Characteristics of Nonsuicidal Self-Injury Associated with Suicidal Ideation: Evidence From a Clinical Sample of Youth

Nonsuicidal self-injury (NSSI) and suicidal ideation (SI) are both distressing and quite common, particularly in youth. Given the relationship between these two phenomena, it is crucial to learn how we can use information about NSSI to understand who is at greatest risk of suicidal thoughts. In this study, we investigated how characteristics of nonsuicidal self-injury related to SI among treatment-seeking adolescents and young adults.

Low severity methods of NSSI (e.g. banging) were more strongly associated with SI than high severity methods (e.g. breaking bones). SI was associated with intrapersonal (automatic) NSSI functions. SI was associated with some indices of NSSI severity, such as number of methods and urge for NSSI, but not with others, such as age of onset.

This study provides a valuable opportunity to expand our knowledge of suicide risk factors beyond those that may apply broadly to self-injurers and to non-injurers (e.g., depression, substance use) to NSSI-related factors that might be specifically predictive of suicidal thoughts among self-injurers. Findings inform clinical risk assessment of self-injurious youth, a population at high risk of suicidal thoughts and behaviors, and provide further insight into the complex NSSI/suicide relationship.

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By: Sarah E. Victor¹, Denise Styer² and Jason J. Washburn^23*

¹Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver V6T1Z4, BC, Canada

²Alexian Brothers Behavioral Health Hospital, 1650 Moon Lake Boulevard, Hoffman Estates 60169, IL, USA

³Northwestern University Feinberg School of Medicine, Abbott Hall Suite 1204, 710 N Lake Shore Drive, Chicago 60611, IL, USA

Improvement of Nonsuicidal Self-Injury Following Treatment with Antipsychotics Possessing Strong D1 Antagonistic Activity: Evidence from a Report of Three Cases

Below:  Persistent remission of nonsuicidal self-injury was associated with the administration of neuroleptics possessing strong D1 receptor antagonistic activity. Shown are the courses of pharmacotherapy in three adult female patients (a–c) suffering from NSSI associated with major depression. The x-axis indicates the day of treatment. Above the x-axis, the frequency of NSSI (times per day, black bars) is shown. The y-axis indicates the doses of the different drugs administered (in mg/day). Graphs were created using the IGOR Pro 6® software (WaveMetrics, Portland, OR, USA). Flupentixol is highlighted in red. Chlorprothixene is highlighted in blue. Zuclopenthixol is highlighted in green. AMI, amitriptyline; CPT, chlorprothixene; d, day; FPX, flupentixol; GPN, gabapentin; LTG, lamotrigine; LZP, lorazepam; OZP, olanzapine; QTP, quetiapine; TPM, topiramate; TRI, trimipramine; VLX, venlafaxine; ZPT, zuclopenthixol.

There is no drug treatment for nonsuicidal self-injury (NSSI), a highly prevalent and burdensome symptom of several psychiatric diseases like posttraumatic stress disorder (PTSD), personality disorders, and major depression (MD).

Here, we present a retrospective series of three patients demonstrating a persistent remission in MD-associated NSSI in response to treatment with antipsychotics possessing marked D1 receptor antagonistic activity.

Together with previously published data from rodent models, the findings suggest a role for D1 antagonists in NSSI drug therapy and hence for the D1 receptor in NSSI pathogenesis. This conclusion is limited by the facts that the patients presented here received polypharmacy and that the D1 receptor antagonistic antipsychotics suggested here as effective ‘anti-auto-aggressants’ do not address D1 receptors only but multiple neurotransmitter receptors/systems.

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