Diagnostic Considerations
The diagnostic and statistical manual of mental disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) addresses NSSI under section three ‘Conditions for Further Study’ and includes a V code (V15.59) listed as ‘Personal History of Self Harm’.
NOTE: Section III disorders will not generally be reimbursed by insurance companies, since they are still undergoing research and revision to their criteria.
APA (2013) proposed the below criteria in section III:
2. To resolve an interpersonal difficulty
3. To induce a positive feeling state
Diagnostic Features:
NOTE: Section III disorders will not generally be reimbursed by insurance companies, since they are still undergoing research and revision to their criteria.
APA (2013) proposed the below criteria in section III:
- In the last year, the individual has, on 5 or more days, engaged in intentional self inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the exception that the injury will lead to only minor or moderate physical harm (i.e. there is no suicidal intent).
- The individual engages in the self-injurious behavior with one or more of the flowing expectations:
2. To resolve an interpersonal difficulty
3. To induce a positive feeling state
- The intentional self-injury is associated with at least one of the following:
- Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self injurious act.
- Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control.
- Thinking about self-injury that occurs frequently, even when it is not acted upon.
- The behavior is not socially sanctioned (body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting.
- The behavior or its consequences cause clinically significant distress ro interference in interpersonal, academic, or other important areas of functioning.
- The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopment disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another medical condition or mental disorder.
Diagnostic Features:
- Essential feature of NSSI is that the individual repeatedly inflicts shallow, yet painful injuries to the surface of his or her body
- Most commonly, the purpose is to reduce negative emotions, such as tension, anxiety, and self reproach, and/ or to resolve an interpersonal difficulty
- When behavior occurs frequently, it might be associated with a sense of urgency and craving, the resultant behavioral pattern resembling an addiction
- Injury is most often inflicted with a knife, needle, razor, or other sharp object
- Common areas for injury include the frontal area of the thighs and the dorsal side of forearms
- Other methods include stabbing an area, most often upper arm, with a needle, or sharp, pointed knife; inflicting a superficial burn with a lit cigarette end; or burning the skin by repeated rubbing with an eraser.
- Borderline Personality Disorder
- Suicidal Behavior Disorder
- Trichotillomania (hair-pulling disorder)
- Stereotypic self-injury
- Excoriation (skin-picking)