Self-harm in adolescents:

Definition:
What constitutes non-suicidal self-injury (NSSI) is a matter of some debate, but its growing presence in
mainstream and popular media as well as the growing number of anecdotal reports by physicians, therapists,
and junior and senior high school counselors suggest that it may be, as some have called it, the next teen
disorder. Self-injury is typically defined as the deliberate, self-inflicted destruction of body tissue without
suicidal intent and for purposes not socially sanctioned. Although most often not a suicidal gesture, it is
statistically associated with suicide and can result in unanticipated severe harm or fatality. NSSI is generally
used to cope with distressing negative affective states, especially anger and depression, and mixed emotional
states. Although previously believed to be a characteristic of severe psychopathology, it now appears that
NSSI is associated with a wide variety of externalizing and internalizing conditions.

In general, U.S. studies tend to find that lifetime prevalence of common NSSI ranges from 12% to 37.2% in
secondary school populations and 12% to 20%, in late adolescent and young adult populations. NSSI
scholarship consistently shows an average age of onset between 11 and 15 with a normally distributed age of
onset ranging from about 1024.

Why Do Youth Self-Injure? :

In general, reasons for self-injuring break down into three general categories: psychological, social, and
biological. Of these, psychological functions are most commonly cited and center on reducing psychological
pain, expressing and alleviating psychological distress, and refocusing one's attention away from negative
stimulus. Much less common but sometimes cited are reasons such as so someone would pay attention and
to get a rush or surge of energy. Both underscore the role of both social and biological roles in maintaining
NSSI. Social function models point to the importance of viewing NSSI as a behavior undertaken to fulfill
multiple functions simultaneously, most of which are intrapersonal (emotion regulation) but some of which
are fundamentally interpersonal in nature.

A recent study on the mental health of college students, presented in August at the American Psychological
Association Meeting, found empirical evidence to document these observations. The results show that at one
university, the rate of non-suicidal self-injury doubled from 1997 to 2007.

The consequences of the behavior go beyond physical harm and include depression, anxiety, social isolation
and an increased risk for attempting suicide, said Peggy Andover, a psychology professor at Fordham
University in New York.

"All of these negative consequences put together, coupled with the fact that this is such a highly prevalent
behavior in our high schools, in our colleges, just in our community, it really highlights the fact that we really
need to address this behavior," Andover said.

The "disorder" could also become official in the upcoming revision to the Diagnostic and Statistical Manual of
Mental Disorders, or DSM, also known as the "Psychiatric Bible," due to arrive in 2013.
Characteristics of Adolescents with NSSI:
Recent research calls into question the presumption that adolescent NSSI is primarily limited to people with
developmental disabilities, eating disorders, or borderline personality disorder. Psychiatric conditions that are
specifically associated with NSSI in adolescents include internalizing disorders (primarily depression, but also
posttraumatic stress disorder and generalized anxiety), externalizing disorders (including conduct disorder
and oppositional defiant disorder), and substance abuse disorders. It has been suggested that there is a strong
link between NSSI and maltreatment in early childhood, especially child sexual abuse. However, a recent meta-
analysis found only a modest correlation between child abuse and NSSI, and this was due to the association
of both features with psychiatric risk factors.

Statistics:
As self-harming behaviors usually occur in private, it can be difficult to determine exact statistics on the
prevalence rate. Mental Health America estimates that around 2 million people in the United States purposely
injure themselves in some way. Typically, self-injury behaviors are more prominent in adolescents and young
women, but a growing number of men are intentionally injuring themselves as well. While the average age of
onset for self-mutilation experimentation is said to occur between ages 12 and 15, it has been known to occur
in striking numbers among children as young as 7 years old.

Causes and Risk Factors for Self-Harm:

There is not any one single or simple cause that can be identified as the cause that leads a person to begin
partaking in self-mutilation behaviors. However, there has been some evidence suggesting that a combination
of factors may be linked to its onset. The following are a few examples of causes and risk factors that may play
a role in the development of self-injurious behaviors:

Genetic: Some of the disorders of which self-harm can be a symptom of may have a genetic component. Some
examples of disorders that self-harm may be a symptoms of include, but are not limited to, borderline
personality disorder, bipolar disorder, and depressive disorders.

Physical: Mental illnesses are believed to be due in some aspect to chemical imbalances in the brain. A
disruption or imbalance in the part of the brain that is involved in emotional regulation may contribute to
ones predisposition to self-harm.

Environmental: The environment in which a person is surrounded has the potential to play a role in the
development of ones desire to begin partaking in self-harming behaviors. If a persons home life is chaotic,
unpredictable, or scary, that person may find solace in the act of self-mutilation as it gives them something
they have control over.
Risk Factors:

Peer pressure Having suffered from punishment at the hands of

parents or other authority figures
Poor emotional regulation
Perceived chaos in ones surroundings, whether it
Coming to terms with ones sexuality be true or imagined

Being the victim of bullying Experiencing trauma

Poor relationships Inability to express emotions in a healthy,

productive manner
Experiencing trauma

Signs and Symptoms of Self-Harm

The signs and symptoms of self-harming behaviors can vary greatly based on the age of the person
participating in the behaviors, their chosen form of self-harm, and the length of time in which they have been
partaking in the behaviors. Some examples of symptoms that may lead to the suspicion that a person is
harming himself or herself can include: Behavioral symptoms, Cognitive symptoms, Physical symptoms,
Psychosocial symptoms.

Effects of Self-Harm
The long-term effects of self-harm can be devastating for the individuals engaging in the behaviors, as well as
their loved ones. Some effects that can result from these behaviors can include:

Family discord Consistent, obsessive, and intruding thoughts

about the behavior itself
Social isolation
Substance addiction
Isolation from family members
Chronic negative mood states
Delusional thoughts
Self-injuring can also produce long-term physical effects in the person who participates in the behaviors. Some
examples of these physical effects can include:

Broken bones that dont heal properly Permanent tissue damages

Severe bleeding and anemia Permanent scarring that may not fade due to the
presence of scar tissue
Infected wounds
Chronic pain

The most serious effect that self-mutilation can have on people is death resulting from their injuring going
wrong. For example, cutting themselves so deep that they bleed too much, drinking too much of a chemical
substance that causes body failure, or breaking ones neck when attempting to break a different bone.

Conclusion
Self-harm among adolescents is common and the rate may be increasing. While many adolescents with NSSI
may not have severe psychopathology, teenagers presenting with self-harming behaviors should have a
thorough psychiatric assessment that includes screening for suicidal ideation and risk factors. Family and other
interpersonal supports are important in formulating and implementing treatment recommendations.
Pharmacological treatment should focus on treating underlying psychiatric disorders. Psychotherapeutic
treatment should be recommended to assist the adolescent in understanding NSSI and utilizing more adaptive
coping strategies. Adolescents with more severe and chronic symptoms should be referred to a DBT program
when available.