Presentation is loading. Please wait.

Presentation is loading. Please wait.

Non-Suicidal Self-Injury: Description, Motivations, and Relationship to Suicide E. David Klonsky, PhD Associate Professor Department of Psychology University.

Similar presentations


Presentation on theme: "Non-Suicidal Self-Injury: Description, Motivations, and Relationship to Suicide E. David Klonsky, PhD Associate Professor Department of Psychology University."— Presentation transcript:

1 Non-Suicidal Self-Injury: Description, Motivations, and Relationship to Suicide E. David Klonsky, PhD Associate Professor Department of Psychology University of British Columbia

2 Non-Suicidal Self-Injury Common in youth and adolescents Can be confused for attempted suicide Has an important relationship to suicide risk

3 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Relationship to Suicide

4 A Preliminary Note What we know (many many studies) What we think (one or two studies) What we don’t know (no research yet)

5 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Relationship to Suicide

6 What is Self-Injury? Self-inflicted damage to body tissue Intentional No suicidal intent

7 What is Self-Injury? Intentional, direct injuring of one’s body tissue without suicidal intent Also called: non-suicidal self-injury (NSSI), self-mutilation, self-injurious behavior, self-wounding, and deliberate self-harm.

8 What is Self-Injury? Skin-cutting, burning, scratching, rubbing skin against rough surfaces, interfering with wound healing Does not include overdosing, eating disorder behaviors, alcohol/substance use, body piercings/tattoos*

9 Variation in Self-Injury Frequency Methods Medical Severity Contexts Motivations Desire/Efforts to Stop

10 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Relationship to Suicide

11 Famous Self-Injurers Princess Diana

12 Famous Self-Injurers Angelina Jolie

13 Famous Self-Injurers Christina Ricci

14 Famous Self-Injurers Drew Barrymore

15 Famous Self-Injurers Johnny Depp

16 Famous Self-Injurers Eminem

17 Famous Self-Injurers Marsha Linehan

18 Famous Self-Injurers Harry Potter’s Dobby Klonsky, E.D. & Laptook, R. (2007). Dobby had to iron his hands, sir! Self-inflicted cuts, burns, and bruises in Harry Potter. In the Psychology of Harry Potter. BenBella Books.

19 Who Self-Injures? Young Adolescents8% High-School % University Students17% General Adult Population4-6% Adolescent Inpatients % Klonsky, E.D. & Muehlenkamp, J.J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology: In Session.

20 Psychological Characteristics Negative Emotions/Emotion Dysregulation Depression Anxiety Anger Self-Directed Negative Emotion Suicide Ideation and Attempts

21 Defining Characteristic Intense, Self-Directed Negative Emotions?

22 What About Abuse Histories? “may be reenacting the abuse perpetrated on them” (Noll, 2003) “manifestation of sexual abuse” (Cavanaugh, 2002) Abuse “contributes heavily to the initiation of self-destructive behaviors” (van der Kolk, 1991)

23 Child Sex Abuse and Self-Injury Analysis of 44 studies Median phi = 0.23 (small relationship) Klonsky, E.D. & Moyer, A. (2008). Childhood sexual abuse and non-suicidal self-injury: Meta- analysis. British Journal of Psychiatry.

24 Child Sex Abuse and Self-Injury: Conclusion Abuse histories can contribute to negative emotions driving NSSI, but … … many who self-injure do not have abuse histories, and many with abuse histories do not self-injure.

25 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Relationship to Suicide

26 Why People Self-Injure: Theories TheoryDescription of Theory Anti-DissociationTo end the experience of depersonalization or dissociation Anti-SuicideTo replace or compromise with the impulse to commit suicide Emotion RegulationTo alleviate intense negative emotions Interpersonal BoundariesTo assert one’s identity or a distinction between self and other Interpersonal InfluenceTo seek help from or manipulate others Self PunishmentTo derogate or express anger towards oneself Sensation SeekingTo generate excitement or exhilaration SexualTo control, distract from, or gratify uncomfortable sexual urges

27 Why People Self-Injure: Research Sources of evidence 1) Reasons/motivations for self-injury 2) Experience of self-injury 3) Laboratory studies of proxies for self-injury Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

28 Why People Self-Injure: Research TheoryEvidence For Theory Anti-DissociationR, R, R, r, r, r, P, p, -p Anti-SuicideR, r, r Emotion RegulationR, R, R, R, R, R, R, R, R, R, R, P, P, P, P, P, P, L, L, L Interpersonal Boundariesr, r Interpersonal InfluenceR, r, r, r, r, r, r, p, p Self PunishmentR, R, R, R, R, R, r, r, r, r, r Sensation Seekingr, r, r, r, r Results of 18 studies of reasons [R, r], self-report of phenomenology [P, p], or laboratory data [L, l].

29 Why People Self-Injure: Research Primary sources of evidence 1) Reasons/motivations for self-injury 2) Experience of self-injury Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

30 Why People Self-Injure: Research Primary sources of evidence 1) Reasons/motivations for self-injury 2) Experience of self-injury Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

31 Emotion Regulation 50-95% of self-injurers “To release emotional pressure that builds up inside me” “To get rid of intolerable emotions” “To control how I am feeling” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

32 Self-Punishment More than 50% of self-injurers “To express anger at myself” “To punish myself” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

33 Anti-Suicide 3 rd most common reason “To avoid the impulse to attempt suicide” “To stop suicidal ideation or attempts” “To stop me from killing myself” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

34 Anti-Dissociation/Depersonalization 4 rd most common reason “To know I am capable of feeling physical pain” “To feel like myself again” “To feel real” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

35 Interpersonal Influence 5 th most common reason “To let others know what I am going through” “To get those around me to understand what I’m going through” “To get reactions out of people” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

36 Sensation/Excitement Seeking 6 th most common reason “To feel exhilarated” “I thought it would be fun” Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

37 Why People Self-Injure: Research Primary sources of evidence 1) Reasons/motivations for self-injury 2) Experience of self-injury Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

38 Why People Self-Injure: Research Primary sources of evidence 1) Reasons/motivations for self-injury 2) Experience of self-injury Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review.

39 Emotions and Self-Injury 40 Emotions Before, During, and After Self-Injury Examples: Angry, Sad, Lonely, Frustrated, Worthless, Guilty Happy, Relieved, Hopeful, Satisfied Bored, Restless, Apathetic Unreal, Mesmerized, In a Trance Klonsky, E.D. (2009). The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation. Psychiatry Research.

40 Emotions and Self-Injury Before Overwhelmed Sad Hurt Emotionally During Angry at Self Hurt Emotionally Isolated After Relieved Angry at Self Calm

41 Low-Arousal Negative Emotions

42 High-Arousal Negative Emotions

43 Low-Arousal Positive Emotions

44 Big Changes in Negative Arousal EmotionCohen’s d Relieved+2.25 Calm Overwhelmed Anxious- 0.81

45 Why People Self-Injure: Theories TheoryDescription of Theory Anti-DissociationTo end the experience of depersonalization or dissociation Anti-SuicideTo replace or compromise with the impulse to commit suicide Emotion RegulationTo alleviate intense negative emotions Interpersonal BoundariesTo assert one’s identity or a distinction between self and other Interpersonal InfluenceTo seek help from or manipulate others Self PunishmentTo derogate or express anger towards oneself Sensation SeekingTo generate excitement or exhilaration SexualTo control, distract from, or gratify uncomfortable sexual urges

46 Why People Self-Injure: Theories TheoryDescription of Theory Anti-DissociationTo end the experience of depersonalization or dissociation Anti-SuicideTo replace or compromise with the impulse to commit suicide Emotion RegulationTo alleviate intense negative emotions Interpersonal BoundariesTo assert one’s identity or a distinction between self and other Interpersonal InfluenceTo seek help from or manipulate others Self PunishmentTo derogate or express anger towards oneself Sensation SeekingTo generate excitement or exhilaration SexualTo control, distract from, or gratify uncomfortable sexual urges

47 Why People Self-Injure: Theories TheoryDescription of Theory Anti-DissociationTo end the experience of depersonalization or dissociation Anti-SuicideTo replace or compromise with the impulse to commit suicide Emotion RegulationTo alleviate intense negative arousal Interpersonal BoundariesTo assert one’s identity or a distinction between self and other Interpersonal InfluenceTo seek help from or manipulate others Self PunishmentTo derogate or express anger towards oneself Sensation SeekingTo generate excitement or exhilaration SexualTo control, distract from, or gratify uncomfortable sexual urges

48 Why People Self-Injure: Theories TheoryDescription of Theory Anti-DissociationTo end the experience of depersonalization or dissociation Anti-SuicideTo replace or compromise with the impulse to commit suicide Emotion RegulationTo alleviate intense negative arousal Interpersonal BoundariesTo assert one’s identity or a distinction between self and other Interpersonal InfluenceTo seek help from or manipulate others Self PunishmentTo derogate or express anger towards oneself Sensation SeekingTo generate excitement or exhilaration SexualTo control, distract from, or gratify uncomfortable sexual urges

49 Functions of Self-Injury 1. Organizing conceptual framework 2. Valid and comprehensive assessment

50 Inventory of Statements about Self-injury (ISAS) Assesses 13 functions of NSSI Three items per function 39-item measure Klonsky, E.D. & Olino. T.O. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology. Klonsky, E.D. & Glenn, C.R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment.

51 Affect Regulation…calming myself down. Self-Punishment…expressing anger towards myself for being worthless or stupid. Anti-Suicide…putting a stop to suicidal thoughts. Anti-Dissociation…causing pain so I will stop feeling numb. Interpersonal Influence…letting others know the extent of my physical pain. Sensation Seeking…doing something to generate excitement or exhilaration. Peer Bonding…fitting in with others. Self-Care…creating a physical injury that is easier to care for than my emotional distress Marking Distress…creating a physical sign that I feel awful. Interpersonal Boundaries …creating a boundary between myself and others. Toughness…seeing if I can stand the pain. Revenge…getting back at someone. Autonomy…demonstrating I do not need to rely on others for help. Sample I-SAS items “When I harm myself, I am…

52 Inventory of Statements about Self-injury (ISAS) 235 self-injurers from a college sample yrs old, 57% female, 42% Caucasian Hitting self, biting, cutting, pinching, wound-picking

53 ISAS Factor loadings (Exploratory Factor Analysis with Promax Rotation) FunctionMean (SD)Social FunctionsIntrapersonal Functions Affect Regulation Anti-Dissociation Anti-Suicide Marking Distress Self-Punishment Autonomy Interpersonal Boundaries Interpersonal Influence Peer Bonding Revenge Self-Care Sensation Seeking Toughness 3.0 (2.1) 1.0 (1.6) 0.8 (1.5) 1.5 (1.8) 2.0 (2.1) 0.6 (1.3) 0.8 (1.4) 0.5 (1.3) 0.6 (1.4) 0.8 (1.4) 0.7 (1.3) 1.0 (1.4)

54 ISAS Factor loadings (Exploratory Factor Analysis with Promax Rotation) FunctionMean (SD)Social FunctionsIntrapersonal Functions Affect Regulation Anti-Dissociation Anti-Suicide Marking Distress Self-Punishment Autonomy Interpersonal Boundaries Interpersonal Influence Peer Bonding Revenge Self-Care Sensation Seeking Toughness 3.0 (2.1) 1.0 (1.6) 0.8 (1.5) 1.5 (1.8) 2.0 (2.1) 0.6 (1.3) 0.8 (1.4) 0.5 (1.3) 0.6 (1.4) 0.8 (1.4) 0.7 (1.3) 1.0 (1.4)

55 Relationship of Functions to NSSI Frequency NSSI Behavior Social Functions α =.87 Intrapersonal Functions α =.80 Cutting Needle sticking Carving Banging/Hitting self Note. All correlations are statistically significant at an alpha of.03.

56 Relationship of Functions to Cutting Correlation with Cutting Affect Regulation Anti-Dissociation Anti-Suicide Marking Distress Self-Punishment Autonomy Interpersonal Boundaries Interpersonal Influence Peer Bonding Revenge Self-Care Sensation Seeking Toughness Note. Correlations above.20 are statistically significant at an alpha of.001.

57 Relationship of Functions to Clinical Variables Clinical Variable Social Functions α =.87 Intrapersonal Functions α =.80 Depression Anxiety Borderline Personality Disorder *.36.43* Note. Correlations above.16 are statistically significant an at alpha level of.01. * Indicates correlations are significantly different at an alpha of.01.

58 Relationship of Functions to Clinical and Contextual Variables Clinical/Contextual Variable Social Functions α =.87 Intrapersonal Functions α =.80 Suicidal Ideation Suicide Plans Attempted Suicide *.33*.29* Note. Correlations above.16 are statistically significant an at alpha level of.01. * Indicates correlations are significantly different at an alpha of.01.

59 ISAS in Alexian Brothers Hospital 108 psychiatric patients Ages 11 – 62, mean=19 90% female 72% Caucasian

60 FunctionSocialIntrapersonal Affect Regulation.77 Anti-Dissociation.62 Anti-Suicide.50 Marking Distress.75 Self-Punishment.67 Autonomy.55 Interpersonal Boundaries.44 Interpersonal Influence.51 Peer Bonding.95 Revenge.47 Self-Care Sensation Seeking.71 Toughness.37.43

61 ISAS in an Adolescent Psychiatric Sample 80 psychiatric patients with NSSI from South Oaks Hospital in Long Island, NY Mean age = 15 ( ) 70% female 61% Caucasian

62 FunctionSocialIntrapersonal Affect Regulation.87 Anti-Dissociation.83 Anti-Suicide.66 Marking Distress.63 Self-Punishment.77 Autonomy.79 Interpersonal Boundaries.69 Interpersonal Influence.54 Peer Bonding.77 Revenge.70 Self-Care Sensation Seeking.73 Toughness.72

63 FASM in Alexian Brothers Sample ItemSocialIntrapersonal Receive more attention (S-P).83 Get a reaction (S-P).75 Feel more a part of a group (S-P).74 Get parents to notice (S-P).72 Get attention (S-P).64 Avoid something unpleasant (S-N).63 Avoid school/work/activities (S-N).55 Stop bad feelings (I-N).68 Feel something (I-P).68 Relive feeling numb/empty (I-N).64 Punish self (I-P).58 Feel relaxed (I-P).54

64 Two Motivational Dimensions 1. Self-Focused2. Other-Focused

65 Two Motivational Dimensions 1. Self-Focused2. Other-Focused Affect Regulation Anti-Dissociation Anti-Suicide Marking Distress Self-Punishment

66 Two Motivational Dimensions 1. Self-Focused2. Other-Focused Affect RegulationInterpersonal Influence Anti-DissociationPeer Bonding Anti-SuicideRevenge Marking DistressExcitement Seeking Self-PunishmentToughness

67 Two Motivational Dimensions 1. Self-Focused2. Other-Focused More Self-Injury More Psychopathology More Suicidality

68 NSSI Motivations: Summary 1. Most common motivations are emotion regulation and self-punishment 2. NSSI motivations fall into two super-ordinate dimensions: 1) self-focused and 2) other-focused 3. Self-focused motivations are associated with greatest clinical severity

69 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Relationship to Suicide

70 NSSI vs. Attempted Suicide Differ in terms of intent and medical severity Commonly co-occur Avoid oversimplified conclusions! Complex relationship needs careful study

71 NSSI vs. Attempted Suicide NSSI sometimes mistaken for attempted suicide Unnecessary hospitalizations Harms case conceptualization Misallocates valuable resources NSSI conveys valuable information regarding suicide risk Results from 4 Studies: Does NSSI predict attempted suicide?

72 Predictors of Attempted Suicide 139 Adolescent Psychiatric Inpatients Suicide Ideation.55 NSSI.50 Borderline Personality Disorder.37 Depression.20 Anxiety.16 Impulsivity.11

73 Predictors of Attempted Suicide 426 High-School Students Suicide Ideation.51 NSSI.38 Borderline Personality Disorder.29 Depression.24 Anxiety.18 Impulsivity.11

74 Predictors of Attempted Suicide 1,351 Undergraduates Suicide Ideation.44 NSSI.28 Borderline Personality Disorder.22 Depression.24 Anxiety.16 Impulsivity.10

75 Predictors of Attempted Suicide 438 United States Adults Suicide Ideation.36 NSSI.34

76 Summary of Results From Four Studies 1. NSSI relates to attempted suicide 2. NSSI relates to attempted suicide more strongly than other risk-factors 3. NSSI is similar to suicide ideation in conferring risk for suicide 4. Yet, like suicide ideation, many/most who engage in NSSI have not attempted suicide

77 ?? Why does NSSI have such a strong relationship to attempted suicide? Thomas Joiner’s Interpersonal-Psychological Theory Desire + Capability  Suicide

78 ?? Most risk factors only confer desire Depression Hopelessness Suicidal ideation Others only confer capability Access to lethal means Combat exposure in military

79 ?? NSSI confers both desire and capability Desire (intense negative emotions) Capability (habituation to self-inflicted violence) (Nock et al., 2006) NSSI is relatively unique among risk-factors in that it represents double-trouble!

80 So what have we learned? Is NSSI a form of suicidal behavior? No! Is NSSI unrelated to attempted suicide? No! NSSI is different from attempted suicide, but confers strong suicide risk because it represents double-trouble (both desire + capability)

81 Suicide: Take-Home Message NSSI is not attempted suicide, but… … People who self-injure are at greater risk for suicidal ideation … People who self-injure are more capable of acting on suicidal thoughts

82 For more information… Published 2011 User-friendly information for health professionals

83 Thank you Graduate Students Catherine Glenn Alexis May Sarah Victor Anita Hibbert Funding Sources National Institute of Mental Health American Foundation for Suicide Prevention Stony Brook University Center for Survey Research

84 Thank you!! Questions, Comments, Discussion??

85 Extra Slides

86 NSSI and BPD DSM-IV: NSSI is part of a BPD criterion DSM-5: NSSI proposed as own diagnostic entity What exactly is the relationship of NSSI to BPD?

87 What BPD and NSSI Share Frequently co-occur Both have emotion dysregulation as a core feature Both associated with shame

88 Can NSSI be Distinct from BPD? 198 Adolescent Psychiatric Inpatients Average of 3.3 Axis-I diagnoses Two Key Questions: 1. Does BPD overlap with NSSI more than with other disorders? 2. Does NSSI overlap with BPD more than with other disorders?

89 Of those with BPD… … 78% NSSI … 84% Anxiety Disorder … 84% Disruptive Behavior Disorder (ODD or Conduct) … 78% Mood Disorder

90 Of those with NSSI… … 52% BPD … 74% Anxiety Disorder … 73% ADHD … 66% Mood Disorder

91 NSSI and BPD: Conclusions NSSI and BPD are correlated, but … Many who have BPD do not self-injure Many who self-injure do not have BPD

92 Clinical Take-Home Message Diagnosis of BPD is not implied by presence of NSSI, but made through careful assessment on a case-by-case basis. Think of BPD and NSSI as you do Depression and Suicidality… … they often co-occur and even contribute to one another, yet are best view as distinct phenomena

93 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Key Clinical Issues: Borderline Personality Disorder DSM-5 Suicide

94 94 A Distinct NSSI Diagnosis? A symptom of a personality disorder in DSM-IV Proposed as a Behavioral Disorder for DSM-V

95 95 The Process Group of Experts Members from Mood Disorders and Child/Adolescent Disorders Workgroups Advisors with particular expertise in NSSI Lots of phone and discussions Separateness Independent Clinical Significance Threshold Defining Characteristics Differentiation from other Behaviors/Disorders

96 And the proposed NSSI diagnosis is ……….. …not going to take effect in DSM-5 … but will appear in DSM-5 appendix as a research diagnosis

97 A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body, of a sort likely to induce bleeding or bruising or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), for purposes not socially sanctioned (e.g., body piercing, tattooing, etc.), but performed with the expectation that the injury will lead to only minor or moderate physical harm. The absence of suicidal intent is either reported by the patient or can be inferred by frequent use of methods that the patient knows, by experience, not to have lethal potential. (When uncertain, code with NOS 2.) The behavior is not of a common and trivial nature, such as picking at a wound or nail biting. B. The intentional injury is associated with at least 2 of the following: 1. Negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act. 2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to resist. 3. The urge to engage in self-injury occurs frequently, although it might not be acted upon. 4. The activity is engaged in with a purpose; this might be relief from a negative feeling/cognitive state or interpersonal difficulty or induction of a positive feeling state. The patient anticipates these will occur either during or immediately following the self-injury. 97

98 Agenda What is Self-Injury Who Self-Injures Why People Self-Injure Key Clinical Issues: Borderline Personality Disorder DSM-5 Suicide

99 Some Overall Clinical Conclusions Treatment should emphasize Functions (functional assessment) Negative Emotions (emotion regulation skills) Self-criticism (cognitive techniques) Arousal regulation (exercise?) Careful Diagnosis Suicidality should be carefully monitored

100 Choose your own adventure 1. Why do people choose NSSI and not something else? (role of self-derogation/criticism) 2. Physiologically speaking, how does NSSI work? 3. Is NSSI an ‘addictive’ behavior? 4. Why is physical pain reduced in NSSI?

101 Many ways to cope with negative emotions … why self-injury?

102 Self-Derogation Self-injurers consistently score high on measures of self- derogation, self-criticism, and low self-esteem Klonsky, Oltmanns, & Turkheimer, 2003, American Journal of Psychiatry; Klonsky & Muehlenkamp, 2007, Journal of Clinical Psychology/In Session; Glassman et al., 2007, Behaviour Research and Therapy) Self-punishment/self-directed anger is the second most common motivation for self-injury (Klonsky, 2007, Clinical Psychology Review) “To express anger at myself” (Klonsky, 2009, Psychiatry Research)

103 NESD Theory For those high in negative emotionality (NE) and self-derogation (SD) … … Self-injury is an ego-syntonic regulation method … Self-injury uniquely fulfills a self punishment function

104 NESD Model Temperament Self-injury Intense self-derogation Intense, negative emotions Normative/Low Environmentself-derogation Other healthy & unhealthy coping

105 NESD Theory Hypothesis: Those high in both negative emotionality (NE) and self-derogation (SD) are most likely to self-injure Predicts a statistical interaction between NE and SD in identifying self-injurers

106 Sample 1: Young Adults 2,011 Air Force recruits in basic training Thomas, Turkheimer, & Oltmanns. (2003). Factorial structure of pathological personality traits as evaluated by peers. Journal of Abnormal Psychology. Mean age 20 (SD=5), 62% Male, 65% Caucasian, 17% African American Administered the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1996)

107 Self-Injury “When I get very tense, hurting myself physically somehow calms me down” “I have hurt myself on purpose several times” 1% endorsed both of these items

108 Negative Emotionality SNAP Negative Temperament Scale 28 items: “I often have strong feelings such as anxiety or anger..” True-False format

109 Self-Derogation SNAP Self-Derogation/Low Self-Esteem scale 7 items: “I’ve really made a mess of my life” True-False format

110 Results Frequent InjurersControl Negative Emotionality (NE) Self-Derogation (SD) NE and SD interact to distinguish frequent cutters from controls (Binary Logistic Regression: Wald’s X 2 (1) =3.24, p=.07)

111

112 Sample 2: Adolescents 432 high-school students Ages 13-17, 61% Female 53% Caucasian, 19% Hispanic, 15% Asian, 11% African American

113 Self-Injury Section I of the Inventory of Statements About Self-injury (ISAS; Klonsky & Olino, 2008; Klonsky & Glenn, in press) Self-injurious behaviors done “intentionally” and “without suicidal intent” 12 different behaviors: “cutting,” “scratching,” “needle- sticking” 6.5% Cut 3 or more times

114 Negative Emotionality Composite of two measures 1. Positive and Negative Affect Scale (PANAS; Watson & Clark, 1994) 10-items: “Upset,” “Ashamed,” “Irritable” [just NA scale] 2. Difficulties in Emotion Regulation Scale (DERS; Gratz, 2004) 36-items: “When I’m upset, my emotions feel overwhelming” PANAS NA scale and DERS correlated r=.68

115 Self-Derogation Composite of three measures 1. Self-Derogation scale from the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1996) 7-items: “I’ve really made a mess of my life” 2. Self-Perception Profile for Adolescents-Revised (SPPA; Harter, 1988; Wichstrom, 1995) Global Self-Worth 5-items: “often disappointed with [yourself]” Physical Appearance 5-items: “not happy with the way [you] look”

116 Results Frequent CuttersControl Negative Emotionality (NE) Self-Derogation (SD) NE and SD interact to distinguish frequent cutters from controls (Binary Logistic Regression: Wald’s X 2 (1) =3.86, p<.05)

117

118 NESD Theory: Next Steps Preliminary evidence supports NESD theory Examine large group of severe self-injurers Consider functions of self-injury (e.g., Klonsky & Olino, 2008)

119 How Does NSSI Work? Parasympathetic Rebound Theory

120 Sympathetic nervous system – “fight or flight” Intense emotion: Fear, rage, panic Increases heart rate Increases blood flow to major muscle gruops Parasympathetic nervous system – “rest and digest” Limits effects of sympathetic system Slows heart rate Facilitates sustained engagement and attention

121 Parasympathetic Impairment Inability to restrain sympathetic responses and emotions (panic, anger) Impaired parasympathetic activity observed in self-injury and Borderline Personality Disorder (Austin et al, 2007; Crowell et al., 2005; Weinberg, Hajcak, Klonsky, 2009)

122 Parasympathetic Rebound Surges in sympathetic activity are followed by increases in parasympathetic activity What if surges are too strong or too weak? Too strong: fainting Too weak: emotional dysregulation observed in BPD and self-injurers Perhaps self-injury causes a surge in sympathetic activity which in turn triggers a strong parasympathetic rebound?

123 Parasympathetic Rebound Some self-injurers report that seeing the blood is important for achieving calming influence of self- injury (Glenn & Klonsky, 2010) Interestingly, the fainting response observed in blood phobics is often attributed to parasympathetic rebound The pain and blood caused by self-injury may both trigger a parasympathetic rebound

124 Parasympathetic Activity Pre- and Post- Self-Injury NSSI Mean RSA Minutes Data from Matthew Nock, shown with permission (Nock & Mendes, in preparation)


Download ppt "Non-Suicidal Self-Injury: Description, Motivations, and Relationship to Suicide E. David Klonsky, PhD Associate Professor Department of Psychology University."

Similar presentations


Ads by Google