Clinical and diagnostic aspects of non-suicidal self-harming behavior

The scientific review is devoted to the actual problem of non-suicidal self-harming behavior. The relevance of this problem is confirmed by the steady increase in cases of various forms of autoaggression in different age categories. Such a high interest in the problem is explained by its high social significance. It is worth noting the insufficient development of the theoretical and methodological base on the phenomenon of non-suicidal self-harming behavior. The aim of the study was theoretical analysis of clinical and diagnostic aspects of non-suicidal self-harming behavior. A theoretical analysis of articles satisfying the criteria requirements has been carried out: the publication presents an analysis of an empirical or experimental study; the study was conducted on persons with suicidal and non-suicidal behavior; the publication is freely available. The analysis of 60 sources of domestic and foreign authors was carried out. The methods of theoretical analysis were used: analytical comparison, systematization and generalization of domestic and foreign works on the problem of non-suicidal self-harming suicidal behavior in a healthy population.

The criteria for distinguishing suicidal and non-suicidal behavior are defined. In the process of theoretical analysis, it was established that the criterion of differentiation for the above-mentioned phenomena is the presence / absence of an intention to die, motivation and methods of self-harming acts. The advantages and disadvantages of describing non-suicidal self-harming behavior as an independent clinical phenomenon are revealed. Due to the lack of clear criteria for determining non-suicidal self-harm, the author of this study conducted a theoretical analysis of the problem of non-suicidal self-harming behavior. The analysis of the works confirms the importance of a deeper and more detailed study of the problem of non-suicidal selfharming behavior from the standpoint of research methodology, including issues of diagnosis, classification and differentiated measures for the prevention of autoaggressive behavior.

1. Andronnikova OO, Volkova EN. Review of foreign studies on the problem of non-suicidal self-harm in children and adolescents. Teoreticheskaya i eksperimental'naya psihologiya. 2020;13(3):38-50. (In Russ.).

2. Bokhan NA, Evseev VD, Mandel AI, Peshkovskaya AG. Review of studies of non-suicidal forms of self-injury on NSSI scales and questionnaires. Suicidologiya. 2020;11(1):70-83. (In Russ.). https://doi.org/10.32878/suiciderus.20-11-01(38)-70-83

3. Bykova VI, Polukhina YuP, Lvova EA, Fufaeva EV, Valiullina SA. To The Question of Suicidal Behavior of Adolescents — Realities of an Emergency Hospital. Konsul’tativnaya psikhologiya i psikhoterapiya. 2023;31(2):68-83. (In Russ.). https://doi.org/10.17759/cpp.2023310203

4. Garagasheva EP, Molina OV. Non-suicidal self-harm: self-cutting (clinical observation). Akademicheskij zhurnal Zapadnoj Sibiri. 2022;18(4):15-20. (In Russ.). https://10.32878/sibir.22-18-04(97)-15-20

5. Gorbatov SV, Arbuzova EN, Shaboltas AV, Gorbacheva VV. Features of Self-concept of female adolescents with non-suicidal self-harming behavior. Suicidologiya. 2020;11(1):53-69. (In Russ.). https://doi.org/10.32878/suiciderus.20-11-01(38)-53-69

6. Davidouski SV, Igumnov SA. Modern conceptions and manifestation features of self-harming behavior. Suitsidologiya. 2020;11(3):33-43. (In Russ.). https://doi.org/10.32878/suiciderus.20-11-03(40)-33-43

7. Davidouski SV, Igumnov SA. Non-suicidal self-harm behavior in adolescents. Voprosy psihicheskogo zdorov'ya detej i podrostkov. 2021;21(1):90-101. (In Russ.).

8. Davidouski SV, Igumnov SA, Kozlov KS. Non-suicidal self-harm: modern concepts. Voprosy psihicheskogo zdorov'ya detej i podrostkov. 2022;22(2):80-91. (In Russ.).

9. Darin EV. Non-suicidal self-harming behavior in adolescents. Medicinskij vestnik Yuga Rossii. 2019;10(4):6-14. (In Russ.). https://doi.org/10.21886/2219-8075-2019-10-4-6-14

10. Darin EV, Zaitseva OG. The epidemiology of non-suicidal self-injurious behavior, a non-systematic narrative review. Obozrenie Psihiatrii i Medicinskoj Psihologii im. V.M. Bekhtereva. 2023;57(2):8-19. (In Russ.). http://doi.org/10.31363/2313-7053-2023-694

11. Evseev VD, Peshkovskaya AG, Bokhan NA, Mandel AI. A screening study of non-suicidal forms self-injuri ous behavior in persons of draft age. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021;121(8):54–60. (In Russ.). https://doi.org/10.17116/jnevro202112108154

12. Kuznetsova SYu, Basova AYa, Zalmanova SL, Khlomov KD. Body Image in Adolescents with Suicidal and Non-Suicidal Self-Harm Behavior: Satisfaction with Their Own Bodies. Klinicheskaia i spetsial'naia psikhologiia. 2023;12(2):138–163. (In Russ.). https://doi.org/10.17759/cpse.2023120207

13. Kuznetsova SO, Enikolopov SN. Investigation of the features of autoaggressive behavior in survivors of childhood sexual abuse. Vestnik Moskovskogo Universiteta. Seriya 14. Psihologiya. 2019:88-100 (In Russ.). https://doi.org/10.11621/npj.2019.0310

14. Kulakova SV, Novikov AV, Krotova DN. Determinants of suicidal behavior. Psikhologiya. Istoriko-kriticheskie obzory i sovremennye issledovaniya. 2019;8(2A):139-146. (In Russ.).

15. Lidova AV, Skripov VS, Kochorova LV. The suicide burden: an estimate of potential years of life lost. Profilakticheskaya medicina. 2023;26(2):50–55. (In Russ.). https://doi.org/10.17116/profmed20232602150

16. Lyubov EB, Zotov PB. Adolescents non-suicidal self-injury: general and particular. Part I. Suicidologiya. 2020;11(3):44-71. (In Russ.). https://doi.org/10.32878/suiciderus.20-11-03(40)-44-71

17. Nosova ES, Spasennikov BA, Alexandrova OYu. Epidemiology of suicides in the world and review of risk factors of suicidal behavior. Byulleten' Nacional'nogo nauchno-issledovatel'skogo instituta obshchestvennogo zdorov'ya imeni N.A. Semashko. 2021;(4):4–17 (In Russ.).

18. Polskaya NА, Melnikova MA. Dissociation, Trauma and Self-Harm. Konsul'tativnaya psikhologiya i psikhoterapiya. 2020;28(1):25-48. (In Russ.). https://doi.org/10.17759/cpp.2020280103

19. Razvaliaeva AYu, Polskaya NA, Basova AY. Diagnostics of Suicidal Risk in Adolescents: Systematic Review of Systematic Reviews. Konsul’tativnaya psikhologiya i psikhoterapiya. 2023;31(2):33-67. (In Russ.). https://doi.org/10.17759/cpp.2023310202

20. Rozanov VA. On the gender paradox in suicidology – a contemporary context. Suicidologiya. 2021;12(1):80-108. (In Russ.). https://doi.org/10.32878/suiciderus.20-12-01(42)-80-108

21. Skryabin EG, Zotov PB, Akselrov MA, et al. Intentional suicidal and non-suicidal self-cutting in clinical practice. Suicidologiya. 2020;11(3):130-147. (In Russ.). https://doi.org/10.32878/suiciderus.20-11-03(40)-130-147

22. Subotich MI. Clinical-Psychological and Socio-Demographic Factors of Suicidal Behavior and the Risk of its Chronicity: a Review of Studies. Konsul’tativnaya psikhologiya i psikhoterapiya 2023;31(1):9-30. (In Russ.). https://doi.org/10.17759/cpp.2023310101

23. Sultanova AN, Mammadov TN. The problem of non-suicidal self-harming behavior: a modern view and its essence (review article). Zhivaya psihologiya. 2023;10(8(48)):27-34. (In Russ.). https://doi.org/10.58551/24136522_2023_10_8_27

24. Barton-Breck A, Heyman B. Accentuate the positive, eliminate the negative? The variable value dynamics of non-suicidal self-hurting. Health, Risk & Society. 2012;14(5):445-464. https://doi.org/10.1080/13698575.2012.697130

25. Bulat LR, Sušac N, Ajduković M. Predicting prolonged non-suicidal self-injury behaviour and suicidal ideations in adolescence – the role of personal and environmental factors. Current Psychology. 2024;43:1533–1544. https://doi.org/10.1007/s12144-023-04404-8

26. Bjureberg J, Kuja-Halkola R, Ohlis A, et al. Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: A longitudinal cohort study. Journal of Child Psychology and Psychiatry. 2022;63(8):921-928. https://doi.org/10.1111/jcpp.13544

27. Costa RPO, Peixoto ALRP, Lucas CCA, et al. Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness Jornal de Pediatria. 2021;97(2):184-190. https://10.1016/j.jped.2020.01.006.

28. Daukantaitė D, Lundh LG, Wångby-Lundh M, et al. What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up. European Child & Adolescent Psychiatry. 2021;30:475–492. https://doi.org/10.1007/s00787-020-01533-4

29. Geulayov G, Casey D, Bale L, et al. Self-harm in children 12 years and younger: characteristics and outcomes based on the Multicentre Study of Self-harm in England. Social Psychiatry and Psychiatric Epidemiology. 2021;19:1-10. https://doi.10.1007/s00127-021-02133-6

30. Gunn J, McGrain P, Ördög B, & Guerin M. Their final words: An analysis of suicide notes from the United States. Death Studies. 2024:1–11. https://doi.org/10.1080/07481187.2024.2348057

31. Herzog S, Choo T-H, Galfalvy H, Mann JJ, Stanley BH. Effect of non-suicidal self-injury on suicidal ideation: real-time monitoring study. The British Journal of Psychiatry. 2022;221(2):485-487. https://doi:10.1192/bjp.2021.225

32. Huang X, Ribeiro JD and Franklin JC The Differences Between Individuals Engaging in Nonsuicidal Self-Injury and Suicide Attempt Are Complex (vs. Complicated or Simple). Frontiers in Psychiatry. 2020;11:239. https://doi.10.3389/fpsyt.2020.00239

33. Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: a scoping review. Journal of Psychiatric Research. 2023;164:28-36. https://doi.org/10.1016/j.jpsychires.2023.05.066

34. Kalashnikova O, Leontiev D, Rasskazova E, Taranenko O. Meaning of life as a resource for coping with psychological crisis: Comparisons of suicidal and non-suicidal patients. Frontiers in Psychology. 2022;13:957782. https://doi.10.3389/fpsyg.2022.957782

35. Laporte N, Ozolins A, Westling S, Westrin Å, Wallinius M. Clinical characteristics and self-harm in forensic psychiatric patients. Frontiers in Psychiatry. 2021;12:698372. https://doi.org/10.3389/fpsyt.2021.698372

36. Lübbert M, Bahlmann L, Sobanski T, et al. Investigating the clinical profile of suicide attempters who used a violent suicidal means. Journal of Clinical Medicine. 2022;11(23):717-720. https://doi.10.3390/jcm11237170

37. May AM, Pachkowski MC, Klonsky ED. Motivations for suicide: Converging evidence from clinical and community samples. Journal of Psychiatric Research. 2020;123:171-177. https://doi.10.1016/j.jpsychires.2020.02.010

38. Miller M, Redley M, Wilkinson PO. A qualitative study of understanding reasons for self-harm in adolescent girls. International Journal of Environmental Research and Public Health. 2021;18(7):3361. https://doi.org/10.3390/ijerph18073361

39. Moher D, Liberati A, Tetzlaff J, et al. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Medicine. 2009;3(3):123-130. https://doi.10.1016/j.jclinepi.2009.06.005

40. Moselli M, Frattini C, Williams R, Ronningstam E. The study of motivation in the suicidal process: the motivational interview for suicidality. Frontiers in Psychiatry. 2021;11:598866. https://doi.org/10.3389/fpsyt.2020.598866

41. Muehlenkamp JJ, Brausch AM, Littlefield A. Concurrent changes in nonsuicidal self-injury and suicide thoughts and behaviors. Psychological Medicine. 2023;53(11):4898-4903. https://doi.10.1017/S0033291722001763

42. Neupane SP, & Mehlum L. Adolescents With Non-Suicidal Self-Harm—Who Among Them Has Attempted Suicide? Archives of Suicide Research. 2023;27(3):866–879. https://doi.org/10.1080/13811118.2022.2072254

43. Poudel A, Lamichhane A, Magar KR, Khanal GP. Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors. BMC Psychiatry. 2022;22(1):96. https://doi.org/10.1186/s12888-022-03763-z

44. Reinhardt M, Rice KG, Horváth Z. Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample. Frontiers Psychiatry. 2022;13:1046576. https://doi.org/10.3389/fpsyt.2022.1046576

45. Robillard CL, Merrin GJ, Legg NK, Ames ME, Turner BJ. Different self-damaging behaviours, similar motives? Testing measurement invariance of motives for nonsuicidal self-injury, disordered eating and substance misuse. British Journal of Clinical Psychology. 2024. https://doi.org/10.1111/bjc.12467

46. Robinson K, Garisch JA, Wilson MS. Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents. Journal of affective disorders. 2021;1(282):1247-54. https://doi.org/10.1016/j.jad.2020.12.201

47. Russell AE, Hemani G, Jones HJ, et al. An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt. BMC Psychiatry. 2021:21:207. https://doi.org/10.1186/s12888-021-03216-z

48. Samari E, Shahwan S, Abdin E, et al. An exploration of differences between deliberate self-harm with and without suicidal intent amongst a clinical sample of young people in Singapore: a cross-sectional study. International Journal of Environmental Research and Public Health. 2020;17(4):1429. https://doi.org/10.3390/ijerph17041429

49. Seonaid C, Wetherall K, Eschle S, et al. Using the integrated motivational-volitional (IMV) model of suicidal behaviour to differentiate those with and without suicidal intent in hospital treated self-harm. Preventive Medicine. 2021;152:106592. https://doi.org/10.1016/j.ypmed.2021.106592

50. Shahwan S, Zhang Y, Sambasivam R, et al. A qualitative study of motivations for non-suicidal self-injury in a sample of psychiatric outpatients in Singapore. Singapore Medical Journal. 2022;63(12):723-730. https://doi.org/10.11622/smedj.2021161

51. Suh H, Jeong J. Association of Self-Compassion With Suicidal Thoughts and Behaviors and Non-suicidal Self Injury: A Meta-Analysis. Fronties Psychology. 2021;12:633482. https://doi.org/10.3389/fpsyg.2021.633482

52. Suzuki T, Comtois KA, Dickens H, Bagge CL. Motivations for suicide attempts amongst psychiatric inpatients: Associations with risk factors and recent suicide attempt characteristics. Psychiatry Research. 2021;295:113574. https://doi.org/10.1016/j.psychres.2020.113574

53. Thomas D, Bonnaire C. Non-Suicidal Self-Injury and Emotional Dysregulation in Male and Female Young Adults: A Qualitative Study. Soa Chongsonyon Chongsin Uihak. 2023;34(3):159-168. https://doi.org/10.5765/jkacap.230033.

54. Vafaei T, Samavi SA., Whisenhunt JL, et al. An investigation of self-injury in female adolescents: a qualitative study. Qual Quant 2023;57:5599–5622. https://doi.org/10.1007/s11135-023-01632-9

55. Voss C, Hoyer J, Venz J, Pieper L, Beesdo-Baum K. Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults. Acta Psychiatrica Scandinavica. 2020;142(6):496-508. https://doi.org/10.1111/acps.13237

56. Wilkinson PO, Qiu T, Jesmont C, et al. Age and gender effects on non-suicidal self-injury, and their interplay with psychological distress. Journal of Affective Disorders. 2022;306:240-245. https://doi.org/10.1016/j.jad.2022.03.021

57. Ye Z, Xiong F, Li W. A meta-analysis of co-occurrence of non-suicidal self-injury and suicide attempt: Implications for clinical intervention and future diagnosis. Frontiers Psychiatry. 2022;13:976217. https://doi.org/10.3389/fpsyt.2022.976217

58. Yu J, Kim MS, Kim M. Non-suicidal self-injury motivation scale in a community sample of adolescents: a methodological study. BMC Psychology. 2024;12:292 https://doi.org/10.1186/s40359-024-01795-6

59. Xiao Q, Song X, Huang L, Hou D, Huang X. Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis. Frontiers Psychiatry. 2022;13:912441. https://doi.org/10.3389/fpsyt.2022.912441

60. Xu H, Jiang Z, Li S, et al. Differences in Influencing Factors Between Non-suicidal Self-Injury and Suicide Attempts in Chinese Adolescents: The Role of Gender. Frontiers Psychiatry. 2022;13:870864. https://doi.org/10.3389/fpsyt.2022.870864