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DOI: 10.1055/s-0028-1109848
© Georg Thieme Verlag KG Stuttgart · New York
Selbstverletzendes Verhalten und Suizidversuche: Fundierung der Differenzialdiagnostik
Publication History
Publication Date:
26 October 2009 (online)
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Zusammenfassung
Drei Kriterien zur Differenzialdiagnostik von selbstverletzendem Verhalten und Suizidversuchen sollen anhand neuerer empirischer Studien auf ihre Gültigkeit geprüft werden. Untersucht werden die Kriterien zu Motiven (Funktionen), Selbstverletzungsmethoden (Verletzungsschwere) sowie Auftretenshäufigkeit und Episodenanzahl über die Lebenszeit. Die Literaturanalyse ergab, dass nur wenige Studien einen direkten Vergleich zwischen selbstverletzendem Verhalten und Suizidversuchen thematisieren. Daher wurden zusätzlich Studien hinzugezogen, die Unterschiede in Zusammenhang mit der Ausprägung der Suizidabsicht fokussieren. Die empirischen Befunde zu Motiven und Funktionen, Methoden und Verletzungsschwere sowie zu Auftretenshäufigkeit und Episodenanzahl über die Lebenszeit wurden mit den bestehenden Kriterien abgeglichen. Bis auf die Lebenszeithäufigkeit differenzieren alle Merkmale entsprechend den Vorgaben. Im Falle der Motive ermöglicht jedoch erst eine differenzierte Betrachtung eine Unterscheidung zwischen selbstverletzendem Verhalten und Suizidversuchen. Zur Optimierung der Differenzialdiagnostik sind die Kriterien daher geringfügig zu modifizieren. Aufgrund der phänomenologischen Überlappungen beider Selbstschädigungstypen scheint ein dimensionales Vorgehen hilfreich.
Abstract
Three criteria for differential diagnosis of non-suicidal self-injury and suicide attempts were validated by means of more recent empirical studies. Criteria concerning motives (functions), methods of self-injury (medical severity), lifetime frequency and lifetime number of episodes were investigated. Literature research showed only a few studies concentrated on a direct comparison of non-suicidal self-injury and suicide attempts. Therefore, studies examing the relationship of suicide intent to the relevant features, are considered, too. Empirical results concerning motives (functions), methods (medical severity), lifetime frequency and number of episodes were compared to the three criteria. Except for lifetime frequency, studies support the criteria. However, in the case of motives, a more differentiated examination is needed to distinguish between non-suicidal self-injury and suicide attempts. To optimize the assessment, guidelines should be slightly modified. Because of the phenomenological overlap of non-suicidal self-injury and suicide attempts, a dimensional assessment can be helpful.
Schlüsselwörter
selbstverletzendes Verhalten - Suizidversuch - Differenzialdiagnostik
Key words
non-suicidal self-injury - suicide attempt - differential diagnosis
Literatur
- 1 Petermann F, Winkel S. Selbstverletzendes Verhalten. Göttingen; Hogrefe 2009 2., erw. überarb. Aufl
- 2 Claes L, Vandereycken W. Self-injurious behavior: Differential diagnosis and functional differentiation. Compr Psychiatry. 2007; 48 137-144
- 3 Fleischer M, Herpertz S C. Phänomenologie und Epidemiologie selbstverletzenden Verhaltens. Schmahl C, Stiglmayr C Selbstverletzendes Verhalten bei stressassoziierten Erkrankungen Stuttgart; Kohlhammer 2009: 15-28
- 4 Petermann F, Winkel S. Selbstverletzendes Verhalten: Diagnostik und psychotherapeutische Ansätze. Z Psychiatr Psychol Psychother. 2007; 55 123-132
- 5 Bologini M, Plancherel B, Laget J. et al . Adolescents’ self-mutilation – Relationship with dependent behaviour. Swiss J Psychol. 2003; 62 241-249
- 6 Jacobson C M, Muehlenkamp J J, Miller A L. et al . Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol. 2008; 37 363-375
- 7 Nock M K, Joiner T E, Gordon K H. et al . Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006; 144 65-72
- 8 Becker K, Meyer-Keitel A. Suizidales Verhalten. Petermann F Lehrbuch der Klinischen Kinderpsychologie Göttingen; Hogrefe 2008 6., vollst. überarb. Aufl: 445-460
- 9 Muehlenkamp J J. Self-injurious behaviour as a separate clinical syndrome. Am J Orthopsychiatry. 2005; 75 324-333
- 10 Walsh B W. Treating Self-Injury. A practical Guide. New York; Guilford Press 2006
- 11 Stanley B, Winchel R, Molcho A. et al . Suicide and the self harm continuum: Phenomenological and biochemical evidence. Int Rev Psychiatry. 1992; 4 149-155
- 12 Hawton K, Houston K, Haw C. et al . Comorbidity of axis I and axis II disorders in patients who attempted suicide. American Journal of Psychiatry. 2003; 160 1494-1500
- 13 Silverman M M, Berman A L, Sanddal N D. et al . Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors – Part 1: Background, rationale, and methodology. Suicide Life Threat Behav. 2007; 37 248-263
- 14 Petermann F, Nitkowski D. Selbstverletzendes Verhalten: Erscheinungsformen, Risikofaktoren und Verlauf. Nervenarzt. 2008; 79 1017-1022
- 15 Silverman M M, Berman A L, Sanddal N D. et al . Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors – Part 2: Suicide-related ideations, communication, and behaviors. Suicide Life Threat Behav. 2007; 37 264-277
- 16 Hasley J P, Ghosh B, Huggins J. et al . A review of ”suicidal intent” within the existing suicide literature. Suicide Life Threat Behav. 2008; 38 576-591
- 17 Klonsky E D. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007; 27 226-239
- 18 Brown M Z, Comtois K A, Linehan M M. Reasons for suicide attempts and nonsuicidal self-injury in woman with borderline personality disorder. J Abnorm Psychol. 2002; 111 198-202
- 19 Groholt B, Ekeberg O, Haldorsen T. Adolescents hospitalised with deliberate self-harm: The significance of an intention to die. Eur Child Adolesc Psychiatry. 2000; 9 244-254
- 20 Skogman K, Öjehagen A. Motives for suicide attempts: The views of the patients. Archiv Suicide Res. 2003; 7 193-206
- 21 Hjelmeland H, Stiles T C, Bille-Brahe U. et al . Parasuicide: The value of suicidal intent and various motives of future suicidal behaviour. Arch Suicide Res. 1998; 4 209-225
- 22 McAuliffe C, Arensman E, Keeley H S. et al . Motives and suicide intent underlying hospital treated deliberate self-harm and their association with repetition. Suicide Life Threat Behav. 2007; 37 397-408
- 23 Chapman A L, Dixon-Gordon K L. Emotional antecedents and consequences of deliberate self-harm and suicide attempts. Suicide Life Threat Behav. 2007; 37 543-552
- 24 Welch S S, Linehan M M, Sylvers P. et al . Emotional responses to self-injury imagery among adults with borderline personality disorder. J Consult Clin Psychol. 2008; 76 45-51
- 25 Antretter E, Dunkel D, Seibl R. et al . Die klassifikatorische und prädiktive Qualität des Merkmals ”suicide intent” bei Parasuiziden. Eine clusteranalytische Untersuchung. Nervenarzt. 2002; 73 219-230
- 26 Klonsky E D. The functions of self-injury in young adults who cuts themselves: Clarifying the evidence for affect regulation. Psychiatry Res. 2009; 166 260-268
- 27 Csorba J, Dinya E, Plener P. et al . Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. Eur Child Adolesc Psychiatry. 2009; 18 309-320
- 28 Wichstrøm L. Predictors of non-suicidal self-injury versus attempted: Similar or different?. Arch Suicide Res. 2009; 13 105-122
- 29 Brezo J, Paris J, Turecki G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: A systematic review. Acta Psychiatr Scand. 2006; 113 180-206
- 30 Goldstein D B, Reboussin B A, Daniel S S. Predictors of suicide attempts: State and trait components. J Abnorm Psychol. 2006; 115 842-849
- 31 Linehan M M, Comtois K A, Brown M Z. et al . Suicide Attempt Self-Injury Interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self injury. Psychol Asses. 2006; 18 303-312
- 32 Muehlenkamp J J, Gutierrez P M. An investigation of differences between self-injurious behaviour and suicide attempts in a sample of adolescents. Suicide Life Threat Behav. 2004; 34 12-23
- 33 Muehlenkamp J J, Gutierrez P M. Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Arch Suicide Res. 2007; 11 69-82
- 34 Brown G K, Henriques G R, Sosdjan D. et al . Suicide intent and accurate expectation of lethality: Predictors of medical lethality of suicide attempts. J Consult Clin Psychol. 2004; 72 1170-1174
- 35 Gindhu A L, Schonert-Reichl K A. Nonsuicidal self-harm among community adolescent: Understanding the ”whats” and ”whys” of self-harm. J Youth Adolesc. 2005; 34 447-457
- 36 Muehlenkamp J J, Hoff E R, Licht J G. et al . Rates of non-suicidal self-injury: A cross-sectional analysis of exposure. Curr Psychol. 2008; 27 234-241
- 37 Nixon M K, Cloutier P, Jansson S M. Nonsuicidal self-harm in youth: A population-based survey. CMAJ. 2008; 178 306-312
- 38 Nock M K, Holmberg E B, Photos V I. et al . Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychol Assess. 2007; 19 309-317
- 39 Plener P, Libal G, Keller F. et al . An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med. 2009; 39 1549-1558
- 40 Ross H, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc. 2002; 31 67-77
- 41 Whitlock J, Knox K L. The relationship between self-injurious behavior and suicide in a young adult population. Arch Pediatr Adolesc Med. 2007; 161 634-640
- 42 Zoroglu S S, Tuzun U, Sar V. et al . Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry Clin Neurosci. 2003; 57 119-126
- 43 Herpertz S, Sass H, Favazza A R. Impulsivity in self-mutilative behavior: Psychometric and biological findings. J Psychiatr Res. 1997; 31 451-165
- 44 Nock M K, Kessler R C. Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. J Abnorm Psychol. 2006; 115 616-623
- 45 Nock M K, Borges G, Bromet E J. et al . Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008; 192 98-105
- 46 McCloskey M S, Ben-Zeev D, Lee R. et al . Prevalence of suicidal and self-injurious behaviour among subjects with intermittent explosive disorder. Psychiatry Res. 2008; 158 248-250
- 47 Joiner T E, Conwell Y, Fitzpatrick K K. et al . Four studies on how past and current sucidality relate even ”Everything but the kitchen sink” is covaried. J Abnorm Psychol. 2005; 114 291-303
- 48 Stanley B, Gameroff M J, Michalsen V. et al . Are suicide attempters who self-mutilate a unique population?. Am J Psychiatry. 2001; 158 427-432
- 49 Nitkowski D, Petermann F. Verhaltensdiagnostik selbstverletzenden Verhaltens. Nervenheilkunde. 2009; 28 227-231
- 50 Shneidman E S. Suicide as psychache. J Nerv Ment Dis. 1993; 181 145-147
- 51 De Leo D, Burgis S, Bertolote J M. et al . Definitions of suicidal behavior. Lessons learned from the WHO/EURO multicentre study. Crisis. 2006; 27 4-15
- 52 Petermann F, Noeker M. Entwicklungspsychopathologie. Z Psychiatr Psychol Psychother. 2008; 56 239-241
Dipl.-Psych. Dennis Nitkowski
Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
Grazer Straße 6
28359 Bremen
Email: nitkowski@uni-bremen.de