A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability
A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability
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DOI：
10.1186/s13229-019-0267-3
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发表时间：
2019-04-11
期刊：
影响因子：
6.2
通讯作者：
Baron-Cohen, S.
中科院分区：
文献类型：
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作者：
Moseley, R. L.;Gregory, N. J.;Baron-Cohen, S.
背景：非自杀性自伤（non - suicide self injury， NSSI）描述了一种个体故意对其身体造成疼痛和组织损伤的现象。自残行为在自闭症谱系中尤为普遍，但对于没有智力障碍的自闭症患者自残行为的特征和功能，以及可能对这一群体的临床应用有价值的风险因素，人们知之甚少。方法：根据非自杀性自伤评估工具（nsi - at）的回答，将103名对网络广告有反应的自闭症成年人分为当前自伤者、既往自伤者和非自伤者。多项回归旨在根据自闭症特征、述情障碍、抑郁、焦虑、心智化和感官敏感性测试的分数来预测参与者的分类。线性回归检验了这些预测因子与自伤的范围、频率、终生发生率和功能目的之间的关系。定性分析探讨了参与者认为有用的治疗干预措施，以及他们希望人们对自残的理解。结果：当前，历史和非自我伤害的参与者在年龄，诊断年龄，男女比例，就业水平或教育水平（大多数符合至少学位水平）方面没有差异。自伤最常见的功能是调节低能量情感状态（抑郁、解离），其次是调节高能量状态（愤怒、焦虑）。述情障碍显著地预测了参与者目前、过去或非自我伤害者的分类，并预测了使用自伤来调节高能状态和向他人传达痛苦。抑郁、焦虑和感觉敏感性也对参与者群体有差异，感觉差异也预测了自伤的目标身体区域范围、终生发病率和频率。在定性分析中，感觉差异、表达和识别情绪的困难也出现了问题，参与者表达了同情、耐心、不判断和认识自我伤害者之间差异的需要，一些参与者认为自伤是一种实用的、没有问题的应对策略。结论：述情障碍、抑郁、焦虑和感觉差异可能使一些自闭症个体具有自残的特殊风险。调查这些变量的参与及其对识别和治疗的效用是非常重要的，参与者的声音为面对自闭症患者自伤的从业者提供了指导。
Background: Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group.Methods: One hundred and three autistic adults who responded to an online advertisement were classified as current, historic or non-self-harmers in accordance with responses to the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT). Multinomial regression aimed to predict categorisation of participants in accordance with scores on tests of autistic traits, alexithymia, depression, anxiety, mentalising and sensory sensitivity. Linear regression examined relationships between these predictors and the range, frequency, lifetime occurrence and functional purposes of NSSI. Qualitative analysis explored the therapeutic interventions that participants had found helpful, and what they wished people understood about self-injury.Results: Current, historic and non-self-harming participants did not differ in age, age at diagnosis, male-to-female ratio, level of employment or education (the majority qualified to at least degree level). The most common function of NSSI was the regulation of low-energy affective states (depression, dissociation), followed by the regulation of high-energy states such as anger and anxiety. Alexithymia significantly predicted the categorisation of participants as current, historic or non-self-harmers, and predicted use of NSSI for regulating high-energy states and communicating distress to others. Depression, anxiety and sensory-sensitivity also differentiated participant groups, and sensory differences also predicted the range of bodily areas targeted, lifetime incidence and frequency of NSSI. Sensory differences, difficulty expressing and identifying emotions also emerged as problematic in the qualitative analysis, where participants expressed the need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers, with some participants perceiving NSSI as a practical, non-problematic coping strategy.Conclusions: Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.