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Behavioral Emergencies Update

Fall/Winter 2004-5

Section on Clinical Emergencies and Crises
American Psychological Assn.
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In this issue...

The President's Column

Ethical Issues in Research on Behavioral Emergencies and Crises

Subtle Differences between Self-Injury and Suicide in Adolescents

Section VII in Hawaii

Conference Photos

What is Suicidal Behavior? Definitional Problems in Research and Practice

Congratulations to Our Newly Elected Members

A Message from the Treasurer

Notes from the Editor



Subtle Differences between Self-Injury and Suicide in Adolescents

Jennifer J. Muehlenkamp, M.A.

Self-injury, the deliberate destruction of body tissue without suicidal intent, is gaining increasing attention from researchers and clinicians. Studies have documented that non-suicidal self-injury (NSSI) is more prevalent among adolescents than originally believed, with estimates that 5 to 40% of non-clinical samples of adolescents report engaging in NSSI (Darche, 1990; Ross & Heath, 2002). Despite increasing attention, our understanding of NSSI and its distinction from suicide attempts is incomplete. Research and clinical experience support ort differentiating the two behaviors on the basis of the amount of death-intention underlying the act. However, retrospective reports on intent may not be accurate and many adolescents report ambivalence surrounding the behavior. Effective treatment options may differ depending on the intent of the behavior, so identifying ways to differentiate NSSI and suicide attempts is critical. To begin this line of research, I conducted a study with Peter Gutierrez, Ph.D. that examined differences in depressive symptoms, suicidal ideation, and attitudes towards life and death among high school students that reported engaging in only-NSSI and only suicide attempts.

Data was collected from 390 adolescents (62.2% Caucasian; 45% Male) attending an urban public high school in the Midwest. Participants were recruited through classroom announcements and letters sent to students’ homes. Adolescents with parental consent completed a packet of questionnaires that included the Suicidal Ideation Questionnaire (Reynolds, 1988), Reynolds Adolescent Questionnaire (Reynolds, 1987), Multi-Attitude Suicide Tendency Scale (Orbach et al., 1991), and the Self-Harm Behavior Questionnaire (Gutierrez et al., 2001).   Adolescents reporting only an act of NSSI (n = 62, 15.9%) or suicide attempt (n = 22, 5.6%) were compared on the variables of interest.

Chi-square analyses indicated there were no significant sex differences in the NSSI group, but females were more likely to report a suicide attempt than males. ANOVAs were run to test for group differences on depression, suicidal ideation, and attitudes towards life and death. Results showed significant differences on the MAST repulsion by life subscale, such that individuals reporting NSSI were less repulsed by life than those who had attempted suicide. No other significant differences were found. However, results from regression analyses demonstrated that in addition to the MAST repulsion by life scale, attraction to life (MAST subscale), depressive symptoms, and suicidal ideation were predictive of self-harm category.

The results from this study suggest that NSSI and suicide attempts are qualitatively different from each other, particularly from the adolescent’s perspective. Based on the current findings, it appears that attitudes towards life better distinguish NSSI from suicide attempts than do reports of depression or suicidal ideation. Adolescents who engaged in only NSSI reported less repulsion by life, and having a greater attraction to life was predictive of no self-harm. These findings support the notion that NSSI is more likely to be an emotion regulation strategy devoid of death-intention whereas suicidal behavior is seen as a death-intended solution. Clinicians and researchers working with NSSI and suicide need to be aware of the subtle differences between the two behaviors so that appropriate assessments and treatment approaches can be capitalized.

Note:  Further details regarding this study can be found in the spring (2004) issue of Suicide and Life-Threatening Behavior, 34(1), 12-23.

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