The Non-Suicidal Self-Injury Assessment Tool (NSSI-AT)

Transcription

1 The Nn-Suicidal Self-Injury Assessment Tl (NSSI-AT) Develped by: Janis Whitlck and Amanda Puringtn The Crnell Research Prgram n Self-Injury and Recvery Revised: March 15, 2013 Hw t Interpret this Dcument: This dcument shws main questins as well as subquestins, as indicated in clred text. The respnse ptin that triggers a sub-questin will appear in clr (mst are blue, thugh ther levels f sub-questins als appear in red). The sub-questin that relates t that respnse ptin appears immediately belw and is in the same clr as the respnse ptin that triggers the sub-questin. If mre than ne sub-questin fllws frm this ne respnse ptin, the additinal subquestins appear belw in the same clr. If a sub-questin has anther sub-questin within it, the same pattern fllws (the respnse ptin that triggers the sub-questin is in a clr that matches the clr f the text f the sub-questin belw) thugh it will be in a different clr frm the first sub-questin. Citatin: Whitlck, J.L., Exner-Crtens, D. & Puringtn, A. (under review). Validity and reliability f the nn-suicidal self-injury assessment test (NSSI-AT) Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults

2 A. Primary and secndary NSSI characteristics 1. Have yu ever dne any f the fllwing with the purpse f intentinally hurting yurself? 1 Severely scratched r pinched with fingernails r ther bjects t the pint that bleeding ccurs r marks remain n the skin Cut wrists, arms, legs, trs r ther areas f the bdy Dripped acid nt skin Carved wrds r symbls int the skin Ingested a caustic substance(s) r sharp bject(s) (Dran, ther cleaning substances, pins, etc.) Bitten yurself t the pint that bleeding ccurs r marks remain n the skin Tried t break yur wn bne(s) Brke yur wn bne(s) Ripped r trn skin Burned wrists, hands, arms, legs, trs r ther areas f the bdy Rubbed glass int skin r stuck sharp bjects such as needles, pins, and staples int r underneath the skin (nt including tatting, bdy piercing, r needles used fr medicatin use) Banged r punched bjects t the pint f bruising r bleeding Punched r banged neself t the pint f bruising r bleeding Intentinally prevented wunds frm healing Engaged in fighting r ther aggressive activities with the intentin f getting hurt 2. Are there any ther ways that yu have physically hurt r mutilated yur bdy with the purpse f intentinally hurting yurself? Yes; please specify N B. Functins 3. Hw true are the fllwing statements abut why yu hurt yurself? Please select the mst accurate respnse. I hurt myself t feel smething because my friends hurt themselves as a self-punishment r t atne fr sins t get a rush r surge f energy t deal with frustratin t cpe with uncmfrtable feelings (e.g., depressin r Strngly Dis (1) Smewhat Dis (2) Smewhat Agree (3) Strngly Agree (4) 1 Nte: It is nt advisable t use a behavir-based NSSI screening item with secndary schl students. Single item measures, while slightly less effective, are preferred in this ppulatin. The replacement measure we use is, Have yu ever hurt yur bdy (e.g. cut, carve, burn, scratch really hard, punch) n purpse but withut wanting t end yur life? Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 2

3 anxiety) in hpes that smene wuld ntice that smething is wrng r that s thers will pay attentin t me s I d nt hurt myself in ther ways because it feels gd t deal with anger t get cntrl ver myself r my life t shck r hurt smene t avid cmmitting suicide because I get the urge and cannt stp it t relieve stress r pressure t change my emtinal pain int smething physical because f my self-hatred because I like the way it lks as a way t practice suicide as an attempt t cmmit suicide Other, please describe 4. In the abve questin, yu indicated that yu intentinally hurt yurself with the intentin f practicing r cmmitting suicide. Was practicing r attempting suicide the primary reasn yu intentinally hurt yurself? Yes N I am nt sure If nly these items are indicated r if #4 is answered yes, we exclude these individuals frm the NSSI track and recde as n NSSI C. Recency and Frequency (and age f cessatin) 5. The fllwing questins ask abut yur experience with intentinally hurting yurself. We knw that this can be a difficult issue t think and talk abut. Please nte that there are web links n the bttm f every page and at the end f the survey with cntact infrmatin yu can use if yu feel like yu want t talk with smene. There is als a distractin buttn yu can use t take a break if yu start t feel triggered r at all uncmfrtable. The infrmatin yu prvide abut this tpic will be used t help thers wh intentinally hurt themselves. It will take abut 15 mre minutes t cmplete this survey. Thank yu in advance fr yur time and hnesty. ~~~~~~~~ When was the last time yu intentinally hurt yurself in ne f the ways listed in the previus questin? Less than 1 week ag Between 1 week and 1 mnth ag Between 1 and 3 mnths ag Between 3 and 6 mnths ag Between 6 mnths and 1 year ag Between 1 and 2 years ag Mre than 2 years ag Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 3

4 6. Hw likely are yu t intentinally hurt yurself again? Very likely Smewhat likely Nt sure Smewhat unlikely Very unlikely 7. Hw ld were yu the last time yu self-injured? 8. Apprximately n hw many ttal ccasins have yu intentinally hurt yurself? Only nce 2-3 times 4-5 times 6-10 times times times Mre than 50 times 9. If yu had t estimate the ttal number f ccasins yu have intentinally hurt yurself, what wuld yu estimate? D. Age f nset and cessatin 10. Hw ld were yu the first time yu intentinally hurt yurself? E. Wund Lcatins 11. On what areas f yur bdy have yu intentinally hurt yurself? Wrists Hands Arms Fingers Calves r ankles Thighs Stmach r chest Back Buttcks Head Feet Face Lips r tngue Shulders r neck Breasts Genitals r rectum Other; please specify F. Initial Mtivatins 12. Which f the fllwing descriptins best describes yur mtivatins fr first intentinally hurting yurself? (Please check all that apply) A friend suggested that I try it I read abut it n the Internet and decided t try it I saw it in a mvie / n televisin r read abut it in a bk and decided t try it It seemed t wrk fr ther peple I knw It seemed t wrk fr celebrities I have heard f Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 4

5 I accidentally discvered it - I had never heard f it r seen it befre It was part f a dare I did it because I had friends wh did it and I wanted t fit in I wanted t be part f a grup I wanted t shck r hurt smene I was upset and decided t try it I wanted smene t ntice me and / r my injuries It felt gd I was angry at smene else I was angry with myself I was drunk r high Other; please specify I cannt remember G. Severity 13. Have yu ever intentinally hurt yurself mre severely than yu expected? Yes N 14. Have yu ever intentinally hurt yurself s badly that yu shuld have been seen by a medical prfessinal (even if yu were nt)? Yes N 15. Hw many times have yu intentinally hurt yurself mre severely than yu expected? Mre than Were yu under the influence f drugs r alchl in any instance that yu hurt yurself mre severely than yu expected? Yes N 17. Please briefly describe ne specific thing yu have dne t intentinally hurt yurself. 18. Have yu ever sught medical treatment (nt therapy) fr any f the physical injuries yu intentinally caused? Yes N 19. Hw ften have yu intentinally hurt yurself while yu are in yur mst active phase(s)? Every day 2-3 times a week Once a week 1-3 times a mnth Once every few mnths Abut nce a year Once every tw years r mre years Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 5

6 20. During the perid(s) in which yu mst actively hurt yurself, what was the lngest interval f time during which yu did nt hurt yurself? Less than a week Less than a mnth 1-3 mnths 4-6 mnths 7-12 mnths Mre than a year H. Practice Patterns 21. Hw true are each f the fllwing statements fr yu? I always intentinally hurt myself in private Strngly dis (1) Smewhat dis (2) Neither nr dis (3) Smewhat (4) Strngly (5) Des nt apply I smetimes intentinally hurt myself in the presence f thers I smetimes let ther peple intentinally hurt me physically I have intentinally physically hurt anther persn I have a regular rutine I fllw when I intentinally hurt myself I have a particular place / rm I prefer t be in when I intentinally hurt myself I tend t g thrugh perids in which I intentinally hurt myself, then perids in which I d nt, and this pattern repeats Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 6

7 I. Habituatin and Perceived Life Interference 22. Hw true are each f the fllwing statements fr yu? I have had t intentinally hurt myself mre deeply and / r in mre places n my bdy ver time t get the same effect Strngly dis (1) Smewhat dis (2) Neither nr dis (3) Smewhat (4) Strngly (5) Des nt apply I want t stp intentinally hurting myself altgether, but have truble stpping I will nt need help frm smene t stp intentinally hurting myself altgether - I can d it n my wn Nthing else wrks as well as intentinally hurting myself t calm me dwn r give me relief I have had t fight the urge t start intentinally hurting myself again When I have the urge t intentinally hurt myself it is easy t cntrl it 23. The fact that I intentinally hurt myself is a prblem in my life. Strngly dis Smewhat dis Neither nr dis Smewhat Strngly 24. The fact that I intentinally hurt myself interferes with: (Please check all that apply) Relatinships which are imprtant t me My ability t cmplete schl r wrk bligatins My ability t take care f myself (eat right, exercise, etc.) My ability t engage in hbbies r things that I like t d My self-wrth / self-esteem Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 7

8 The clthing I wear Other; please specify It des nt interfere with my life in any way J. NSSI Disclsure 25. Des the fllwing statement describe yur experience? Smene knws that I intentinally hurt myself and has had a cnversatin with me abut it. True False 26. Wh knws abut it and has talked with yu abut it? Parent r custdial guardian Sibling Friend Significant ther (byfriend, girlfriend, r spuse / partner) Other relative Teacher Cach Adult friend Therapist Physician Religius r spiritual leader (e.g., priest, pastr, rabbi) Health care prvider Other; please specify 27. (Fr each selected) Did yu initiate the cnversatin r did they? I initiated the cnversatin They initiated the cnversatin 28. (Fr each selected) Have the cnversatin(s) yu've had with this persn been helpful? Yes N I d nt knw 29. Des the fllwing statement describe yur experience? One r mre peple knw r suspect that I intentinally hurt myself but have nt had a cnversatin with me abut it. True False Pssibly, but I d nt knw 30. Wh knws / suspects abut it and has nt talked with yu abut it? (Please check all that apply) Parent r custdial guardian Sibling Friend Significant ther (byfriend, girlfriend, r spuse / partner) Other relative Teacher Cach Adult friend Therapist Physician Religius r spiritual leader (e.g., priest, pastr, rabbi) Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 8

9 Health care prvider Other; please specify 31. (Fr each selected) D yu wish this persn wuld talk with yu abut it? Yes N I d nt knw 32. Des the fllwing statement describe yur experience? N ne knws that I intentinally hurt myself. True False K. NSSI Treatment Experiences 33. Have yu ever gne t therapy because yu intentinally hurt yurself? Yes N Intentinally hurting myself was part f the reasn I went but nt all f it 34. Did smene else insist yu g t therapy r did yu decide t g n yur wn? Smene else insisted that I g I went n my wn Other; please specify 35. If yu have received therapy fr any reasn, did yu intentinally hurt yurself after yur treatment ended? Yes, I did intentinally hurt myself after treatment N, I cmpletely stpped intentinally hurting myself after receiving treatment I have seen multiple therapists abut intentinally hurting myself and sme helped me and sme did nt 36. In yur pinin, hw helpful was therapy in helping yu t stp intentinally hurting yurself? Very helpful Helpful Smewhat helpful Nt at all helpful 37. What in yur experience with therapy (even if yur experience with intentinally hurting yurself was nt the fcus f yur therapy) has been mst helpful in helping yu t understand r cntrl intentinally hurting yurself? L. Persnal Reflectins and Advice 38. Lking back, hw has yur experience with intentinally hurting yurself impacted yur life, bth psitively and negatively? (Please check all that apply) I still cannt talk abut it and smetimes even thinking abut it is difficult The lasting marks / scars are cnstant reminders f a bad / rugh time in my life I am nw able t help thers wh intentinally hurt themselves In thinking / discussing my experience arund intentinally hurting myself, I have learned a lt abut myself and because f it have mentally / emtinally grwn My scars are my battle wunds - I made it thrugh Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 9

10 Discussin f my experience arund intentinally hurting myself has helped me grw clser t the peple I care abut The remaining marks / scars are a surce f embarrassment fr me It really did nt impact my life much at all Other; please specify 39. What d yu think is imprtant fr peple wh want t understand and help thse wh intentinally hurt themselves t knw? Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults 10