non-suicidal self-injury in adolescents: forms, functions
TRANSCRIPT
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Non-suicidal self-injury in adolescents: Forms, functions and
clinical implicationsMarc Wilson, Jessica Garisch, Robyn Langlands, Angelique O’Connell, Lynne Russell,
Emma-Jayne Brown & Tahlia Kingi
NZCCP Conference, Christchurch, April 2014
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Youth Wellbeing Study
• Longitudinal survey with secondary school students.
• Non-Suicidal Self-injury
• Primarily investigating– Risk and protective factors for the development of non-suicidal self-
injury
– Barriers to help-seeking
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Trajectory of NSSI among young New Zealanders
• We have data spanning age-groups
– 13 – 15 years olds
– 16 – 19 year olds
– University students (M=19 yo)
How do these groups compare in prevalence, form and function of NSSI…
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Prevalence
• YWS Wave 1 results– N=1027 (991 responded to questions on NSSI)
• 213 (21%) engaged in NSSI at least once– 81.6% had engaged in NSSI in the past year
• Senior secondary school students– N=1162
• 48.7% had engaged in NSSI at least once– 53.6% had engaged in NSSI in past year
» 46.4% over a year ago
• University students– N= 593
• 43.7% had engaged in NSSI at least once
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YWS wave 1: Further information on prevalence...
Type of NSSI Neverthought about
Thought about, never done
Have done once
Have done a few times
Have done many times
Cut 80.2 6.0 3.8 6.2 3.8
Scratched 87.5 2.7 3.8 4.0 1.9
Carved 89.2 2.3 3.7 3.0 1.7
Punched/ banged
90.3 2.5 3.7 2.7 0.7
Stuck sharp objects
91.1 2.1 3.4 2.4 0.9
Prevent healing 91.8 1.5 3.3 1.9 1.4
Bitten self 93.8 2.4 2.4 1.0 0.4
Burn 94.3 2.7 1.5 1.0 0.5
Rubbed glass 96.0 1.4 1.5 0.8 0.3
Broken bones 97.1 1.6 0.7 0.4 0.2
Rubbed sandpaper
97.7 1.1 0.8 0.3 0.1
Dripped acid 99.2 0.3 0.2 0.0 0.0
Used bleach/ cleaning agent
99.2 0.7 0.1 0.0 0.0
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Prevalence of Types of NSSI
• YWS Wave 1 sample
– Cutting most common
– Severe scratching, carving the skin, punching or banging
• Senior Secondary School students
– Sticking sharp objects into the skin, carved, scratch most common
– Cutting
Other types assessed (e.g. using acid, sandpaper, etc.) much less frequently reported.
Types of NSSI generally cluster into 2 factors: ‘common’ + ‘uncommon’
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Engagement in multiple types of NSSI
University student data suggests that the majority of young people engage in 1 – 3 types of NSSI...
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Engagement in multiple types of NSSI
• YWS Wave 1
• Of the 213 who reported NSSI– 25.6% reported 1 form
– 17.4% reported 2 forms
– 15.5% reported 3 forms
– 37.1% reported > 3 forms
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Self-reported Function of NSSI
• Three datasets investigating functions
– Senior Secondary school data
– Adult data
– Wave 1 YWS
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Functions: Senior secondary school students
• Functional Assessment of Self-Mutilations (FASM; Lloyd et al., 1997)
• Identified three factors:– Intrapersonal (endorsed by 38.2% participants)
• “To feel more a part of a group”
• “To get your parents to understand or notice you”
– Emotional relief/control (endorsed by 18.2%)
• “To feel something, even if it is pain”
• “To punish yourself”
– Avoidance (endorsed by 20.0%)
• “To avoid being with people”
• “To avoid punishment or paying the consequences”
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Adult Community Sample (Langlands, 2012)Using the Inventory of Statement about Self-Injury (ISAS) (Klonsky & Olino, 2008)
Inte
rper
son
alIn
trap
erso
nal
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YWS Wave 1: Four Clusters(Functions assessed using FASM (Klonsky & Olino, 2008)
Interpersonal:
Other-focused
Interpersonal: self-focused
Intrapersonal: Disconnection
Intrapersonal: Affect & Punish
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Functions & Psycho-social functioning
• Generally, intrapersonal functions (both disconnection and affect regulation/self-punishment) most strongly associated with indicators of poor functioning...
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Anxiety
Leve
l of
Fun
ctio
n e
nd
ors
emen
t
DepressionLe
vel o
f Fu
nct
ion
en
do
rsem
ent
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Attachment to Parents
Leve
l of
Fun
ctio
n e
nd
ors
emen
t
Attachment to PeersLe
vel o
f Fu
nct
ion
en
do
rsem
ent
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Emotion Regulation
Leve
l of
Fun
ctio
n e
nd
ors
emen
t
ResilienceLe
vel o
f Fu
nct
ion
en
do
rsem
ent
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Suicidal Ideation
Leve
l of
Fun
ctio
n e
nd
ors
emen
t
Self-EsteemLe
vel o
f Fu
nct
ion
en
do
rsem
ent
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YWS: Participant Clusters by Function
• Cluster 1: Affect regulation & self-punishment (n=75)
• Cluster 2: Low on all (n=81)
• Cluster 3: Highest on intrapersonal (n=13)
• Cluster 4: High on all, highest on both interpersonal (n=22)
0
1
2
C1
C4
C2
C3
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• Klonsky & Olino (2008)
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YWS: Clusters + Psycho-social functioning
• Four clusters differed significantly on:– Suicidality (notably C1 and C3)
– Self-esteem
– Resilience
– Depression
– Anxiety
– Emotion regulation
– Attachment to parents (but not peers...)
– NSSI behaviour
Cluster 2 (low on all) generally the best
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The NUMBER of types of self-injury engaged in is strongly predictive of suicidal ideation:
For each additional form, SBQ scores increase:
1 form SBQ = 3.5ish
2 forms SBQ = 5ish
3 forms SBQ = 7ish
7 is the recommended cutoff for concern…
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0
1
2
0
1
2
3
4
5
6
C1 C2 C3 C4N
um
be
r o
f o
rms
of
NSS
I e
nga
ged
in
YWS: Participant Clusters by NSSI forms
C1
C4
C2
C3
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0
1
2
YWS: Participant Clusters by NSSI forms
C1 – 2nd most likely to cut, 3rd most likely for most forms
C4 – most likely to self-bite, 2nd most likely for most.Most likely to have thought about ‘atypical’ self-injury like bone breaking, using glass, bleach, etc
C2
C3 – Most likely to cut, carve, insert
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Implications for clinical practice
• Results congruent with the idea that NSSI begins in early adolescents, and continues into early adulthood for some individuals
• Forms of NSSI: multiple behaviours need to be queried.
• Functions
– Heterogeneity
– Affect regulation most prevalent
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Implications for clinical practice continued...
• Functions can point to skills required...
– Affect regulation• Distress tolerance skills
• Labelling and communicating emotions
• Understanding beliefs regarding experiencing (and showing) emotion
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Acknowledgements
• Participating schools + students
• HRC
Thanks for listening
Any questions? Comments?