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Tracy Alderman, Ph.D.

Tracy Alderman Ph.D.


Non-Suicidal Self-Injury: A New Diagnosis?

Should Self-Injury be a diagnosable mental disorder?

May 2013 is just around the corner (well, sort of) and with that comes the publication of the DSM-5. According to the American Psychiatric Association will be releasing the Diagnostic and Statistical Manual - 5 during their 2013 annual meeting in San Francisco, CA.

Of particular interest are two disorders not currently listed in DSM-IV that are being proposed for inclusion in the DSM-5: Non-Suicidal Self Injury and Non-Suicidal Self Injury, Not Otherwise Specified.

According to these diagnoses are potentially being defined utilizing the following criteria:

"Non-Suicidal Self Injury
A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body, of a sort likely to induce bleeding or bruising or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), for purposes not socially sanctioned (e.g., body piercing, tattooing, etc.), but performed with the expectation that the injury will lead to only minor or moderate physical harm. The absence of suicidal intent is either reported by the patient or can be inferred by frequent use of methods that the patient knows, by experience, not to have lethal potential. (When uncertain, code with NOS 2.) The behavior is not of a common and trivial nature, such as picking at a wound or nail biting.

B. The intentional injury is associated with at least 2 of the following:
1. Negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act.
2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to resist.
3. The urge to engage in self-injury occurs frequently, although it might not be acted upon.
4. The activity is engaged in with a purpose; this might be relief from a negative feeling/cognitive state or interpersonal difficulty or induction of a positive feeling state. The patient anticipates these will occur either during or immediately following the self-injury.

C. The behavior and its consequences cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.

D. The behavior does not occur exclusively during states of psychosis, delirium, or intoxication. In individuals with a developmental disorder, the behavior is not part of a pattern of repetitive stereotopies. The behavior cannot be accounted for by another mental or medical disorder (i.e., psychotic disorder, pervasive developmental disorder, mental retardation, Lesch-Nyhan Syndrome).

Potential NOS Categories if DSM-5 adopts subtyping NOS categories:

Non-Suicidal Self-Injury Disorder, Not Otherwise Specified (NOS), Type 1, Subthreshold: The patient meets all criteria for NSSI disorder, but has injured himself or herself fewer than 5 times in the past 12 months. This can include individuals who, despite a low frequency of behavior, frequently think about performing the act.

Non-Suicidal Self-Injury Disorder, Not Otherwise Specified (NOS), Type 2, Intent Uncertain: The patient meets criteria for NSSI but insists that in addition to thoughts expressed in B4 also intended to commit suicide."

The implications for creating and including an independent diagnostic category for self-injury are immense. I'll address some of these implications next time.


About the Author

Tracy Alderman, Ph.D.

Tracy Alderman, Ph.D., is the author of The Scarred Soul: Understanding and Ending Self-Inflicted Violence.