Borderline Personality Disorder,  Self-Injury

Self-Injury: Raising the Profile of a Dangerous Behavior

“By applying one type of pain,” he says, “they get rid of a different type of pain,”

Self-Injury: Raising the Profile of a Dangerous Behavior

A Rutgers researcher appeals to the medical community for better treatment tools and insurance coverage

By Rob Forman

Self-injury so often occurs in private, an important reason why solid statistics are hard to come by. But researchers estimate between 10 and 40 percent of adolescents, and up to 10 percent of adults, harm themselves physically – usually by cutting or burning their skin.

Yet, the condition – known as nonsuicidal self-injury – is not officially recognized by the American Psychiatric Association (APA) as a mental disorder, which means insurance may not cover treatment.

“The mental health system is failing patients who have a clear problem for which they need help,” says Edward Selby, an assistant professor of psychology in Rutgers’ School of Arts and Sciences in New Brunswick.

Selby, who recently published a paper in Clinical Psychological Review on the topic, is among a growing number of psychologists who believe that non-suicidal self-injury should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard compilation of psychiatric disorders used by mental health practitioners and insurers.

Since self-injury is not on that list, to qualify for medical coverage those who cut, burn or otherwise injure themselves must fit other existing diagnoses, such as borderline personality disorder, depression or an anxiety disorder, which, Selby says, occurs barely half the time.

The current fifth edition of the manual – issued in 2013 and called DSM-5 – calls self-injury a condition that needs “further study,” well short of the recognition needed to trigger insurance coverage, better define the affected population and permit development of more effective treatment methods.

Selby’s research, including his most recent paper, “Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles,” is aimed at filling in any blanks that are holding the APA back, leading – he hopes – to the full recognition he feels the disorder deserves.

The urge to self-injure can baffle people who do not engage in it. Most obvious is the severe pain it can cause. But in cases where psychological pain becomes overwhelming – negative thoughts that cascade and won’t stop – Selby says a person may feel that a diversion, even if it hurts, is the only solution available. “By applying one type of pain,” he says, “they get rid of a different type of pain,”


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