2. Some notes on self-injury in New Zealand: Prevalence, correlates and functions Jessica Garisch Tamsyn Gilbertson Robyn Langlands Angelique O’Connell Lynne Russell Marc Wilson Emma Brown Tahlia Kingi Please note that this presentation will include discussion of suicide and life-threatening behaviour

3. So what are we talking about…? Does it cover… Overdosing? Drinking ‘til you throw up? Taking risks? Accepting emotional abuse? Depriving yourself of food? Piercings? Tattoos? Brandings or scarification? ‘Mortification of the flesh’?

4. 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.”

5. What do we know about it…?

7. Why do people do it…?

9. What do we know about it…? …In New Zealand?

10. Prevalence… 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations 1 24% - Lifetime prevalence among community-based New Zealand adults 2 48% of adolescents presenting to CAMHS reported SH at initial assessment 3 20% of 9,000 secondary students reported SH in previous year 4 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5 years 5  (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.

11. SampleNMeasure# itemsLifetime Prevalence 1. 100-level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† Prevalence… † r=.40 with suicidal behaviour

13. SampleNMeasure# itemsLifetime Prevalence 1. 100-level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† 2. 16-18 year-old School students 325De Leo & Heller (2004)114.8% Prevalence… † r=.40 with suicidal behaviour

15. SampleNMeasure# itemsLifetime Prevalence 1. 100-level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† 2. 16-18 year-old School students 325De Leo & Heller (2004)114.8% 3. 16-18 year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% 4. 100-level PSYC students 593Lundh et al’s (2007) DSHI1443.7% Prevalence… † r=.40 with suicidal behaviour

17. SampleNMeasure# itemsLifetime Prevalence 1. 100-level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† 2. 16-18 year-old School students 325De Leo & Heller (2004)114.8% 3. 16-18 year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% 4. 100-level PSYC students 593Lundh et al’s (2007) DSHI1443.7% 5. 100-level PSYC students 722Lundh et al’s (2007) DSHI (SV)739.7%‡ Prevalence… † r=.40 with suicidal behaviour ‡ correlates.79 with the full 14-item DSHI

20. Self-injury is most likely when… …one is experiencing peer victimisation AND one is highly alexithymic.

21. Self-injury is most frequent, most diverse, and most thought about when… …one is highly perfectionistic AND highly alexithymic.

22. These are all psychological, contextual and interpersonal predictors of SI Why do those who self-injure, self-injure?

23. N Training? NSSI client attempted Suicide? NSSI client COMPLETED suicide Non-NSSI client attempted Suicide? Non-NSSI client COMPLETED suicide Tell active/past SI client of research? Mental Health Nurse8861%90%49%88%65%56/58% General Practitioner160%62%25%88%56%31/25% Social Worker5744%86%16%72%26%33/32% Clinical Psychologist5777%86%25%83%30%28/32% Psychiatrist10%100%0%100% 0/0% Counsellor3234%69%9%78%13%28/25%

27. ISAS subscale Global Mean (SD) Most recent Mean (SD) Affect regulation4.62 (1.62)4.57 (1.74) Self-punishment4.14 (1.91)3.89 (2.15) Marking distress2.82 (2.00)2.66 (1.96) Anti-dissociation/ feeling generation2.68 (2.16)2.04 (2.25) Anti-suicide2.22 (1.98)2.02 (2.27) Self-care1.49 (1.48)1.34 (1.51) Toughness1.29 (1.53)1.04 (1.54) Interpersonal influence1.18 (1.47)0.92 (1.36) Interpersonal boundaries1.16 (1.51)0.89 (1.50) Sensation-seeking0.77 (1.21)0.52 (1.17) Autonomy0.77 (1.18)0.60 (1.17) Revenge0.68 (1.26)0.62 (1.37) Peer-bonding0.14 (0.56)0.15 (0.81) Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed.

28. The ‘paradox of self-injury’ Self-injury worthy of help is private, but attention-seeking self-injury is public.  How does one seek help for ‘worthy’ self-injury without becoming unworthy?

29. 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