The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

DSM Update: Nonsuicidal Self-Injury Disorder, or a Clinical Specifier?

Episode Summary

Drs. Greg Lengel, Maria Zetterqvist, Amy Brausch, and Jason Washburn explain why they now advocate for nonsuicidal self-injury and self-harm to be considered a clinical specifier rather than a disorder in the Diagnostic & Statistical Manual of Mental Disorders (DSM).

Episode Notes

In this episode, four of the top experts in researching and treating nonsuicidal self-injury (NSSI) talk about the research behind NSSI Disorder, the evolution of how they now think about NSSI within the context of the DSM, and why they now advocate for an NSSI specifier rather than an NSSI Disorder in the DSM. They also delineate their proposed criteria for self-harm as a specifier and both the positive and negative consequences of doing so.

Below are papers referenced in this episode:

  1. Lengel, G. J., Muehlenkamp, J. J., Zetterqvist, M., Ammerman, B. A., Brausch, A. M., & Washburn, J. J. (2025). Non-suicidal self-injury: proposal to shift designation from disorder to a clinical specifier. The Lancet Psychiatry. Online advanced publication.
  2. Shaffer, D., & Jacobson, C. (2009). Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. American Psychiatric Association, 1-21.
  3. Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75(2), 324–333.
  4. Brausch, A. (2019). Diagnostic classification of nonsuicidal self-injury. In J. J. Washburn (Ed.), Nonsuicidal self-injury: Advances in research and practice (pp. 71-87). Routledge.

NONSUICIDAL SELF-INJURY SPECIFIER (PROPOSED CRITERIA):

A. The specifier should be used when the nonsuicidal self-injury (NSSI) behavior is characterized by the following:

  1. The individual intentionally engages in NSSI behavior to inflict bodily damage or pain
  2. The individual's NSSI behavior is recent, such that it occurred at least once during the past month
  3. The individual’s NSSI behavior is repetitive, such that it occurred on about 5 or more days in an individual’s lifetime

Note: culturally specific NSSI behavior (e.g., piercings and tattoos) and harm that is habitual (e.g., scab picking, nail biting, and hair pulling) should not be considered to be NSSI unless the behavior is explicitly for the purposes of causing damage or pain to one’s body. The NSSI specifier can still be applied if the behavior occurs under the influence of substances, as long as the behavior meets the required features.

Coding note: use code Z91.52 for individuals with a previous history of NSSI when all criteria except for recency are met (A2).

Want to have a bigger role on the podcast?:

  1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
  2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at thepsychologyofselfinjury@gmail.com
  3. Want to be involved in research? Send us a message at thepsychologyofselfinjury@gmail.com and we will see if we can match you to an active study.
  4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."