Non-Suicidal Self Injury

Abstract

This report discusses non-suicidal self injury among young adults or adolescents and how it is becoming a growing trend. The percentage of adolescents injuring themselves without the intent to commit suicide is related to a number of factors including media, childhood experiences, and comorbidity of an eating disorder or borderline personality disorder. Not knowing precisely what the cause does not help health professionals or parents help the young adult cope with the already extremely stressful pressures of education and societal obligations, therefore, the percentage will increase.

Keywords: non-suicidal self injury, media, trend

Non-suicidal self-injury (NSSI) can be described in many ways, such as self-injury, self-mutilating behavior, or deliberate self-harm. It has been concluded that, "The most common forms of NSSI are pinching and scratching the skin, punching or hitting objects until marking or bleeding occurs, or cutting the skin." (Kelly, Jorm, Kitchener, & Langlands, 2008). Repetitive NSSI can create scarring, infection or painful injury though it's extremely rare that such wounds are lethal (Plante 2007). Variations of NSSI include carving initials or symbols into the skin, burning or branding the skin, pulling hair out of the roots, or preventing a wound to heal (Kelly et al, 2008). The occurrence and visibility of deliberate, non-suicidal self injurious behavior are increasing among adolescents and young adults, both as a result of specific known risk factors and social influence.

NSSI is a growing trend among the teenage community. Some speculate this growing trend is due to the fact that self-injury, or "cutting" is becoming more prevalent in "pop" culture. You see this phenomenon depicted on the big screen in movies such as Girl, Interrupted and Thirteen. In addition, NSSI has been exploited in the media by celebrities such as Princess Diana, Angelina Jolie, Johnny Depp, Drew Barrymore, Marilyn Manson, and Courtney Love. Many of these celebrities, whom some consider role models for teens, publicly stated they once inflicted some form of pain or self-injury on their bodies (D'Onofrio, 2007).

Statistics on the incidence and prevalence of self-injury are skewed in several ways. Most recent research studies have consisted of case studies or surveys of relatively small sample sizes. This, as well as the tendency of self-injurers to underreport, may lead to numbers that do not accurately reflect the scope of those suffering from self-injure disorders. U.S. studies have prevalence estimates anywhere from 4% to 38%, while British surveys estimate prevalence around 10%. Other British studies have disclosed a 65% increase in reports of self-injury to children's help lines over a five-year period (Whitlock, Powers & Eckenrode, 2006). Whether or not this is due to an increase in reporting or an increase in actual prevalence is uncertain, though researchers tend to believe it is both (Whitlock, Powers & Eckenrode, 2006). Increased awareness through media campaigns may lead youths to seek help for their condition, others may learn of the behavior and become curious, while still others may be led to begin the behavior in response to the seeming increase of others their age doing it. In institutional settings such as correctional facilities and hospitals, workers have noted a contagion effect regarding self-injurious behaviors (Whitlock, Powers & Eckenrode, 2006). This contagion-like tendency is a possible reason for the reported increase in NSSI among adolescents. Research has supported the idea that mutual social reinforcement amongst self-injurers aids in the development of NSSI (Oliver, Hall & Mercy, 2005).

Though there is not one definitive profile of a self-injurer, certain characteristics are more likely to exist among those who self-injure versus those who do not. While self-injury occurs among males as well as females, females are far more likely to engage in self-injurious behaviors (Brown University, 2004). Some studies have documented cases of NSSI wherein the first act took place as early as before the age of 10, however early adolescence is the typical age of onset (Oliver, Hall, & Murphy, 2005). Research indicates that the majority of those who self-harm will do so more than once, with as many as 17% reporting more than ten past instances of self-harm (Gratz, 2006). The motivations and causes for NSSI are varied and the typically discussed causes are not exclusive. Little is known about NSSI, particularly in relation to other psychological disorders. However, self-injury is traditionally correlated with several psychological conditions and environmental factors, such as past sexual abuse, borderline personality and eating disorders, and emotional inexpressivity (Gratz, 2006). The American Psychiatric Association does not include NSSI in the Diagnostic and Statistical Manual of Mental Disorders fourth edition, but have included a proposed revision for the fifth edition. (APA, 2010)

Research suggests that childhood abuse increases the risk of NSSI in adulthood; particularly sexual abuse. In addition, "Theoretical literature suggests the role of other potentially distressing childhood experiences ... in particular, experiences that occur in the context of the caregiving relationship" (Gratz, 2006, p. 239). Parent-child bonds and the treatment a child receives during developmental years provide clues as to why some children go on to engage in NSSI. Children who are raised in invalidating environments experience a lack of communication, wherein displays of emotion are ignored, punished, dismissed or not permitted. In these environments, emotional control is highly expected and a lack of such control may result in a child's feelings being trivialized or rebuked. In turn, their basic needs are not met hindering their emotional development as they mature. All kinds of abuse, ranging from sexual abuse to emotional neglect and parental over involvement or manipulative psychological control, can occur within such invalidating environments.

These same environmental factors are related to the development of certain disorders of which NSSI is a symptom, such as borderline personality disorder and eating disorders. Both suicide attempts and NSSI are most common among women and those with borderline personality disorder (Brown, Comtois & Linehan, 2002). Borderline personality disorder affects about 2% of the general population and accounts for 15-20% of psychiatric inpatients (Harvard Medical School, 2006).

Those suffering from eating disorders are also slightly more likely to suffer from