Discussion on Non-Suicidal Self-Injury (NSSI)

Please respond to the discussion post below. Please all references should be five years or less. Thank you
Define NSSI behavior.
NSSI behavior is defined as a “partial suicide” or an intentional and deliberate intent of damaging one’s own body tissue through self-infliction without suicidal intention (Cipriano, Cella, & Cotrufo, 2017). This is done by cutting, burning, scratching, and self-hitting, using different methods to inflict harm to their arms, legs, wrists, and stomach (Cipriano, Cella, & Cotrufo, 2017). This occurs more in adolescents and younger adults with comorbidity of BPD (Borderline personality), post-traumatic stress disorder, depressive disorders, obsessive-compulsive disorder, anxiety disorder, and eating disorder (Cipriano, Cella, & Cotrufo, 2017). It is believed to relieve negative feelings or thinking and resolve interpersonal problems such as anger, anxiety, depression, and loneliness (Cipriano, Cella, & Cotrufo, 2017).
Discuss how the psychiatric mental health nurse practitioner (PMHNP) differentiates between NSSI and suicide attempts.
The behaviors between NSSI and Suicidal behaviors can be similar and difficult to distinguish (Huang, Ribeiro, & Franklin, 2020). Both NSSI and suicide attempts are commonly dangerous forms of acts done to oneself as a way to control their negative feelings (Huang, Ribeiro, & Franklin, 2020). The PMHNP differentiates between NSSI and suicide attempts based on the factors of prevalence, demographics, intent, lethality, how often it occurs, method of harm, thought process, the reaction of their behavior, and the aftermath of the event (Huang, Ribeiro, & Franklin, 2020).
The prevalence of NSSI for adolescents is 17%, young adults 13%, and adults 5.5% (AFSP, 2022). The prevalence of suicide attempts in adolescents and young adults is 14.24%, middle age adults at 18.35%, and older adults at 20.86% (AFSP, 2022). Females have more NSSI behaviors than males. self-cutting is most common among women that generally involve blood, while hitting, burning, and banging are most common among men (AFSP, 2022). In suicide men attempt suicide more than women (AFSP, 2022).
The difference between NSSI and suicidal attempts is the capability/intent and desire to want to end their life (Huang, Ribeiro, & Franklin, 2020). People with a suicide attempts have an increased desire and intent to want to end their life (Huang, Ribeiro, & Franklin, 2020). They are more fearless about death than those with NSSI behaviors (Huang, Ribeiro, & Franklin, 2020). They have a plan, desire, intent, and capability to end their life as they have no reason to live (Huang, Ribeiro, & Franklin, 2020). They feel more lonely and hopeless than people with NSSI behaviors (Huang, Ribeiro, & Franklin, 2020).
NSSI behaviors are more chronic than Suicidal attempts(Huang, Ribeiro, & Franklin, 2020). NSSI occurs more often, with weekly at 23.51%, Monthly at 5.96-3.45%, with an increased likeliness to continue the act again(Huang, Ribeiro, & Franklin, 2020). Suicide attempts occur less frequently, with some people having three attempts in their lifetime(Huang, Ribeiro, & Franklin, 2020). Suicide attempts are more likely to occur in the past year at 42.98%, 13.28% in the last month, and 4.41% in the past week(Huang, Ribeiro, & Franklin, 2020).
People with NSSI behaviors are less lethal but are at an increased risk of suicide attempts (Huang, Ribeiro, & Franklin, 2020). People with suicide attempts/behaviors are more lethal and have an increased risk of death (Huang, Ribeiro, & Franklin, 2020). NSSI behaviors may cause damage to the body but are not severe enough to go to the hospital or seek hospitalization(Huang, Ribeiro, & Franklin, 2020). Suicidal attempts are more lethal and bad enough to require hospitalization and face permanent physical damage or death(Huang, Ribeiro, & Franklin, 2020).
The method of injury between NSSI and Suicide attempt can be similar, such as using knives(Huang, Ribeiro, & Franklin, 2020). People with NSSI behaviors perform self-cutting using knives or other sharp instruments (Huang, Ribeiro, & Franklin, 2020). They also burn, scratch, and intentionally prevent wounds from healing so that superficial injury and damage are done to the body(Huang, Ribeiro, & Franklin, 2020). Males are more common than females to injure their heads (Huang, Ribeiro, & Franklin, 2020). Those with suicide attempt use more lethal weapons such as a gun, hanging, and poisoning than less lethal modalities such as swallowing pills and cutting to end one’s life(SPRC, 2020).
NSSI behaviors are a coping mechanism to feel better about themselves to alter rather than eliminate their negative feelings by disfiguring their body (Huang, Ribeiro, & Franklin, 2020). The person uses NSSI behavior to self-soothe and relieves the pain of not being able to control or escape the feelings of increased anger, tension, anxiety, unhappiness, distress, and a feeling of being disconnected from oneself(Huang, Ribeiro, & Franklin, 2020). People with NSSI behaviors have lesser psychological distress than those with suicide attempts(Huang, Ribeiro, & Franklin, 2020). It avoids suicide(Huang, Ribeiro, & Franklin, 2020). The person with suicide attempts wants to eliminate or end their negative thoughts/feelings by ending their life. People with suicidal attempts are more cognitively constricted in that their thought process is either black or white- good or bad or all or nothing, none in between (Whitlock, Minton, Babington, & Ernhout, 2015). In the aftermath, it is uncommon for death to occur with NSSI. NSSI is a short-term resolution; with suicidal attempts, death is more likely to end one’s life (Whitlock, Minton, Babington, & Ernhout, 2015).
Discuss evidence-based therapy for BPD. How does therapy interrupt the patterns of NSSI and suicidality?
The most common evidence-based therapy for BPD is DBT (Dialectical Behavior Therapy) (Robert, 2019). DBT has been successfully widely spread to almost every community and throughout the world by professionals in psychiatry and psychology and has also been included in the American Managed Care system (Robert, 2019). It is integrated psychotherapy comprising change techniques based on behavioral therapy and acceptance techniques based on Zen Buddhism, on the other hand (Reddy & Vijay, 2017). The dialectical theory is based on the belief that there is more than one truth, so the goal is to integrate all viewpoints using behavioral therapy and acceptance techniques in a dialectic way to help patients handle and navigate their affective and cognitive states that are difficult to challenge (Reddy & Vijay, 2017). The requirements for DBT are attending one week of individual therapy and group skills training sessions and keeping a record in a diary (Reddy & Vijay, 2017).
DBT in the use of borderline personality, is made up of 4 stages, each stage having a goal (Reddy & Vijay, 2017). Stage 1 goal is to reduce suicide using therapy-interfering and quality-of-life-interfering behaviors that will improve behavioral skills (Reddy & Vijay, 2017). This stage usually takes one year to complete. Stage 2 goal is to treat past trauma such as PTSD using exposure techniques (Reddy & Vijay, 2017). Stage 3 goal is to gain back being happy, develop self-esteem, and improve behavioral skills(Reddy & Vijay, 2017). Stage 4 goal is the ability to find a higher purpose and the capacity to develop optimum experience. (Reddy & Vijay, 2017).
What ethical and clinical challenges might the clinician face when treating clients with BPD who are suicidal?
Ethical and clinical challenges the clinicians face in treating clients with BPD who are suicidal is telling them what their diagnosis is as this is believed to lead to a negative outcome (Howe, 2013). The stigma is also tied to having a BPD (Howe, 2013). Clinicians see this as a highly stigmatized disorder, so they're very reluctant to make the diagnosis (Howe, 2013). There is fear that disclosing their diagnosis will impair the clinician-client relationship (Howe, 2013). The client may feel their prognosis is bad and might not comply with treatment (Howe, 2013). Discussing BPD increased risk for suicide is another ethical and clinical challenge (Howe, 2013). Clinicians feel giving this information to the patient can increase their risk of suicide because they may think they may not get better, feel hopeless, and try to take their life (Howe, 2013). Being available for phone calls after business hours is another issue faced by clinicians who care for BPD patients (Howe, 2013). The time clinicians make themselves available apart from office hours creates a challenge when patients may want to call more times they need (Howe, 2013). As a result, clinicians restrict the time clients are allowed to call after regular business hours and let the client make the decision on their own whether they are suicidal (Howe, 2013). This puts a client at risk of suicide as they may not call when they are suicidal and may not have the mental capacity to know if they are (Howe, 2013). Disclosing to the BPD patient the possibility of involuntary hospitalization because of high suicide risk is a big challenge as they believe they may not harm themselves, which can also make them upset and interfere with the clinician-client therapeutic relationship (Howe, 2013). It is a legal and ethical responsibility to inform the client and to discuss if this is the best option (Howe, 2013).
Cipriano A, Cella S and Cotrufo P (2017) Nonsuicidal Self-injury: A Systematic Review. Front. Psychol. 8:1946. doi: 10.3389/fpsyg.2017.01946
Reddy, M. S., & Vijay, M. S. (2017). Empirical Reality of Dialectical Behavioral Therapy in Borderline Personality. Indian journal of psychological medicine, 39(2), 105–108. https://doi(dot)org/10.4103/IJPSYM.IJPSYM_132_17
Howe E. (2013). Five ethical and clinical challenges psychiatrists may face when treating patients with borderline personality disorder who are or may become suicidal. Innovations in clinical neuroscience, 10(1), 14–19.
Huang, X., Ribeiro, J. D., & Franklin, J. C. (2020). The Differences Between Individuals Engaging in Nonsuicidal Self-Injury and Suicide Attempt Are Complex (vs. Complicated or Simple). Frontiers in psychiatry, 11, 239. https://doi(dot)org/10.3389/fpsyt.2020.00239
Whitlock, J., Minton, R., Babington, P., & Ernhout, C. (2015). The relationship between non-suicidal self-injury and suicide. The Information Brief Series, Cor[1]nell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY.
Suicide Prevention Resource Center. (2020). Means of Suicide. https://sprc(dot)org/scope/means-suicideLinks to an external site.
American Foundation for Suicide Prevention, (2022). Suicide Statistics. https://afsp(dot)org/suicide-statistics/#:~:text=In%202020%2C%20the%20suicide%20rates,middle%2Daged%20and%20older%20adultsLinks to an external site..
Gregory, R. (2019). Borderline Personality Awareness Month with Dr. Robert Gregory
https://neiglobal(dot)libsyn(dot)com/borderline-personality-awareness-month-with-dr-robert-gregoryLinks to an external site.