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Self-Injury – The hidden side of a visible problem

Thursday, October 10, 2019

Extract from an article in INPSYCH, October 2018

Published with kind permission of the author, Clinical Psychologist Lee-Ellen Bresland

Non-suicidal self- injury (NSSI) is well documented as a behaviour occurring in community settings and, sadly, there is now a generation of young people without significant psychiatric issues who self-injure. Many of these young people appear well adjusted with supportive social networks. However, the fact that they are turning to self injury to help cope with the stresses of life suggests there are problems with managing psychological distress.

Non-suicidal self- injury (NSSI) refers to a range of distressing and disturbing behaviours that involve the intentional, self-inflicted destruction of body tissue without suicidal intent carried out for the purposes that are not socially sanctioned (International Society for the Study of Self-Injury, 2007). Cutting is the most well-known NSSI behaviour, but NSSI behaviours may take the form of self-inflicted punching, hitting or slapping, scratching, biting, burning, gouging, carving words or symbols into flesh, piercing the skin with things, interfering with wound healing, and breaking bones.

For young people experiencing feelings of isolation, online connections and social media can be appealing. These anonymous social media interactions help form important relationships with others to whom they can relate. The less positive aspect of social media is that it enhances the likelihood of social contagion, with many vulnerable young people connecting to similar others through social modelling in influential and high-profile songs, books, movies, and other communications. Alternatively, online communication can offer those who self-injure positive opportunities to find assistance to move them towards ceasing the behaviours.

Defining the terms

By definition, NSSI lacks suicidal intent and typically involves efforts to manage overwhelming emotional distress, such as anxiety, sadness, guilt, emptiness, or disassociation, so as to gain relief. NSSI is also more prevalent, and involves multiple methods (e.g., burning and cutting rather than more potentially lethal methods such as shooting or hanging) resulting in physical harm that is of low medical severity and rarely fatal compared to suicide attempts (Pompili et. al., 2015).

Who self-injures

There is no particular kind of person who self-injures. NSSI crosses ethnicity, age, gender and social class. However, self-injury typically begins in early adolescence and peaks at mid-to-late adolescence. Studies have shown 20 percent of those engaging in NSSI reported onset between the ages of 11 and 13 (Jacobson, Uyeji & McCloskey, 2018). Some studies have shown a second peak occurring at around 20 years of age and NSSI can begin as late as middle age or even older.

Why do people self-injure

Furthermore, they suggested that adolescents engage in NSSI for such reasons as, to stop undesirable thoughts and feelings, to generate some kind of feeling, even pain, to escape interpersonal tasks or demands and to gain attention from others.

Emotion-regulation overwhelmingly emerges as the most commonly supported function of self- injury in both adolescent and adult samples. Negative feeling such sadness and anxiety precede NSSI, and the act of NSSI reduces arousal and negative emotions resulting in feelings of calmness and relief (Klonsky, 2007). Explanations for self-injury include “to release emotional pressure that builds up inside of me”, “to manage stress”or “to stop bad feelings”(Klonsky & Meuhlenkamp, 2007).

More than half of those who self- injure endorsed self-punishment or self-directed anger as a motivation for NSSI (Klonsky, 2007).

People who self-injure endorsed multiple functions of NSSI such as a desire to seek help from or influence others, or to create a physical sign of their emotional distress. Other NSSI functions identified include anti-disassociation (e.g., creating pain to end numbness), anti-suicide (e.g., to avoid or replace the impulse to commit suicide) and sensation seeking (e.g., doing something to generate excitement).

Time to act

NSSI has become more common, and its prevalence may be increasing in adolescent and young people. This makes it an important area of focus for psychologists. NIHRACS Psychologist’s Felicity Wiseman, Child and Adolescent, 51399 or Margie Meagher, Mental Health, 56400 are available for consultation.

OTHER RESOURCES FOR THE PUBLIC

Mental Health First Aid Australia (2014) developed guidelines which may be helpful for members of the public in responding to NSSI prior to seeking appropriate professional help: bit.ly/2NnCkXR.  A series of five informative e-books has been developed by the Centre for Suicide Prevention Studies at the University of Queensland under the series name “Seeking Solutions to Self-injury”. These guides inform a number of different populations (emergency staff, family doctors, school staff, young people; and parents and families) and provide an excellent basis for responding to individuals who engage in NSSI.



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