Page 105 - Personality disorders and insecure attachment among adolescents

2013; Zetterqvist, 2015). The DSM-5 (APA, 2013) defines a NSSI disorder (NSSID) as deliberate, direct, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned, engaged on five or more days in the past year. With this definition more covert forms of NSSI behaviours (e.g., self-poisoning) are excluded although several studies showed the existence of forms of NSSI without visible body tissue damage and with psychological damage (Han, Wang, Xu, & Su, 2018; Skegg, 2005).
Research on different aspects of NSSI reports that in clinical practice, 87.6% of the adolescents engaging in NSSI have a psychiatric disorder (Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006), and cutting is the most common method (Horgan & Martin, 2016; Wilkinson, 2013). Persons with BPD engaging in NSSI report higher rates of cutting, scratching, head banging, and self-punching than patients without BPD (Turner et al., 2015). In addition, the more methods of NSSI that are used, the higher the risk of suicidal ideation (Wester, Ivers, Villalba, Trepal, & Henson, 2016), accompanied by higher scores for of perceived stress and depressive coping and lower scores for active and optimistic coping (Kiekens et al., 2015). Various functions of NSSI, which are not mutually exclusive, are described in order of prevalence, including affect regulation or reduction of mental pain and transferring mental pain onto the body, self-punishment, influencing other people, anti-dissociation, anti-suicide, and thrill seeking (Glenn & Klonsky, 2010; Klonsky, 2007; Lloyd- Richardson et al., 2009). The contagiousness of NSSI is considered problematic, especially in clinical practice (Bateman & Fonagy, 2006), although to the authors’ knowledge, no research has been conducted on this topic. The Child & Adolescent Self-harm in Europe (CASE) study (Madge et al., 2011) found that higher impulsivity alongside being in connection with the suicide or self-harm thoughts of others, as well of the occurrence of physical or sexual abuse, worries about sexual orientation and trouble with the police, independently differentiated adolescents who regularly engage in NSSI from single time and non-NSSI adolescents.
Finally, the financial burden of NSSI on society is substantial. In the Netherlands in 2011, the direct medical costs of self-inflicted injury including NSSI was estimated at 60 million euros (RIVM, 2016). Moreover, approximately 157,000 young people between 10 and 24 years old visit emergency departments each year for self-injurious behaviours in the USA, resulting in over 200 million dollars in direct annual medical costs (Glenn et al., 2016). Optimizing prevention and treatment programs can reduce the burden of NSSI on individuals and on society.
In the current prospective cohort study, different aspects of NSSI were inquired pre-treatment and post-treatment in a high-risk adolescent sample with clinically diagnosed personality disorders and comorbidity to enhance the understanding of NSSI. In search of treatment targets, personality disorders, coping skills, and symptoms of distress were examined. Therefore the aims of this study were threefold. First, to investigate the occurrence of NSSI in an inpatient adolescent sample. Second, to examine associations between NSSI and personality disorders, symptoms, and copings skills. Third, to examine contagiousness, frequency, method, and function of NSSI for these groups at pre- and post-
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