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Is self-injury an impulse disorder? (from Non-suicidal self-injury: A brief overview and diagnostic considerations)

Is self-injury an impulse disorder?

If self-injury were to become a mental disorder in a future edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM], where should it be included? Advocates for a repetitive self-injury syndrome have suggested it be listed in the class of disorders that are referred to in the DSM-IV-TR as “Impulse-Control Disorders Not Elsewhere Classified”. The essential feature of such disorders is  “the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others”  (American Psychiatric Association, 2000, p. 675). Further, “for most of the disorders…, the individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure, gratification, or relief at the time of committing the act. Following the act, there may or may not be regret, self-reproach, or guilt” (p. 663).One rationale for self-injury to be included as an impulse-control disorder are the seeming parallels observed between this description and dynamics involved in self-injury. For example, Klonsky (2007) found in his research review a pattern whereby:

(a) acute negative affect precedes self-injury; (b) decreased negative affect and relief are present after self-injury; (c) most self-injurers identify the desire to alleviate negative affect as a reason for self- injuring; and (d) the performance of proxies for self-injury in the laboratory leads to reductions in negative affect and arousal. (p. 235)

Nevertheless, we could ask if this is the most appropriate place to locate a disorder of repetitive self-injury? It is not clear, for example, whether the psychological processes involved in self-injury are similar to other disorders listed in the “Impulse Disorders Not Elsewhere Classified” section. Further, there is some question over the extent to which impulsivity (e.g., no pre-planning) is a significant factor in self-injury. In a preliminary study by Klonsky and Glenn (2008), findings indicated that the majority of people who self-injure may try to resist self-injuring in a variety of ways and that they may be successful in resisting at least some, if not half or more of the time.

You are reading the series, Non-suicidal self-injury: A brief overview and diagnostic considerations by Tracy Riley.

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