To the untrained eye, non-suicidal self-injury (NSSI) and suicidal self-injury may seem to be the exact same disorder. This could not be further from the truth. Non-suicidal self-injury (NSSI) is defined in the fifth addition of the Diagnostic and Statistical Manual of Mental Health Disorders [link to glossary] (DSM-V) as a condition distinct from borderline personality disorder (BPD)(although NSSI is often associated with additional BPD; 80% of those diagnosed with BPD engage in self-harm), which involves self-inflicted damage without suicidal intent. The manual also stipulates the purpose of this harm is to seek relief from a negative feeling, or to resolve an interpersonal difficulty
Although its position in the relatively new DSM 5 is controversial—with many feeling it needs a larger focus, being prevalent in young adults—the new Diagnostic and Statistical Manual of Mental Health Disorders is far from without flaw as a whole anyway. Having begun it’s life as a slim pamphlet in the 1950s, however, we may consider it to be a great tool in diagnosis now. Although written about in the DSM, then, it is worth noting that the underlying mechanisms of NSSI are still relatively unknown.
Described by Deborah Serani in “When the skin becomes an emotional canvas”, in its simplest form, NSSI is a physical solution to an emotional problem. Sometimes viewed as a way to communicate feelings or emotions that cannot be spoken, individuals with the disorder come from all socio-economic status backgrounds.
A recent paper by Dr Amber Saldias and colleagues explores the relationship between maladaptive schema modes, parental bonding, and NSSI. Using the Deliberate Self-Harm inventory (DSHI), a 17 item self-report questionnaire, the Schema Mode Inventory (SMI), a 188 item shortened questionnaire, and the Parental Bonding Instrument (PBI), a 20 item version allowing self-report of parental rearing styles, the researchers investigated maladaptive schema (a schema at its simplest being a plan or theory) modes in 70 NSSI outpatients. Maladaptive schema modes were found to be very important in NSSI. Two types in particular, punitive parent and angry child, also significant mediators. The study itself is the first to demonstrate this relationship between maladaptive schemas and NSSI, but the results are not surprising for previous research has indicated that heightened maladaptive schema modes are associated with (among other psychopathologies) BPD.
Low parental care (specifically maternal) and not high control is associated with NSSI in particular in this study. It is unclear why this is, for NSSI is often seen as a way to gain control in uncontrollable situations by the public. It is possible, the researchers suggest, that low maternal care is not a causal factor but one that increases the severity of an already existing NSSI. Generalization for such a complicated disorder is difficult, so future research may look at mapping maladaptive schemas in NSSI specifically.
Amber Saldias, Kevin Power, David T Gillanders, Claire W Campbell, Roger a Blake (2013) The Mediatory Role of Maladaptive Schema Modes Between Parental Care and Non-Suicidal Self-Injury., 37-41. In Cognitive behaviour therapy.