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A unified theoretical framework for understanding suicidal and self-harming behavior: Synthesis of diverging definitions and perspectives

Liljedahl, Sophie LU and Westling, Sofie (2014) 3rd International Conference on Borderline Personality Disorder and Allied Disorders
Abstract
Borderline Personality Disorder (BPD) has largely been associated with self-harm and chronic suicidality, despite the fact that these behaviours comprise only one diagnostic criterion. Treatments for self-harm are mostly indicated for individuals with BPD. Emerging literature suggests that youth with histories of depression are at risk of both self-harm and completed suicide. For individuals with repeated self-harm, co-occurring suicidal ideation and behavior is not uncommon. In the field of self-harm research, two major positions and corresponding definitional terms have evolved. “Deliberate self-harm” is a broad definition that includes direct suicidal and non-suicidal forms of the behavior. “Non-suicidal self-injury” (NSSI) encompasses... (More)
Borderline Personality Disorder (BPD) has largely been associated with self-harm and chronic suicidality, despite the fact that these behaviours comprise only one diagnostic criterion. Treatments for self-harm are mostly indicated for individuals with BPD. Emerging literature suggests that youth with histories of depression are at risk of both self-harm and completed suicide. For individuals with repeated self-harm, co-occurring suicidal ideation and behavior is not uncommon. In the field of self-harm research, two major positions and corresponding definitional terms have evolved. “Deliberate self-harm” is a broad definition that includes direct suicidal and non-suicidal forms of the behavior. “Non-suicidal self-injury” (NSSI) encompasses only behaviours resulting in direct tissue damage in the absence of suicidal intent. Neither position systematically evaluates indirect self-harm. The discrepancy between definitions and deficiency of either alone produces an inability to compare results in clinical research, and limits the applicability of evidence-based treatments. We propose that these behaviors are best understood as possible dimensions on a broad self-harm spectrum, within a theory derived from the literature on suicide, self-harm, NSSI, and BPD. Methods: Research and theory review. Results: A number of recent empirical studies have concluded that self-harm and suicide should not be considered separately, lending support to a broader definition of self-harm than that encompassed by NSSI alone. Extending the definitional scope of self-harm enables a more thorough understanding of indirect self-harming behaviors, proposed to have the same function as NSSI. These studies as well as Emerging Models from DSM-5 inform the proposed theory. Conclusion: The proposed unified theoretical framework provides a formulation of both NSSI and suicidal behavior as two dimensions on a broad spectrum of self-harming behaviors. The empirical and theoretical basis for the theory is presented alongside the clinical and research utility of integrating a literature that remains divergent. (Less)
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author
organization
publishing date
type
Contribution to conference
publication status
unpublished
subject
keywords
self-harm, suicide
conference name
3rd International Conference on Borderline Personality Disorder and Allied Disorders
language
English
LU publication?
yes
id
19e4834f-4ce7-4925-a55f-df6cfc7c97ec (old id 5155174)
date added to LUP
2015-03-16 15:51:02
date last changed
2016-04-16 11:15:19
@misc{19e4834f-4ce7-4925-a55f-df6cfc7c97ec,
  abstract     = {Borderline Personality Disorder (BPD) has largely been associated with self-harm and chronic suicidality, despite the fact that these behaviours comprise only one diagnostic criterion. Treatments for self-harm are mostly indicated for individuals with BPD. Emerging literature suggests that youth with histories of depression are at risk of both self-harm and completed suicide. For individuals with repeated self-harm, co-occurring suicidal ideation and behavior is not uncommon. In the field of self-harm research, two major positions and corresponding definitional terms have evolved. “Deliberate self-harm” is a broad definition that includes direct suicidal and non-suicidal forms of the behavior. “Non-suicidal self-injury” (NSSI) encompasses only behaviours resulting in direct tissue damage in the absence of suicidal intent. Neither position systematically evaluates indirect self-harm. The discrepancy between definitions and deficiency of either alone produces an inability to compare results in clinical research, and limits the applicability of evidence-based treatments. We propose that these behaviors are best understood as possible dimensions on a broad self-harm spectrum, within a theory derived from the literature on suicide, self-harm, NSSI, and BPD. Methods: Research and theory review. Results: A number of recent empirical studies have concluded that self-harm and suicide should not be considered separately, lending support to a broader definition of self-harm than that encompassed by NSSI alone. Extending the definitional scope of self-harm enables a more thorough understanding of indirect self-harming behaviors, proposed to have the same function as NSSI. These studies as well as Emerging Models from DSM-5 inform the proposed theory. Conclusion: The proposed unified theoretical framework provides a formulation of both NSSI and suicidal behavior as two dimensions on a broad spectrum of self-harming behaviors. The empirical and theoretical basis for the theory is presented alongside the clinical and research utility of integrating a literature that remains divergent.},
  author       = {Liljedahl, Sophie and Westling, Sofie},
  keyword      = {self-harm,suicide},
  language     = {eng},
  title        = {A unified theoretical framework for understanding suicidal and self-harming behavior: Synthesis of diverging definitions and perspectives},
  year         = {2014},
}