Some notes on self-injury Jessica Garisch Tamsyn Gilbertson Robyn Langlands Angelique O’Connell Lynne Russell Marc Wilson Emma Brown Tahlia Kingi

So what are we talking about…? Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007): “…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).” “As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”

Why do people do it…?

Why do people do it…?

Prevalence… 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1 24% - Lifetime prevalence among community-based New Zealand adults2 48% of adolescents presenting to CAMHS reported SH at initial assessment3 20% of 9,000 secondary students reported SH in previous year4 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5 years5    (conflation between SSI and NSSI) 1. Hatcher et al., 2009. 2. Nada-Raja et al., 2004. 3. Fortune et al., 2005. 4. Fortune et al., 2010. 5. Pryor & Jose, 02/04 to 09/09.

Prevalence… Sample N Measure # items Lifetime Prevalence 1. 100-level PSYC students 285 Sansone et al’s (1998) SHI 22 78.9%/54.9%† † r=.40 with suicidal behaviour

Prevalence… Sample N Measure # items Lifetime Prevalence 1. 100-level PSYC students 285 Sansone et al’s (1998) SHI 22 78.9%/54.9%† 2. 16-18 year-old School students 325 De Leo & Heller (2004) 1 14.8% † r=.40 with suicidal behaviour

Prevalence… Sample N Measure # items Lifetime Prevalence 1. 100-level PSYC students 285 Sansone et al’s (1998) SHI 22 78.9%/54.9%† 2. 16-18 year-old School students 325 De Leo & Heller (2004) 1 14.8% 3. 16-18 year-old School students 1,162 Lundh et al’s (2007) DSHI 14 48.7% 4. 100-level PSYC students 593 43.7% † r=.40 with suicidal behaviour

Prevalence… Sample N Measure # items Lifetime Prevalence 1. 100-level PSYC students 285 Sansone et al’s (1998) SHI 22 78.9%/54.9%† 2. 16-18 year-old School students 325 De Leo & Heller (2004) 1 14.8% 3. 16-18 year-old School students 1,162 Lundh et al’s (2007) DSHI 14 48.7% 4. 100-level PSYC students 593 43.7% 5. 100-level PSYC students 722 Lundh et al’s (2007) DSHI (SV) 7 39.7%‡ † r=.40 with suicidal behaviour ‡ correlates .79 with the full 14-item DSHI

Why do those who self-injure, self-injure?

Interpersonal Intrapersonal

Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed. ISAS subscale Global Mean (SD) Most recent Mean (SD) Affect regulation 4.62 (1.62) 4.57 (1.74) Self-punishment 4.14 (1.91) 3.89 (2.15) Marking distress 2.82 (2.00) 2.66 (1.96) Anti-dissociation/ feeling generation 2.68 (2.16) 2.04 (2.25) Anti-suicide 2.22 (1.98) 2.02 (2.27) Self-care 1.49 (1.48) 1.34 (1.51) Toughness 1.29 (1.53) 1.04 (1.54) Interpersonal influence 1.18 (1.47) 0.92 (1.36) Interpersonal boundaries 1.16 (1.51) 0.89 (1.50) Sensation-seeking 0.77 (1.21) 0.52 (1.17) Autonomy 0.77 (1.18) 0.60 (1.17) Revenge 0.68 (1.26) 0.62 (1.37) Peer-bonding 0.14 (0.56) 0.15 (0.81)

Myths of self-injury: All people who self-injure are suicidal Self-injury is a female issue Only adolescents hurt themselves People who hurt themselves are mentally ill People who hurt themselves have been abused Supporting people who self-injure: 1. Avoid pejorative labels 2. Remember the myths! 3. Aim for low-key dispassionate demeanour and respectful curiosity – be professional! 4. Aim for a balance of appropriate level of concern that doesn’t alarm the person, condone the behaviour, but also provides support 5. Pass it on to the professionals – be clear of your own limits.

Useful resources Excellent factsheets developed by the team from the Cornell Research Programme on Self-injurious behaviour in adolescents and young adults: http://www.crpsib.com/resources.asp An information booklet written by an Australian psychologist for young people who self-injure: http://www.decd.sa.gov.au/speced2/files/pages/chess/hsp/Information/revised_selfharm_finalweb.pdf An online power-point presentation for parents with children who are self-injuring: http://store.selfinjury.com/products/Parents-Webinar%3A-by-Dr.-Wendy-Lader.html A free, downloadable copy of 'Healing the Hurt Within' by Jan Sutton: http://www.e-booksdirectory.com/details.php?ebook=2363 Our website: http://www.victoria.ac.nz/psyc/research/youth-and-wellbeing-study/news-and-events

Where next? Towards understanding how NSSI starts, stops, and continues… Year 9 and older Longitudinal Funded by the Health Research Council of New Zealand To be on our newsletter mailing list email jessica.garisch@vuw.ac.nz