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Depress Anxiety. 2018 Jul;35(7):629-637. doi: 10.1002/da.22754. Epub 2018 Apr 26.

The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors.

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Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.
School of Psychology, Curtin University, Perth, Australia.
Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium.
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
School of Education, Boston University, Boston, MA, USA.
Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA.
Department of Psychology, Harvard University, Cambridge, MA, USA.
Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA.



Approximately one in five college students report a history of nonsuicidal self-injury. However, it is unclear how many students meet criteria for the recently proposed DSM-5 nonsuicidal self-injury disorder (NSSI-D). In this study, we used full NSSI-D criteria to identify those students most in need of clinical care.


Using data from the Leuven College Surveys (n = 4,565), we examined the 12-month prevalence of DSM-5 NSSI-D in a large and representative sample of incoming college students. We also explored the optimal frequency threshold as a function of interference in functioning due to NSSI, and examined comorbidity patterns with other 12-month mental disorders (i.e., major depressive disorder, broad mania, generalized anxiety disorder, panic disorder, and alcohol dependence) and suicidal thoughts and behaviors (STB).


Twelve-month NSSI-D prevalence was 0.8% and more common among females (1.1%) than males (0.4%). The proposed 5+ diagnostic threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. A dose-response relationship was observed for NSSI recency-severity (i.e., 12-month NSSI-D, subthreshold 12-month NSSI-D, past NSSI, no history of NSSI) with number of 12-month mental disorders and STB. NSSI-D occurred without comorbid disorders for one in five individuals, and remained associated with severe role impairment when controlling for the number of comorbid disorders.


These findings offer preliminary evidence that DSM-5 NSSI-D is uncommon among incoming college students, but may help to improve the deployment of targeted resource allocation to those most in need of services. More work examining the validity of NSSI-D is required.


DSM-5; college students; mental disorders; nonsuicidal self-injury; suicide

[Indexed for MEDLINE]

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