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The Non-Suicidal Self-Injury Assessment Tool(NSSI-AT)Developed by: Janis Whitlock and Amanda PuringtonThe Cornell Research Program on Self-Injury and Recoverywww.selfinjury.bctr.cornell.eduRevised: March 15, 2013How to Interpret this Document: This document shows main questions as well as subquestions, as indicated in colored text. The response option that triggers a sub-questionwill appear in color (most are blue, though other levels of sub-questions also appear inred). The sub-question that relates to that response option appears immediately belowand is in the same color as the response option that triggers the sub-question. If morethan one sub-question follows from this one response option, the additional subquestions appear below in the same color. If a sub-question has another sub-questionwithin it, the same pattern follows (the response option that triggers the sub-question isin a color that matches the color of the text of the sub-question below) though it will be ina different color from the first sub-question.Citation: Whitlock, J.L., Exner-Cortens, D. & Purington, A. (under review). Validity andreliability of the non-suicidal self-injury assessment test (NSSI-AT).1 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

A. Primary and secondary NSSI characteristics1. Have you ever done any of the following with the purpose of intentionally hurting1yourself?o Severely scratched or pinched with fingernails or other objects to the point thatbleeding occurs or marks remain on the skino Cut wrists, arms, legs, torso or other areas of the bodyo Dripped acid onto skino Carved words or symbols into the skino Ingested a caustic substance(s) or sharp object(s) (Drano, other cleaningsubstances, pins, etc.)o Bitten yourself to the point that bleeding occurs or marks remain on the skino Tried to break your own bone(s)o Broke your own bone(s)o Ripped or torn skino Burned wrists, hands, arms, legs, torso or other areas of the bodyo Rubbed glass into skin or stuck sharp objects such as needles, pins, and staplesinto or underneath the skin (not including tattooing, body piercing, or needlesused for medication use)o Banged or punched objects to the point of bruising or bleedingo Punched or banged oneself to the point of bruising or bleedingo Intentionally prevented wounds from healingo Engaged in fighting or other aggressive activities with the intention of getting hurt2. Are there any other ways that you have physically hurt or mutilated your body with thepurpose of intentionally hurting yourself?o Yes; please specifyoNoB.Functions3. How true are the following statements about why you hurt yourself? Please select themost accurate response.I hurt myself atAgree(3)StronglyAgree(4) to feel something because my friends hurtthemselves as a self-punishment or to atonefor sins to get a rush or surge of energy to deal with frustration to cope with uncomfortablefeelings (e.g., depression or1Note: It is not advisable to use a behavior-based NSSI screening item with secondaryschool students. Single item measures, while slightly less effective, are preferred in thispopulation. The replacement measure we use is, “Have you ever hurt your body (e.g.cut, carve, burn, scratch really hard, punch) on purpose but without wanting to end yourlife?2 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

oooooooooooooooanxiety) in hopes that someone wouldnotice that something is wrong orthat so others will pay attention tome so I do not hurt myself in otherways because it feels good to deal with anger to get control over myself or mylife to shock or hurt someone to avoid committing suicide because I get the urge andcannot stop it to relieve stress or pressure to change my emotional pain intosomething physical because of my self-hatred because I like the way it looks as a way to practice suicide as an attempt to commit suicideOther, please describe4. In the above question, you indicated that you intentionally hurt yourself withthe intention of practicing or committing suicide. Was practicing orattempting suicide the primary reason you intentionally hurt yourself?o Yeso Noo I am not sureIf only these items are indicated or if #4 is answered yes, we exclude theseindividuals from the NSSI track and recode as no NSSIC.Recency and Frequency (and age of cessation)5. The following questions ask about your experience with intentionally hurting yourself. Weknow that this can be a difficult issue to think and talk about. Please note that there areweb links on the bottom of every page and at the end of the survey with contactinformation you can use if you feel like you want to talk with someone. There is also adistraction button you can use to take a break if you start to feel triggered or at alluncomfortable. The information you provide about this topic will be used to help otherswho intentionally hurt themselves. It will take about 15 more minutes to complete thissurvey. Thank you in advance for your time and honesty. When was the last time you intentionally hurt yourself in one of the wayslisted in the previous question?o Less than 1 week agoo Between 1 week and 1 month agoo Between 1 and 3 months agoo Between 3 and 6 months agoo Between 6 months and 1 year agoo Between 1 and 2 years agoo More than 2 years ago3 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

6. How likely are you to intentionally hurt yourself again?o Very likelyo Somewhat likelyo Not sureo Somewhat unlikelyo Very unlikely7. How old were you the last time you self-injured?8. Approximately on how many total occasions have you intentionally hurt yourself?o Only onceo 2-3 timeso 4-5 timeso 6-10 timeso 11-20 timeso 21-50 timeso More than 50 times9. If you had to estimate the total number of occasions you have intentionally hurt yourself,what would you estimate?D.Age of onset and cessation10. How old were you the first time you intentionally hurt yourself?E.Wound Locations11. On what areas of your body have you intentionally hurt yourself?o Wristso Handso Armso Fingerso Calves or ankleso Thighso Stomach or chesto Backo Buttockso Heado Feeto Faceo Lips or tongueo Shoulders or necko Breastso Genitals or rectumo Other; please specifyF.Initial Motivations12. Which of the following descriptions best describes your motivations for first intentionallyhurting yourself? (Please check all that apply)o A friend suggested that I try ito I read about it on the Internet and decided to try ito I saw it in a movie / on television or read about it in a book and decided to try ito It seemed to work for other people I knowo It seemed to work for celebrities I have heard of4 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

oooooooooooooG.I accidentally discovered it - I had never heard of it or seen it beforeIt was part of a dareI did it because I had friends who did it and I wanted to fit inI wanted to be part of a groupI wanted to shock or hurt someoneI was upset and decided to try itI wanted someone to notice me and / or my injuriesIt felt goodI was angry at someone elseI was angry with myselfI was drunk or highOther; please specifyI cannot rememberSeverity13. Have you ever intentionally hurt yourself more severely than you expected?o Yeso No14. Have you ever intentionally hurt yourself so badly that you should have been seen by amedical professional (even if you were not)?o Yeso No15. How many times have you intentionally hurt yourself more severelythan you expected?o 1o 2-3o 4-5o More than 516. Were you under the influence of drugs or alcohol in any instance thatyou hurt yourself more severely than you expected?o Yeso No17. Please briefly describe one specific thing you have done to intentionally hurt yourself.18. Have you ever sought medical treatment (not therapy) for any of the physical injuries youintentionally caused?o Yeso No19. How often have you intentionally hurt yourself while you are in your most activephase(s)?o Every dayo 2-3 times a weeko Once a weeko 1-3 times a montho Once every few monthso About once a yearo Once every two years or more years5 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

20. During the period(s) in which you most actively hurt yourself, what was the longestinterval of time during which you did not hurt yourself?o Less than a weeko Less than a montho 1-3 monthso 4-6 monthso 7-12 monthso More than a yearH.Practice Patterns21.How true are each ofthe followingstatements for DoesnotapplyI always intentionallyhurt myself in privateI sometimesintentionally hurt myselfin the presence ofothersI sometimes let otherpeople intentionally hurtme physicallyI have intentionallyphysically hurt anotherpersonI have a regular routineI follow when Iintentionally hurt myselfI have a particular place/ room I prefer to be inwhen I intentionally hurtmyselfI tend to go throughperiods in which Iintentionally hurtmyself, then periods inwhich I do not, and thispattern repeats6 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

I.Habituation and Perceived Life Interference22.How true are each ofthe followingstatements for DoesnotapplyI have had tointentionally hurt myselfmore deeply and / or inmore places on mybody over time to getthe same effectI want to stopintentionally hurtingmyself altogether, buthave trouble stoppingI will not need help fromsomeone to stopintentionally hurtingmyself altogether - I cando it on my ownNothing else works aswell as intentionallyhurting myself to calmme down or give mereliefI have had to fight theurge to startintentionally hurtingmyself againWhen I have the urge tointentionally hurt myselfit is easy to control it23. The fact that I intentionally hurt myself is a problem in my life.o Strongly disagreeo Somewhat disagreeo Neither agree nor disagreeo Somewhat agreeo Strongly agree24. The fact that I intentionally hurt myself interferes with: (Please check all that apply)oRelationships which are important to meoMy ability to complete school or work obligationsoMy ability to take care of myself (eat right, exercise, etc.)oMy ability to engage in hobbies or things that I like to dooMy self-worth / self-esteem7 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com

oooJ.The clothing I wearOther; please specifyIt does not interfere with my life in any wayNSSI Disclosure25. Does the following statement describe your experience? Someone knows that Iintentionally hurt myself and has had a conversation with me about it.o Trueo False26. Who knows about it and has talked with you about it?o Parent or custodial guardiano Siblingo Friendo Significant other (boyfriend, girlfriend, or spouse / partner)o Other relativeo Teachero Coacho Adult friendo Therapisto Physiciano Religious or spiritual leader (e.g., priest, pastor, rabbi)o Health care providero Other; please specify27. (For each selected) Did you initiate the conversation or did they?o I initiated the conversationo They initiated the conversation28. (For each selected) Have the conversation(s) you've had with this personbeen helpful?o Yeso Noo I do not know29. Does the following statement describe your experience? One or more people know orsuspect that I intentionally hurt myself but have not had a conversation with me about it.o Trueo Falseo Possibly, but I do not know30.Who knows / suspects about it and has not talked with youabout it? (Please check all that apply)o Parent or custodial guardiano Siblingo Friendo Significant other (boyfriend, girlfriend, or spouse / partner)o Other relativeo Teachero Coacho Adult friendo Therapisto Physiciano Religious or spiritual leader (e.g., priest, pastor, rabbi)8 2007. Cornell Research Program on Self-Injurious Behaviors in Adolescents and Young Adultswww.crpsib.com