Nonsuicidal self‐injury across cultures and ethnic and racial minorities: A review

The field of nonsuicidal self‐injury (NSSI) is dominated by research conducted with Caucasian‐majority samples in Western countries such as United States, Canada, Australia and European countries. This article critically reviewed the empirical research on NSSI in non‐Western countries and among ethnic/racial minority individuals who live in the West to give voice to and understand the patterns of NSSI among individuals who do not fall within the dominant Caucasian majority. The study found both similarities and differences between Western and non‐Western data in terms of characteristics and functions of NSSI. Differences in gender patterns in regards to prevalence of NSSI and methods used as well as presence of a more relational functionality of NSSI rather than emotion regulation functionality were two points of divergence in the findings of these studies. In addition, the findings seem to indicate that the role of ethnicity/race is mediated by important factors such as socioeconomic status (SES) and gender. Existing gaps in the literature and suggestions for further research are discussed.     

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.     

Basing the treatment of stereotypic and self-injurious behaviors on hypotheses of their causes.

Stereotypic and self-injurious behaviors are common forms of maladaptive responding demonstrated by severely handicapped persons. Various review papers suggest that no single treatment procedure is universally effective. Although there may be many reasons for this finding, one could be that people engage in these behaviors for various reasons, and that procedures that are incompatible with the cause of the behavior are unlikely to be effective. These studies also suggest many hypotheses for the development and maintenance of these behaviors, three of which are the self-stimulation, positive reinforcement, and negative reinforcement hypotheses. The purpose of this paper was to determine whether one of these hypotheses could be matched to the cause of the behavior and used as an effective treatment procedure. We therefore compared one hypothesis with one other for 3 subjects in a three-phase study. During baseline, data were taken in two classrooms for each subject, and a judgement was made about the hypothesis most likely to be related to the cause of the behavior. During the second phase, a treatment based on that hypothesis was used in one classroom, and a treatment based on another hypothesis was used in the second classroom. During the third phase, the treatment that was most effective in the second phase was used in both classrooms. Results showed that a successful treatment program can be developed on an hypothesis of why the behavior occurred during baseline. Results are discussed in terms of supporting the argument that treatment programs should be based on a functional analysis of the behavior in its environmental context.     

FIXED-TIME SCHEDULES ATTENUATE EXTINCTION-INDUCED PHENOMENA IN THE TREATMENT OF SEVERE ABERRANT BEHAVIOR

We compared the effects of extinction (EXT) and fixed-time (FT) schedules as treatment for severe problem behavior displayed by 3 individuals with developmental disabilities. First, functional analyses identified the reinforcers maintaining aberrant behavior for all 3 individuals. Next, EXT and FT schedules were compared using a multielement design. During EXT, the reinforcer maintaining problem behavior was withheld. During FT, the reinforcers were presented response independently at preset intervals. Results showed that FT schedules were generally more effective than EXT schedules in reducing aberrant behavior. FT schedules may be used in situations when extinction-induced phenomena are problematic.     

EFFECTS OF WARNING STIMULI FOR REINFORCER WITHDRAWAL AND TASK ONSET ON SELF-INJURY

Results of a functional analysis of self-injurious behavior (SIB) in a child with autism showed that her SIB was maintained by access to preferred objects and escape or avoidance of task demands. Extinction and noncontingent reinforcement treatments were supplemented by presenting a statement combined with a picture cue at 30-s intervals indicating that a preferred object would be removed or a task would be presented. Warning stimuli in combination with extinction and noncontingent reinforcement reduced SIB to acceptable levels. SIB rates remained comparatively high in a control condition consisting of a 2-min delay to onset of reinforcer removal or task demands.     

A WATER-PROMPTING PROCEDURE FOR THE TREATMENT OF URINARY INCONTINENCE

Based on clinical observations of a naturally occurring phenomenon, a water-prompting procedure was used to facilitate toilet training with a 9-year-old boy with profound mental retardation. Other frequently used toilet-training procedures were either ineffective or were associated with increased self-injury. The water-prompting treatment package may increase continence by eliciting and reinforcing urination under specific stimulus conditions.     

MOVEMENT SUPPRESSION TIME-OUT FOR UNDESIRABLE BEHAVIOR IN PSYCHOTIC AND SEVERELY DEVELOP MENTALLY DELAYED CHILDREN

The effects of a movement suppression time-out, which involved punishing any movement or verbalization while a client is in the time-out area, were evaluated in four experiments. The first experiment examined the effects of a DRO procedure and movement suppression plus DRO in suppressing self-injurious behavior in a psychotic child in three different situations. In Experiment 2, the results of the previous experiment were replicated with two dangerous behaviors in a second psychotic child. In a third experiment, movement suppression plus DRO was compared with contingent restraint in reducing inappropriate poking behavior in two settings. The movement suppression procedure eliminated poking whereas contingent restraint had little effect. In the final experiment, movement suppression time-out alone was compared with exclusionary time-out alone and simple corner time-out alone. Self-stimulation occurred at high levels during the exclusionary and simple corner time-out procedures. Self-stimulation was either suppressed or reduced during movement suppression time-out. The movement suppression time-out procedure produced a larger reduction in the target behavior in all three children. The effectiveness of the movement suppression procedure was explained in terms of the suppression of self-stimulation while the time-out procedure was being applied.     

青少年抑郁与自伤关系的追踪研究：亲子沟通的调节作用

为考察青少年抑郁与自伤的双向关系及亲子沟通的调节效应,采用青少年自我伤害问卷、流动中心用抑郁量表和亲子沟通量表对595名初一学生进行为期10个月的追踪研究。结果发现,从初一到初二,抑郁呈增长趋势,且性别差异显著,而自伤的增长趋势不明显,但到初二后表现出了明显的性别差异;抑郁和自伤的同时性相关和继时性相关均显著;前测抑郁对后测自伤有明显的预测作用,但前测自伤对后测抑郁的预测作用不明显;父子沟通和母子沟通在前测抑郁与后测自伤水平之间有显著的负向调节作用。     

The role of emotion reactivity and gender in the relationship between psychopathology and self-injurious behavior

The goal of the present study was to examine emotion reactivity, a broad construct that consists of an individual’s sensitivity, intensity, and persistence of emotional reactions, as a mediator of the relationship between two types of psychopathology (depression symptoms and borderline personality disorder (BPD) symptoms) and history of self-injurious behavior (non-suicidal self-injury (NSSI) and suicide attempts (SA)). We also examined gender as a potential moderator of this relationship. Participants (N = 1914) completed measures of emotion reactivity, psychopathology, and self-injurious behavior. Results using a series of mediated path analyses indicated that emotion reactivity mediated the relationship between (1) depressive symptoms and NSSI in females only, (2) depressive symptoms and SA in females only, and (3) probable BPD diagnosis and NSSI in both genders. Emotion reactivity did not mediate the relationship between probable BPD diagnosis and SA in either gender. Our findings suggest that emotion reactivity is a possible pathway through which depression and self-injurious behavior relate, especially in women. We temper these findings, however, within the context of relatively modest observed effects.