AD ALTA
JOURNAL OF INTERDISCIPLINARY RESEARCH
The application of the DSM-5 system led to a statistically
significant decrease in the number of detected cases (sig. =
0.000), even when compared to the already narrowed ICD-10
system. The decrease was primarily caused by four items:
“abused alcohol to hurt yourself”, “not slept enough to hurt
yourself”, “starved yourself to hurt yourself” and “over-
exercised to hurt yourself” – all of them have the potential to
detect 2 to 6% of cases. It is apparent that indirect forms of
physical self-harm represent a crucial element of self-harming
behaviour. Without recording them, 129 (15.5%) cases of self-
harm in adolescents would “be lost”. Considering the fact that
two items (“not slept enough to hurt yourself”, and “over-
exercised to hurt yourself”) were added as part of our research
(modification of the SHI questionnaire), it is impossible to
compare them with other (international) studies. According to
our findings (Demuth & Demuthova 2019), their prevalence is as
high as 52.5% (“not slept enough to hurt yourself”) and 26.1%
(“over-exercised to hurt yourself”). Considering their high
prevalence, we believe it is very necessary to integrate them into
any diagnostic checklist.
6 Conclusion
The application of three independent systems for the detection of
the presence of self-harm (the DSM-5 criteria, ICD-10 criteria,
SHI criteria) revealed that the most substantial drop-out of cases
of self-harming behaviour occurred when using the DSM-5
criteria. The system failed to detect 15.5% of self-harming
adolescents, and the analysis identified items which should be
preserved for diagnostic purposes. It appears that it is viable to
define self-harm in accordance with the ICD-10 criteria, with the
possibility of using the most frequent forms of self-harm as
identified by the SHI questionnaire. In order to draw more
unambiguous conclusions, we suggest the further analyses of a
sample that is more balanced in terms of gender representation.
At the same time, it would be appropriate to investigate the
prevalence of other forms of intentional self-harm that are
included in the ICD-10 criteria (e.g. choking, throttling, searing
with acid, etc.) and were not examined in our research, and to
assess their diagnostic potential. A subsequent factor analysis of
the items (of self-harm forms) could also be helpful in terms of
the extended analysis of other forms of self-harm.
Literature:
1. Balogh, E. P., Miller, B. T., & Ball, J. R. (eds.) (2015).
Improving Diagnosis in Health Care. Washington (DC):
National Academies Press.
2. Brent, D. (2011). Nonsuicidal self-injury as a predictor of
suicidal behavior in depressed adolescents. The American
Journal of Psychiatry, vol. 168 (5), 452–454.
3. Chadda R. K. (2018). Youth & mental health: Challenges ahead.
The Indian Journal of Medical Research, 148 (4), 359–361.
4. Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent
advances in understanding and managing self-harm in
adolescents. F1000Research, 8, F1000 Faculty Rev-1794, doi:
10.12688/f1000research.19868.1.
5. Comeau, J., Georgiades, K., Duncan, L., Wang, L., Boyle,
M. H., & 2014 Ontario Child Health Study Team (2019).
Changes in the prevalence of child and youth mental disorders
and perceived need for professional help between 1983 and
2014: Evidence from the Ontario Child Health Study. Canadian
Journal of Psychiatry. Revue canadienne de psychiatrie, 64 (4),
256–264.
6. Demuth, A. & Demuthova, S. (2019). Forms of Deliberate
Self-Harm and Their Prevalence in Adolescence.
In: International Conference on Research in Psychology.
London: Diamond Scientific Publication, 23–38.
7. Demuthova, S. & Demuth, A. (2019
A
8. Demuthova, S. & Demuth, A. (2019
). Questioning the
DSM-5 proposal for the NSSI diagnostic criteria. International
Journal of Arts & Sciences’ (IJAS) International Conference for
Academic Disciplines, 12 (1), 107–113.
B
9. Demuthova, S. & Doktorova, D. (2019). Interpohlavné
rozdiely v prevalencii jednotlivých foriem sebapoškodzovania
u adolescentov [Gender differences in the prevalence of
individual forms of self-harm in adolescents]. In: Baranovska, A.
(ed.): Kondášove dni 2018. Trnava: Katedra psychológie
Filozofickej fakulty UCM v Trnave, 19–32.
).
The Prevalence and
Most Frequent Forms of Self-Harm in Adolescents.
In: International Conference on Research in Psychology.
London: Diamond Scientific Publication,
39
–
51.
10. DSM-5 (2013). Diagnostic and Statistical Manual of Mental
Disorders. 5
th
Dyl, J. (2008). Understanding cutting in adolescents: prevalence,
prevention, and intervention. The Brown University Child and
Adolescent Behavior Letter, vol. 24 (3), 4–6.
ed. Washington: American Psychiatric Publishing.
11. Glenn, C. R. & Klonsky, E. D. (2013). Nonsuicidal self-
injury disorder: An empirical investigation in adolescent
psychiatric patients. Journal of Clinical Child and Adolescent
Psychology, 42 (4), 496–507.
12. Gratz, K. L. (2001). Measurement of Deliberate Self-Harm:
Preliminary Dataon the Deliberate Self-Harm Inventory. Journal of
Psychopathology and Behavioral Assessment, 23 (4), 253–263.
13. Hallab, L. & Covic, T. (2010). Deliberate self-harm: The
interplay between attachment and stress. Behaviour Change, 27
(2), 93–103.
14. Hawton, J. C., Saunders, E. A., & O’Connor, R. (2012). Self-
harm and suicide in adolescents. Lancet, 379, 2372–2382.
15. ICD-10 (2016). International Statistical Classification of
Diseases and Related Health Problems. [Online]. World Health
Organization. Available <https://www.who.int/classificatio
ns/icd/icdonlineversions/en/> [2019-07-15].
16. Jurewicz I. (2015). Mental health in young adults and
adolescents - supporting general physicians to provide holistic
care. Clinical medicine, 15 (2), 151–154.
17. Klonsky, D. E., Victor, S. E., & Saffer, B. Y. (2014).
Nonsuicidal Self-Injury: what we know, and what we need to
know. The Canadian Journal of Psychiatry, 59 (11), 565–568.
18. Klonsky, E. D. & Moyer, A. (2008). Childhood sexual abuse
and Non-Suicidal Self-Injury: Meta-analysis. British Journal of
Psychiatry, 192 (3), 166–170.
19. Laye-Gindhu, A. & Schonert-Reichl, K. A. (2005).
Nonsuicidal self-harm among community adolescents:
Understanding the “whats” and “whys” of self-harm. Journal of
Youth and Adolescence, 34 (5), 447–457.
20. Maddox, B. B., Trubanova A., & White, S. W. (2017).
Untended wounds: Non-suicidal self-injury in adults with autism
spectrum disorder. Autism, 21 (4), 412–422.
21. Madge, N., Hewitt, A., Hawton, K., de Wilde, E. J.,
Corcoran, P., Fekete, S., … Ystgaard, M. (2008). Deliberate
Self-harm within an International Community Sample of Young
People: Comparative Findings from the Child & Adolescent
Self-harm in Europe (CASE) Study. The Journal of Child
Psychology and Psychiatry, 49 (6), 667–677.
22. Moran, P., Coffey, C., Romaniuk, H., Borschmann, R.,
Carlin, J. B., Patton, G. C. (2012). The natural history of self-
harm from adolescence to young adulthood: a population-based
cohort study. Lancet, 379 (9812), 236–243.
23. Müller, A., Claes, L., Smits, D., Brähler, E., & de Zwaan, M.
(2016). Prevalence and correlates of self-harm in the German
general population. PLoS ONE 11 (6): e0157928. doi:
10.1371/journal.pone.0157928.
24. Pincus H. (2014). Diagnostic error: Issues in behavioral
health.
25. Plener, P. L., Libal, G., Keller, F., Fegert, J. M., &
Muehlenkamp, J. J. (2009). An international comparison of
adolescent non-suicidal self-injury (NSSI) and suicide attempts:
Germany and the USA. Psychological Medicine, 39 (9), 1549–1558.
Washington, DC: 2014. (Presentation to the Committee
on Diagnostic Error in Health Care, November 6, 2014).
26. Rodham, K., Hawton, K. & Evans, E. (2004). Reasons for
deliberate self-harm: comparison of self-poisoners and self-cutters in
a community sample of adolescents. Journal of the American
Academy of Child and Adolescent Psychiatry, 43 (1), 80–87.
27
. Rojkova, Z. & Mickova, Z. (2020). Osobnostné a motivačné
faktory sebapoškodzovania u adolescentov na Slovensku
[Personality and motivational factors of self-harm among
adolescents in Slovakia]. Psychologica, recenzovaný vedecký
zborník. Bratislava: FF UK, 73–81.
28. Sansone, R. A., Sinclair, J. D., & Wiederman, M. W. (2009).
Self-harm behavior among chronic pain patients. Primary Care
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