Non-Suicidal Self-Injury: Description, Motivations, and Relationship to Suicide

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 Adolescents 8% High-School 14 - 15% University Students 17% General Adult Population 4-6% Adolescent Inpatients 40 - 80% Klonsky, E.D. & Muehlenkamp, J.J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology: In Session.

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

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

27. Why People Self-Injure: Research

28. Why People Self-Injure: Research

29. Why People Self-Injure: Research

30. Why People Self-Injure: Research

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 • 3rd 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 • 4rd 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 • 5th 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 • 6th 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

38. Why People Self-Injure: Research

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

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 +1.39 Overwhelmed - 0.89 Anxious - 0.81

45. Why People Self-Injure: Theories

46. Why People Self-Injure: Theories

47. Why People Self-Injure: Theories

48. Why People Self-Injure: Theories

49. Functions of Self-Injury • Organizing conceptual framework • 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.