Non-suicidal self-injury (Nssi) in adolescent inpatients: assessing personality features and attitude toward death

Abstract

Background: Non-suicidal self-injury (NSSI) is a common concern among hospitalized adolescents, and can have significant implications for short and long-term prognosis. Little research has been devoted on how personality features in severely ill adolescents interact with NSSI and "attitude toward life and death" as a dimension of suicidality. Developing more specific assessment methodologies for adolescents who engage in self-harm without suicidal intent is relevant given the recent proposal of a non-suicidal self-injury (NSSI) disorder and may be useful in predicting risk in psychiatrically impaired subjects.

Methods: Consecutively hospitalized adolescents in a psychiatric unit (N = 52; 71% females; age 12-19 years), reporting at least one recent episode of self-harm according to the Deliberate Self-harm Inventory, were administered the Structured Clinical Interview for DSM Mental Disorders and Personality Disorders (SCID I and II), the Children's Depression Inventory and the Multi-Attitude Suicide Tendency Scale (MAST).

Results: Mean age onset of NSSI in the sample was 12.3 years. All patients showed "repetitive" NSSI (high frequency of self-harm), covering different modalities. Results revealed that 63.5% of adolescents met criteria for Borderline Personality Disorder (BPD) and that the rest of the sample also met criteria for personality disorders with dysregulated traits. History of suicide attempts was present in 46.1% of cases. Elevated depressive traits were found in 53.8%. Results show a statistically significant negative correlation between the score on the "Attraction to Life" subscale of the MAST and the frequency and diversification of self-harming behaviors.

Conclusions: Most adolescent inpatients with NSSI met criteria for emotionally dysregulated personality disorders, and showed a reduced "attraction to life" disposition and significant depressive symptoms. This peculiar psychopathological configuration must be addressed in the treatment of adolescent inpatients engaging in NSSI and taken into account for the prevention of suicidal behavior in self-injuring adolescents who do not exhibit an explicit intent to die.

Figure 1

The Figure shows the average scores of the 4 MAST subscales (AL: Attraction to Life, RL: Repulsion by Life, AD: Attraction to Death and RD: Repulsion by Death) in our sample: 1)NSSI-SA, 2)NSSI-only.

Figure 2

The Figure shows the average scores of the 4 MAST subscales (AL: Attraction to Life, RL: Repulsion by Life, AD: Attraction to Death and RD: Repulsion by Death) in 3 samples: 1) NSSI patients (this study); 2) Suicidal Patients and 3) Psychiatric Non-suicidal Patients (Orbach's Study).