Self-injury: A research review for the practitioner
Corresponding Author
E. David Klonsky
Stony Brook University
Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500Search for more papers by this authorCorresponding Author
E. David Klonsky
Stony Brook University
Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500Search for more papers by this authorAbstract
Non-suicidal self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. In this practice-friendly review, the authors summarize the empirical research on who self-injures, why people self-injure, and what treatments have demonstrated effectiveness. Self-injury is more common in adolescents and young adults as compared to adults. Common forms include cutting, severe scratching, burning, and banging or hitting; most individuals who self-injure have used more than one method. Although diagnostically heterogeneous, self-injurers typically exhibit two prominent characteristics: negative emotionality and self-derogation. Self-injury is most often performed to temporarily alleviate intense negative emotions, but may also serve to express self-directed anger or disgust, influence or seek help from others, end periods of dissociation or depersonalization, and help resist suicidal thoughts. Psychotherapies that emphasize emotion regulation, functional assessment, and problem solving appear to be most effective in treating self-injury. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1045–1056, 2007.
References
- American Psychiatric Association. ( 2000). Diagnostic and statistical manual of mental disorders ( 4th ed., text rev.). Washington, DC: Author.
- Andover, M. S., Pepper, C. M., Ryabchenko, K. A., Orrico, E. G., & Gibb, B. E. ( 2005). Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder. Suicide and Life-Threatening Behavior, 35, 581–591.
- Aviram, R. B., Hellerstein, D. J., Gerson, J., & Stanley, B. ( 2004). Adapting supportive psychotherapy for individuals with borderline personality disorder who self-injure or attempt suicide. Journal of Psychiatric Practice, 10, 145–155.
- Bateman, A., & Fonagy, P. ( 2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: An 18-month follow-up. American Journal of Psychiatry, 158, 36–42.
- Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., et al. ( 2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683–1696.
- Briere, J., & Gil, E. ( 1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68, 609–620.
- Cavanaugh, R. M. ( 2002). Self-mutilation as a manifestation of sexual abuse in adolescent girls. Journal of Pediatric Adolescent Gynecology, 15, 97–100.
- Claes, L., Vandereycken, W., & Vertommen, H. ( 2007). Self-injury in female versus male psychiatric patients: A comparison of characteristics, psychopathology and aggression regulation. Personality and Individual Differences, 42, 611–621.
- Crowe, M., & Bunclark, J. ( 2000). Repeated self-injury and its management. International Review of Psychiatry, 12, 48–54.
- Darche, M. A. ( 1990). Psychological factors differentiating self-mutilating and non-self-mutilating adolescent inpatient females. The Psychiatric Hospital, 21, 31–35.
- DiClemente, R. J., Ponton, L. E., & Hartley, D. ( 1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 151, 1305–1311.
- Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., et al. ( 1999). Manual-assisted cognitive–behaviour therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29, 19–25.
- Favazza, A. R., & Conterio, K. ( 1989). Female habitual self-mutilators. Acta Psychiatrica Scandinavica, 79, 283–289.
- Glenn, C. R., & Klonsky, E. D. ( 2007). The functions of non-suicidal self-injury: Measurement and structure. Paper presented at the annual meeting of the American Psychological Society, Washington, DC, in May, 2007.
- Gratz, K. L. ( 2001). Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253–263.
- Gratz, K. L. ( 2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry, 76, 238–250.
- Gratz, K. L., Conrad, S. D., & Roemer, L. ( 2002). Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72, 128–140.
- Gratz, K. L., & Roemer, L. ( 2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.
- Gross, J. J., & Munoz, R. F. ( 1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2, 151–164.
- Guertin, T., Lloyd-Richardson, E., & Spirito, A. ( 2001). Self-mutilative behavior in adolescents who attempt suicide by overdose. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1062–1069.
- Herpertz, S. ( 1995). Self-injurious behavior: Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatrica Scandinavica, 91, 57–68.
- Herpertz, S., Sass, H., & Favazza, A. ( 1997). Impulsivity in self-mutilative behavior: Psychometric and biological findings. Journal of Psychiatric Research, 31, 451–465.
- Jeppson, J. E., Richards, P. S., Hardman, R. K., & Granley, H. M. ( 2003). Binge and purge processes in bulimia nervosa: A qualitative investigation. Eating Disorders, 11, 115–128.
- Joiner, T. E. ( 2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
- Jones, A. ( 1986). Self-mutilation in prison: A comparison of mutilators and nonmutilators. Criminal Justice and Behavior, 13, 286–296.
- Klonsky, E. D. ( 2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226–239.
- Klonsky, E. D., & Glenn, C. R. (in press-a). Resisting urges to self-injure. Behavioural and Cognitive Psychotherapy.
- Klonsky, E. D., & Glenn, C. R. (in press-b). Psychosocial risk and protective factors for self-injury. In M. K. Nixon & N. Heath (Eds.), Self-injury in youth: The essential guide to assessment and intervention.
- Klonsky, E. D., & Moyer, A. (in press). Childhood sexual abuse and non-suicidal self-injury: A meta-analysis. British Journal of Psychiatry.
- Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. ( 2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160, 1501–1508.
- Korner, A., Gerull, F., Mears, R., & Stevenson, J. ( 2006). Borderline personality disorder treated with the conversational model: A replication study. Comprehensive Psychiatry, 47, 406–411.
- Kraemer, H. C., Stice, H., Kazdin, A., et al. ( 2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158, 848–856.
- Langbehn, D. R., & Pfohl, B. ( 1993). Clinical correlates of self-mutilation among psychiatric inpatients. Annals of Clinical Psychiatry, 5, 45–51.
- Laye-Gindhu, A., & Schonert-Reichl, K. A. ( 2005). Nonsuicidal self-harm among community adolescents: Understanding the ‘whats’ and ‘whys’ of self-harm. Journal of Youth and Adolescence, 34, 447–457.
- Linehan, M. M. ( 1993). Cognitive–behavioral treatment of borderline personality disorder. New York: Guilford Press.
- Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. ( 2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.
- Lloyd-Richardson, E., Perrine, N., Dierker, L., & Kelley, M. L. ( 2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37, 1183–1192.
- Lundh, L.-G., Karim, J., & Quilisch, E. ( 2007). Deliberate self-harm in 15-year-old adolescents: A pilot study with a modified version of the Deliberate Self-Harm Inventory. Scandinavian Journal of Psychology, 48, 33–41.
-
Maden, A.,
Chamberlain, S., &
Gunn, J. (
2000).
Deliberate self-harm in sentenced male prisoners in England and Wales: Some ethnic factors.
Criminal Behavior in Mental Health, 10, 199–204.
10.1002/cbm.357 Google Scholar
-
Martens, W. H. J. (
2006).
Effectiveness of psychodynamic therapy in patients with borderline personality disorder.
Journal of Contemporary Psychotherapy, 36, 167–173.
10.1007/s10879-006-9021-1 Google Scholar
- Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. ( 2005). Preliminary evidence for an emotion dysregulation theory of generalized anxiety disorder. Behavior Research and Therapy, 43, 1281–1310.
- Mizes, J. S., & Arbitell, M. R. ( 1991). Bulimics' perceptions of emotional responding during binge–purge episodes. Psychological Reports, 69, 527–532.
- Monsen, J., Odland, T., Faugli, A., Daae, E., & Eilertsen, D. E. ( 1995). Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment. Scandinavian Journal of Psychology, 36, 256–268.
- Muehlenkamp, J. J. ( 2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75, 324–333.
-
Muehlenkamp, J. J. (
2006).
Empirically supported treatments and general therapy guidelines for non-suicidal self-injury.
Journal of Mental Health Counseling, 28, 166–185.
10.17744/mehc.28.2.6w61cut2lxjdg3m7 Google Scholar
- Muehlenkamp, J. J., & Gutierrez, P. M. ( 2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life Threatening Behavior, 34, 12–23.
- Muehlenkamp, J. J., & Gutierrez, P. M. ( 2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research, 11, 69–82.
- Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. ( 2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65–72.
- Nock, M. K., & Prinstein, M. J. ( 2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.
- Nock, M. K., & Prinstein, M. J. ( 2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140–146.
- Noll, J. G., Horowitz, L. A., Bonanno, G. A., et al. ( 2003). Revictimization and self-harm in females who experienced childhood sexual abuse. Journal of Interpersonal Violence, 18, 1452–1471.
- Nose, M., Cipriani, A., & Biancosino, B. ( 2006). Efficacy of pharmacotherapy against core traits of borderline personality disorder: Meta-analysis of randomized controlled trials. International Clinical Psychopharmacology, 21, 345–353.
- Ross, S., & Heath, N. ( 2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31, 67–77.
- Ryle, A. ( 2004). The contribution of cognitive analytic therapy to the treatment of borderline personality disorder. Journal of Personality Disorders, 18, 3–35.
- Soloff, P. H., Lis, J. A., Kelly, T., Cornelius, J., & Ulrich, R. ( 1994). Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 8, 257–267.
- Suyemoto, K. L. ( 1998). The functions of self-mutilation. Clinical Psychology Review, 18, 531–554.
- Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., et al. ( 2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness, and improvement in problems. Psychological Medicine, 31, 979–988.
- Tryer, P., Thompson, S., Schmidt, U., Jones, V., Knapp, M., Davidson, K., et al. ( 2003). Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POMPACT study. Psychological Medicine, 33, 969–976.
- Turner, R. M. ( 2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413–419.
- Walsh, B. W. ( 2006). Treating self-injury: A practical guide. New York: Guilford Press.
- Whitlock, J., Eckenrode, J., & Silverman, D. ( 2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948.
- Zlotnick, C., Shea, M. T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. ( 1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Comprehensive Psychiatry, 37, 12–16.