Skip to main content
SpringerLink
Log in

Deliberate Self-Harm in Adolescents

  • Chapter
  • First Online:
Book cover Handbook of Adolescent Health Psychology

  • 5833 Accesses

Abstract

Occurrences of deliberate self-harm (DSH) are commonly encountered when caring for adolescents, especially in mental healthcare settings. Defined as the intentional damage of body tissues without suicidal intent, DSH is officially included as a symptom of borderline personality disorder. However, DSH also occurs along with many other mental health conditions and also in nonclinical populations. The lifetime prevalence of DSH in adolescents and young adults varies greatly depending on the population studied, and is noted to be up to 80 % in some psychiatric inpatient populations. Because DSH is a marker for increased risk of future suicide attempts and can cause distress and injury, clinicians need to be able to provide thorough assessment of the behavior, monitor for suicidality, and refer for or provide proper treatment. This chapter covers how self-harm is defined and reviews the epidemiology of this behavior. Theories of the psychological function and the currently understood pathophysiology, along with recommended clinical approaches, assessment, and treatment strategies, are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 329.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Andover, M. S., & Gibb, B. E. (2010). Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Research, 178(1), 101–105. doi:10.1016/j.psychres.2010.03.019.

    Article  PubMed  Google Scholar 

  • Ballard, E., Bosk, A., & Pao, M. (2010). Invited commentary: Understanding brain mechanisms of pain processing in adolescents’ non-suicidal self-injury. Journal of Youth and Adolescence, 39(4), 327–334. doi:10.1007/s10964-009-9457-1.

    Article  PubMed  Google Scholar 

  • Bateman, A., & Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. The American Journal of Psychiatry, 156(10), 1563–1569. Retrieved from EBSCOhost.

    PubMed  Google Scholar 

  • Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. The American Journal of Psychiatry, 165(5), 631–638. doi:10.1176/appi.ajp.2007.07040636.

    Article  PubMed  Google Scholar 

  • Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39(3), 233–242. doi:10.1007/s10964-009-9482-0.

    Article  PubMed  Google Scholar 

  • Cassano, P., Lattanzi, L., Pini, S., Dell’Osso, L., Battistini, G., & Cassano, G. B. (2001). Topiramate for self-mutilation in a patient with borderline personality disorder. Bipolar Disorders, 3(3), doi:10.1034/j.1399-5618.2001.030306.x.

    Article  Google Scholar 

  • Chengappa, K., Ebeling, T., Kang, J. S., Levine, J., & Parepally, H. (1999). Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. The Journal of Clinical Psychiatry, 60(7), 477–484. Retrieved from EBSCOhost.

    Article  PubMed  Google Scholar 

  • Chengappa, K. R., Rathore, D., Levine, J., Atzert, R., Solai, L., Parepally, H., et al. (1999). Topiramate as add-on treatment for patients with bipolar mania. Bipolar Disorders, 1(1), 42–53. Retrieved April 20, 2011.

    Article  PubMed  Google Scholar 

  • Claes, L., Houben, A., Vadereycken, W., Bijttebier, P., & Muehlenkamp, J. (2010). Brief report: The association between non-suicidal self-injury self-concept and acquaintance with self- injurious peers in a sample of adolescents. Journal of Adolescent Health, 33(5), 775–778.

    Google Scholar 

  • Clarkin, J. F., Foelsch, P. A., Levy, K. N., Hull, J. W., Delaney, J. C., & Kernberg, O. F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, 15(6), 487–495. doi:10.1521/pedi.15.6.487.19190.

    Article  PubMed  Google Scholar 

  • Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. The American Journal of Psychiatry, 164(6), 922–928. doi:10.1176/appi.ajp.164.6.922.

    Article  PubMed  Google Scholar 

  • DSM-III-R. (2000). American Psychiatric Association’s diagnostic and statistical manual of mental disorders (3rd ed.). PsycCRITIQUES, 35(3), doi:10.1037/028425.

  • DSM-III-R. (1990). American Psychiatric Association’s diagnostic and statistical manual of mental disorders (4th ed.). PsycCRITIQUES, 35(3), doi: 10.1037/028425.

  • Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., et al. (1999). Manual-assisted cognitive-behavior therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29(1), 19–25.

    Article  PubMed  Google Scholar 

  • Ferrerri, M. M., Loze, J., Rouillon, F., & Limosin, F. (2004). Clozapine treatment of a borderline personality disorder with severe self-mutilating behaviours. European Psychiatry, 19(3), 177–178. doi:10.1016/j.eurpsy.2003.11.004.

    Article  PubMed  Google Scholar 

  • Fikke, L. T., Melinder, A. A., & Landrø, N. I. (2011). Executive functions are impaired in adolescents engaging in non-suicidal self-injury. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 41(3), 601–610. doi:10.1017/S0033291710001030.

    Article  Google Scholar 

  • Glenn, C. R., & Klonsky, E. (2010). The role of seeing blood in non-suicidal self-injury. Journal of Clinical Psychology, 66(4), 466–473. Retrieved from EBSCOhost.

    PubMed  Google Scholar 

  • Graff, H., & Mallin, R. (1967). The syndrome of the wrist cutter. The American Journal of Psychiatry, 124(1), 36–42. Retrieved from EBSCOhost.

    PubMed  Google Scholar 

  • Gratz, K. L. (2007). Targeting emotion dysregulation in the treatment of self-injury. Journal of Clinical Psychology, 63(11), 1091–1103. doi:10.1002/jclp.20417.

    Article  PubMed  Google Scholar 

  • Gratz, K. L., Conrad, S., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. The American Journal of Orthopsychiatry, 72(1), 128–140. doi:10.1037/0002-9432.72.1.128.

    Article  PubMed  Google Scholar 

  • Griengl, H., Sendera, A. A., & Dantendorfer, K. K. (2001). Naltrexone as a treatment of self- injurious behavior: A case report. Acta Psychiatrica Scandinavica, 103(3), 234–236. doi:10.1034/j.1600-0447.2001.00087.x.

    Article  PubMed  Google Scholar 

  • Gutierrez, P., Osmann, A., Barrios, F., & Kopper, B. (2001). Development and initial validation of the self-harm behavior questionnaire. Journal of Personality Assessment, 77, 475–490.

    Article  PubMed  Google Scholar 

  • Hawton, K., Townsen, E., Arensman, E., Gunnell, D., Hazell, P., House, A., et al. (1999). Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database of Systematic Reviews, 3. Retrieved April 20, 2011.

    Google Scholar 

  • Karr, P. L., Muehlenkamp, J. J., & Turner, J. M. (2010). Nonsuicidal self-injury: A review of current research for family medicine and primary care physicians. Journal of the American Board of Family Medicine, 23(2), 240–259.

    Article  Google Scholar 

  • Klonsky, E. (2007a). Non-suicidal self-injury: An introduction. Journal of Clinical Psychology, 63(11), 1039–1043. doi:10.1002/jclp.20411.

    Article  PubMed  Google Scholar 

  • Klonsky, E. (2007b). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. doi:10.1016/j.cpr.2006.08.002.

    Article  PubMed  Google Scholar 

  • Klonsky, E., & 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, 31(3), 215–219. doi:10.1007/s10862-008-9107-z.

    Article  Google Scholar 

  • Klonsky, E., & Moyer, A. (2008). Childhood sexual abuse and non-suicidal self-injury: Meta analysis. The British Journal of Psychiatry, 192(3), 166–170. doi:10.1192/bjp.bp.106.030650.

    Article  PubMed  Google Scholar 

  • Klonsky, E., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology, 63(11), 1045–1056. doi:10.1002/jclp.20412.

    Article  PubMed  Google Scholar 

  • Klonsky, E., Oltmanns, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. The American Journal of Psychiatry, 160(8), 1501–1508. doi:10.1176/appi.ajp.160.8.1501.

    Article  PubMed  Google Scholar 

  • Koons, C. R., Robins, C. J., Tweed, J., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32(2), 371–390. doi:10.1016/S0005-7894(01)80009-5.

    Article  Google Scholar 

  • Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: Understanding the ‘Whats’ and ‘Whys’ of self-harm. Journal of Youth and Adolescence, 34(5), 447–457. doi:10.1007/s10964-005-7262-z.

    Article  Google Scholar 

  • Lester, D. (1972). Self-mutilating behavior. Psychological Bulletin, 78(2), 119–128. doi:10.1037/h0033066.

    Article  PubMed  Google Scholar 

  • Levy, K. N., Kelly, K. M., & Meehan, K. B. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74, 1027–1040.

    Article  PubMed  Google Scholar 

  • Levy, K. N., Yeomans, F. E., & Diamond, D. (2007). Psychodynamic treatments of self-injury. Journal of Clinical Psychology, 63(11), 1105–1120.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Armstrong, H. E., Suarez, A., & Allmon, D. (1991). Cognitive–behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064. Retrieved from EBSCOhost.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Comtois, K., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303–312. doi:10.1037/1040-3590.18.3.303.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Comtois, K., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. doi:10.1001/archpsyc.63.7.757.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1994). ‘Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients’: Erratum. Archives of General Psychiatry, 51(5), 422. Retrieved from EBSCOhost.

    Article  Google Scholar 

  • Lloyd-Richardson, E. E. (2008). Adolescent nonsuicidal self-injury: who is doing it and why? Journal of Developmental and Behavioral Pediatrics, 29(3), 216–218.

    Article  PubMed  Google Scholar 

  • Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristic and functions on non-suicidal self-injury in a community sample of adolescents. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(8), 1183–1192. doi:10.1017/S003329170700027X.

    Article  Google Scholar 

  • Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self- injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behavior, 34(1), 12–23. doi:10.1521/suli.34.1.12.27769.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2010). Preventing non-suicidal self-injury in adolescents: The signs of self-injury program. Journal of Youth and Adolescence, 39(3), 306–314. doi:10.1007/s10964-009-9450-8.

    Article  PubMed  Google Scholar 

  • Nafisi, N., & Stanley, B. (2007). Developing and maintaining the therapeutic alliance with self-injuring patients. Journal of Clinical Psychology, 63(11), 1069–1079. doi:10.1002/jclp.20414.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Elizabeth, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Joiner, T. R., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non- suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. doi:10.1016/j.psychres.2006.05.010.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. doi:10.1037/0022-006X.72.5.885.

    Article  PubMed  Google Scholar 

  • Prossin, A. R., Love, T. M., Koeppe, R. A., Zubieta, J., & Silk, K. R. (2010). Dysregulation of regional endogenous opioid function in borderline personality disorder: Correction. The American Journal of Psychiatry, 167(8), 925–933. Retrieved from EBSCOhost.

    Article  PubMed  Google Scholar 

  • Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31(1), 67–77. doi:10.1023/A:1014089117419.

    Article  Google Scholar 

  • Roth, A. S., Ostroff, R. B., & Hoffman, R. E. (1996). Naltrexone as a treatment for repetitive self-injurious behavior: An open-label trial. The Journal of Clinical Psychiatry, 57(6), 233–237.

    PubMed  Google Scholar 

  • Stanley, B., Sher, L., Wilson, S., Ekman, R., Huang, Y., & Mann, J. (2010). Non-suicidal self- injurious behavior, endogenous opioids and monoamine neurotransmitters. Journal of Affective Disorders, 124(1–2), 134–140. doi:10.1016/j.jad.2009.10.028.

    Article  PubMed  Google Scholar 

  • Tyrer, P., Thompson, S., Schmidt, U., Jones, V., Knapp, M., Davidson, K., et al. (2003). Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychological Medicine, 33(6), 977–986. ISSN 0033-2917.

    Article  PubMed  Google Scholar 

  • Walsh, B. (2007). Clinical assessment of self-injury: A practical guide. Journal of Clinical Psychology, 63(11), 1057–1068. doi:10.1002/jclp.20413.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Lader, W., & Conterio, K. (2007). The Internet and self-injury: What psychotherapists should know. Journal of Clinical Psychology, 63(11), 1135–1143. doi:10.1002/jclp.20420.

    Article  PubMed  Google Scholar 

  • Whitlock, J., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child and Adolescent Psychology, 37(4), 725–735. doi:10.1080/15374410802359734.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Adolescent Health, Lucile Packard Children’s Hospital at Stanford University, 1174 Castro St. Suite 250, Mountain View, CA, 94040, USA

    Catherine Miller M.D.

  2. Pediatric, Adolescent and Young Adult Medicine, University of Michigan Pediatrics, 1931 Taubman Center, 1500 E. Hospital Dr., Ann Arbor, MI, 48109, USA

    Christian Pariseau M.D.

Authors
  1. Catherine Miller M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Pariseau M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine Miller M.D. .

Editor information

Editors and Affiliations

  1. , Department of Psychology, University of Nevada, Reno, MS 0296, Reno, 89557-0062, New York, USA

    William T. O'Donohue

  2. , Department of Psychology, MS 0296, University of Nevada, Reno, North Virginia Street, Reno, 89557, Nevada, USA

    Lorraine T. Benuto

  3. , Integration Services, Aurora Mental Health Center, 11059 East Bethany Drive, Suite 105, Aurora, 80014, Colorado, USA

    Lauren Woodward Tolle

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Miller, C., Pariseau, C. (2013). Deliberate Self-Harm in Adolescents. In: O'Donohue, W., Benuto, L., Woodward Tolle, L. (eds) Handbook of Adolescent Health Psychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6633-8_30

Download citation

Publish with us

Policies and ethics

Search

Navigation