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About Self-Injury Talking About Self-Injury Resources / About Self-Injury / Talking About Self-Injury "Adopt respectful curiosity" The language we use to talk about people and the behaviours they engage in is powerful. Language is the medium we use to communicate our understanding of the world, to establish social structures, define cultures, and establish meaning to phenomena and people. Language shapes the way we view the world and our place in it. The language that is commonly used when talking about NSSI and people with lived experience of NSSI is often derogatory, can perpetuate myths and foster stigma, and can make people with lived experience feel even more misunderstood and isolated. Conversely, adopting a "respectful curiosity" and being conscious of using respectful language can open the way for helpful conversations and encourage support seeking. Top Tips Always be respectful when talking about NSSI, or people with a lived experience of NSSI Poorly-considered language can exacerbate stigma among people who already feel highly stigmatised Avoid language that defines a person by their behaviour (e.g., “cutter”; “self-injurer”) Avoid language that is value-laden (e.g., good/bad), or propagates stigma (e.g., attention-seeking) Use of appropriate language can foster open communication and facilitate support-seeking Check out specific guidelines for members of the media in reporting on and writing about NSSI. References Hasking, P., & Boyes, M. (2018). Cutting words: A commentary on language and stigma in the context of nonsuicidal self-injury. Journal of Nervous and Mental Disease , 206 , 829-833. https://doi.org/10.1097/nmd.0000000000000899 Hasking, P., Lewis, S. P., & Boyes, M. E. (2019). When language is maladaptive: Recommendations for discussing self-injury. Journal of Public Mental Health , 18 , 148-152. https://doi.org/10.1108/JPMH-01-2019-0014 Lewis, S. P. (2017). I cut therefore I am? Avoiding labels in the context of self-injury. Medical Humanities , 43 , Article 204. https://doi.org/10.1136/medhum-2017-011221

About Self-Injury Is NSSI a Disorder? Resources / About Self-Injury / Is NSSI a Disorder? "A condition for further study" The short answer is no, NSSI is not a disorder; however, in 2013, the American Psychiatric Association included Nonsuicidal Self-Injury Disorder (NSSI-D) as a condition for further study in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). ISSS was consulted during the development of the proposed criteria for NSSI-D, where concerns and benefits of the diagnosis were discussed. There are currently six diagnostic criteria, and ISSS members continue to be involved in research to improve the reliability and validity of these criteria. Criterion A The first criterion relates to the frequency of self-injury. To meet this criterion, self-injury must have occurred on at least five days during the previous 12 months. Criterion B The second criterion relates to the reasons for engaging in self-injury. To meet this criterion, self-injury must have occurred for one or more of the following reasons: To reduce negative thoughts or emotion To manage interpersonal difficulties To induce a positive state Criterion C There are several components captured by the third criterion. To meet this criterion, self-injury must meet one of more of the following: Be preceded by: negative thoughts/emotions conflict with others Involve preoccupation with self-injury that is difficult to resist Involve recurrent thoughts about self-injury Criterion D This is an exclusion criterion, and stipulates that the self-injurious behaviours must not be socially sanctioned. Therefore, behaviours that cause injury but are socially acceptable, such as piercing or body modification, are excluded. Criterion E As with other disorders outlined in the DSM, to meet this criterion, the self-injury must cause distress or interfere with an individual's quality of life. Criterion F As with other disorders outlined in the DSM, to meet this criterion, the self-injury must cause distress or interfere with an individual's quality of life. References Zetterqvist, M. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health , 9 , Article 31. https://doi.org/10.1186/s13034-015-0062-7

About Self-Injury Who Self-Injures and Why? Resources / About Self-Injury / Who Self-Injures and Why? "A kaleidoscope of people & reasons" People of all ages, genders, sexualities, ethnicities, and social classes self-injure, though there are factors that may increase the likelihood that an individual will self-injure. Age Current research suggests that self-injury most commonly begins between ages 12 and 15 (Plener et al., 2015), with a second onset peak in early adulthood, around age 20 (Ghandi et al., 2018). Some people first start to self-injure before the age of 12 and some first self-injure much later in life. An age of onset before 12 is associated with more severe self-injury over a longer period of time (Muehlenkamp et al., 2019). Typically rates of self-injury increase through early-mid adolescence and decline in later adolescence. Sex, gender, and sexuality A 2015 meta-analysis of 116 studies showed that girls and women are slightly more likely to self-injure than boys and men, with this gender difference particularly evident in clinical samples. Self-injury is also more common among individuals identifying within the LGBTQIA+ community, with rates 2-3 times that of heterosexual/cisgender individuals (Liu et al., 2019). Culture and race A majority of research to date has focussed on samples comprising mostly Caucasian individuals from Western societies. This has lead to a significant gap in our understanding of NSSI among individuals in underrepresented cultural and racial groups. Current knowledge suggests that self-injury is present across cultures and races. A review by Gholamrezaei et al. (2015) showed there may be differences in age of onset and function, but the differences are complicated by social and economic factors, often brought about by racism. Psychological profile A meta-analysis (Fox et al., 2015) found that risk factors for self-injury include depression, hopelessness, abuse, personality and eating disorders, and impulsivity. People who engage in self-injury report being more sensitive to interpersonal stress or conflict, and experiencing greater difficulty expressing and regulating their emotions. That being said, most people who engage in self-injury do not have a mental illness. Trauma and hardship Experiences of trauma can leave lasting psychological damage resulting in instrusive thoughts, flashbacks, painful emotional states, and dissociation. Self-injury may be used by individuals facing these experineces, as it can be an effective strategy for escaping unwanted experiences and ending dissociation (Smith et al., 2014). Whilst people who have experienced trauma are more likely to engage in self-injury (Liu et al., 2018), it is a myth that all people who self-injure have experienced childhood trauma. Poverty is an additional risk factor for self-injury, with individuals from impoverished backgrounds more likely to self-injure than individuals whose socioeconomic needs were met (Liu, 2021). Why People Self-Injure Self-injury can be difficult to understand, as it appears to go against humans' innate desire to avoid harm. However, the reasons someone might injure themselves on purpose are often similar to the reasons people engage in other behaviours. Individuals who have self-injured often report more than one reason for their self-injury, and their reasons may change over time. The functions of self-injury can be classified into two broad categories: intrapersonal and interpersonal. Self-injury for intrapersonal reasons is more common than for interpersonal reasons (Taylor et al., 2018). Intrapersonal Functions Intrapersonal reasons have to do with an individual's internal state, including thoughts and emotions. There are three main intrapersonal functions: Emotion regulation. The most commonly reported reason to engage in self-injury is to manage emotional experiences. This includes escaping an unwanted emotions or inducing a desired emotion. Typically, these emotions are "negative", such as anger, frustration, sadness, and loneliness, but "positive" emotions such as excitement or pride have also been reported. Thought regulation. This is closely linked to emotion regulation, as our thoughts and emotions are connected. Individuals may use self-injury to control or quieten unwanted thoughts, such as self-criticism or suicidal ideation. Self-punishment. While self-punishment appears to serve an emotion regulation purpose, self-injury for this reason is usually tied to feelings or shame or thoughts about oneself being "flawed" or "bad". Interpersonal Functions Interpersonal functions have to do with an individual's connection with others, and include three main reasons: Communicating distress. Sometimes individuals may not know how to explain their distress to others and use self-injury as a way to communicate their feelings. Social influence. There may be several motivations underlying self-injury as a way to influence others. An individual may engage in self-injury to keep people away from them, to demonstrate their belonging to a social group, to elicit care, or to encourage a change in behaviour. Punishment. Sometimes a person may engage in self-injury as a way to punish another person for something they have or have not done. In these instances, the self-injury is typically communicating distress and serving an emotion regulation function as well. References Fox, K. R., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Bentley, K. H., & Nock, M. K. (2015). Meta-analysis of risk factors for nonsuicidal self-injury. Clinical Psychology Review , 42 , 156-167. https://doi.org/10.1016/j.cpr.2015.09.002 Gandhi, A., Luyckx, K., Baetens, I., Kiekens, G., Sleuwaegen, E., Berens, A., Maitra, S., & Claes, L. (2018). Age of onset of non-suicidal self-injury in Dutch-speaking adolescents and emerging adults: An event history analysis of pooled data. Comprehensive Psychiatry , 80 , 170-178. https://doi.org/10.1016/j.comppsych.2017.10.007 Gholamrezaei, M., De Stefano, J., & Heath, N. (2015). Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review. International Journal of Psychology , 52 , 316-326. https://doi.org/10.1002/ijop.12230 Liu, R. R. (2021). The epidemiology of non-suicidal self-injury: Lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychological Medicine , 53 , 274-282. https://doi.org/10.1017/S003329172100146X Liu, R. T., Scopelliti, K. M., Pittman, S. K., & Zamora, A. S. (2018). Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis. The Lancet - Psychiatry , 5 , 51-64. https://doi.org/10.1016/S2215-0366(17)30469-8 Liu, R. T., Sheehan, A. E., Walsh, R. F. L., Sanzari, C. M., Cheek, S. M., & Hernandez, E. M. (2019). Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clinical Psychology Review , 74 , Article 101783. https://doi.org/10.1016/j.cpr.2019.101783 Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2019). Self-injury age of onset: A risk factor for NSSI severity and suicidal behavior. Archives of Suicide Research , 23 , 551-563. https://doi.org/10.1080/13811118.2018.1486252 Plener, P. L., Schumachers, T. S., Munz, L., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation , 2 , Article 2. https://doi.org/10.1186%2Fs40479-014-0024-3 Smith, N. B., Kouros, C. D., & Meuret, A. E. (2014). The role of trauma symptoms in nonsuicidal self-injury. Trauma, Violence, and Abuse , 15 , 41-56. https://doi.org/10.1177/1524838013496332 Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders , 227 , 759-769. https://doi.org/10.1016/j.jad.2017.11.073

About Self-Injury Self-Injury and Suicide Resources / About Self-Injury / Self-Injury and Suicide "Related but not the same" The relationship between NSSI and suicide is complex. Although NSSI is not a suicidal behavior itself, it is a reliable predictor of later suicidal thoughts, plans, and attempts (Kiekens et al., 2018, Ribeiro et al., 2016). So, why is this the case? There are lots of factors that contribute to the relationship between NSSI and suicidal behaviours. A recent review by Griep and MacKinnon (2020) found that past-year NSSI frequency and depressive symptoms increase an individual's risk of attempting suicide. There were mixed findings regarding age and sex differences. Suicidality can fluctuate over time. It is important to continually check in with clients and loved ones regarding their self-injury and suicidality. References Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Greene, J. G., Kessler, R. C., Myin-Germeys, I., Nock, M. K., & Bruffaerts, R. (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. Journal of Affective Disorders , 239 , 171-179. https://doi.org/10.1016/j.jad.2018.06.033 Griep, S. K., & MacKinnon, D. F. (2020). Does nonsuicidal self-injury predict later suicidal attempts? A review of studies. Archives of Suicide Research , 26 , 428-446. https://doi.org/10.1080/13811118.2020.1822244 Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2015). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine , 46 , 225-236. https://doi.org/10.1017/S0033291715001804

2023 - 2024 Home / Collaborative Research Program / NSSI in Chinese Adolescents NSSI and other life-threatening behaviours among adolescents in China Mentor/s: Moye Xin 2024 - 2025 Project Overview Affiliation: Xhaanxi Normal University, China Project Description: My research interests mainly focus on a combination with Life-threatening behaviors (e.g., NSSI and suicidal behaviors) among other minorities (e.g., adolescents and young adults at risk) and gender study, then try to figure out the mechanism of them, with the perspective of social science and psychological methodology, meanwhile, cooperating with international platforms, if possible. Applicants should have the following skills: Basic skills of data analysis, literature review and a little bit of mind of innovation Junior researcher responsibilities: Collecting literatures and revelant data, drafting manuscripts based on their own research interests Anticipated outcome(s) for junior researcher: Able to start your own research by choosing frontiers of research field, and start to write basic literature reviews and do some basic data analysis. Time commitment: 3 days per week for 1 year Application Deadline: June 1, 2024 Apply Now

2023 - 2024 Home / Collaborative Research Program / NSSI and STB Prediction Proximal mechanisms of NSSI predicting suicide thoughts and behaviors Mentor/s: Jennifer Muehlenkamp 2024 - 2025 Project Overview Affiliation: University of Wisconsin – Eau Claire Project description: Very little is known about the short-term temporal course of NSSI in relation to suicidal behavior, and information about possible mechanisms that facilitate, or reduce, transition to suicidal behavior among those engaging in NSSI is sparse. This project aims to provide data filling gaps in the suicide research by conducting a micro-longitudinal study of transdiagnostic processes believed to interact with and influence risk for suicidal behavior conferred by NSSI. Using the Integrative-Motivational-Volitional (IMV) theory of suicide as a guide, the current study proposes that variability in sleep quality and emotional reactivity will interact with self-perceptions and perceived social connectedness to influence NSSI features and mechanisms of risk to predict near-term, acute, change in suicidal behavior. Young adults reporting current NSSI and suicidal ideation will wear actigraph watches (to obtain sleep data) and complete daily diary assessments of the study variables along with weekly lab-based assessment for 4 weeks, and complete 1- and 2-month follow-ups. Multi-level modeling analyses will examine the moderating effects of sleep and emotional reactivity on the proposed risk-processes to influence NSSI and suicidal behaviors over days, weeks, and months. The results will provide novel and essential information to the field of suicidology by advancing current knowledge about acute risk for suicide and have potential to significantly impact clinical practice by identifying specific, modifiable markers of risk that can translate into clinical targets for assessment and intervention strategies. Applicants should have the following skills: Multi-level modeling /SEM / longitudinal data analytic statistical knowledge, scientific writing experience Junior researcher responsibilities: Assist with data analysis and write up of manuscript; Can conceptualize own research question/project from existing data and co-create a manuscript Anticipated outcome(s) for junior researcher: Peer-reviewed manuscript, Conference presentation(s) Time commitment: Approximately 1 day per week for 4-6 months Application Deadline: June 1, 2024 Apply Now

About Self-Injury Recovery and Ambivalence Resources / About Self-Injury / Recovery and Ambivalence "A non-linear push and pull" Recovery Recovery for self-injury can mean different things to different people. In recent years, there has been a greater focus both academically and clinically on the lived experience of self-injury. Part of this focus has drawn attention to the varied conceptualisations of recovery. Clinical conceptualisations According to the proposed diagnostic criteria for non-suicidal self-injury disorder (NSSI-D), an individual may be considered "recovered" after self-injury has been ceased for 12 months. As identified by Lewis and Hasking (2020), this may be unrealistic and does not reflect individuals' lived experience of recovery. Lived experience conceptualisations Not surprisingly, individuals' conceptualisations of NSSI recovery are vast and varied. Theoretical conceptualisations Recent developments in the research field have led to new theoretical conceptualisations of NSSI recovery, including that proposed by Lewis and Hasking (2021). Sourced from Lewis & Hasking (2021) In their framework, Lewis and Hasking capture the following in their person-centred model of self-injury recovery: Emphasis realistic expectations Recovery is non-linear and "relapses" are common Viewing recovery in absolute terms may be unrealistic and unhelpful Normalise thoughts and urges Continued thoughts about self-injury and urges to self-injure are common. These thoughts and urges may persist indefinitely Foster self-efficacy Recognition of times when urges have been overcome can strengthen self-efficacy to resist NSSI in the future Identify strengths Identifying and leveraging strengths can foster self-efficacy and support other coping strategies Find alternatives Finding strategies as effective as NSSI takes time and involves trial and error There is no one-size-fits all, and alternative strategies that work for one individual may not work for another Address underlying adversities There are many possible difficulties and adversities underlying self-injury; these need to be addressed to support NSSI recovery Address and accept scarring While not relevant to all individuals, scarring can be a significant concern Scarring may contribute to ongoing psychological distress/urges, but can also represent strength and resilience For individuals with scars, accepting scarring may be particularly important in their recovery Prepare for navigating disclosures Disclosure may be voluntary, unwanted, or unintentional Disclosure may be necessary to recovery (accessing support) Considering how to navigate these disclosures may be useful for recovery Foster self-acceptance Through the above, self-acceptance can be fostered Ambivalence Understanding ambivalence around self-injury and recovery is important for individuals who self-injure and their loved ones. References Lewis, L. P., & Hasking, P. A. (2020). Rethinking self-injury recovery: A comentary and conceptual reframing, BJ Psych Bulletin , 44 , 44-46. https://doi.org/10.1192/bjb.2019.51 Lewis, S. P., & Hasking, P. A. (2021). Self-injury recovery: A person-centred framework. Journal of Clinical Psychology , 77 , 884-895. https://doi.org/10.1002/jclp.23094

About Self-Injury Treatments for Self-Injury Resources / About Self-Injury / Treatments for Self-Injury "It must be person-centred" "Treatment" and "recovery" can mean different things to different people. In general, "treatment" refers to physical (e.g., wound care) and psychological (e.g., DBT) interventions that help people who are self-injuring. Generally, the goal of psychological treatments is to reduce NSSI by targeting the thoughts, emotions, and behaviors that underlie an individual's self-injury. Until recently, few treatments were developed specifically for self-injury. Although there is currently no “gold-standard” treatment for self-injury, several treatments show promise in helping people decrease or stop these behaviors (Calvo et al., 2022; Turner et al., 2014), although the efficacy of treatments is still unclear (Fox et al., 2020). Dialectical Behavior Therapy (DBT) DBT is a psychotherapeutic treatment designed to treat Borderline Personality Disorder (BPD), of which NSSI is a common behaviour (Linehan, 1993). It was modified by Miller et al. (2007) to reduce NSSI and suicidality among adolescents, and has shown efficacy to reduce NSSI in multiple studies (Fleischhaker et al., 2011; Pistorello et al., 2012, Stanley et al., 2007). DBT is an intensive treatment lasting 6 months to 2 years and involves weekly individual therapy, group-based skills training, and between-session coaching. DBT integrates behavioral strategies (e.g., behavior analysis, problem-solving strategies, skills training in emotion regulation and interpersonal effectiveness, contingency management) with mindfulness (e.g., nonjudgmental, present-focused attention), and dialectical strategies (e.g., balancing acceptance and change) to reduce self-injury by: Improving emotion regulation Increasing behavioral control Strengthening positive identity Improving interpersonal skills It is important to note that some research shows that DBT is not superior to other treatments in reducing self-injury (e.g., Katz et al., 2004, Nock et al., 2007). Emotion Regulation Group Therapy (ERGT) ERGT was developed as an alternative to DBT, offering a briefer treatment period including 14 weeks of group-based psychotherapy. Unlike DBT, which is intended to treat NSSI in combination with other challenges facing people living with BPD, ERGT focuses solely on NSSI. It integrates components of DBT and Acceptance and Commitment Therapy (ACT). ERGT treats NSSI in several ways: Increasing awareness, understanding, and acceptance of emotions. By learning more about emotions and how to recognise them, individuals are better equipped to cope with emotional experiences. Improving emotional control and tolerance. Individuals learn how to better control the intensity and duration of their emotions, and develop greater tolerance of uncomfortable emotional experiences. Facilitating behavioral control. Individuals learn how to enact goal-directed behaviors and inhibit impulsive behaviors in response to negative emotions. ERGT was designed as an adjunctive treatment, meaning it is best used in conjunction with, rather than instead of, other types of treatment (such as individual psychotherapy). Several well-designed studies have shown that ERGT is effective in reducing self-injury in adult women living with BPD. A recent feasibility study also suggests that ERGT may be effective in adolescent girls engaging in NSSI. Importantly, research on ERGT has been limited to studies on women; more research is needed to determine whether ERGT is equally effective for men. ERGT was also recently adapted to an individual setting for adolescents (ERIT-A; Bjureberg et al., 2017). An open trial investigating the online delivery of ERIT-A showed a reduction in NSSI, which was strengthened at 3-month follow up, and maintained at 6-month follow-up (Bjureberg et al., 2018). Treatment for Self-Injurious Behaviors (T-SIB) T-SIB is a brief, nine-session intervention conducted weekly on an individual basis (Andover et al., 2017). Designed for young adults engaging in NSSI, T-SIB uses motivational enhancement strategies, functional analysis, and skills training for problem-solving, distress tolerance, cognitive distortions, and interpersonal communication to address self-injury. An initial pilot study of T-SIB found decreased self-injury over the course of treatment; however, further research is needed to see if T-SIB will be effective in other groups of people and to compare T-SIB to other treatments that address self-injury. References Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., & Miller, I. W. (2017). An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology , 85 , 620–631. https://doi.org/10.1037/ccp0000206 Bjureberg, J., Sahlin, H., Hellner, C., Hedman-Lagerlöf, E., Gratz, K. L., Bjärehed, J., Jokinen, J., Tull, M. T., & Ljótsson, B. (2017). Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: A feasibility study. BMC Psychiatry , 17 , Article 411. https://doi.org/10.1186/s12888-017-1527-4 Bjureberg, J., Sahlin, H., Hedman-Lagerlöf, E., Gratz, K. L., Tull, M. T., Jokinen, J., Hellner, C., & Ljótsson, B. (2018). Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: Open pilot trial and mediation analysis of a novel online version. BMC Psychiatry , 18 , Article 326. https://doi.org/10.1186/s12888-018-1885-6 Calvo, N., Sara García-González, S., Perez-Galbarro, C., Regales-Peco, C., Lugo-Marin, J., Ramos-Quiroga, J.- A., & Ferrer, M. (2022). Psychotherapeutic interventions specifically developed for NSSI in adolescence: A systematic review. European Neuropsychopharmacology , 58 , 86-98. https://doi.org/10.1016/j.euroneuro.2022.02.009 Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical behavioral therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health , 5 , Article 3. https://doi.org/10.1186/1753-2000-5-3 Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin , 146 , 1117-1145. https://doi.org/10.1037/bul0000305 Katz, L. Y., Cox, B. J., Gunasekara, S., & Miller, A. L. (2004). Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry , 43 , 276-282. https://doi.org/10.1097/00004583-200403000-00008 Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder . Guilford. Miller, A. L., Rathaus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents . Guilford. Nock, M. K., Teper, R., & Hollander, M. (2007). Psychological treatment of self-injury among adolescents. Journal of Clinical Psychology , 63 , 1081-1089. https://doi.org/10.1002/jclp.20415 Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. Journal of Consulting and Clinical Psychology , 80 , 982–994. https://doi.org/10.1037/a0029096 Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self-injury. Archives of Suicide Research , 11 , 337-341. https://doi.org/10.1080/13811110701542069 Turner, B. J., Austin, S. B., & Chapman, A. L. (2014). Treating nonsuicidal self-injury: A systematic review of psychological and pharmacological interventions. The Canadian Journal of Psychiatry , 59 , 576-585. https://doi.org/10.1177%2F070674371405901103

About Self-Injury What is Self-Injury? Resources / About Self-Injury / What is Self-Injury? "A distinct behaviour" Self-injury is a common yet poorly understand behaviour. Educating ourselves about self-injury starts with being specific about what we mean when we talk about it. There are several key elements to our definition: The harm is intentional or expected Risky behaviors that could result in harm, such as not wearing a seatbelt while driving, or behaviors that can result in accidental harm, such as playing extreme sports, are typically excluded under our definition. The injury results in immediate physical injury Behaviors that do not directly result in physical injury are typically excluded under our definition, even though they may be harmful or dangerous. For instance, food restriction is typically not considered a form of NSSI since the associated physical damage tends to build up over time, instead of happening as soon as the behavior occurs. Is not intended to cause death While suicidal thoughts may be present when someone self-injures, the self-injury itself is not intended to cause death. Some people may use self-injury to manage suicidal urges or intense distress related to suicidal thoughts. Self-injury enacted with suicidal intent is not classified as NSSI. Is not part of social or cultural practices Behaviors that might cause physical damage but are acceptable in our society, or part of a recognized cultural, spiritual or religious ritual, are not considered self-injury. Behaviors such as body modification, body piercing, tattooing, and religious self-flagellation are not usually considered forms of self-injury. A note on terminology The term "NSSI" is often used interchangeably with self-injury - we do so throughout this site; however, it is important to bear in mind that someone may use the term 'self-injury' and be referring to suicidal behaviour. Likewise, while we do not use the term self-harm on this site, many people, including researchers, clinicians, and individuals with lived experience, use this term to refer to NSSI. Regardless of the source, it is important to always ascertain whether the term is being used to refer to suicidal or non-suicidal behaviours. There are some other terms used throughout the field that may or may not refer to NSSI. Self-harm Often, when people think of 'self-harm', what comes to mind is NSSI. However, self-harm is an umbrella term that captures all self-directed injury regardless of intent. In some conceptualisations, self-harm includes indirect injury, such as that caused by reckless behaviours, or psychological injury, such as that caused by self-criticism. While NSSI falls under the self-harm umbrella, ISSS distinguishes NSSI from other behaviors due to the aetiological, functional, and predictive factors that are unique to NSSI. Deliberate self-harm Deliberate self-harm is a term usually used to refer to non-suicidal self-injury; however, it may also encompass any self-inflicted injury, regardless of intent. Determining what is meant when this term is used is important. Self-cutting NSSI is sometimes referred to by focusing on particular methods (e.g., self-cutting). While cutting is among the most widely recognized forms of self-injury, the behavior can take many other forms, including burning, hitting, or scratching. Furthermore, many people who self-injure report using more than method during their lives. Therefore, we recommend avoiding this term when referring to self-injury more broadly, as it dismisses the experiences of many people. Parasuicide, self-mutilation These terms are no longer used in contemporary research and practice, but are occasionally still seen in news media. The term 'parasuicide' links injury to suicide, creating an assumption that self-injury is a suicide attempt. As we know, this is not always that case. The term 'self-mutilation' is stigmatising and harmful, characterising an individual's injury as negative due to its appearance and conjuring judgement and fear (Hasking & Boyes, 2018; Hasking et al., 2019). References Hasking, P., & Boyes, M. (2018). Cutting words: A commentary on language and stigma in the context of nonsuicidal self-injury. Journal of Nervous and Mental Disease , 206 , 829-833. https://doi.org/10.1097/nmd.0000000000000899 Hasking, P., Lewis, S. P., & Boyes, M. E. (2019). When language is maladaptive: Recommendations for discussing self-injury. Journal of Public Mental Health , 18 , 148-152. https://doi.org/10.1108/JPMH-01-2019-0014 Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know. Canadian Journal of Psychiatry , 59 , 565-568. https://doi.org/10.1177%2F070674371405901101

Home / Awards / Invited Fellow / Dr. Janis L. Whitlock Dr. Janis L. Whitlock Previous Dr. Janis Whitlock is a Senior Research Scientist and Director Emerita at the Cornell Research Program on Self-Injury and Recovery (United States). For over two decades, she has been a pioneering force in understanding the epidemiology, context, and recovery process of self-injury, especially among adolescents and college students. Her work has illuminated how social, developmental, and digital factors influence self-injury, and she has been at the forefront of translating research into accessible educational materials for clinicians, parents, and young people. Her work has been foundational in understanding self-injury among adolescents and young adults, particularly in community and online contexts. Dr. Whitlock is deeply respected for her compassionate approach, her emphasis on resilience and recovery, and her lifelong commitment to empowering individuals and communities to respond to self-injury with understanding rather than stigma. Next ISSS Fellow | 2022

2023 - 2024 Home / Collaborative Research Program / CANDI Validation in Youth Characteristics of nonsuicidal self-injury disorder in youth and psychometric evaluation of the Clinician-Administered Nonsuicidal Self-Injury Disorder Index Mentor/s: Johan Bjureberg 2024 - 2025 Project Overview Affiliation: Karolinska Institutet, Sweden Project description: Although NSSI usually debuts in adolescence, few studies have examined the full set of DSM-5 NSSID diagnostic criteria in youth. In this study, we will analyze the reliability and validity of the structured diagnostic interview Clinician-Administered NSSI Disorder Index (CANDI) and provide information on the clinical characteristics and features of DSM-5 NSSID in youth. Data on the internal consistency, factor structure, and construct validity of the CANDI and associated characteristics of NSSID will be analyzed in a clinical sample of youth (N = 166; (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) with recent recurrent NSSI (≥5 days with NSSI the past year and ≥1 episode in the month). Participants and their caregivers completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, and clinicians assess diagnostic interviews of borderline personality disorder (SCID–II), common mental disorders (Mini International Neuropsychiatric Interview), global functioning, and clinical severity. Applicants should have the following skills: Interest in psychometric evaluations and experience conducting literature search Junior research responsibilities: Conducting literature search, drafting the manuscript, and assist in data analysis Anticipated outcome(s) for junior researcher: Co-authorship on an academic peer-reviewed paper Time commitment: Approximately 1 day per week for 6 months Application Deadline: June 1, 2024 Apply Now

Special Interest Groups Collaboration / Special Interest Groups Groups with a Special Focus Special interest groups (SIGs) are groups of researchers, clinicians, and other stakeholders (including individuals with lived and/or living experience) who share an interest in a specific area of focus. Find out more about each SIG below. Research on NSSI in Daily Life Conduct and disseminate ethical, accessible, and priority-driven research to advance understanding, assessment, treatment, and prevention of NSSI. More ICSES The International Consortium on Self-Injury in Educational Settings is an interdisciplinary and international research group focused on prevention and intervention in educational settings. More Stigma, Recovery, & Lived Experience The Stigma, Recovery, and Lived Experience Special Interest Group focuses on the lived experiences of self-injury, paying particular attention to issues related to stigma and recovery. More Biological Factors and NSSI The Biological Factors and NSSI Special Interest Group focuses on neurological and physiological processes that impact NSSI. More