Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters.
BACKGROUND
Self-inflicted injury, including cutting or burning, is the most frequent reason for psychiatric visits to medical emergency departments. This behavior, particularly when there is no apparent suicidal intent, is poorly understood from both biological and clinical perspectives.


OBJECTIVE
To examine the role of endogenous opioids and monoamine neurotransmitters in non-suicidal self-injury (NSSI).


METHODS
We compared cerebrospinal fluid (CSF) levels of endogenous opioids, 5 hydroxyindolacetic acid (5-HIAA) and homovanillic acid (HVA) in individuals with a history of repetitive non-suicidal self-injury with a diagnostically-matched group of individuals who had never engaged in non-suicidal self-injury. History of suicidal behavior, demographic background and psychopathology was assessed. All patients were diagnosed with a Cluster B personality disorder (i.e. borderline, antisocial, narcissistic or histrionic) (N=29) and had a history of at least one suicide attempt. Fourteen participants had a history of repeated non-suicidal self-injurious behavior (NSSI) in adulthood and 15 did not (no NSSI).


RESULTS
The NSSI group had significantly lower levels of CSF beta-endorphin and met-enkephalin when compared with the non-NSSI group. CSF dynorphin, HVA and 5-HIAA levels did not differ. Severity of depression, hopelessness and overall psychopathology was greater in the NSSI group.


CONCLUSIONS
beta-endorphin and met-enkephalin, opioids acting upon receptors involved in mediating stress-induced and physical pain analgesia respectively, are implicated in NSSI. Serotonergic and dopaminergic dysfunctions do not appear to be related to NSSI. Based on our findings, we propose a model of non-suicidal self-injury. Our results suggest that drugs acting on the opioid system warrant exploration as pharmacological treatments for NSSI.
Stanley
Barbara
B
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York 10032, USA. bhs2@columbia.edu
Sher
Leo
L
Wilson
Scott
S
Ekman
Rolf
R
Huang
Yung-yu
YY
Mann
J John
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology; D004399:Dynorphins / Q000134:cerebrospinal fluid*; D004744:Enkephalin, Methionine / Q000134:cerebrospinal fluid*; D005260:Female; D006719:Homovanillic Acid / Q000138:chemical synthesis*; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000134:cerebrospinal fluid* / Q000523:psychology; D012016:Reference Values; D016728:Self-Injurious Behavior / Q000134:cerebrospinal fluid* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology*; D055815:Young Adult; D001615:beta-Endorphin / Q000134:cerebrospinal fluid*
D006897:Hydroxyindoleacetic Acid; D004744:Enkephalin, Methionine; D001615:beta-Endorphin; D004399:Dynorphins; D006719:Homovanillic Acid