Non-suicidal self-injury in adolescents, why does it occur and how to address it

Non-suicidal self-injury encompasses all those intentional and self-induced behaviors that cause harm to the person but are not intended to end one’s own life.

The prevalence of self-injurious behaviors is increasingly high, being nowadays a more and more frequent reason for consultation. It is known that between 40 and 60% of adolescents who consult psychiatry and/or psychology clinics have presented self-injurious behavior. Moreover, it is one of the main reasons for consultation in psychiatric emergencies in children and adolescents. As for the age at which they usually present, their onset is becoming increasingly earlier, around 12 years of age.

This type of behavior results in a limitation of the functionality of the child or adolescent in important areas such as academic, social or family, generating emotional discomfort, feelings of frustration and even guilt in the family environment.

Why do self-injurious behaviors occur?

The function of this type of behavior is to calm or communicate emotional discomfort. It should be taken into account that it is usually easier and quicker to bear physical discomfort than emotional discomfort. After all, physical pain is more tolerable and sometimes more manageable than emotional pain. On the other hand, self-injurious behaviors can have a punitive function for the patient, appearing as a form of punishment.

There are personality factors that increase the risk of presenting this type of behavior, such as: high emotional reactivity, low tolerance to stress or frustration or to intense emotional factors, difficulties in emotional regulation, and impulsivity traits. That is why they appear more frequently in pathologies such as Borderline Personality Disorder or ADHD, especially in the combined or impulsive subtype. However, it is also present in many other disorders, such as depressive, anxiety, substance use or post-traumatic stress disorder.

The association of the personality factors described above and certain external elements, such as exposure to stressful life situations, contributes to the debut and maintenance of self-injurious behaviors.

How should self-injurious attitudes be addressed?

First of all, it is essential to perform a detailed assessment of the case, detect a possible underlying psychiatric disorder and differentiate suicidal behaviors from non-suicidal self-injurious behaviors. To this end, it will be necessary to investigate whether there are suicidal thoughts of death and suicidal intent and, on this basis, make a differential diagnosis and develop a plan of action.

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As for the approach to non-suicidal self-injurious behaviors, often related to impulsivity traits in the young person and emotional regulation difficulties, it will be necessary to teach both patients and their parents or guardians the origin and purpose of this type of behavior so that they can sit down with them, ask them questions and make them feel understood. It will be necessary to help them to be aware of the “function” of this type of behavior in moments of emotional overflow in order to be able to replace them with other more adaptive behaviors. In short, it is a matter of teaching them and searching with them for alternatives to self-injury in order to be able to manage in an adaptive way the discomfort that overwhelms them.

Obviously, most of the time self-injury does not appear isolated and other behaviors or problems that are perpetuating or contributing to the maintenance of self-injury, such as lack of self-esteem, relational difficulties, consumption of toxic substances or school absenteeism, will have to be addressed. It will be necessary to work with patients on aspects of emotional regulation, looking for hobbies or leisure activities that protect them and prevent them from using these problem strategies, such as self-injury.

What influence do social networks have on self-injurious behaviors?

Nowadays, the virtually unlimited access to social networks by more and more young children and adolescents means that they have at their disposal a source of feedback for this type of pathological behavior. Unfortunately, more and more young people, either directly or indirectly, share this type of behavior on social networks, which generates a contagious effect on peers, inducing imitation in those with fewer emotional resources, or with a history of social rejection.

Can non-suicidal self-injurious behaviors eventually lead to suicide?

Indeed, self-injurious behaviors, although not suicidal in themselves, have been shown to increase the risk of suicidal behavior in the future. In fact, repeated self-injury in adolescence is the most important predictor for the development of suicidal behavior in the future. For this reason, early detection and management of these self-injuries is of particular importance for the prevention of suicidal behavior.