School Psychology Forum

Nonsuicidal Self Injury
Volume 7, Issue 4 (Winter 2013 )

Editor: Steven R. Shaw

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  • Nonsuicidal Self-Injury in Our Schools, From Research to Practice: Introduction to the Special Issue

    Nancy Heath & Stephen P. Lewis

    pp. 89-92

    Nonsuicidal self-injury (NSSI) refers to the deliberate destruction of one's body tissue (e.g., cutting, burning, bruising) without conscious suicidal intent (Nock & Favazza, 2009) and has a lifetime prevalence of 12–25% among adolescents, with 4–7% reporting ongoing NSSI (see Whitlock & Rodham in this issue for a full review). Approximately one quarter of these youth repeatedly self-injure (Nixon & Heath, 2009). Youth NSSI is associated with myriad difficulties, including physical injuries, scarring, psychiatric difficulties (e.g., anxiety, depression), and elevated suicide risk (Alfonso & Dedrick, 2010; Nock & Favazza, 2009; Nock, Joiner, Gordon, Lloyd- Richardson, & Prinstein, 2006). Moreover, in the last decade, NSSI has emerged as a significant issue in school settings (e.g., Heath, Toste, & Beettam, 2006; Muelenkamp, Williams, Gutierrez, & Claes, 2009; Toste & Heath, 2010). It has been suggested that a majority of school mental health professionals, including school psychologists, counselors, and social workers encounter students who engage in NSSI (e.g., Carroll, Olwig, & Vasquez, 2011; Duggan, Heath, Toste, & Ross, 2011; Roberts-Dobie & Donatelle, 2007). For example, in a recent study 92% of school counsellors reported working with a student who had self-injured (Duggan et al., 2011).

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  • Understanding Nonsuicidal Self-Injury in Youth

    Janis Whitlock & Karen Rodham

    pp. 93-110

    ABSTRACT: In this article we summarize what is known about nonsuicidal self-injury (NSSI) in youth. First, we describe basic demographic trends, prevalence, and function. Then we turn our attention to the implications of NSSI for schools, school-related policies, and school guidelines. Having provided an overview of the field, we conclude that even in the absence of academic and clinical consensus of the definition, measurement, and NSSI function, schools are uniquely poised to raise awareness about NSSI and about mental health issues in general among their students and their staff. By taking proactive approaches to building awareness and skills, schools are well positioned to assist in equipping young people with the skills they need to better cope with the inevitable vicissitudes of life including but not limited to NSSI.

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  • Exploring Why Students Self-Injure: The Functions of Nonsuicidal Self-Injury

    Angela G. Darosh & Elizabeth E. Lloyd-Richardson

    pp. 111-120

    ABSTRACT: Nonsuicidal self-injury (NSSI) is a relatively common behavior engaged in by adolescents. School mental health professionals have identified NSSI as a behavior for which they need more information and practice guidelines. Despite a clear need, few resources exist to help with understanding the development and maintenance of NSSI in adolescents. This article reviews relevant literature from counseling and clinical psychology and related disciplines to clearly outline the theoretical models most relevant to understanding why youth engage in NSSI. The use of case vignettes serves to illustrate relevant theoretical underpinnings and scientific literature. Functional assessment of NSSI is dovetailed with implications for treatment. Suggestions for the practice of school psychology are discussed.

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  • Treatment of Nonsuicidal Self-Injury: Critical Review and Implications for School Applications

    Amy Shapiro, Nancy Heath & Elizabeth Roberts

    pp. 121-135

    ABSTRACT: Treatment of nonsuicidal self-injury (NSSI) among adolescents within a school setting poses unique and specific challenges. Further, schools vary in resources available to students, and school psychologists differ in training regarding interventions for youth who self-injure. Currently there are no evidence-based approaches to the assessment and treatment of NSSI in the schools. To address this gap, the present article critically reviews the treatment literature for NSSI among both adults and adolescents in clinical and community settings and extrapolates the common elements of effective treatment that could be feasible within schools. Following this, a description of recommended approaches to assessment, triage, and service provision within schools is provided. Finally, three contrasting cases illustrating the use of these different elements are presented and relevant resources and links provided.

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  • Mental Health Issues and Nonsuicidal Self-Injury Among Youth: Implications for Mental Health Professioanls in the School System

    Heather T. Schatten, Blair W. Morris, Abigail L. Wren, Margaret S. Andover

    pp. 136-147

    ABSTRACT: Nonsuicidal self-injury (NSSI) is a behavior that is prevalent among children and adolescents. Although NSSI is often associated with borderline personality disorder and depression, it co-occurs with numerous psychiatric symptoms and associated diagnoses. The current article reviews the research addressing psychiatric symptoms that are commonly found among children and adolescents who engage in NSSI, such as depression, anxiety, disordered eating, substance use, impulsivity, and suicide. Implications for the role of assessment by school mental health professionals are discussed.

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  • Nonsuicidal Self-Injury on the Internet: An Overview and Guide for School Mental Health Professionals

    Jasmine C. Mahdy & Stephen P. Lewis

    pp. 148-160

    ABSTRACT: In the past few years, there has been an explosion of online content and communication regarding nonsuicidal self-injury (NSSI). Research indicates the Internet may be particularly salient among those adolescents who engage in NSSI. Indeed, many youth who self-injure connect with others who self-injure via the Internet in order to obtain needed support and to share their NSSI experiences. Certain forms of online NSSI activity may confer risk for NSSI continuation and may possibly trigger NSSI urges. In light of this, the current article provides school mental health professionals with an overview of knowledge about the nature of online NSSI activity among youth, the manner by which certain forms of online activity may have an impact on youth, and how to incorporate online NSSI activity in work with adolescents who self-injure. To illustrate how this may transpire, a case example is presented. Online resources to recommend to youth and caregivers are also provided.

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  • Managing Nonsuicidal Self-Injury in Schools: Use of a Structured Protocol to Manager the Behavior and Prevent Social Contagion

    Barent Walsh & Jennifer J Muehlenkamp

    pp. 161-171

    ABSTRACT: Nonsuicidal self-injury (NSSI) such as cutting, burning, self-hitting, and abrading is currently occurring at high rates in middle schools, high schools, and universities. This article focuses on understanding and managing NSSI strategically within middle and high school settings. The need for, and specific components of, a thorough staff training sequence are reviewed. A protocol for responding to NSSI behavior in students is also discussed. Specific suggestions are offered to prevent and manage social contagion of self-injury in school populations.

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