During the last few years, the rates of self-injury have increased considerably. However, this type of behavior has increased exponentially after the last few months in which we have all suffered the consequences of confinement and a Covid-19 pandemic, which is dragging on. It is vital to understand its origin and what is intended to be transmitted through self-injury in order to be able to carry out an effective therapeutic intervention. Also, the role of the family environment in the management of the situation is key to facilitate communication with the patient.
What is the prevalence rate?
It should be noted that the incidence of these behaviors is based on the cases treated by emergency services, so there could be an underestimation of this phenomenon, since not all cases of self-injury are reported to a physician. Often not even the parents themselves are aware that self-injury is occurring.
A literature review by Cuban researchers, limiting self-injury only to those without suicidal intent, found the following prevalences:
● Between 30-40% of adolescents with psychiatric hospitalization have been admitted for self-injurious behavior, with the age of onset decreasing. While in 2015 the median age of onset was 16 years, in 2017 it has decreased to 12 years.
● In the general population self-injury is committed by 13-29% of adolescents at least once in their lifetime. They have an age of initiation between 10-15 years and, in rare cases, after 30 years of age.
These behaviors are more frequent in women, especially during adolescence.
What are self-injuries and are they a suicide risk?
Before starting, it is important to understand what this concept consists of. Self-injuries are injuries that a person deliberately causes to him/herself, the method and type of injury is diverse, the most frequent being cuts, blows, burns, scratches and punctures.
Similarly, we must differentiate between suicidal self-injury and self-injury without suicidal intent. While the former involve a high risk of committing suicide and are related to ideas of hopelessness about life, the latter are intended to calm emotional states of anger, anguish or despair that have not been learned to manage and generate great discomfort in the patient.
Why do people self-injure?
Faced with the difficulty of managing intense emotional states that are unpleasant, these people find in non-suicidal self-injury a way to alleviate the discomfort.
Thus, when a thought, event or emotion occurs that causes intense emotional discomfort that is difficult to manage, they try to alleviate this discomfort or emotional distress with a physical cut, blow, pinch or burn. Thus, in an attempt to take control of the situation, attention is distracted from the emotionality, since it is easier to manage physical pain than emotional pain.
Despite this, after the calm, relief and relaxation they experience after self-injury, feelings of shame, guilt, stigma, isolation and abandonment begin to set in. Thus, the discomfort they felt reappears and even increases, and the person is more likely to resort to these behaviors and even increase in frequency and intensity.
An incorrect way of communicating?
Self-injurious behavior without suicidal intent has the function of communicating to the environment the pain that the patient is experiencing internally, communicating through the body what perhaps cannot be expressed with words.
To break this vicious circle, the mission of specialists in Psychology is to provide the appropriate tools to identify, manage and express different emotional states, providing the person with alternative behaviors that allow him/her to face different situations in an adaptive way.
What are the risk factors?
There are some risk factors shared by people who self-injure: difficulty in emotional management, low self-esteem, feelings of rejection, high levels of perfectionism and self-demand, impulsivity, hopelessness and insecurity, low frustration tolerance, high levels of self-criticism and frequent conflicts with friends and family.
The situation may pose a greater risk if the following circumstances are present: eating disorder, history of sexual and physical abuse, post-traumatic stress disorder, depressive disorder, use of various substances, bullying or cyberbullying.
How can therapy help?
Currently, there is a false belief that if we talk about suicide or self-injurious behaviors, we incite them to precipitate them, which is called the Werther effect. However, being able to talk about these issues is essential.
In the consultation, patients find a safe place to deal with suicidal ideation, self-injurious behavior and a sense of hopelessness with life. It is a safety and an opportunity for openness that they have probably not found elsewhere. This, far from inciting them, provides them with a profound relief, confidence and feeling of understanding.
Guilt in the family environment
As parents, discovering that our child is self-injuring generates a set of emotions such as: guilt for not having noticed it earlier, helplessness, fear for their health, sadness, anger towards oneself or towards the child, etc.
The appearance of guilt is a very common emotion, but we must think that if we have not noticed it before it is not because of carelessness or lack of attention but because the adolescent has done everything possible to keep it hidden.
For this reason, it is important that the feeling of guilt does not paralyze us; when faced with guilt, we must always ask ourselves what it is that guilt prevents us from doing. On the contrary, the appropriate conduct will be to approach the adolescent in order to understand, without judging, what has led him/her to self-injury and to make him/her feel understood and helped.
It is necessary to separate the behavior from the person, as well as to show unconditional acceptance, to encourage open communication without transmitting worries or fears and, of course, to provide the professional help he/she may need.