Understanding and Treating Atypical, Severe Nonsuicidal Self-Injury

This chapter focuses on an outlier in the field of nonsuicidal self-injury (NSSI): atypical, severe NSSI. The definition consists of three types of behavior: (a) NSSI requiring medical attention such as sutures, staples, glue, bandages; (b) NSSI to unusual body areas: face, eyes, breasts, genitals, and anus; and (c) foreign body ingestion. Although at first look, these behaviors may not appear to have a great deal in common, they share several features. This chapter contends that atypical, severe NSSI may be a distinct, clinically important category. A study reviewed in this chapter examined whether atypical, severe NSSI was related to other self-destructive and self-defeating behaviors in a sample of 467 male and female adults living in intensive community-based group homes or supported housing programs. Analysis using general linear models showed that clients with a lifetime history of atypical, severe NSSI had a significantly higher number of risk indicators than clients without a lifetime history of atypical, severe NSSI. More important, clients with a history of atypical, severe NSSI also had significantly more risk indicators than clients with a history of common NSSI only. The study also found that individuals with a history of atypical, severe NSSI demonstrated more severe psychopathology than clients with common NSSI only. Based on these findings, it may be clinically useful to consider individuals with an atypical, severe NSSI history to be a high-risk subgroup. The chapter concludes with a description of the psychological functions of atypical, severe NSSI, treatment recommendations, two client examples, and suggestions for future research.