Nonsuicidal self-injury

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]

Synonyms and keywords: Self-harm (SH), Self-inflicted violence (SIV), self-injury (SI), Non suicidal self injury (NSSI) or self-injurious behavior (SIB),

Overview

Non Suicidal Self Injury means the intentional or conscious effort by someone to destruct his or her own body tissues with out having any intent for suicidality. The most common examples associated with NSSI includes cutting, scratching, burning, banging, self hitting. Mostly the people who self injure themselves are having the history of using two or more methods out of what described before. Because NSSI is frequently connected with emotional and psychiatric discomfort, as well as an increased risk of suicide, correct establishment of conceptual and clinical models of this behavior are critical.

The Non suicidal Self Injury is most commonly seen in young adults and adolescents age groups of around 13-14 years with a lifetime rates of 15-20%. But when the stats studied adult population the rate is 6%. Psychiatric groups, particularly those who report features linked with emotional distress, such as negative emotionality, depression, anxiety, and emotion dysregulation, have the highest incidence of NSSI in both adolescents and adult age group. In addition People who are prone to self-directed negative emotions and self-criticism are more likely to develop NSSI. Although it is typical for people to believe that NSSI is more common in women, general population surveys show that men and women have similar rates. However the sex difference makes the contribution when its comes to the point of methods used for NSSI. The women's are more found to be using cutting whereas the men's more often use the method of hitting and burning

Classification

Non Suicidal Self Injury

The NSSI also known as Self Harm, Self Injury, Self-inflicted violence, Self Injurious Behavior. These are the common term used interchangeably by various authors and practioners to name the disease. The behavior entails intentional tissue injury that is usually carried out without a suicidal motive. Cutting the skin with a sharp item, such as a knife or razor blade, is the most prevalent type of self-harm. The word "self-mutilation" is also occasionally used, albeit it has connotations that some people find alarming, inaccurate, or unpleasant.

Soldiers use the term "self-inflicted wounds" to describe non-lethal injuries they cause in order to be released from combat sooner. But this damage is inflicted for a defined secondary aim, which differs from the standard definition of self-harm. we can also say the people who injure their bodies through disordered eating may be included in the definition of self-harm when broader aspect of the disease is considered.

NSSI has been proposed as a disorder in the DSM-5's "Conditions for Further Study" category. It should be noted that this proposed diagnostic criteria for a future diagnosis is not an officially approved diagnosis and should not be utilized in clinical practice; rather, it is intended solely for research purposes. The NSSI is classified as deliberate self-inflicted harm without the intent to commit suicide. The criteria for diagnosing and identifying NSSI includes 5 or more days of self inflicted harm over the duration of one year without having any intention to commit the suicide and along with that the person must have been having a motivation to relief from the negative state or to achieve a positive state.

Self-harm is commonly misunderstood as an attention-seeking behavior; however, this is not always the case. Many self-harmers are self-conscious about their scars and wounds, and they feel bad about their actions, therefore they go to great measures to hide their actions from others. They try to give the alternate reasoning for their scars or try to hide them with clothing. Self-harmers aren't usually trying to take their own lives; instead, it's thought that they're using it as a coping method to ease emotional anguish or discomfort, or as a way to communicate their distress.

Self-harm is dependent on environmental circumstances such as receiving attention or escaping expectations, according to studies of people with developmental disabilities (such as intellectual disability). Some people suffer from dissociation because they want to feel authentic or fit to society's rules.

Pathophysiology

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The progression to [disease name] usually involves the [molecular pathway].

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Causes

Self-injury is a complicated condition without any simple explanation. Most people use it as a coping mechanism to deal with the feelings of unreality or numbness, to express distressful emotions, to punish themselves, to stop flashbacks and to relieve tension.

Common causes of Non Suicidal Self Injury

• Psychological factors: Abuse during childhood, troubled relationships with parents or partner, bereavement. Lack of belonging, considering oneself as a burden, feelings of entrapment,defeat, with the onset of pubertal period and sexual activity because of neurodevelopmental vulnerability. Associated with autism spectrum disorders, borderline personality disorder. As an experience of dissociative state and depersonalisation. Unemployment, war and poverty are other contributing factors.

• Mental disorder:The mental illnesses which have an increased associated risk of self-injury are depression, dissociative disorders, borderline personality disorder, autism spectrum disorders, bipolar disorder, conduct disorders and phobias. OCD, PTSD, Schizophrenia, Substance abuse, poor problem-solving skills and impulsivity, Münchausen syndrome. Eating disoreds and anxiety disorders.

• Genetics: The rare genetic condition, Lesch–Nyhan syndrome is characterised by self harm which includes biting and head-banging. Genetics is involved in the development of psychological conditions such as anxiety and depression which may contribute to self-injuring behaviour.

• Drugs and alcohol: Self-harm is linked to chronic substance abuse, dependency, and withdrawal.
• Benzodiazepine dependence as well as benzodiazepine withdrawal.
• Alcohol addiction.
• Cannabis use and intentional self-injury.
• Smoking

Differentiating Nonsuicidal self-injury from other Diseases

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Epidemiology and Demographics

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Patients of all age groups may develop [disease name].

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[Disease name] affects men and women equally.

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Risk Factors

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Screening

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Natural History, Complications, and Prognosis

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Diagnosis

Diagnostic Study of Choice

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History and Symptoms

Eighty percent of self-injury includes stabbing or cutting the skin with a sharp tool, sometimes completely piercing the skin. Self-harm is frequently committed in regions of the body that are readily hidden and undetectable to others. Most often it is a symptom of an underlying disorder and these people look for help to get out of this.
Common signs and symptoms that a person may be engaging in self-harm include the following:

• Self-poisoning, self-embedding of objects, hair pulling, burning, alcohol abuse, bruising/hitting one's self,
• Fresh cuts, bruises, scratches, bite marks or other wounds.
• Knowingly abusing over the counter or prescription drugs,
• Scars, often in patterns
• Excessive rubbing of an area to create a burn
• Self-harm related to anorexia and bulimia.
• Frequent reports of accidental injury
• Keeping sharp objects close by or on hand
• Wearing long sleeves or long pants, even in hot weather
• Statements of helplessness, worthlessness or hopelessness
• Emotional and behavioral instability, unpredictability and impulsivity
• Difficulties in interpersonal relationships

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Physical Examination

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Laboratory Findings

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Electrocardiogram

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X-ray

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Echocardiography or Ultrasound

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CT scan

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MRI

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Other Imaging Findings

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Other Diagnostic Studies

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Treatment

Surgery

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Primary Prevention

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Secondary Prevention

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Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

References

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