). The behavior recently increased in prominence among mental health counselors, given that NSSI was added to the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5; American Psychiatric Association [APA], 2013) as a "condition for future study" (p. 801). The diagnostic criteria included the following: (a) performance on at least 5 days in the past year of nonsuicidal, self-inflicted injury to one's own body with the intent of causing superficial or moderate tissue damage, (b) the behavior is performed with expectations about the positive functions of the behavior in interpersonal (e.g., communicating distress to others) or intrapersonal domains (e.g., reduction of adverse emotions), (c) the behavior is preceded by interpersonal (e.g., relational conflict) or intrapersonal (e.g., preoccupation or negative affect) difficulties, (d) the behavior lacks social sanction, (e) the behavior is associated with negative consequences in life functioning, and (f) the behavior is not attributable to other disorders or conditions (APA, 2013). Among the issues in need of future study, as noted by several authors, is NSSI assessment (e.g., Buser & Buser, 2013; Craigen, Healey, Walley, Byrd, & Schuster, 2010; Whitlock, Exner-Cortens, & Purington, 2014).

In the past two decades, there has been a profusion of assessments featuring items on NSSI. For a relatively new field of study, the diversity' of assessment types is impressive, including structured interviews (Linehan, Comtois, Brown, Heard, & Wagner, 2006; Nock, Holmberg, Photos, & Michel, 2007), observer ratings (Iwata, Pace, Kissel, Nan, & Farbcr, 1990), implicit association tests (Nock & Banaji, 2007), informal interviews (Buser & Buser, 2013), and self-report measures (e.g., Cheng, Mallinckrodt, Soet, & Sevig, 2010; Gratz, 2001; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Martin et al., 2013; Turner, Chapman, & Gratz, 2014; Whitlock et al., 2014). The focus of these assessments has ranged across a variety of NSSI characteristics, such as functions of the behavior, frequency of use, methods, addictive features, and motivations to cease performance of the behavior (Glenn & Klonsky, 2011; Gratz, 2001; Lloyd-Richardson et al., 2007; Martin et al., 2013; Sansone, Wiederman, & Sansone, 1998; Turner et al., 2014; Whitlock et al., 2014).

Although existing NSSI assessments have contributed a wealth of information and have clinical value, they were created before or without reference to the DSM-5 classification for NSSI (with the exception of one informal assessment; Buser & Buser, 2013). Thus, in developing these assessments, researchers did not map assessment items to criteria of the new NSSI diagnostic classification. This is an important limitation for two reasons: first, as mentioned above, the new diagnostic classification has been designated as a "condition for future study" (APA, 2013, p. 801). Since previous assessments were created without reference to its criteria, they would be relevant to this condition only in part. …

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