New Behavioral Test Assesses Self-Injurious Thoughts

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NEW YORK (Reuters Health) May 22 - A new behavioral test that does not rely on the patient to express his or her thoughts appears to more accurately predict those at risk of cutting and other self-injurious behaviors, according to the results of a study published in the May issue of the American Journal of Psychiatry.

"People have engaged in self-injurious behavior for thousands of years, and a dilemma as old as the problem itself is that the only method we have of assessing thoughts of self-injury is to ask a person if he is thinking about hurting himself," lead author Dr. Matthew K. Nock, of Harvard University, Boston, explained in an interview with Reuters Health.

"This is problematic because people often do not want to tell others about their self-injurious thoughts or plans because they are embarrassed, they do not want to be stopped, or possibly because they are unaware of the severity of their self-injurious thoughts."

Dr. Nock and colleagues tested a new method of assessing peoples' self-injurious thoughts using their reaction time on a brief computerized test showing images and words related to self-injury.

A total of 89 subjects (mean age 17.10 years) were included in the study. Of these, 53 had a recent history of non-suicidal self-injury and 36 were not self-injurious. Most of the subjects were white females.

The participants completed two versions of the Self-Injury Implicit Association Test, which measures the automatic association of self-injury with oneself (the identity version) and with favorableness (the attitude version).

The new test revealed significant differences in the behavioral responses of people who had recently engaged in non-suicidal self-injury compared with those who had not. The performance on both versions of the Self-Injury Implicit Association Test significantly improved the prediction of non-suicidal self-injury beyond what was possible using known risk factors.

For example, subjects who selected a positive association between the words "Cutting" and "Me" were more likely to engage in self-injurious behaviors. Those who did not have self-injurious behaviors perceived a negative association.

"What we have is the first evidence of a behavioral measure of self-injurious thoughts," Dr. Nock said. "The potential implications of this line of research are enormous."

"This work could improve our ability to understand, assess, and treat self-injurious behaviors," the investigator continued. "For instance, this test ultimately could be used in emergency rooms, doctor's offices, and other health care settings to help clinicians identify those who are most at risk for self-injury."

"This test could also be used to assess the effectiveness of treatment, and to make decisions about whether a person should be admitted or discharged from hospital care," he added. "The use of objective, behavioral tests can take a lot of the guesswork out of risk assessment and can provide more accurate prediction of future behavior."

He added that "it is important to note that this is only the first test of this new method, and much more research is needed before this test is ready and available for clinical use."

"We are currently studying slightly modified versions of this test that assess thoughts about death and suicide," he noted.

Am J Psychiatry 2007;164:820-823.

Source: http://www.medscape.com/viewarticle/557068?src=mp