Article Figures & Data
Tables
Feature Indicator Severity/Risk Number of types used 1 Low 2–3 Moderate >3 High Number of episodes ≤10 Low 11–50 Moderate >50 High What to Assess How to Assess It High-Risk Indicators Warranting Referral for Behavioral Health Services Suicidal ideations “[Specific behavior] might be different than trying to kill yourself, but for some people they’re related. Do you ever think about killing yourself when you [specific behavior]?
Do you think about killing yourself when you don’t [specific behavior]?”
Intense thoughts about suicide while self-injuring
Thoughts about suicide before or after self-injuring
Types “What have you used to [specific behavior]?”
“In what ways do you injure yourself?”
Multiple types
≥3 methods
Onset “When did you first [specific behavior]?”
Early/childhood onset
Extended duration or history ≥6 months
Place/location “What parts of your body have you [specific behavior]?”
Genitals or breasts
Face
Severity of damage “Has [specific behavior] ever caused any bleeding/bruising/scarring?”
“Have you ever had to go to the hospital after you [specific behavior]?”
“How do you handle the wound after you [specific behavior]?
Hospitalization or suturing required
Neglect of wounds
Reopening of wounds
Functions “What does [specific behavior] do for you?”
“How do you usually feel before [specific behavior]?”
“How do you usually feel after [specific behavior]?”
“Would it help you in any way if you stopped [specific behavior]?”
Any relationship to suicide (eg, compromise between living and dying; reduces suicidal thoughts or urges)
Intensity of self-injury urges “How strongly would you rate your urges to [specific behavior] in a typical day from 0 to 100?”
70 or higher
Repetition “About how many times would you say you [specific behavior] since you started?”
11–50 (moderate risk)
≥50 (high risk)
Episodic frequency “How often do you [specific behavior] in a typical day? What about a typical week?”
Multiple times per week
≥5 wounds per episode
Intervention Level of Evidence SORT Rating RCTs Treatment Description Patients Treated in Published Reports or RCTs (n) Effect on Self-Injury Topiramate 3 C N/A 200 mg/day 3 Cessation of self-injury Clozapine 3 C N/A 300 to 550 mg/day for 4 to 12 months 8 Cessation of self-injury Naltrexone 3 C N/A 50 mg/day 8 Cessation of self-injury Dialectical behavior therapy 1 B 3 12-month outpatient program; weekly individual modified cognitive-behavioral therapy; weekly skills training; ongoing skills coaching between sessions 188 Significant reduction of self-injury in 2/3 RCTs compared with TAU group Manual-assisted cognitive behavior therapy 3 C 2 2–7 individual cognitive therapy-oriented sessions; 70-page self-help book 512 No effect on self-injury Transference-focused psychotherapy 2 C 2 12-month outpatient program; weekly individual psychodynamic therapy 23 No effect on self-injury Mentalization-based therapy 2 C 0 18-month inpatient program; weekly individual psychodynamic therapy; weekly group psychodynamic therapy (3×); weekly individual psychodrama session 19 Significantly lower proportion of self-injurers compared with TAU group The number of patients is from randomized controlled trials only when available or from available, published, nonrandomized studies if no randomized controlled trials have been conducted.
SORT, strength of recommendation taxonomy; RCTs, randomized placebo-controlled trials; TAU, treatment as usual.
