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. 2014 Nov;59(11):576-85.
doi: 10.1177/070674371405901103.

Treating nonsuicidal self-injury: a systematic review of psychological and pharmacological interventions

Brianna J Turner  1 , Sara B Austin  1 , Alexander L Chapman  2
Affiliations

Treating nonsuicidal self-injury: a systematic review of psychological and pharmacological interventions

Brianna J Turner et al. Can J Psychiatry. 2014 Nov.

Abstract
in English, French

Objective: Nonsuicidal self-injury (NSSI), the deliberate, self-inflicted damage of bodily tissue without the intent to die, is associated with various negative outcomes. Although basic and epidemiologic research on NSSI has increased during the last 2 decades, literature on effective interventions targeting NSSI is still emerging. Here, we present a comprehensive, systematic review of existing psychological and pharmacological treatments designed specifically for NSSI, or including outcome assessments examining change in NSSI.

Method: We conducted a systematic search of PsycINFO, MEDLINE, and ERIC databases to retrieve relevant articles that met inclusion criteria; specifically, uncontrolled and controlled trials that 1) presented quantitative outcome data on NSSI, and 2) clearly differentiated NSSI from suicidal self-injury (SSI). Consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, definition of NSSI, we excluded studies examining populations with developmental or intellectual disabilities, or with psychotic disorders.

Results: Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics (aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or without cognitive-behavioural therapy). Nevertheless, there remains a paucity of well-controlled studies investigating treatment efficacy for NSSI.

Conclusions: Structured psychotherapeutic approaches focusing on collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviours seem to be most effective in reducing NSSI. Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some benefits. Future studies employing controlled designs as well as a clear delineation of NSSI and SSI will improve knowledge regarding treatment effects.

Objectif :: L’automutilation non suicidaire (AMNS), c’est-à-dire les dommages délibérés et auto-infligés aux tissus corporels sans intention de mourir, est associée à divers résultats négatifs. Bien que la recherche basique et épidémiologique sur l’AMNS ait augmenté au cours des 20 dernières années, la littérature sur les interventions efficaces ciblant l’AMNS est encore naissante. Ici, nous présentons une revue systématique exhaustive des traitements psychologiques et pharmacologiques existants conçus spécifiquement pour l’AMNS, ou incluant des évaluations de résultats examinant le changement de l’AMNS.

Méthode :: Nous avons mené une recherche systématique dans les bases de données PsycINFO, MEDLINE, et ERIC pour extraire les articles pertinents qui satisfaisaient aux critères d’inclusion; spécifiquement, les essais incontrôlés et contrôlés qui 1) présentaient des données quantitative de résultats de l’AMNS, et 2) différenciaient nettement l’AMNS de l’automutilation suicidaire (AMS). En conformité avec la définition de l’AMNS du Manuel diagnostique et statistique des troubles mentaux, 5e édition, nous avons exclu les études qui examinaient les populations souffrant de déficiences développementales ou intellectuelles, ou de troubles psychotiques.

Résultats :: Plusieurs interventions semblent prometteuses pour réduire l’AMNS, dont la thérapie comportementale dialectique, la thérapie de groupe de régulation émotionnelle, la thérapie cognitive à l’aide d’un manuel, la psychothérapie dynamique déconstructive, les antipsychotiques atypiques (aripiprazole), le naltrexone, et les inhibiteurs spécifiques du recaptage de la sérotonine (avec ou sans thérapie cognitivo-comportementale). Néanmoins, il demeure que les études bien contrôlées sur l’efficacité des traitements de l’AMNS sont rares.

Conclusions :: Les approches psychothérapeutiques structurées axées sur les relations thérapeutiques de collaboration, la motivation de changer, et qui abordent directement les comportements d’AMNS semblent être les plus efficaces pour réduire l’AMNS. Les médicaments ciblant les systèmes sérotoninergique, dopaminergique et opioïde ont également démontré des avantages. Les futures études employant des méthodes contrôlées ainsi qu’une nette délimitation entre AMNS et AMS amélioreront nos connaissances sur les effets des traitements.

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Figures

Figure 1
Figure 1
Flow chart depicting inclusion and exclusion process Figure adapted from Moher et al; the PRISMA Statement and the PRISMA Explanation and Elaboration document are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; NSSI = nonsuicidal self-injury; SSI = suicidal self-injury
See this image and copyright information in PMC

References

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