Recent advances in understanding and managing self-harm in adolescents

Stephanie Clarke, Lauren A Allerhand, Michele S Berk, Stephanie Clarke, Lauren A Allerhand, Michele S Berk

Abstract

Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.

Keywords: adolescent; self-harm; suicide.

Conflict of interest statement

No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Copyright: © 2019 Clarke S et al.

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    1. Linehan MM: Cognitive behavioral treatment of borderline personality disorder.Guilford Press, New York, 1993.
    1. Miller AL, Rathus JH, Linehan MN, et al. : Dialectical Behavior Therapy Adapted for Suicidal Adolescents. J Psychiatr Pract. 1997;3(2):78–86. 10.1097/00131746-199703000-00002
    1. Miller AL, Rathus JH, Linehan MM: Dialectical behavior therapy with suicidal adolescents. Guilford Press, New York, NY. 2007.
    1. Mehlum L, Tørmoen AJ, Ramberg M, et al. : Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. J Am Acad Child Adolesc Psychiatry. 2014;53(10):1082–91. 10.1016/j.jaac.2014.07.003

    2. F1000 Recommendation

    1. Mehlum L, Ramberg M, Tørmoen AJ, et al. : Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up. J Am Acad Child Adolesc Psychiatry. 2016;55(4):295–300. 10.1016/j.jaac.2016.01.005
    1. McCauley E, Berk MS, Asarnow JR, et al. : Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. 10.1001/jamapsychiatry.2018.1109
    1. Berk M, Adrian M, McCauley E, et al. : Conducting Research on Adolescent Suicide Attempters: Dilemmas and Decisions. Behav Ther (N Y N Y). 2014;37(3):65–9.
    1. Vigod SN, Kurdyak PA, Dennis CL, et al. : Transitional interventions to reduce early psychiatric readmissions in adults: Systematic review. Br J Psychiatry. 2013;202(3):187–94. 10.1192/bjp.bp.112.115030

    2. F1000 Recommendation

    1. Owen C, Rutherford V, Jones M, et al. : Psychiatric rehospitalization following hospital discharge. Community Ment Health J. 1997;33(1):13–24. 10.1023/a:1022409009436
    1. Loch A: Discharged from a mental health admission ward: Is it safe to go home? A review on the negative outcomes of psychiatric hospitalization. Psychol Res Behav Manag. 2014;7:137–45. 10.2147/PRBM.S35061
    1. Introduction to a Special Issue Dialectical Behavior Therapy: Evolution and Adaptations in the 21 st Century. Miller AL: Am J Psychother. 2015;69(2):91–5. 10.1176/appi.psychotherapy.2015.69.2.91

Source: PubMed

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