Table 1.

Operationalization of the proposed DSM-5 NSSI disorder criteria in the current study

Proposed NSSI disorder criterion for DSM-5	Operationalization of criterion in the current study
(A) In the past year, 5 days of NSSI that was severe enough to cause tissue damage but without suicidal intent	Participants were only included if they had engaged in: (a) more than 5 NSSI episodes in their lifetime, (b) at least one episode of NSSI in the last 12 months, (c) NSSI that was without suicidal intent, and (d) severe NSSI, including cutting, burning, severe scratching, or banging/hitting self.
(B) NSSI is associated with two of the following:
(1) Negative feelings or thoughts immediately precede engagement in NSSI	This criterion was not directly assessed. However, almost all self-injurers (98%) reported that NSSI served an affect regulation function, assessed using the ISAS (e.g., “When I self-injure, I am reducing anxiety, frustration, anger, or other overwhelming emotions”).
(2) A period of preoccupation with NSSI precedes the NSSI	This criterion was not directly assessed.
(3) NSSI urges occur frequently even if not acted upon	This criterion was not directly assessed.
(4) NSSI is engaged in with a purpose	Participants were only included if they endorsed at least one item on the ISAS, indicating that NSSI served a specific function.
(C) NSSI causes significant distress or impairment in important areas of functioning	Participants’ reason for admission was not available. However, all participants were admitted to the inpatient or partial outpatient unit for severe psychopathology, and many adolescents reported during the interview that their NSSI led to their current admission to the hospital.
(D) NSSI does not occur exclusively in a state of psychosis, delirium, or intoxication, and cannot be accounted for by another mental or medical disorder	This criterion was not assessed directly. However, participants were excluded if they were in a current psychotic episode. Delirium is rarely diagnosed in adolescents. It is unknown whether participants engaged in NSSI exclusively when intoxicated. However, only half the sample engaged in substance use, so this could not account for the NSSI in the total sample. Further, most substance use occurred in groups whereas most self-injurers reported that they engaged in NSSI only when alone. Finally, participants were excluded if they had cognitive impairments that inferred with their ability to complete the study, therefore ruling out other severe disorders that could be accounting for the NSSI.