Turner Brianna J, Austin Sara B, Chapman Alexander L
Graduate Student, Simon Fraser University, Burnaby, British Columbia.
Associate Professor, Simon Fraser University, Burnaby, British Columbia.
Can J Psychiatry. 2014 Nov;59(11):576-85. doi: 10.1177/070674371405901103.
Nonsuicidal self-injury (NSSI), the deliberate, self-inflicted damage of bodily tissue without the intent to die, is associated with various negative outcomes. Although basic and epidemiologic research on NSSI has increased during the last 2 decades, literature on effective interventions targeting NSSI is still emerging. Here, we present a comprehensive, systematic review of existing psychological and pharmacological treatments designed specifically for NSSI, or including outcome assessments examining change in NSSI.
We conducted a systematic search of PsycINFO, MEDLINE, and ERIC databases to retrieve relevant articles that met inclusion criteria; specifically, uncontrolled and controlled trials that 1) presented quantitative outcome data on NSSI, and 2) clearly differentiated NSSI from suicidal self-injury (SSI). Consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, definition of NSSI, we excluded studies examining populations with developmental or intellectual disabilities, or with psychotic disorders.
Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics (aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or without cognitive-behavioural therapy). Nevertheless, there remains a paucity of well-controlled studies investigating treatment efficacy for NSSI.
Structured psychotherapeutic approaches focusing on collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviours seem to be most effective in reducing NSSI. Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some benefits. Future studies employing controlled designs as well as a clear delineation of NSSI and SSI will improve knowledge regarding treatment effects.
非自杀性自伤（NSSI）是指故意对身体组织造成自我伤害且无死亡意图的行为，与多种负面后果相关。尽管在过去20年中，关于NSSI的基础研究和流行病学研究有所增加，但针对NSSI的有效干预措施的文献仍在不断涌现。在此，我们对专门针对NSSI设计的现有心理和药物治疗方法，或包括对NSSI变化进行结果评估的研究进行全面、系统的综述。
我们对PsycINFO、MEDLINE和ERIC数据库进行了系统检索，以获取符合纳入标准的相关文章；具体而言，包括未设对照和设对照的试验，这些试验1）提供了关于NSSI的定量结果数据，且2）明确区分了NSSI与自杀性自伤（SSI）。根据《精神疾病诊断与统计手册》第五版中NSSI的定义，我们排除了研究发育或智力残疾人群或精神病性障碍人群的研究。
几种干预措施似乎有望减少NSSI，包括辩证行为疗法、情绪调节团体疗法、手册辅助认知疗法、动态解构心理疗法、非典型抗精神病药物（阿立哌唑）、纳曲酮和选择性5-羟色胺再摄取抑制剂（联合或不联合认知行为疗法）。然而，针对NSSI治疗效果的严格对照研究仍然很少。
注重合作治疗关系、改变动机并直接解决NSSI行为的结构化心理治疗方法似乎在减少NSSI方面最为有效。针对5-羟色胺能、多巴胺能和阿片类系统的药物也已显示出一些益处。未来采用对照设计以及明确区分NSSI和SSI的研究将提高对治疗效果的认识。
