What is Self-Injury?
Non-suicidal Self-Injury (NSSI) is most often defined as the intentional destruction of body tissue that is not culturally sanctioned and is without conscious suicide intent. The most common forms of NSSI include self-cutting, scratching, burning and hitting. Self-Injury is one of a broader spectrum of self-harm behaviours that may also include ingesting a medication in excess of the prescribed or generally recognized therapeutic dose.
How Common is Self-Injury in Youth?
In a college sample of two Northeastern U.S. universities, a random sample of students completed an Internet based survey (Whitlock, 2006) in which a lifetime prevalence of Self-Injury was reported in 17% of respondents. In Canada, several studies have investigated rates of self-harm in the general population or high school based youth (Ross & Heath, 2002; Laye-Gindu & Schonert-Reichl, 2005; Nixon, Cloutier & Jansson, 2008). Lifetime prevalence rates ranged from 14% to 17%.
In a recent Canadian population based survey of youth ages 14 to 20, three quarters of those who had ever self-harmed were females and most began in mid adolescence. 83.2% reported at least one episode of self injury, while 31.5% ingested medication in a non therapeutically prescribed dose. Almost 40 % of those who had ever self-harmed, did so repeatedly (i.e., more than three times). Over two thirds of youth who self-harmed believed that they got the idea themselves, while much fewer indicated that the idea came from friends, family or the media (Nixon, Cloutier, & Jansson, 2008).
What may Co-occur with Self-Injury in Youth?
There are a number of factors associated with NSSI. These include being female, having symptoms of depression, anxiety, impulsivity, or disruptive disorders, low self-esteem, increased emotional distress, problems with anger control and anger discomfort and drug misuse (Ross & Heath, 2002; Laye-Gindhu & Schonert-Reichi, 2005; Nixon et al., 2008; De Leo & Heller, 2004). Suicidal ideation and attempts are more likely to be reported in those with repeated non suicidal Self-Injury (Whitlock et al., 2007).
Social factors associated with NSSI include awareness of self-harm in peers, having self-harming family members, and families having problems affording basic necessities. Family factors include emotional neglect (Lipschitz, Winegar, Nicolaou, Harnick, Wolfson, & Southwick, 1999), impaired communication (Tulloch, Blizzard, & Pinkus, 1997) and family related stressors (Rubenstein, Halton, Kasten, Rubin, & Stechler,1998). In the latter study, family cohesiveness appeared protective against NSSI.
Why do Youth Self-Injure?
There are many reasons why youth might self-injure. In some cases, there may be more than one reason. Common functions appear to include regulation of affect, such as to reduce tension or relieve dysphoric or unpleasant feelings. Self-Injury may also be used for self punishment, interpersonal reasons, sensation seeking and as an anti-dissociation mechanism (Klonsky, 2007).
As indicated, certain youth who engage in NSSI experience a feeling of relief or tension reduction from self injuring. For this reason some of these youths repeat their self-injuring and see it as “effective” means to temporarily manage difficult feelings. Because of this, Self-Injury had the potential to become an addictive behaviour and may have reinforcing effects at a biological level (Nixon, Cloutier & Aggarwal, 2002). It is therefore helpful to understand that, in certain youths changing this behaviour may take some time and require a number of interventions.
Do youth who Self-Injure seek help?
Forty percent of college students reported that no one was aware that they self injured (Whitlock et al., 2006). For those who did seek help, peers were the most likely to know. Studies of youth who self harm also substantiate that friends were most commonly made aware of this behaviour (De Leo & Heller, 2004; Nixon, Cloutier & Jansson, 2008).
Treating Youth who Self-Injure
More recently, dialectical behaviour therapy (DBT) has been used for youth who self injure. DBT is a skills based therapy that is based on a philosophy of balancing acceptance and change. Specific skills include mindfulness, distress tolerance, emotional regulation and improving interpersonal relationships. Cognitive behaviour therapy may be used to treat specific symptoms associated with depression and anxiety.
While there are no specific medications for the treatment of repetitive self injury, medication may be used to target symptoms of depression, anxiety and/or impulsivity. A critical aspect of therapy is that these youth feel accepted and are not judged for their behaviour. Other aspects of treatment/intervention may include family work, interventions with the school, work around identified stressors and increasing levels of support.
More information about Youth who Self-Injure
This news article includes a review of a Western Canadian survey of youth looking at the prevalence of self harm in youth ages 14 to 21 and associated factors: Survey warns youth hurt themselves to deal with mental stress Tuesday, January 29, 2008 | The Canadian Press at www.cbc.ca
The following article in the Personal Health Section of the New York Times, May 6, 2008, reviews issues related to self injury in youth and young adults: The Growing Wave of Teenage Self-Injury Tuesday May 6, 2008 | The New York Times at www.nytimes.com
The Globe and Mail recently published an article reviewing the role of YouTube videos in teens’ self-injury and risky behaviours: Teens influenced by YouTube videos of self-cutting, risky behaviour: studies Thursday August 12, 2012 | The Globe and Mail at www.theglobeandmail.com
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Laye-Gindhu A, Schonert-Reichl K. Nonsuicidal self-harm among community adolescents: understanding the “whats” and “whys” of self-harm. J Youth Adolesc 2005;34:447-57.
Nixon MK, Cloutier PF, Aggarwal S. Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 2002;41:1333-41
Nixon M K, Cloutier P, Jansson M. Nonsuicidal self-harm in youth: a population-based survey. Canadian Medical Association Journal 2008;178(3):306-312.
Lipschitz, D. S., Winegar, R. K., Nicolaou, A. L., Hartnick, E., Wolfson, M., & Southwick, S. M. (1999). Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients. Journal of Nervous and Mental Disease, 187,(1), 32-39.
Ross S, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 2002;31:67-77.
Rubenstein J L, Halton A, Kasten L, Rubin C, Stechler G. Suicidal behavior in adolescents: stress and protection in different family contexts. Am J Orthopsychiatry 1998;68(2):274-84.
Tulloch A L, Blizzard L, Pinkus Z. Adolescent-parent communication in self-harm. J Adolesc Health 1997;21(4):267-75.
Whitlock J, Eckenrode J, Silverman D. Self-injurious behaviors in a college population. Pediatrics 2006;117:1939-48.
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