Non-suicidal self injurious behavior
Self-injurious behavior is prevalent in our society. It is estimated that approximately 7% of preadolescents, 12-40% of adolescents, and 17-35% of college students have engaged in non-suicidal self-injury. I just searched “cutting myself” on YouTube and found almost 5,000 hits! Self-injury is described in books, the news and now you can watch it happening on YouTube! I never heard of such a thing when I was a kid. Why is it so common now? Some have argued the theory of contagion. Many kids tell me they learned about self injurious behavior from a friend. Having heard about it, they then try it when in distress. For those who feel some relief after the behavior; a seriously bad, dangerous habit is born.
I guess I should first back up and provide a definition of self-injurious behavior. The acronym for Non-suicidal self injury is NSSI. It is generally agreed that non-suicidal self injury (NSSI) begins in adolescence, typically between 12 and 14 years of age.
These are not suicide attempts. These behaviors are a deliberate attempt to harm one’s own body tissue without the intent to die. The behavior can include, but is not limited to, skin cutting, burning, picking or interfering with a wound healing, punching oneself or objects, and inserting objects under the skin. Many self-injurers report the use of multiple injury methods.
How is suicidal behavior different from non-suicidal behavior? The biggest difference is that the NSSI person does not have the desire to die. The NSSI person attempts to temporarily escape from distress, where as the suicidal person is making a conscious effort to end their life. Self-injurious behavior is usually engaged in more frequently than suicidal behaviors, and with more varied methods. The NSSI person feels distressed, but hasn’t given up. The suicidal person feels hopeless and/or helpless and no longer has the desire to live.
Why would anyone purposefully desire to hurt themselves? Actually what motivates a person to self-injury can change over time. It may serve more than one function for a person. Self-injury is reinforced through either an internal release or through external environmental gain. The most common reinforcer is a release of internal emotions (stop bad feeling, relieve feeling numb or empty, to punish oneself, etc.). External reinforcers include gaining attention from others (letting others know how they are feeling, to avoid something, to get parents to notice them, etc.).
So what do you do if you know someone who is exhibiting NSSI behaviors? Take it seriously. It doesn’t matter what the reinforcers are, self injurious behavior is dangerous and unhealthy. Counseling can help. Currently researchers have focused on two types of therapy that have proven effective with NSSI behavior: cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).
CBT is a well- researched therapeutic intervention, aimed at assisting clients in identifying their maladaptive thoughts, modifying these in order to manage emotions and change negative thinking.
The DBT focus is on what is called “emotional dysregulation.” In theory, the clients inability to tolerate distress, and their experience of an invalidating environment, contribute to both non-self injurious behavior as well as suicidal behavior. DBT incorporates change-based behaviors, problem-solving, skills-training, and acceptance and tolerance strategies from Zen Buddhism.
I have found that combining CBT with a psycho-educational approach (which includes problem solving and crisis intervention techniques), a useful tool in treating self injurious behaviors. For more information about my practice or to make an appointment, check out my website at www.LauraFleming.com
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