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Nonsuicidal self-injurious behavior in patients with and without epilepsy: a case-control study
Mikhail Zinchuk1, Georgii Kustov1, Sofya Popova1
1Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
Objectives:
Nonsuicidal self‑injury (NSSI) is common among persons with epilepsy (PWE) and is associated with multiple adverse outcomes, including suicide attempts. No prior study directly compared PWE with NSSI to NSSI patients without epilepsy. We aimed to test the hypothesis that PWE constitute a more severely affected subgroup of individuals engaging in NSSI in terms of clinical presentation and associated characteristics.
Methods:
A case-control study was conducted: 42 consecutively enrolled patients with epilepsy and non‑psychotic mental disorders who engaged in NSSI were compared with 126 age‑ and sex‑matched patients with NSSI without epilepsy. Participants were evaluated by a psychiatrist and completed the Self‑Injurious Thoughts and Behaviors Interview, Inventory of Statements About Self‑Injury, Brief Reasons for Living Inventory, Childhood Abuse and Trauma Scale, Modified Personality Inventory for DSM‑5 and ICD‑11 Brief Form Plus-Modified, Beck Depression Inventory, State-Trait Anxiety Inventory, World Health Organization Quality of Life assessment, and a case report form recording sociodemographic, clinical, and biographical variables.
Results:
The study results do not support our initial hypothesis that PWE constitute a more severely affected subgroup of patients engaging in NSSI. Several risk factors (alcohol consumption, smoking, multiple piercings, same‑sex sexual experience) were less prevalent among PWE. PWE also showed a trend toward a less severe NSSI course. After correction for multiple comparisons, there were no group differences in levels of anxiety or depression, suicide‑related parameters, personality profile, or quality of life.
Significance:
In non‑psychotic patients with NSSI, epilepsy was not associated with greater psychiatric severity, a worse NSSI course, or higher suicide risk. While PWE share many risk factors for NSSI with patients without epilepsy, several typical parameters were less prevalent in the PWE group. In PWE, emotional dysregulation - for which NSSI may be used as a maladaptive coping strategy - may arise via partly different pathways than in the general population.
