Interconnectivity among different nonsuicidal self-injurious methods - a network analysis.

Background: An important indicator of self-harm severity is the co-occurrence of different nonsuicidal self-injurious (NSSI) behaviors. However, there is little research on how different self-injurious behaviors (e.g., cutting, biting, burning, carving) are related. In contrast to person-centred approaches, variable-centred network analysis helps to identify the most meaningful associations between different forms of NSSI behavior, thus allowing the identification of structural patterns in different NSSI methods. Based on network analysis, it will be possible to examine which NSSI methods are the most central and which are most closely linked to other methods.

Methods: We used network analysis to investigate interconnections between 12 different self-harm methods. The Inventory of Statements About Self-Injury [24] was utilized to assess the types and frequency of NSSI in a community adult sample.

Results: More than one-third (39.7%; n = 744) of 1873 adults reported at least one episode of NSSI in their lifetime. Most (77%) of those engaged in NSSI used more than one NSSI method. The most frequently used NSSI methods were hitting self, interfering with wound healing, pinching, biting, and severe scratching. In the NSSI methods network analysis, severe scratching, cutting, and pinching had the highest rates of interrelationship with other NSSI behaviors. Moreover, the interconnectedness of certain specific NSSI-methods (i.e., cutting with burning and carving; severe scratching with pinching, biting and hitting self) have a greater risk of co-occurrence (versatility).

Conclusions: Although different NSSI methods occurred as distinct entities, some play a more central role in the network. Our results suggest that the NSSI methods identified as central should be given more attention in clinical settings as these behaviors may indicate the severity of the condition. Specifically, when assessing and treating those who engage in self-harm, clinicians may find it useful to create a detailed map of the person-specific NSSI-methods to inform risk assessment and treatment.