Person:

St. Germain, Sarah Ann

People who engage in nonsuicidal self-injury (NSSI) endure physical pain for longer periods than do noninjuring individuals. Pain endurance is also predicted by the presence of highly self-critical beliefs. We tested the hypothesis that changing beliefs about the self would change pain endurance in NSSI individuals. NSSI (n = 50) and control (n = 84) participants were randomly assigned to hear positive music, to receive a brief cognitive intervention designed to improve feelings of personal self-worth, or to a neutral condition. Pain endurance was measured before and after the experimental manipulations. As predicted, there was a significant Group × Condition × Time interaction. After the cognitive intervention, NSSI participants showed a 69-s decrease in pain endurance compared with a 9-s decrease for control participants. For NSSI participants, improvement in self-worth was also significantly correlated with decreased willingness to endure pain. Cognitive approaches that focus on self-worth may provide a new treatment direction for NSSI.

Non-suicidal self-injury (NSSI) involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. However, other non-suicidal behaviors that involve people mistreating or abusing themselves but that do not deliberately and directly damage bodily tissue may have much in common with NSSI. Such ‘indirect’ methods of self-injury might include involvement in abusive relationships, substance abuse, risky or reckless behavior, or eating disordered behavior. Using a community sample (N = 156) we compared individuals engaging in NSSI (n = 50), indirect (non-suicidal) self-injurers (n = 38), and healthy controls (n = 68) on a range of clinical and personality characteristics. As predicted, non-suicidal self-injurers and indirect self-injurers showed more pathology than healthy controls on all measures. Comparisons of the NSSI and the Indirect self-injury groups revealed no significant differences on measures of dissociation, aggression, impulsivity, self-esteem, negative temperament, depressive symptoms, and borderline personality disorder. However, compared to people who engaged only in indirect forms of self-injury, those who engaged in NSSI were more self-critical, had higher scores on a measure of suicide proneness, and had a history of more suicide attempts. The findings suggest that NSSI and indirect self-injury are best viewed as separate and distinct clinical phenomena.