Non-Suicidal Self-Injury in Adolescents

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Introduction

Non-Suicidal Self-Injury (NSSI) is defined as self-inflicted damage to oneself without suicidal intent and is not for social purposes like tattoos or piercings. The most common forms include cutting, but other forms include burning, scratching, or hitting (Klonsky et al., 2014). NSSI among adolescents has gained increasing attention in recent years. However, there seem to be few psychotherapeutic interventions designed explicitly for NSSI, and none have been evaluated for the treatment of NSSI among adolescents (Washburn et al., 2012). Adolescence is a vulnerable time for developing NSSI, as emotional reactivity and elevated impulsivity are present due to brain developmental processes.

Prevalence

The average onset for NSSI is around 13 to 14 years of age, and the second age of onset is in late adolescence, about 18 to 19. These ages are usually critical transition periods in the lives of adolescents (Klonsky et al., 2014). Around 13 adolescents typically transition from middle school to high school. Around the age of 18, they transition from high school to college. These changes can often disrupt their sense of identity and social support system while also providing new stressors and challenges to face. When individuals do not have adaptive coping skills and a positive social support network, the stressors can become overwhelming, putting them at a higher risk of engaging in NSSI (Brown & Plener, 2017).

Risk Factors

Some risk factors that can lead to NSSI include elevated levels of unpleasant thoughts and feelings, poor problem-solving abilities, and poor communication skills. Other factors include abuse, mistreatment, the need for self-punishment, criticism during childhood, and modeling behaviors seen by peers or media (Brown & Plener, 2017). It is essential not to assume that self-injury is always done for attention-seeking purposes as a clinician. The reason is often due to emotional regulation, as individuals try to cope with overwhelming adversity or self-punishment, which usually comes from self-hatred. It is vital to validate the patients’ experiences and emotions by confirming that their feelings and actions are understandable in light of their circumstances.

Intervention

Dialectical Behavior Therapy (DBT) combines skills training, contingency management, exposure and response prevention, problem-solving training, and cognitive modification strategies with mindfulness, validation, and acceptance practices (Washburn et al., 2012). DBT was designed to treat borderline personality disorder but adapted for use with adolescents with various problem behaviors, including NSSI and suicidal self-injury. DBT focuses on identifying and changing negative thinking patterns while encouraging positive changes. Its purpose is to arm patients with better coping skills for responding to stress and resist using maladaptive ones. Studies suggest that DBT for adolescents may help reduce suicidal ideation, hospitalization, and treatment dropout (Washburn et al., 2012).

Conclusion

Non-Suicidal Self Injury is self-inflicted harm meant to cause pain but is not intended to cause death. Although there is no immediate danger of lethality, there can be a long-term increased risk of suicide attempts and suicide completion, and therefore, NSSI should not be dismissed (Klonsky et al., 2014). Using DBT for reducing NSSI is limited but a promising intervention among adolescents. There is a need for more research to be conducted in this area as the empirical support for applying DBT to adolescents with NSSI remains limited (Washburn et al., 2012).

Authors’ Bio:

Yasmin Arias is a third-year PsyD student pursuing a concentration in Neuropsychology. She has clinical experience working with the child and adolescent population at Nicklaus Children’s Hospital (NCH) in the Psychiatric Department. Currently, she works inpatient in a crisis stabilization unit providing individual, group, and family therapy. She is also part of the NCH Intensive Outpatient Program, which offers group therapy for children, adolescents, and their families post-discharge. Yasmin recently presented Covid-19 related research at the 2021 APA Virtual Conference and will be presenting new research at the 2022 APA Conference.

References

Brown, R. C., & Plener, P. L. (2017). Non-suicidal Self-Injury in Adolescence. Current

psychiatry reports, 19(3), 20. https://doi.org/10.1007/s11920-017-0767-9

Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Non-suicidal self-injury: what we know and what we

need to know. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 59(11), 565–568. https://doi.org/10.1177/070674371405901101

Washburn, J.J., Richardt, S.L., Styer, D.M. et al. (2012) Psychotherapeutic approaches to non-suicidal

self-injury in adolescents. Child Adolesc Psychiatry Mental Health 6, 14. https://doi.org/10.1186/1753-2000-6-14

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