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. 2017 May 3;17(1):160.
doi: 10.1186/s12888-017-1326-y.

Self-injury and externalizing pathology: a systematic literature review

Gergely Meszaros  1   2 , Lili Olga Horvath  3   4 , Judit Balazs  5   4
Affiliations

Self-injury and externalizing pathology: a systematic literature review

Gergely Meszaros et al. BMC Psychiatry. .

Abstract

Background: During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications.

Methods: A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD).

Results: Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors.

Conclusions: Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.

Keywords: ADHD: attention deficit hyperactivity disorder; CD: conduct disorder; DSH: deliberate self-harm; NSSI: nonsuicidal self-injury; ODD: oppositional defiant disorder; SIB: self-injurious behaviour; externalization; psychiatric disorder; psychopathology; self-injury.

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Figures

Fig. 1
Fig. 1
QUORUM flowchart
Fig. 2
Fig. 2
Flowchart of inclusion/exclusion process
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