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Understanding Self-Injurious Behavior in Adolescents and Young Adults and its Remedies

Self-injury is defined as "A deliberate, intentional injury to one’s own body that causes tissue damage or leaves marks for more than a few minutes which is done to cope with an overwhelming or distressing situation” (Cutter, Jaffe & Segal, 2008). Methods of self-injury vary from person to person, but the most common form of self-injury is by cutting. By using a sharp object such as a razor blade, self-inflicted cuts are made on the skin. Other types of self-injury include, but are not limited to, the act of self burning , excessive picking at healing wounds, pulling out hair, and digging nails into the skin. “Although cutting is one of the most common and well documented forms, over sixteen forms have been documented”(Whitlock, Eckenrode, & Silverman, 2006 ). When most people cut themselves, there is often a ritualistic aspect involved. This can be in where they hurt themselves on their body (ie. on the underside of their arms, or their stomach) the environment in which they choose to hurt themselves (ie. a bathroom, or bedroom) or the time of day in which they most often will self-injure. The individual may choose to play certain music during the time they are hurting themselves. Many even clean their tools a certain way before and after hurting themselves. After they hurt themselves, the individual will often bandage it a specific way, write about it in a journal or possibly, just go to sleep. The act of cutting oneself can become just as ritualistic and necessary to the individual as brushing their teeth or cleaning their room. At some points, those who self-harm may need to self-harm, but is not in a safe environment to do so, or does not have their tools on hand. When this occurs, they will often find an alternative place to cut themselves, such as a bathroom stall. They will use a different object to hurt themselves, such as a safety pin or push-pin, and they will skip their ritualistic procedure all together (Alderman, 1997).

There is a fine line between what self-injury is and what it is not. It is often debated and misconstrued by family, friends, and even doctors. Behaviors or activities that adolescents and young adults may exhibit such as getting tattoos and piercings or drinking excessively, may seem like self-harming behavior—however, “Tattoos and body piercings are not typically considered self-injurious unless undertaken with the intention to harm the body” (Favazza,1996). Contrary to popular belief, self-injurious behavior does not imply that the individual is suicidal. Self-injury differs from suicidal behavior by the mere fact that the intent to kill oneself is not there.

So why exactly would somebody hurt themselves if they didn’t want to commit suicide? People exhibit self-injurious behavior for many reasons. Self-injury is often used as a coping mechanism that can provide relief from negative feelings. It is very different from suicidal behavior. “A person who truly attempts suicide seeks to end all feelings, whereas a person who self-mutilates seeks to feel better”(Favazza,1998 p 263). During the act of self-injury, the brain releases endorphins. Endorphins are neurotransmitters in the brain, which can create a sense of euphoria or relief from negative emotions. When these endorphins are released, the self-injurer does not feel the physical pain being inflicted upon themselves, nor do they feel the emotional pain which caused them to self-injure in the first place. This process is called Affect modulation, which is what enables the self -injurer to find hurting themselves to be helpful. It can also create a sense of painlessness and calmness in the individual. However, this does not last for along period of time and is soon replaced with feelings of shame. After prolonged usage of self-injury the endorphins are no longer released due to the fact that the body has become tolerant to the pain. For example, after an individual has been cutting for a period of time to relieve pain of depression, the person will then have to make more cuts or deeper cuts to attain that same sense of euphoria it once had (Alderman 1997). As odd as it may seem, self-harm is like self-help for a number of adolescents and young adults. “The problems are that its effects are short-lived and the scarring can result in a life of self-isolation and demoralization”(Favazza, A., 2006 pp 2283-2284.).

There is no one type of person or a specific image portrayed that an adolescent must have to self-harm. The average self-harmer looks like an every day person and hides the behavior. The music that one listens to or the way that they dress says very little, if anything, about whether the person self-harms. If the individual listens to depressing music on a daily basis, one might be able to conclude that the individual can relate to the music and is feeling depressed. Whether one self-harms or not, cannot be based solely on their interests in things such as music, clothing, or activities. However, the way the adolescent was raised plays a very big part in their self-injurious behavior. Parents are one of the agents of socialization that may unknowingly reinforce bad habits such as self-injury. Both adolescents who have been abused, physically or sexually can be a factor, but those who have been brought up in an environment in which they are constantly being invalidated by their parents is just as significant. The labeling theory, founded by Howard Becker, is a prime example of invalidation being the cause of deviant behavior. If an individual is told repetitively that they have no reason to be depressed and to get over it, the child will feel like their feelings do not matter. They are then left to deal with their emotions in the only way they know how—by hurting themselves. Due to the lack of communication, the individual will not be able to talk to their parent if they need to get help with their self-injurious behavior. Adolescents who are constantly being put down, or are being told that what they are feeling is wrong are just as likely to self-injure as someone who has been abused (Linehan 1993).

Generally, adolescents who practice self-injury often report feelings of alienation, loneliness, or depression due to the mere fact that they have to deal internally with self-injury while hiding it from the surrounding society. However, many adolescents who self-harm are very good at hiding their emotional pain and appear to act and dress just like any other kid their age. The only evidence of their struggle is the physical damage they inflict upon themselves. Many adolescents who self-injure hide their self-inflicted wounds for fear of the adverse reaction they could instill in others. Most adolescents do not show their scars or talk about their experiences with self-injury for this reason. The average self -injurer feels a lot of shame and embarrassment behind their self-inflicted injuries. For this reason, it is not uncommon for adolescents to wear clothing or bracelets to hide their injuries and to avoid unwanted attention (Alderman, 2000).

In spite of the increased use of self-injury among young adults, obtaining statistics on the prevalence of adolescent self-injury in the United States is fairly hard to do. One of the main reasons that information regarding the prevalence of self-harm in adolescents is limited is due to the fact that most individuals who self-harm do not tell anyone about their self-injurious behavior. It is because people so often equate self-injurious behavior with suicidal idealizations and attempts, that society reacts so strongly to self-injury. People who are unfamiliar with self-injurious behavior are quick to label those self-harming adolescents as crazy.

Unlike eating disorders and depression, self-injury is seldom a topic of discussion, in high school health and wellness classes. By not educating society about self-injurious behaviors, adolescents are encouraged to hide their self-inflicted injuries for fear of the many negative reactions they may get upon reveling their secret. Therefore, many self-injuring adolescents do not seek help for their self-injurious behavior nor do they feel that they can talk about it.

Even hospitals make no distinction between those who injure themselves with the intent of committing suicide and those who injure themselves without that intent. When a patient comes into the Emergency Room to treat a self-inflicted wound, they will be classified as having attempted suicide according to hospital records. They will then receive a psychiatric evaluation to determine the course of treatment needed; however, very few facilities specialize in self-injurious behavior. Adolescents who self-injure are often placed into in-patient programs with other “troubled” young adults, most often those struggling with different problems such as drug addiction, anger issues, and/or eating disorders. There is only one inpatient treatment facility that caters specifically to those who self-injure. This facility is called The S. A. F. E. Alternatives Treatment Center in the Linden Oaks Hospital, which is located in Illinois. While an adolescent struggling with self-injury may get treatment in therapy or school counseling, it is not uncommon for the adolescent to simply take more precautions in hiding their self-inflicted injuries and to continue to lie about it. In an inpatient facility the self-injurer has no choice but to comply with the rules and regulations regarding self-harming.

Self-injury among adolescents is so well hidden that it is rarely a subject of study. There have been very few studies conducted in the United States on self-injury among adolescents; the largest of which, have been fairly small in size. The largest study on self-harm in young adults that has been executed in the US was in the spring of 2005. Researchers at Cornell and Princeton University carried out a study to determine the prevalence of self-injurious behavior among college-aged students. In this study, random samples of college students, from two separate universities, were asked to participate in an online survey. After the incomplete surveys and surveys that indicated suicidal intent were eliminated from the study, the researchers were able to identify the prevalence of self-injurious behavior in college-aged students. The researchers concluded that, “Twenty percent of women and fourteen percent of men reported that they have cut, burned, carved or harmed themselves in other ways. Seventy-five percent of those engaged in SIB, [self-injurious behavior] more than once”(Whitlock et al. ). This study suggested that among self-injurers, many were addicted to the behavior or had hurt themselves multiple times. "1 in 5 self-injurious students indicated that they had hurt themselves more than intended at least once and 1 in 10 indicated that they had hurt themselves so badly that they should have been seen by a medical professional. ” This study displayed that not only is self-injury prevalent in college-aged students but that very few seek treatment for their self-injurious behaviors. A whole “Thirty-six percent reported that no one knew about their SIB [self-injurious behavior] and only three percent of participants indicated that a physician knew”

(Whitlock et al. ).

Typically, self-injury behaviors will onset during adolescence and early adulthood. Ideally, this is the time for parents, doctors, teachers and other agents of socialization to address this issue through education and open-mindedness towards the subject. This can be hard to do when they cannot identify a self-harmer unless they see their injuries or scars. For this reason, schools should educate everyone on the topic of self-harm. Self-injurious behavior is an issue in high schools because adolescents are struggling with this self-injurious behavior and do not get the support that they need. Likewise, students, teachers, and counselors are not being educated on self-injury so that they can inform these adolescents about self-injury. This lack of education and understanding of self-harm makes students feel even more alone and less likely to seek out the help that they need. A survey conducted by McGill University entitled, “High School Teachers’ Perceptions of Self-Injury; I Am Not Well-Equipped" examines how teachers react to self-harming students. Fifty high school teachers participated in this study, by answering questions that evaluated their knowledge of self-injury and their attitudes towards it. “Seventy-eight percent of teachers underestimated prevalence of self-injury, and only twenty percent felt knowledgeable on the subject.” Overall, attitudes were mixed, with “forty-eight percent finding the idea of SIB [Self-injurious behavior] horrifying”(Heath, Toste, & Beettam, 2006).

Also, the majority of teenagers, are very ignorant about self-injury and make jokes about it not realizing that self-injury is a serious problem. The lighthearted phrase, “What are you going to do now- go cut your wrists?!” will make students laugh, but could be very triggering to a person who self-injures. Joking among others about self-harm can make a self-harmer feel even more insecure about their addiction, causing them to keep their secret hidden even more than it already is. Should another student find out about one’s self -injurious problems, rumors often occur creating an even worse situation for that individual. Especially after facing a period of time at a treatment facility, the student may feel like everybody is looking at, or treating him or her differently.

Among a certain population of self-injuring adolescents, self-harm is discovered through observational learning. Observational learning is when an individual sees another individual’s behavior and copies it. When an individual sees that a behavior brings positive consequences, they may then exhibit that behavior in order to bring those same positive consequences to themselves. While it is rare that one individual will see the physical act of another self-harming, the act of seeing it can lead a person to try it on their own. This type of observational learning is most commonly, induced by the media. The popular movie “Thirteen” is a story about thirteen year old Tracy who grows up quickly, experimenting in drugs and sex. Two scenes depict Tracy going into the bathroom and cutting herself. Watching this vivid scene is a prime example of how one could pick up self-injurious behaviors through observational learning.

It is more common, however for a friend to tell a close friend about their self-harming issues, or for a friend to see another friend’s cuts or scars. It is possible that the individual had never heard of or seen self-injury and is being introduced to it for the first time. Then, when an individual is feeling down they may think, “if it helps my friend to cut, it might help me too”, only to try it themselves and find that it works for them too. At this point two individuals are both addicted to self-injury and the cycle of observational learning goes on.

There are a number of ways in which the prevalence of self-harm among adolescents can be reduced. The most vital of which, being communication. The main agents of socialization, such as parents, and teachers must be able to communicate with their child or student. This is key in that the adolescent should not be feeling alone in times of distress. By being able to communicate their feelings without being invalidated, the individual will be able to learn healthier coping mechanisms than self-injury. By educating teachers, and students in school about self-injury, more students are likely to seek help rather than get worse as time progresses.

Self-injury needs to be talked about, so self-harming individuals do not feel they cannot get the help they need and so they do not feel like they battle with self-injury alone. If society can accept that self-injury is an ongoing battle for some adolescents, people will no longer dismiss self-harming behavior as a failed suicide attempt or a person seeking attention. Self-injuring adolescents need to know that if they tell somebody about their behavior that that society will respond with understanding and not with disgust. If society promotes communication about

self-injury to struggling adolescents, they are more likely to get the help they need.

Bibliography of Works Cited

Alderman,T. (2000). Helping those who hurt themselves. The Prevention Researcher, 7(4), 43-46.

Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. Oakland: New Harbinger . Retrieved April 1, 2008, from Self-injury: A struggle : http://self-injury.net/faq/

Cutter, Deborah, Jaffe Jaelline , Segal Jeanne (2008 February 26). Self-injury: types causes and treatment. Retrieved April 1, 2008, from Helpguide Web site: http://www. helpguide. org/mental/self_injury. htm

Favazza, A.R (1996). Body under siege: Self-mutilation and body modification in culture and psychiatry (2nd ed.). Baltimore: The Johns Hopkins University Press.

Favazza, A.R (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental Disease, 186, 259-268.

Favazza, A. R. (2006). Self-injurious behavior in college students. Pediatrics, 117, 2283-2284.

Heath, N. L. , Toste, J. R. , & Beettam, E. (2006). "I am not well-equipped": High school teachers’ perceptions of self-injury. Canadian Journal of School Psychology 21(1-2): 73-92.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.

Whitlock, J. L. , Eckenrode, J. E. & Silverman, D. (2006). The epidemiology of self-injurious behavior in a college population. Pediatrics, 117(6).

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