Academic journal article International Journal of Child Health and Human Development

Nonsuicidal Self-Injury Related to Suicide

Academic journal article International Journal of Child Health and Human Development

Nonsuicidal Self-Injury Related to Suicide

Article excerpt


Nonsuicidal self-injury (NSSI) is the deliberate, direct, and self-inflicted destruction of body tissue resulting in immediate tissue damage (1). It must be for purposes not socially sanctioned which means that tattooing and piercing are not NSSI unless done excessively in which case they may be a form of NSSI. As per the definition, the self-injury must not be done with suicidal intent. Types of self-injury are included in Table 1, which is by no means a comprehensive list.

The "Diagnostic and statistical manual, edition 5" lists nonsuicidal self-injury under "conditions for further study" (2) (see Table 2). The proposed criteria include self-inflicted damage to the surface of the body on five or more days in the last year. There cannot be suicidal intent. Suicidal intent can be assessed either by the individual stating this or that the individual knows, or has learned, that the behavior is not likely to result in death (2).


NSSI typically starts in the early teen years and may continue into adulthood (2). However, self-harm behavior may begin in childhood or adulthood. Individuals may self-harm one or two times and then stop self-harming. Other individuals occasionally self-harm or self-harm repeatedly. In a cross-national study of community samples from Italy, the Netherlands and the United States, consisting of a survey of 1862 adolescents, approximately 24% of the adolescents reported at least one NSSI episode within the last year (3). Another cross-sectional study of 11 European countries with a sample size of 12,068 found that the lifetime prevalence of direct self-injurious behavior was 27.6% with 19.7% reporting occasional self-injurious behavior, and 7.8% reporting repetitive self-injurious behavior (4). In the United States, studies have found that the lifetime prevalence of NSSI ranges from 12% to 37.2% in the middle school populations and 12% to 20% in late adolescent and young adult populations (5). The average age of onset is typically between ages 11 and 15 years (5). Of the youth that report ever engaging in self-injurious behavior, approximately 6-7% of adolescents report engaging in repetitive NSSI (5).

NSSI varies in several ways between genders. Currently, studies vary on whether the prevalence of NSSI is equal between males and females or if females have a higher prevalence of NSSI. A study by Sornberger et al. (6) found that females reported higher rates of NSSI. Females were more likely to cut and scratch and had more injuries to arms and legs than their male counterparts. Males reported more burning and hitting behavior. Males had more injuries to the chest, face, and genitals (6). Therefore, it is possible that NSSI in females is more visible than in males (1).

There has been no conclusion in the literature that there is an association with race or socioeconomic status; the study results have been mixed. However, the variable that does appear to be significantly associated with NSSI is sexual orientation. Specifically, youth who are bisexual or questioning seem to be at higher risk than both their heterosexual and homosexual peers. Females who are questioning or bisexual appear to be at the highest risk (7).

Risk factors

NSSI is a way of regulating intense emotion. Therefore, risk factors for NSSI are similar to risk factors for other negative coping mechanisms. A study by Glassman et al. (8) found that emotional and sexual abuse had the strong associations with NSSI. This study supported a theoretical model that in which self-criticism mediates the relationship between emotional abuse and NSSI behaviors. Another study by Baetens et al. (9) investigated whether adolescents' psychological distress and/or perceived parenting predicted the occurrence of NSSI. The study concluded that psychological distress at age 12 years predicted NSSI over time and that parental awareness of NSSI changed the perception of parenting behaviors, specifically a perception of decreased parental rule setting over time (9). …

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