Journal of Cognitive Psychotherapy: An International Quarterly Volume฀26,฀Number฀4฀•฀2012 348 ©฀2012฀Springer฀Publishing฀Company http://dx.doi.org/10.1891/0889-8391.26.4.348 Co-Occurring Disorders in the Treatment of Nonsuicidal Self-Injury: An Evidence-Informed Approach Jason J. Washburn, PhD, ABPP Alexian Brothers Behavioral Health Hospital Northwestern฀University฀Feinberg฀School฀of฀Medicine,฀Hoffman฀Estates,฀Illinois Michelle Gebhardt, PsyD Denise M. Styer, PsyD Alexian฀Brothers฀Behavioral฀Health฀Hospital,฀Hoffman฀Estates,฀Illinois K. R. Juzwin, PsyD Alexian Brothers Behavioral Health Hospital Argosy฀University,฀Schaumburg,฀Illinois Lev Gottlieb, MS Northwestern฀University฀Feinberg฀School฀of฀Medicine,฀Chicago,฀Illinois Co-occurring disorders are common among patients who present for treatment with nonsuicidal self-injury (NSSI). Evidence-based approaches specifically designed for the treatment of NSSI are limited, although interest in this area of research is growing. An evidence-informed model for the treatment of NSSI and co-occurring disorders is presented here to stimulate interest in address- ing co-occurring disorders in the treatment of NSSI. Case examples are presented to highlight the complexity of treating NSSI and co-occurring disorders and to illustrate a model of treatment at the acute level of care. The case examples also underscore the need for clinical researchers to address co-occurring disorders when developing treatments specifically for NSSI. Keywords: nonsuicidal self-injury; co-occurring disorders; treatment; self-regulation N onsuicidal self-injury (NSSI) is the deliberate, self-inflicted damage of body tissue that induces bleeding, bruising, or pain but is absent of evidence for suicidal intent (Nock & Favazza, 2009). NSSI does not include activities engaged in solely for socially sanctioned purposes (e.g., body art) or common or trivial behaviors (e.g., nail-biting). Although estimates of the lifetime prevalence of NSSI vary by study, most studies report a rate of 13% to 23% for ado- lescents and young adults in the community and between 2% and 8% for adults and older adults (Jacobson & Gould, 2007; Rodham & Hawton, 2009). The prevalence rate of NSSI among clinical populations is even more varied, with rates reported between 12% and 82% (Heath, Schuab, & Nixon, 2009; Klonsky & Muehlenkamp, 2007).