The Brief Nn-Suicidal Self-Injury Assessment Tl (BNSSI-AT) Develped by: Janis Whitlck and Amanda Puringtn The Crnell Research Prgram n Self-Injury and Recvery www.selfinjury.bctr.crnell.edu 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). 1 2007. Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults www.crpsib.cm
A. Primary and secndary NSSI characteristics 1. Have yu ever dne any f the fllwing with the purpse f intentinally hurting yurself? 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 Pulled ut hair, eyelashes, r eyebrws (with the intentin f hurting yurself) I have never intentinally hurt myself in these ways 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 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 Strngly Disagree (1) Smewhat Disagree (2) Smewhat Agree (3) 2007. Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults www.crpsib.cm Strngly Agree (4) 2
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 6. Hw likely are yu t intentinally hurt yurself again? Very likely Smewhat likely Nt sure Smewhat unlikely Very unlikely 2007. Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults www.crpsib.cm 3
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 11-20 times 21-50 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 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 2007. Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults www.crpsib.cm 4
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 2007. Crnell Research Prgram n Self-Injurius Behavirs in Adlescents and Yung Adults www.crpsib.cm 5