Monitoring Self-Injury in Real Time, with Dr. Glenn Kiekens

In this episode, Dr. Amy Lucas from Speek Health in the United Kingdom talks about supporting siblings of those who engage in nonsuicidal self-injury (NSSI). How can parents and caregivers of those who self-injure determine if they should share that information with siblings? What should parents do or say if they learn that the one self-injuring has made their siblings promise not to tell their parents about their self-injury? How might the sibling’s age influence these decisions and conversations, and what if parents are worried that a sibling will pick up the same behavior from their brother or sister who self-injures?

Connect with Dr. Lucas on LinkedIn at www.linkedin.com/in/amyhlucas, and learn more about her work at Speek Health, a resource for parents and caregivers of individuals who self-harm, at www.joinspeek.com. Below is one of the few (and free) research articles about siblings of those who engage in NSSI:

1. Tschan, T., Lüdtke, J., Schmid, M., & In-Albon, T. (2019). Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group. Child and Adolescent Psychiatry and Mental Health, 13, 15.  https://doi.org/10.1186/s13034-019-0275-2

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

In 2013, the 5th edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM-5) was released, and for the first time it included Nonsuicidal Self-Injury Disorder as a Condition for Further Study. It is not an actual diagnosis at this time, but there are  currently six criteria listed (see below, bottom of page). In this episode, Dr. Greg Lengel from Drake University in Iowa walks us through what research says about each of the six criteria, and he discusses the pros and cons of formalizing NSSI Disorder as a diagnosis.

Listen to his interview with Dr. Brooke Ammerman from Season 3 ("How Should Self-Harm Be Defined?") here. Learn more about Dr. Lengel at his faculty profile at Drake University here and follow him on Twitter/X at @DrGregLengel. Below are links to many of the papers discussed in this episode as well as other important papers on NSSI as a disorder in the DSM-5:

1. Shaffer, D., & Jacobson, C. (2009). Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. American Psychiatric Association, 1-21.
2. Lengel, G. J., Ammerman, B. A., & Washburn, J. J. (2023). NSSI in the DSM-5. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Vol. Eds.), The Oxford Handbook of Nonsuicidal Self-Injury. New York: Oxford University Press .
3. Lengel, G. J., Ammerman, B. A., & Washburn, J. J. (2022). Clarifying the definition of nonsuicidal self-injury: Clinician and researcher perspectives. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 43, 119-126.
4. Lengel, G. J. & Mullins-Sweatt, S. N. (2013). Nonsuicidal self-injury disorder: Clinician and expert ratings. Psychiatry Research, 210, 940-944.
5. Ammerman, B. A., Jacobucci, R., Kleiman, E. M., Muehlenkamp, J. J., & McCloskey, M. S. (2017). Development and validation of empirically derived frequency criteria for NSSI disorder using exploratory data mining. Psychological Assessment, 29, 221-231.
6. Ammerman, B. A., Jacobucci, R., & McCloskey, M. S. (2019). Reconsidering important outcomes of the nonsuicidal self‐injury disorder diagnostic criterion A. Journal of Clinical Psychology, 75, 1084-1097.
7. Ammerman, B. A., Lengel, G. J, & Washburn J. J. (2021). Consideration of clinician and researcher opinions on the parameters of nonsuicidal self-injury disorder diagnostic criteria. Psychiatry Research, 296, 113642.
8. Ghinea, D., Edinger, A., Parzer, P., Koenig, J., Resch, F., & Kaess, M. (2020). Non-suicidal self-injury disorder as a stand-alone diagnosis in a consecutive help-seeking sample of adolescents. Journal of Affective Disorders, 274, 1122-1125.
9. Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75, 324–333.
10. Muehlenkamp, J. J., Brausch, A. M., & Washburn, J. J. (2017). How much is enough? Examining frequency criteria for NSSI disorder in adolescent inpatients. Journal of Consulting and Clinical Psychology, 85, 611619.
11. Washburn, J. J., Potthoff, L. M., Juzwin, K. R., & Styer, D. M. (2015). Assessing DSM-5 nonsuicidal self-injury disorder in a clinical sample. Psychological Assessment, 27, 31-41.
12. Zetterqvist, M. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health, 9, 31.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

NONSUICIDAL SELF-INJURY DISORDER (PROPOSED DIAGNOSIS):

A. 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 expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent). Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual's repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death.

B. The individual engages in the self-injurious behavior with one or more of the following expectations: 

1. To obtain relief from a negative feeling or cognitive state.
2. To resolve an interpersonal difficulty.
3. To induce a positive feeling state.

Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behavior suggesting a dependence on repeatedly engaging in it.

C. The intentional self-injury is associated with at least one of the following: 

1. 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.
2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control.
3. Thinking about self-injury that occurs frequently, even when it is not acted upon.

D. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting. 

E. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. 

F. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual disability, Lesch-Nyhan syndrome, stereotypic movement disorder with self-injury, trichotillomania [hair-pulling disorder], excoriation [skin-picking] disorder).

What exactly constitutes nonsuicidal self-injury (NSSI)? Dr. Brooke Ammerman from the University of Notre Dame and Dr. Greg Lengel from Drake University discuss the complexities of defining NSSI. They also describe the difference between deliberate self-harm and NSSI and share their research about what many clinicians, researchers, and people with lived experience tell them about what they think constitutes NSSI and how we should define it.

Learn more about Dr. Ammerman and her work in the Affect, Suicide, Self-Injury, and Social Triggers (ASSIST) Lab at https://assistlab.nd.edu/.  Listen to her interview from Season 1 ("Disclosures of Self-Injury") here. Learn more about Dr. Lengel at his faculty profile at Drake University here.  Follow them on Twitter/X at @brooke_ammerman and @DrGregLengel. Below are links to some of the papers discussed in this episode:

1. Lengel, G. J., Ammerman, B. A., & Washburn, J. J. (2022). Clarifying the definition of nonsuicidal self-injury: Clinician and researcher perspectives. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 43(2), 119–126.
2. Ammerman, B. A., Lengel, G. J., & Washburn, J. J. (2021). Consideration of clinician and researcher opinions on the parameters of nonsuicidal self-injury disorder diagnostic criteria. Psychiatry Research, 296, 113642.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

The term "self-harm" is an umbrella term, encompassing a broad range of behaviors, under which is included substance abuse and misuse, eating disorders, suicide, and nonsuicidal self-injury (NSSI). In this episode, Dr. Brianna Turner from the University of Victoria in British Columbia, Canada discusses how often self-damaging behaviors, including risky sex, financial and physical recklessness, co-occur with NSSI and where NSSI fits within the umbrella of self-harming behaviors. She also simplifies research using structural models of self-damaging behaviors in a way that helps us understand the co-occurrences of potentially harmful coping behaviors.

Learn more about Dr. Turner and her work in the Risky Behaviour Lab at the University of Victoria here, and access many of her publications at https://uvic.academia.edu/BriannaTurner. Follow Dr. Turner on Twitter/X (@BriannaT_Psyc) and connect with the Risky Behaviour Lab on Instagram (@riskybehaviourlab_uvic) and Twitter/X (@RBL_UVic), especially if you are interested in participating in NSSI research. Below are the structural models of self-damaging behaviors discussed in this episode:

1. St. Germain, S. A., & Hooley, J. M. (2012). Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction. Psychiatry Research, 197(1-2), 78-84.
2. Green, J. D., Hatgis, C., Kearns, J. C., Nock, M. K., & Marx, B. P. (2017). The Direct and Indirect Self-Harm Inventory (DISH): A new measure for assessing high-risk and self-harm behaviors among military veterans. Psychology of Men & Masculinity, 18(3), 208–214.
3. Bresin, K. (2020). Toward a unifying theory of dysregulated behaviors. Clinical Psychology Review, 80, 101885.
4. Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., . . . Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477.
5. Barlow, D. H., et al. (2017). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide (2nd ed.). Oxford University.
6. Ehrenreich-May, J., et al. (2018). Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents: Therapist Guide. Oxford University.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

In this episode, Allison details her experience of engaging in nonsuicidal self-injury (NSSI) beginning in 9th grade and into her 20's. She explains the complex relationship she and many others have with their self-harm scars and discusses how her husband has supported her when she has self-injured. She also shares about how she makes sense of her scars in the context of her faith as a Christian. Read her To Write Love On Her Arms (TWLOHA) blog, "You are so much more than your pain," at https://twloha.com/blog/more-than-your-pain/. 

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

Up to 1 in 5 (20%) individuals with intellectual and developmental disabilities (IDD) and about 3 in 7 (42%) individuals with autism spectrum disorder (ASD) engage in self-injurious behavior (SIB). Common forms of SIB include repetitive head banging, head-hitting, self-biting, self-hitting, eye-poking, skin-picking, and trichotillomania (hair pulling), among other forms of self-harm.

In this episode, Caroline Roberts from the University of Minnesota and Masonic Institute for the Developing Brain discusses the differences and similarities between SIB and nonsuicidal self-injury (NSSI) and how we can bridge the gap between NSSI research and clinical practice, and SIB among those with IDD. She also shares 4 key topics from her interviews with experts in SIB and NSSI: (1) case ascertainment, (2) perceptions of causal variables, (3) pathways to treatment, and (4) treatment goals and outcomes. 

Learn more about the Masonic Institute for the Developing Brain and their interdisciplinary approaches to understanding and improving SIB workgroup here. Follow Caroline on Twitter/X at @clrobz. Below are one of her papers and other research referenced in today's episode:

1. Roberts, C. L., Avina, A. H., & Symons, F. J. (2023). A qualitative analysis of family caregiver experiences accessing treatment for self-injurious behavior in individuals with intellectual and developmental disabilities. Journal of Mental Health Research in Intellectual Disabilities.
2. Dimian, A. F., & Symons, F. J. (2022). A systematic review of risk for the development and  persistence of self-injurious behavior in intellectual and developmental disabilities. Clinical Psychology Review, 94, 102158.
3. Steenfeldt-Kristensen, C., Jones, C. A., & Richards, C. (2020). The prevalence of self-injurious behaviour in autism: A meta-analytic study. Journal of Autism and Developmental Disorders, 50(11), 3857-3873.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

What is the relationship between nonsuicidal self-injury (NSSI) and pain? Are individuals who self-injure less sensitive to pain than those who don’t self-injure? What are the ethics involved in conducting research on pain? In this episode, Dr. Julian Koenig describes the research on the experience of pain among those who self-harm. Learn more about Dr. Koenig and his research lab at www.koeniglab.de, and follow him on Twitter/X at @koeniglab.

Below are links to some of the research referenced in this episode:

1. Koenig, J., Thayer, J. F., & Kaess, M. (2016). A meta-analysis on pain sensitivity in self-injury. Psychological Medicine, 46(8), 1597-1612.
2. Koenig, J., Klier, J., Parzer, P., Santangelo, P., Resch, F., Ebner-Priemer, U., & Kaess, M. (2021). High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents. European Child & Adolescent Psychiatry, 30(8), 1299-1308.
3. Kaess, M., Hooley, J. M., Klimes-Dougan, B., Koenig, J., Plener, P. L., Reichl, C., Robinson, K., Schmahl, C., Sicorello, M., Schreiner, M. W., & Cullen, K. R. (2021). Advancing a temporal framework for understanding the biology of nonsuicidal self-injury: An expert review. Neuroscience and Biobehavioral Reviews, 130, 228-239.
4. Störkel, L. M., Karabatsiakis, A., Hepp, J., Kolassa, I.-T., Schmahl, C., & Niedtfeld, I. (2021). Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study. Neuropsychopharmacology, 46(7), 1357-1363.
5. Sigrist, C., Kaess, M., & Koenig, J. (2023). Autonomic nervous system function in nonsuicidal self-injury—A Research Domain Criteria perspective on the arousal/regulatory systems. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. C18S1–C18S23). Oxford University Press.
6. Naoum, J., Reitz, S., Krause-Utz, A., Kleindienst, N., Willis, F., Kuniss, S., Baumgärtner, U., Mancke, F., Treede, R.-D., & Schmahl, C. (2016). The role of seeing blood in non-suicidal self-injury in female patients with borderline personality disorder. Psychiatry Research, 246, 676-682.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

Amidst a global youth mental health crisis, is it possible that many young people are experiencing adolescent development challenges but are using mental health language to describe their distress? Even to the degree of experiencing crises that include self-harm like nonsuicidal self-injury and suicidal thoughts and behaviors? In this episode, Drs. Maria Papadima and Rachel Acheson share observations from their clinical work with youth, consider trends such as self-diagnosing through TikTok and Instagram, discuss how they walk parents and youth through these mental health crises, and offer a psychoanalytic perspective of current trends. 

Learn more about Dr. Papadima and her work at www.mariapapadima.com, and read her blog about "Self-diagnosis via TikTok" here. Below is the reference and link to their paper discussed in this episode:

1. Acheson, R., & Papadima, M. (2023). The search for identity: Working therapeutically with adolescents in crisis. Journal of Child Psychotherapy, 49(1), 95-119.

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #1 by Feedspot  in their list of "10 Best Self Harm Podcasts" and #5 in their "20 Best Clinical Psychology Podcasts." It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

Approximately 1-4% of people throughout the world experience obsessive-compulsive disorder (OCD). Individuals with OCD are more likely than those without OCD to engage in nonsuicidal self-injury (NSSI), and recent research has shown that, among those who self-injure, having a diagnosis of OCD predicts more severe self-injury.

In this episode, licensed clinical social worker and OCD expert Nathan Peterson explains how he differentiates nonsuicidal self-injury (NSSI) from Self-Harm OCD, which is just one of many subtypes of OCD and one in which a person experiences intrusive thoughts or mental images of violence toward oneself. He then walks us through how he uses Exposure and Response Prevention (ERP) for Self-Harm OCD in therapy. 

Learn more about Nathan and his therapy practice OCD and Anxiety Counseling here. He has nearly 100k subscribers on YouTube (@ocdandanxiety) where his videos receive thousands and thousands of views. You can also follow him on Instagram (@ocdandanxietyonline), Twitter (@ocdandanxiety1), and Facebook.  Click here to take his online "Do I Have Harm OCD? Test." Below are additional resources about OCD and/or NSSI:

1. Browning, M. E., Lloyd-Richardson, E. E., Schneider, R. L., Faro, A. L., Muehlenkamp, J. J., & Claudio-Hernandez, A. (2022). Obsessive compulsive disorder and co-occurring nonsuicidal self-injury: Evidence-based treatments and future research directions. The Behavior Therapist, 45(6), 199-208.
2. International OCD Foundation at https://iocdf.org/.
3. Winston, S. M., & Seif, M. N. ( 2017). Overcoming unwanted intrusive thoughts: A CBT-based guide to getting over frightening, obsessive, or disturbing thoughts. New Harbinger.
4. Baer, L. (2012). Getting control: Overcoming your obsessions and compulsions (3rd ed.). Plume.

To learn more about how medication can help address OCD (most often in tandem with ERP but not discussed in this episode), click here. 

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "20 Best Clinical Psychology Podcasts" and also featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

What is a parent's role in helping their child recover from self-injury? What might a dad say about supporting his child when he learns his child is engaging in nonsuicidal self-injury (NSSI)?  In this episode, a father and daughter sit down to discuss her lived experience of self-injury and self-harm and how parents, especially dads, can support their child. This is a shared story.

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "20 Best Clinical Psychology Podcasts" and also featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."