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
Historical Perspective
Classification
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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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: Many mental illnesses have an associated risk of self-injury. These are depression, dissociative disorders, borderline personality disorder, autism spectrum disorders, bipolar disorder, conduct disorders and phobias. Schizophrenia, Substance abuse, poor problem-solving skills and impulsivity, Münchausen syndrome.
- Genetics: The rare genetic condition, Lesch–Nyhan syndrome. 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
Mental disorder Although some people who self-harm do not have any form of recognised mental disorder,[30] many people experiencing various forms of mental illnesses do have a higher risk of self-harm. The key areas of disorder which exhibit an increased risk include autism spectrum disorders,[38][39] borderline personality disorder, dissociative disorders, bipolar disorder,[40] depression,[16][41] phobias,[16] and conduct disorders.[42] Schizophrenia may also be a contributing factor for self-harm. Those diagnosed with schizophrenia have a high risk of suicide, which is particularly greater in younger patients as they may not have an insight into the serious effects that the disorder can have on their lives.[43] Substance abuse is also considered a risk factor[12] as are some personal characteristics such as poor problem-solving skills and impulsivity.[12] There are parallels between self-harm and Münchausen syndrome, a psychiatric disorder in which individuals feign illness or trauma.[44] There may be a common ground of inner distress culminating in self-directed harm in a Münchausen patient. However, a desire to deceive medical personnel in order to gain treatment and attention is more important in Münchausen's than in self-harm.[44]
Psychological factors Abuse during childhood is accepted as a primary social factor increasing the incidence of self-harm,[45] as is bereavement,[46] and troubled parental or partner relationships.[12][17] Factors such as war, poverty, and unemployment may also contribute.[16][47][48] Other predictors of self-harm and suicidal behavior include feelings of entrapment, defeat, lack of belonging, and perceiving oneself as a burden along with less effective social problem-solving skills.[21] Self-harm is frequently described as an experience of depersonalisation or a dissociative state.[49] As many as 70% of individuals with borderline personality disorder engage in self-harm.[50] An estimated 30% of individuals with autism spectrum disorders engage in self-harm at some point, including eye-poking, skin-picking, hand-biting, and head-banging.[38][39] The onset of puberty has also been shown to be the onset of self-harm including the onset of sexual activity; this is because the pubertal period is a period of neurodevelopmental vulnerability and comes with an increased risk of emotional disorders and risk-taking behaviors.[21]
Genetics The most distinctive characteristic of the rare genetic condition, Lesch–Nyhan syndrome, is self-harm and may include biting and head-banging.[51] Genetics may contribute to the risk of developing other psychological conditions, such as anxiety or depression, which could in turn lead to self-harming behaviour. However, the link between genetics and self-harm in otherwise healthy patients is largely inconclusive.[7]
Drugs and alcohol Substance misuse, dependence and withdrawal are associated with self-harm. Benzodiazepine dependence as well as benzodiazepine withdrawal is associated with self-harming behaviour in young people.[52] Alcohol is a major risk factor for self-harm.[34] A study which analysed self-harm presentations to emergency rooms in Northern Ireland found that alcohol was a major contributing factor and involved in 63.8% of self-harm presentations.[53] A recent study in the relation between cannabis use and deliberate self-harm (DSH) in Norway and England found that, in general, cannabis use may not be a specific risk factor for DSH in young adolescents.[54] Smoking has also been associated with self-harm in adolescents; one study found that suicide attempts were four times higher for adolescents that smoke than for those that do not.[21] A more recent meta-analysis on literature concerning the association between cannabis use and self-injurious behaviours has defined the extent of this association, which is significant both at the cross-sectional (odds ratio = 1.569, 95% confidence interval [1.167-2.108]) and longitudinal (odds ratio = 2.569, 95% confidence interval [2.207-3.256]) levels, and highlighting the role of the chronic use of the substance, and the presence of depressive symptoms or of mental disorders as factors that might increase the risk of committing self-harm among cannabis users.[55]
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Differentiating Nonsuicidal self-injury from other Diseases
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