Some notes on self-injury in New Zealand:
Prevalence, correlates and functions
Jessica Garisch
Tamsyn Gilbertson
Robyn Langlands
Angelique O’Connell
Lynne Russell
Marc Wilson
Emma Brown
Tahlia Kingi
Please note that this presentation will include discussion of
suicide and life-threatening behaviour
So what are we talking about…?
Does it cover…
• Overdosing?
• Drinking ‘til you throw up?
• Taking risks?
• Accepting emotional abuse?
• Depriving yourself of food?
• Piercings?
• Tattoos?
• Brandings or scarification?
• ‘Mortification of the flesh’?
So what are we talking about…?
Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007):
“…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes
not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal
self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as
self harm, do not differentiate non-suicidal from suicidal intent).”
“As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses,
and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings,
tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms
including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with
intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”
What do we know about it…?
117
120
104
100
92
78
80
75
65
57
60
43
42
37
40
32
27
20
13 12
13
9
9
16
10
5
7
5
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
0
What do we know about it…?
Why do people do it…?
Why do people do it…?
What do we know about it…?
…In New Zealand?
Prevalence…
• 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1
• 24% - Lifetime prevalence among community-based New Zealand adults2
• 48% of adolescents presenting to CAMHS reported SH at initial assessment3
• 20% of 9,000 secondary students reported SH in previous year4
• 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5
years5
 (conflation between SSI and NSSI)
1.
Hatcher et al., 2009.
2. Nada-Raja et al., 2004.
3. Fortune et al., 2005.
4. Fortune et al., 2010.
5. Pryor & Jose, 02/04 to 09/09.
Prevalence…
Sample
1. 100-level PSYC
students
N
285
† r=.40 with suicidal behaviour
Measure
Sansone et al’s (1998) SHI
# items
Lifetime
Prevalence
22
78.9%/54.9%†
Prevalence…
Sample
N
Measure
# items
Lifetime
Prevalence
1. 100-level PSYC
students
285
Sansone et al’s (1998) SHI
22
78.9%/54.9%†
2. 16-18 year-old
School students
325
De Leo & Heller (2004)
1
14.8%
† r=.40 with suicidal behaviour
Prevalence…
Sample
N
Measure
# items
Lifetime
Prevalence
1. 100-level PSYC
students
285
Sansone et al’s (1998) SHI
22
78.9%/54.9%†
2. 16-18 year-old
School students
325
De Leo & Heller (2004)
1
14.8%
14
48.7%
14
43.7%
3. 16-18 year-old
School students
4. 100-level PSYC
students
1,162 Lundh et al’s (2007) DSHI
593
† r=.40 with suicidal behaviour
Lundh et al’s (2007) DSHI
Prevalence…
Sample
N
Measure
# items
Lifetime
Prevalence
1. 100-level PSYC
students
285
Sansone et al’s (1998) SHI
22
78.9%/54.9%†
2. 16-18 year-old
School students
325
De Leo & Heller (2004)
1
14.8%
14
48.7%
3. 16-18 year-old
School students
1,162 Lundh et al’s (2007) DSHI
4. 100-level PSYC
students
593
Lundh et al’s (2007) DSHI
14
43.7%
5. 100-level PSYC
students
722
Lundh et al’s (2007) DSHI (SV)
7
39.7%‡
† r=.40 with suicidal behaviour
‡ correlates .79 with the full 14-item DSHI
Self-injury is most likely
when…
…one is experiencing peer
victimisation AND one is
highly alexithymic.
Self-injury is most frequent,
most diverse, and most
thought about when…
…one is highly perfectionistic
AND highly alexithymic.
These are all psychological, contextual and interpersonal predictors of SI
Why do those who self-injure, self-injure?
N
Training?
NSSI client attempted
Suicide?
NSSI client COMPLETED
suicide
Non-NSSI client
attempted Suicide?
Non-NSSI client
COMPLETED suicide
Tell active/past SI client of
research?
Mental Health Nurse
88
61%
90%
49%
88%
65%
56/58%
General Practitioner
16
0%
62%
25%
88%
56%
31/25%
Social Worker
57
44%
86%
16%
72%
26%
33/32%
Clinical Psychologist
57
77%
86%
25%
83%
30%
28/32%
Psychiatrist
1
0%
100%
0%
100%
100%
0/0%
Counsellor
32
34%
69%
9%
78%
13%
28/25%
Affect regulation was the most strongly endorsed function and,
overall, intrapersonal functions were the most strongly endorsed.
ISAS subscale
Global
Mean (SD)
Most recent
Mean (SD)
Affect regulation
Self-punishment
Marking distress
Anti-dissociation/ feeling generation
Anti-suicide
Self-care
Toughness
Interpersonal influence
Interpersonal boundaries
Sensation-seeking
Autonomy
Revenge
Peer-bonding
4.62 (1.62)
4.14 (1.91)
2.82 (2.00)
2.68 (2.16)
2.22 (1.98)
1.49 (1.48)
1.29 (1.53)
1.18 (1.47)
1.16 (1.51)
0.77 (1.21)
0.77 (1.18)
0.68 (1.26)
0.14 (0.56)
4.57 (1.74)
3.89 (2.15)
2.66 (1.96)
2.04 (2.25)
2.02 (2.27)
1.34 (1.51)
1.04 (1.54)
0.92 (1.36)
0.89 (1.50)
0.52 (1.17)
0.60 (1.17)
0.62 (1.37)
0.15 (0.81)
The ‘paradox of self-injury’
Self-injury worthy of help is private, but attention-seeking self-injury is public.
 How does one seek help for ‘worthy’ self-injury without becoming unworthy?
Where next?
Towards understanding how NSSI starts, stops, and continues…
Year 9 and older
Longitudinal
Funded by the Health Research Council of New Zealand
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